Current Hypertension Reviews最新文献

Hypertension remains a significant global health challenge due to its high preva-lence and complications worldwide. The complex interactions between genetic, environmen-tal, and lifestyle factors mean that current pharmacological treatments for hypertension have limited long-term effectiveness, which can be characterized as refractory hypertension. Tar-geted gene therapy offers a revolutionary approach by addressing the underlying genetic mech-anisms of hypertension, providing a personalized, potentially curative solution with fewer side effects. In Indonesia, the implementation of targeted gene therapy for hypertension faces sig-nificant challenges due to limited genomic infrastructure, high costs of genetic testing, and low awareness among healthcare professionals and the public. This genetic approach is still limited to research or rare monogenic cases and has not been implemented routinely in clinical prac-tice. Ethical, cultural, and religious considerations also continue to limit public acceptance of this genetic intervention, in addition to the lack of a clear legal and regulatory framework gov-erning gene therapy and the protection of genetic data. Nevertheless, the Indonesian govern-ment, through the Biomedical Genome-based Science Initiative (BGSi), has begun to initiate medical integration, which aims to develop population-specific genomic databases, improve precision medicine, and build national capacity for future implementation of gene-based ther-apies, including for hypertension. This literature review aims to comprehensively examine hy-pertension and gene therapy, synthesizing global evidence on genetic mechanisms, therapeutic advances, and implementation challenges, while outlining future opportunities and strategies for integrating gene-based medicine into the Indonesian health care system.

It is widely recognized that not only high blood pressure (BP) but also increased resting heart rate (RHR) impairs prognosis in patients with arterial hypertension (HTN). This study aims to answer 5 questions regarding the guidelines on HTN: 1. 'Is the significance of high RHR in HTN acknowledged?'; 2. 'Is there a recommendation to decrease RHR in chronic antihypertensive treatment?'; 3. 'Which antihypertensive medication is preferred to diminish high RHR in HTN patients?' 4. 'What is the treatment threshold value of RHR in patients with HTN?' and 5. 'Is there a recommendation for target RHR in chronic treatment of HTN?'. The significance of RHR and the treatment approach to it are scarcely mentioned in the key publi-cations-the guidelines on HTN-and there is no obvious firm argument to omit recommen-dations related to threshold and target RHR in HTN patients. On the contrary, there are at least five (major) reasons for addressing increased RHR in HTN guidelines. The vast majority of HTN guidelines do not acknowledge the significance of RHR elevation (as a cardiovascular risk factor). This discrepancy affects as much as 30-38% of the hypertensive population (that is, global > 1.28 billion adults - according to the World Health Organization). We highlight the need for improvement in the forthcoming guidelines that (in the current versions) do not explain the importance of RHR in HTN. Additional investigations are needed to confirm whether reducing high resting heart rate in HTN patients improves prognosis.

Introduction/objective: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, with a rapid increase in cases worldwide. NAFLD has recently emerged as an important driving force in the development and progression of hypertension. The uric acid-toalbumin ratio (UAR) is a new marker of cardiovascular disease. The present study aimed to assess the relationship between UAR and hypertension in patients with NAFLD.

Methods: The present prospective case-control study included 200 NAFLD patients. In addition, there were 100 age- and sex-matched controls. NAFLD was diagnosed on the basis of evidence of fatty liver infiltration shown by ultrasound in the absence of significant alcohol intake (maximum 30 g/day in males and 20 g/day in females) and other possible causes of fatty liver disease. Hypertension was diagnosed according to the recommendations of the 2020 International Society of Hypertension Global Hypertension Practice Guidelines. UAR was calculated by dividing uric acid levels (mg/dL) by serum albumin levels (g/dL). Group comparisons were performed using the independent samples t-test for continuous variables and the chi-square test for categorical variables. Binary logistic regression was used for multivariate analysis.

Results: Comparison between patients and controls revealed that patients had significantly higher UAR than controls (1.46 ± 0.35 versus 1.34 ± 0.28, p=0.001). The NAFLD group included 71 hypertensive patients (35.5 %). Hypertensive patients had significantly higher UAR than normotensive counterparts (1.56 ± 0.38 versus 1.41 ± 0.32 mg/g, p=0.005). Binary logistic analysis identified obesity (OR (95% CI): 9.68 (3.92-23.92), p<0.001), diabetes mellitus (DM) (OR (95% CI): 3.08 (1.56- 6.12), p=0.001) and elevated UAR (OR (95% CI): 11.12 (3.62-34.19), p<0.001) as significant predictors of hypertension in the studied patients in multivariate analysis.

Discussion: The present study identified the trio of obesity, diabetes mellitus, and elevated UAR as predictors of hypertension in multivariate analysis, consistent with multiple previous reports.

Conclusions: UAR may serve as a valuable, readily available marker that can predict hypertension in NAFLD patients, particularly those with associated diabetes and obesity.

Background: Hypertension is a growing burden among the elderly, particularly in lowand middle-income countries. Self-care practices are critical for hypertension management but understudied, especially in the Highlands region of Vietnam.

Aims: This study aims to assess self-care practices among elderly hypertensive patients in the Highlands region of Vietnam and to determine factors associated with non-adherence. By identifying sociodemographic and clinical predictors of poor self-care adherence, the study seeks to provide insights for targeted interventions to enhance hypertension management in this vulnerable population.

Methods: A cross-sectional study was carried out involving 438 hypertensive patients aged 60 and older managed at six commune health centers. Self-care practices were assessed across six HSCALE domains. Data were collected via interviews, medical records, and blood pressure (BP) measurements, with adherence defined as meeting criteria in at least four domains. Multiple logistic regression was used to analyze factors associated with non-adherence.

Results: Overall, 85.4% of participants adhered to self-care practices, with domain-specific adherence ranging from 39.5% (weight management) to 96.1% (low-sodium diet). Despite high adherence, only 12.8% achieved normotension. Non-adherence was associated with male sex [Adjusted Odds Ratio (AOR) = 4.73, 95% Confidence Interval (CI): 2.40 - 9.34], illiterate (AOR = 3.08, 95% CI: 1.18 - 8.03), currently working for income (AOR = 2.01, 95% CI: 1.10 - 3.67), isolated systolic hypertension (AOR = 2.34, 95% CI: 1.24 - 4.40), and poor hypertension knowledge (AOR = 4.57, 95% CI: 2.45 - 8.51).

Conclusion: This study highlights the importance of comprehensive self-care strategies in hypertension control among the elderly. Despite high overall adherence, the persistence of inadequate BP control underscores the need for more effective weight management and tailored interventions. Findings emphasize the role of health literacy, socioeconomic factors, and clinical characteristics in shaping self-care behaviors, which could inform future policy and community-based hypertension management programs.

Introduction: While medication non-compliance for hypertension (HTN) and type II diabetes mellitus (T2DM) patients drives poor outcomes globally, its specific clinical and financial impact in Jordan is poorly quantified. This study aimed to determine the prevalence of medication noncompliance, quantify its effect on hospitalization rates and costs, and assess the role of sociodemographic factors in a Jordanian patient cohort.

Methods: A prospective cohort study was conducted at a major Jordanian hospital from 2022 to 2023. A final sample of 159 patients with HTN and/or T2DM was followed for one year. Participants were classified as compliant (n = 86) or non-compliant (n = 73) based on patient self-reports and pharmacy refill data. Hospitalization rates, intensive care unit admissions, and sociodemographic data were compared between groups.

Results: The prevalence of poor compliance was 45.9% (n = 73). Poor compliance was strongly associated with hospitalization (p < 0.001). Non-compliant patients had significantly higher rates of floor admissions (82.6% vs. 16.4%) and intensive care unit admissions (37.2% vs. 0%) compared to the compliant group (n = 86). This resulted in substantially higher healthcare costs. After statistical adjustment, poor compliance was the most powerful independent predictor of hospital admission (Adjusted Odds Ratio 45.78), while baseline sociodemographic factors were not significantly associated with admission.

Discussion: Our findings highlight that medication non-compliance is a major cause of hospitalizations and escalating healthcare costs in Jordan. The prevalence of non-adherence observed in our cohort (45.9%) aligns with trends reported in neighboring regional studies. Consequently, further research into the specific socio-behavioral barriers to adherence is essential.

Conclusion: Medication non-compliance is a prevalent and critical driver of preventable hospital admissions and high healthcare costs among Jordanian patients with HTN and T2DM. These findings underscore an urgent need for targeted interventions to improve compliance and reduce the associated healthcare burden.

Introduction: Amlodipine, a calcium channel blocker, is widely used to treat hypertension, but its effectiveness varies among individuals. Clinicians have observed this variability, and previous research suggests that the Angiotensinogen (AGT) M235T genotype influences response to antihypertensive drugs like valsartan. This study investigates the association between the AGT M235T genetic variant and non-genetic anthropometric factors, and the response to amlodipine in essential hypertensive patients at the University of Jordan Hospital.

Methods: A cohort of 46 unrelated Arabic Jordanian patients with essential hypertension was enrolled. Baseline systolic and diastolic blood pressure (BP) readings were recorded before initiating 5 mg amlodipine, with follow-up measurements taken after one month. AGT M235T genotyping was performed using PCR-RFLP, and non-genetic data were obtained from hospital records.

Results: It was found that 28.3% of the tested patients did not respond to amlodipine. The heterozygous AGT M235T genotype showed a significantly (p < 0.05, t-test) lower reduction in the BP compared to wild-type carriers, and its frequency was significantly higher (p < 0.05, ꭙ2 test) among the non-responders to amlodipine. In addition, the average age of the non-responders (41.5±10.3 years) was significantly (p < 0.05, t-test) lower than that of responders (47±10 years) to amlodipine.

Discussion: The heterozygous AGT M235T genotype partially explained inter-individual variation in response to amlodipine among hypertensive patients of Jordanian Arab origin.

Conclusion: It can be concluded that the AGT M235T heterozygous genotype is linked to reduced amlodipine response, while older age is associated with a higher efficacy. However, further multi-center studies with larger cohorts are needed to confirm these findings.

Arterial hypertension (HTN) is the leading modifiable risk factor for cardiovascular diseases in Latin America; however, control rates remain inadequate. Two primary contributors to this public health crisis are nonadherence to antihypertensive treatment and clinical inertia. Non-adherence rates in the region range from 14% to 94%, while clinical inertia, defined as healthcare providers' failure to escalate or modify treatment, when necessary, further complicates the issue. The interplay between these two factors creates a self-perpetuating cycle that leads to poorly controlled hypertension, increased morbidity and mortality, and a greater economic burden. A primary concern is "ineffective adherence", which occurs when patients follow prescribed treatments but do not achieve desired outcomes. This phenomenon is primarily driven by medical inertia and affects a significant proportion of cases.

This review examines the scope of these issues in Latin America, their socioeconomic impacts, and potential interventions to mitigate their effects. To better manage hypertension, comprehensive strategies are recommended, including patient-centered interventions, education directed at providers, essential healthcare reforms, and team-based care strategies that involve non-physician providers.

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.