Current Hypertension Reviews最新文献

Introduction: Chronic hemodynamic overload due to hypertension produces cardiovas-cular remodeling, where mechanical stretch (MS) deformation, neurohumoral factors, and/or chronic interaction promote a harmful allostatic overload. Previously, our laboratory demonstrated that rosuvastatin modulates the NO-Hsp70-WT1 pathway during MS at the renal level, and other authors have reported that some statins inhibit the proliferation of rat vascular smooth muscle cells (VSMC) induced by MS. Therefore, this study aims to evaluate, in VSMC culture, the possible modulation of rosuvastatin on NO-Hsp70-WT1 signaling linked to MS and its impact on vascular remodeling due to hypertension.

Methods: After 10 weeks of age, mesenteric vascular smooth muscle cells (VSMCs) were cultured from spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats. Prior to cell culture, systolic blood pressure (SBP) was measured: SHR exhibited SBP of 180 ± 10 mmHg, while WKY rats had SBP of 125 ± 8 mmHg. Eight experimental groups were established: SHR and WKY, each with or without mechanical stretch (MS) for 48 hours (Flexcell® system), and with or without treatment with rosuvastatin (10⁻⁵ mol/L). Apoptosis was assessed by flow cytometry, while fibrosis was evaluated via TGF-β levels. Nitric oxide (NO) levels, as well as WT1 and Hsp70 expression, were also analyzed.

Results: SHR cultures without MS vs WKY without MS showed higher apoptosis/fibrosis and low NO, WT1, and Hsp70 (p < 0.01). Notably, WKY with MS was similar to SHR without MS. Fur-thermore, when comparing SHR with MS vs SHR without MS, we verified more significant apop-tosis/fibrosis with lower NO, WT1, and Hsp70 (p < 0.01). However, rosuvastatin reduced these differences, promoting the restoration of the altered parameters.

Discussion: Mechanical Stretch (MS) induces apoptosis and fibrosis in vascular smooth muscle cells (VSMCs) from hypertensive rats, correlating with impaired nitric oxide (NO) production. Rosuvastatin treatment significantly attenuated MS-induced damage and restored NO bioavaila-bility. Critically, MS downregulated the expression of WT1 and Hsp70, and rosuvastatin restored these levels, suggesting that its protective effects are mediated through the modulation of the NO-Hsp70-WT1 signaling pathway. This study proposes a novel mechanistic framework for statin-mediated vascular protection, highlighting the potential of rosuvastatin to mitigate mechanical stress-induced cardiovascular remodeling in hypertension and related pathologies.

Conclusion: Rosuvastatin can reduce vascular remodeling and allostatic overload during hyper-tension by decreasing MS-associated apoptosis/fibrosis in mesenteric VSMC and regulating the NO-Hsp70-WT1 axis, which highlights its potential clinical use in treating hypertension-induced vascular remodeling.

Introduction: Currently, regional or global assessments of vessel elasticity are per-formed by measuring pulse wave velocity (PWV) along a long arterial segment. However, this method of evaluating arterial stiffness is subject to bias due to several factors, including the difficulty of accurately measuring the arterial distance. The aim of this research was: (a) to develop a non-invasive method for calculating pulse wave velocity in the heart-carotid pathway (hc-PWV) using electrocardiographic and ultrasonic im-ages; (b) to measure hc-PWV in an adult hypertensive population using this new method and compare the results with values reported in the specialized literature; and (c) to perform a cor-relation analysis between hc-PWV and heart-femoral pulse wave velocity (hf-PWV) in a pop-ulation of adult hypertensive subjects.

Material and methods: In this study, PWV was calculated using an image analysis technique developed in our laboratory. As an original technique, the theoretical background is first de-scribed, followed by its application in hypertensive volunteers. For each subject in the analysed population, the hc-PWV was calculated using the new technique, and the hc-PWV was meas-ured using mechanotransducers.

Results: in the analysed cohort of hypertensive patients, values of hc-PWV (8.57 ± 0.51 m/s) were similar to those obtained in the carotid-femoral pathway (8.57 ± 0.51 m/s versus 8.19 ± 1.27 m/s; PNS). Moreover, hc-PWV in our cohort of treated hypertensive patients (8.57 ± 0.51 m/s) was higher than that reported by other authors for healthy subjects in similar territories (4.9 ± 1.1 to 8.12 ± 3.54 m/s). Furthermore, the hc-PWV values in our cohort of treated hypertensive patients (8.57 ± 0.51 m/s) were lower than those reported in older subjects with systemic hyper-tension (11.56 ± 1.74 m/s). A significant correlation was observed between the hc-PWV and cf-PWV (r=0.73, p <0.05). A regression analysis was performed, yielding a slope of 0.2903.

Discussion: This work showed a novel approach to measuring heart-carotid pulse wave veloc-ity using ultrasound-based methods. In this initial exploration, our aim was not to evaluate or confirm a categorical result, but rather to highlight a trend toward a new methodology for cal-culating arterial stiffness, contrasted against previously validated standard methods.

Conclusion: This study confirmed that hc-PWV can be calculated non-invasively using elec-trocardiographic and ultrasonic images. The calculated hc-PWV values were in the range of those reported in the literature.

Introduction: Controlling high blood pressure in older adults is essential for managing cardiovascular risk, as outlined in major guidelines around the world. This study aimed to investigate the effects of strength training on blood pressure in older individuals with hypertension.

Methods: This meta-analysis followed the PRISMA guidelines and PICOS strategy. The databases used were MEDLINE (via PubMed), Web of Science, Scopus, and SciELO. The tools used for assessing risk of bias and methodological quality were Rob2 and TESTEX. In the meta-analysis, RevMan 5.4 software was employed.

Results: After the search process, 8,760 publications were identified, and 6 RCTs were included in this systematic review and meta-analysis. The average age of the population was 69 years, and the total number of participants in the CG and EG was 134 and 191, respectively. The average training volume (VT) was 68 minutes per session, three times a week, over 11 weeks of intervention. In the SBP variable, the forest plot presented 6 studies and 8 analyses. The mean difference (MD) was -8.81 (-17.16 to -0.46) (I² = 95%, p < 0.00001), indicating an improvement in SBP (p= 0.04). In the DBP variable, n=6 studies and 8 analyses were included. The MD was -4.53 (-7.89 to -1.18) (I² = 88%, p< 0.001). Therefore, the mean result differed significantly from zero (p = 0.008), indicating improvement in the DBP variable.

Conclusion: This meta-analysis concluded that strength training reduces systolic and diastolic blood pressure in older hypertensive individuals.

Introduction: To decrypt the tangled interconnections that contribute to the concurrent worsening of hypertension, diabetes mellitus, cardiovascular diseases, and chronic kidney disease, this review focuses on how these interlinked health issues interact. The study aims to deepen our understanding of the complex relationships between diabetes, hypertension, CKD, and CVD, while identifying knowledge gaps that warrant further exploration.

Methods: To gain insight into the shared pathophysiological mechanisms, this review investigates endothelial dysfunction, chronic inflammation, renin-angiotensin-aldosterone system activation, sympathetic nervous system hyperactivity, insulin resistance, and dyslipidemia. Data were extracted from reputable databases and search engines, including Medline, PubMed, Google Scholar, Scopus, Web of Science, Taylor and Francis, ScienceDirect/Elsevier, and Wiley Online Library.

Results: This review emphasizes the necessity of comprehensive and integrative management strategies that account for multi-system interdependencies.

Discussion: The rising prevalence of these conditions can be mitigated through preventive strategies such as lifestyle modification, physical activity, dietary interventions, stress management, and personalized clinical monitoring. Integrated lifestyle and medical interventions can significantly reduce the burden of interrelated chronic diseases.

Conclusion: This comprehensive analysis serves as a vital resource for clinicians and researchers addressing these interconnected chronic health burdens. There is an urgent need for more targeted research into these synergistic disease mechanisms and their unified management.

Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite the use of three or more antihypertensive agents of different pharmacological classes. The treat-ment of resistant hypertension remains a challenge, as it is associated with a heightened risk of cardiovascular events. Many preclinical studies have demonstrated the importance of the endo-thelin pathway in resistant hypertension; however, the therapeutic application of endothelin an-tagonists in clinical practice has been limited due to various factors. Recently, in March 2024, the FDA approved aprocitentan, an orally active endothelin-1 (ET-1) receptor antagonist that inhibits the binding of ET-1 to ETA and ETB receptors. This is the first medication with a novel mechanism for the treatment of resistant hypertension. This review aims to summarise the avail-able evidence on the discovery, chemical nature, pharmacokinetics, pharmacodynamics, effi-cacy, and safety of the novel drug aprocitentan in the pharmacotherapy of resistant hyperten-sion. The landmark PRECISION trial demonstrated a significant BP-lowering effect with the use of the dual endothelin receptor antagonist aprocitentan in the treatment of resistant hyper-tension. Aprocitentan was shown to be particularly effective in patients over 75 years of age, those with a higher cardiovascular-risk profile, patients with diabetes, and individuals with ad-vanced chronic kidney disease (CKD). As a dual receptor antagonist, aprocitentan demonstrated a lower risk of fluid retention and vascular leakage, adverse effects previously observed with other endothelin receptor antagonists. Its mechanism of action, improved efficacy, and excellent tolerability make aprocitentan a promising therapeutic option for resistant hypertension. It may be particularly effective in the treatment of patients with comorbidities, such as diabetes and CKD.

Introduction: Hypertension has become a salient public health issue on a global scale, affecting more than one billion people worldwide. In Vietnam, and specifically in Kon Tum prov-ince, many studies on hypertension have been conducted, mainly focusing on Kinh people, the majority ethnic group in Vietnam. Very few hypertension studies have focused on ethnic minority groups. This study aims to determine the prevalence of hypertension and identify related factors in mem-bers of the Ba Na ethnic group, aged 25 years and older, in Kon Tum City, Kon Tum province, Vietnam, in 2019.

Methods: A descriptive cross-sectional analysis design was carried out among 450 Ba Na ethnic people aged 25 years and older living in Kon Tum province.

Results: The study results indicated that the rate of hypertension in the study population was 30.89%. Increasing age was associated with increasing hypertension, with the highest rate found in the ≥ 65 age group at 66.67%. The lowest rate of hypertension in the group was found among participants aged 25-34 years at 9.66%. In addition to age (>65 years), factors associated with hypertension included BMI (obesity), a family history of hypertension, smoking cigarettes, number of cigarettes smoked per day (>10 cigarettes/day), and having diabetes.

Conclusion: This is one of the very few studies conducted to measure the prevalence of hyperten-sion in ethnic minority populations in Vietnam. It is necessary to implement community interven-tions to reduce the exposure to the risk factors of hypertension for the Ba Na ethnic people in Kon Tum, Vietnam.

Arterial stiffness, a hallmark of cardiovascular aging and disease, is characterized by the reduced elasticity of the arterial walls, which increases cardiovascular risk. Effective treatment aims not only to manage symptoms but also to address underlying causes and reduce associated risks. Thus, the present study aims to provide an understanding of lifestyle modifications and pharmaco-logical treatments for arterial stiffness, as well as the associated cardiovascular risk. The cornerstone of arterial stiffness treatment involves lifestyle changes. Regular aerobic physical activity, com-bined with a healthy diet, can help reduce weight, lower blood pressure, and improve arterial func-tion. Moreover, since tobacco use directly damages arterial walls and promotes stiffness, smoking cessation is necessary. Several classes of medication, such as renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, not only help control blood pressure but also improve arterial compliance. New antidiabetic agents, such as SGLT2 inhibitors and GLP-1 receptor agonists, have been shown to have beneficial effects on arterial stiffness. Statins, which are commonly prescribed for cholesterol management, also have favorable effects on arterial health, beyond their lipid-lowering properties. In conclusion, treating arterial stiffness is a multifaceted process that involves lifestyle modifica-tions, medication, and emerging therapies, all of which are best achieved through consistent moni-toring. This holistic approach aims to enhance arterial elasticity, reduce cardiovascular risk, and improve overall quality of life.

Introduction: Hypertension represents a major public health challenge, contributing to the global health burden. Lifestyle modifications and pharmacotherapeutic interventions are the cornerstones in the management of hypertension. However, suboptimal adherence remains a criti-cal impediment to achieving desired clinical outcomes, stemming from a complex interplay of socioeconomic factors, access to care, and affordability of medications. Therefore, the objective of this study was to assess adherence to lifestyle modifications and drug therapy and their associated factors.

Methods: A monocentric cross-sectional study was conducted on 200 hypertensive patients from July 1st to October 30, 2022. Participants were selected using a consecutive sampling technique. Adherence to lifestyle modifications was assessed through questions filled in a data sheet, with consumption of salt and the DASH diet evaluated using a Food Frequency Questionnaire and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, while medication adherence was assessed using the Morisky Medication Adherence Scale with 4 items (MMAS-4).

Results: The overall adherence to lifestyle modifications was 39.8%, with good adherence to fruit and vegetable consumption at 59.5%, adherence to a low-salt diet at 43%, and physical activity at 24.5%. According to the MMAS-4, poor medication adherence was observed in 58.3% of our patients and was associated with advanced age (>60 years; p = 0.014), low socio-economic level (p = 0.012), and use of free-dose combination therapy (p = 0.001).

Discussion: Our study demonstrates that poor adherence critically undermines hypertension control, while patient education and fixed-dose combination therapies improve outcomes. However, variability across populations and healthcare contexts limits generalizability and warrants further multicenter research.

Conclusion: The findings of this study indicate that therapeutic adherence among individuals with hypertension remains suboptimal, highlighting the need for a comprehensive, multifactorial strategy to address the diverse and intersecting determinants of nonadherence.

Introduction: High blood pressure (BP) damages various structures. The damaged structures are named hypertension-mediated organ damages (HMODs). Some of HMODs are acute (i.e., intracranial haemorrhage), while the others are chronic (e.g., left ventricular hypertrophy (LVH)). The aim of the paper was to investigate how HMODs compare to each other, and to answer the question of whether HMODs are divided into acute and chronic forms in the major medical publications - guidelines.

Methods: A search for 'acute hypertension-mediated organ damage' and 'acute target organ damage' was performed in the whole papers in SCOPUS. Moreover, the available guidelines on hypertension are analysed.

Results: Our results show that the mentioned chronic HMODs differ a lot, both in number and qualitatively, i.e. which HMODs are specified. The difference regarding the number of HMODs listed reflects partially the different approach; some guidelines state organ damage in general, and the other guidelines provide extensive lists.

Discussion: A Substantial number of arterial hypertension (HTN) guidelines do not list both acute and chronic HMODs; several guidelines refer to acute HMODs, and some others to chronic HMODs. In a number of HTN guidelines, acute (e.g., intracranial haemorrhage) and chronic HMODs (such as LVH) were mixed. In the vast majority of guidelines, the acute and chronic HMODs are not directly divided.

Conclusion: Consensus is clearly missing about the definition and classification of HMODs. Multiple reasons suggest that HMODs should be divided into acute and chronic subgroups. We presented some of the arguments and examples to start with.

Introduction: The arterial stiffness index (ASI) is a widely recognized metric used to assess arterial endothelial function and predict cardiovascular issues. This study has validated ASI as a non-invasive clinical assessment tool for atherosclerotic coronary artery disease (CAD).

Methods: We conducted a retrospective, observational study involving 396 patients undergoing coronary angiography. ASI was measured using the CardioVision MS-2000 system, and the SYN-TAX scores (SXscore) were computed to evaluate CAD severity. Patients were divided into two groups according to the SXscore: low SXscore (<22) and intermediate-high SXscore (≥ 22).

Results: In total, 257 (64.9 %) patients had CAD, of whom 166 (64.6%) had low (<22), 75(29.2%) had intermediate (23-32), and 16 (6.2%) had high (≥ 33) SXscore. ASI was significantly higher in CAD patients (120.82 ± 76.26 mmHg×10) compared to non-CAD patients (56.60 ± 35.89 mmHg×10; p < 0.01). In the multivariate regression model, a significant association was observed between ASI and CAD, with an odds ratio (OR) of 1.031 [95% confidence interval (CI): 1.022-1.040; p < 0.0001]. Additionally, ASI demonstrated an independent association with both intermediate and high SXscore (adjusted OR: 1.027; 95% CI: 1.020-1.034; p < 0.0001). The levels of ASI differed significantly in groups of patients with control, low SXScore, and intermediate-high SXScore as follows: 56.60±35.89 mmHg×10, 92.67±51.79 mmHg×10, and 172.2±86.6 mmHg×10, respectively (p < 0.01). ASI exhibited 59% sensitivity and 90% specificity for recognizing CAD.

Conclusion: Our findings suggested ASI to accurately evaluate arterial elastic function and provide information on CAD severity.