Current Hypertension Reviews最新文献

Introduction: Dihydropyridine-calcium channel blockers (DHP-CCBs) are effective first-line blood pressure-lowering agents for primary hypertension. However, data comparing the variations in efficacy and safety between different types of DHP-CCBs are scarce.

Aims and objectives: This study aimed to summarize the latest evidence on the benefits and harms of seven DHP-CCBs (amlodipine, levamlodipine, felodipine, lacidipine, nitrendipine, nifedipine, and benidipine).

Methods: A meta-analysis of DHP-CCBs was carried out to explore differences in efficacy and safety. We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases from inception to September, 2023, for randomized controlled trials (RCTs) comparing DHP-CCBs. The main outcomes were blood pressure lowering and adverse events (AEs) during treatment.

Results: We included 181 RCTs (21,383 patients) in this analysis. In terms of efficacy, levamlodipine ranked highest in reducing office blood pressure (surface under the cumulative ranking systolic blood pressure = 80.81%, diastolic blood pressure (DBP) = 82.42%) and 24-h ambulatory DBP (98.07%). Felodipine had the highest probability of reducing 24-h ambulatory blood pressure (80.65%). Regarding safety, levamlodipine had the least impact on heart rate (85.71%). In terms of AEs, benidipine had the highest rate for cardiovascular (86.58%) and digestive system (93.57%) AEs. Nifedipine and amlodipine had the highest rates of central (80.65%) and peripheral nervous system (83.28%) AEs, respectively. Levamlodipine exhibited significantly lower rates of total AEs (1.24%), central nervous system AEs (1.28%), and cardiovascular system AEs (3.62%) than the other interventions.

Conclusion: In the office setting, levamlodipine may be the best treatment for primary hypertension, and lacidipine shows good safety.

Large artery stiffness (LAS) is widely recognized as a highly clinically relevant determinant of cardiovascular health and an independent prognostic marker. However, routine assessment of LAS has not yet been integrated into clinical practice. Arterial wall stiffness is dependent on distending pressure (i.e., mean arterial pressure), which may confound the interpretation of individual measurements. The cardio-ankle vascular index (CAVI) is an index of arterial stiffness designed to mitigate the dependence of pulse wave velocity on blood pressure. However, because CAVI incorporates pulse wave velocity measured between the heart and the ankle, it is influenced by both the stiffness of the aorta and medium-sized muscular arteries. Several observational, longitudinal studies have demonstrated that higher CAVI is associated with cardiovascular events and mortality, although most available data are derived from Asian populations. Future studies of CAVI are needed to establish its prognostic value in addition to traditionally used cardiovascular risk factors in the setting of primary prevention. This review aims to provide a brief overview of the definition, theoretical principles, practical considerations, key strengths and limitations, and the clinical utility of CAVI.

Introduction: Left Ventricular Dysfunction (LVD) is a frequent complication in Diabetes mellitus (DM) patients, often worsened by cardiovascular disease. This study explores the role of dipyridamole (DP)-induced heart rate variability and G-SPECT imaging in evaluating LVD in DM patients. This study aimed to evaluate the relationship between heart rate ratio (HRR) during DP stress and LVD parameters derived from gated SPECT (G-SPECT) in DM patients, aiming to identify if HRR can serve as a marker for early LVD assessment.

Methods: A cross-sectional study of 125 patients referred for cardiac scanning. Patients were grouped by diabetic status and HRR (≤ 1.2 vs. > 1.2) post-DP. G-SPECT-derived left ventricular parameters were compared between groups.

Results: G-SPECT showed that peak filling rate (PFR) was higher in non-DM patients. In the HRR ≤ 1.2 group, DM patients had significantly higher end-diastolic volume (EDV) and end-systolic volume (ESV) than non-DM patients (EDV: 66.41±31 vs. 51.34±18, p-value:0.009; ESV: 27.88±11.21 vs. 18.63±15.5, p- p-value: 0.015).

Discussion: This study evaluated the role of heart rate response during dipyridamole stress testing combined with G-SPECT imaging in assessing left ventricular dysfunction (LVD) in diabetic patients. The findings indicate that changes in ventricular volume parameters, along with heart rate response, may serve as early markers of cardiac impairment, potentially facilitating earlier detection and improved management of cardiac complications in this population.

Conclusion: Reduced HRR during DP stress, combined with G-SPECT, may aid in the assessment of LVD in DM patients, potentially facilitating earlier diagnostic insights.

Background: Chronic Kidney Disease (CKD) is a known risk factor for End-Stage Renal Disease (ESRD) and Cardiovascular Diseases (CVD). Renal Doppler Ultrasound (RDU) can detect early renal involvement in CKD using the Renal Resistive Index (RRI).

Aims: This study aimed to investigate the effects of risk factors and clinical complications associated with CKD on RRI among patients with different stages of CKD.

Methods: In this analytical cross-sectional study, 186 patients referred to Poursina Hospital for RDU were categorized into six groups (normal and five stages of CKD). We analyzed the impact of demographic factors and clinical complications on RRI across all groups.

Results: Our findings indicated that CKD prevalence was particularly high among older patients and those with CVD, type 2 diabetes mellitus (DM), and hypertension (HTN). Elevated RRI in CKD patients was significantly associated with age, CKD stage, CVD, and HTN (p < 0.05). Furthermore, RRI was higher in CKD patients with elevated serum phosphorus (P) levels, higher low-density lipoproteins (LDL), and lower calcium (Ca) and hemoglobin (Hb) levels. Based on a multivariate regression model, CVD, lower Ca, high LDL, and proteinuria were identified as independent predictors of elevated RRI (p < 0.05).

Conclusion: This study concludes that elevated RRI is associated with the severity of CKD and its clinical complications, suggesting that RRI can serve as a reliable indicator for assessing CKD patients, managing treatment, and preventing early death complications.

Background: Declined kidney function associated with hypertension is a danger for cognitive deficits, dementia, and brain injury. Cognitive decline and vascular dementia (VaD) are serious public health concerns, which highlights the urgent need for study on the risk factors for cognitive decline. Cysteinyl leukotriene (CysLT₁) receptors are concerned with regulating cognition, motivation, inflammatory processes, and neurogenesis.

Objective: This research aims to examine the consequence of montelukast (specific CysLT₁ antagonist) in renovascular hypertension 2-kidney-1-clip-2K1C model-triggered VaD in experimental animals.

Methods: 2K1C tactics were made to prompt renovascular hypertension in mature male rats. Morris water maze was employed to measure cognition. Mean arterial pressure (MAP), serum nitrite levels, aortic superoxide content, vascular endothelial activity, brain's oxidative stress (diminished glutathione, raised lipid peroxides), inflammatory markers (IL-10, IL-6, TNF-α), cholinergic activity (raised acetylcholinesterase), and cerebral injury (staining of 2, 3, 5- triphenylterazolium chloride) were also examined.

Results: Montelukast in doses of 5.0 and 10.0 mg kg^-1 was used intraperitoneally as the treatment drug. Along with cognitive deficits, 2K1C-operated rats showed elevated MAP, endothelial dysfunction, brain oxidative stress, inflammation, and cerebral damage with diminished serum nitrite/nitrate. Montelukast therapy significantly and dose-dependently mitigated the 2K1Chypertension- provoked impaired behaviors, biochemistry, endothelial functions, and cerebral infarction.

Conclusion: The 2K1C tactic caused renovascular hypertension and associated VaD, which was mitigated via targeted regulation of CysLT₁ receptors by montelukast administration. Therefore, montelukast may be taken into consideration for the evaluation of its complete potential in renovascular-hypertension-induced VaD.

Background: The representatives of mathematical concepts and indices allied to the Golden Ratio (GR) have been shown in the human body in superimposed human hands, phalangeal lengths of the digits, human ears, and the cardiovascular system. Recently, it has been demonstrated that the systolic blood pressure (SBP) to diastolic blood pressure (DBP) ratio measured by ambulatory blood pressure monitoring (ABPM) is close to GR. Accordingly, we aimed to evaluate the ratios between the SBP, DBP, and PP in normotensive and hypertensive patients who were on medical treatment or not, to assess the existence of golden proportions in 24-hour ambulatory blood pressure monitoring results.

Material and method: Five hundred and twenty-nine patients who underwent ABPM were retrospectively enrolled in the study population. The ABPM was programmed to measure blood pressure every 30 min during the daytime and 60 min night time. Based on the ABPM results, patients were classified as hypertensive (SBP/DBP≥130/80 mmHg) and normotensive (SBP/DBP<130/80 mmHg), depending on ESC/ESH 2018 guidelines. They were also divided into two subgroups: medicated and nonmedicated. Systolic to diastolic blood pressure ratio (SBP/DBP) and diastolic blood pressure to pulse pressure (DBP/PP) were calculated in the usual fashion in all study populations and subgroups.

Results: After the exclusion of 133 patients who did not fulfill the inclusion criteria, 396 patients were included in the statistical analysis. Mean SBP/DBP ratios were 1.66±0.15 in all the study population, 1.63±0.11 in normotensive without medication, 1.66±0.13 in normotensive with medications, 1.62±0.15 in hypertensive without medication, and 1.76±0.20 with medications.

Conclusion: We have documented that SBP to DBP ratios of untreated patients, irrespective of having normal or high blood pressure, run close around the GR. However, SBP to DBP ratios of patients having antihypertensive treatment are far from the GR.

Background: Suppression of the body's immune system can cause high blood pressure. Also, many people with COVID-19 have underlying diseases, including high blood pressure.

Aim: This study was conducted to investigate the effect of COVID-19 infection on blood pressure caused by pregnancy in women referred to Kashani Hospital in Jiroft City.

Methods: This study was a case-control study with a census sampling method on 266 pregnant women referring to Kashani Hospital in Jiroft City in 2021-2022. Pregnant women were divided into two control groups (pregnant women without COVID-19) and intervention (pregnant women with COVID-19). SPSS software version 22 was analyzed.

Results: 266 pregnant women participating in the study were divided into two equal control (133) and intervention (133) groups. The average age of pregnant women was 29 ± 6.8 years. The average systolic and diastolic blood pressure in the intervention group was 112.6 and 70, and in the control group, it was 107.8 and 66.6, which was not statistically significant (P_Value>0.05). Also, the results showed that there was a difference between home blood pressure during pregnancy and there is a statistically significant relationship between the age of pregnant women (P_Value< 0.05). While there is no significant statistical relationship between gestational age and body mass index (P_Value>0.05).

Conclusion: According to the results of this study, COVID-19 affects blood pressure caused by pregnancy, and gestational age is an important factor in the prevalence of high blood pressure in women with COVID-19.

Introduction: There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients > 75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow-up study, we sought to explore the reasons for not recruiting.

Methods: Furthermore, using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS), UK, were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics.

Results: Nineteen (19) individuals responded to the online questionnaires (15 primary care staff, 4 CRN staff). Moreover, using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes are established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient- facing study documents, limited research resources in primary care, and identification of eligible patients using existing coding.

Conclusion: Our experience showed that recruiting older people from primary care to a WCH study was not feasible. A national scoping survey amongst primary care physicians in the UK, as well as robust patient and public involvement (PPI) targeting older people with WCH, might improve recruitment in future studies addressing the management of WCH in older people.

Arterial hypertension is a multifactorial clinical condition characterized by higher blood pressure levels. The main treatment for controlling high blood pressure consists of drug therapy, but the scientific literature has been pointing to the efficiency of aerobic and resistance exercises acting in a therapeutic and/or preventive way to reduce and control the blood pressure levels. Resistance training is characterized by sets and repetitions on a given muscle segment that uses overload, such as machine weights, bars, and dumbbells. As it successfully affects a number of variables associated to practitioners' functional and physiological features as well as emotional and social variables, resistance training has been a crucial part of physical exercise programs. Several reports highlight the various adaptive responses it provides, with a focus on the improvement in strength, balance, and muscular endurance that enables a more active and healthy lifestyle. Resistance training programs that are acute, sub-chronic, or chronic can help people with varying ages, conditions, and pathologies reduce their arterial hypertension. However, molecular mechanisms associated with resistance training to reduce blood pressure still need to be better understood. Thus, we aimed to understand the main effects of resistance training on blood pressure as well as the associated molecular mechanisms.