Journal of Clinical Hypertension最新文献

Oxidative stress plays a role in vascular dysfunction and cardiometabolic health. The purpose of this study was to assess the effects of aerobic exercise training on antioxidant capacity (ferric reducing ability of plasma/FRAP) and hemodynamic measures: systolic blood pressure (∆SBP), diastolic blood pressure (∆DBP), mean arterial blood pressure (∆MAP), large arterial elasticity index (∆LAEI), and small arterial elasticity index (∆SAEI) in a cohort of healthy women. This was a secondary data analysis of a study designed to evaluate cardiometabolic outcomes. Participants performed supervised aerobic exercise 3 times/week on a stationary cycle ergometer. FRAP and hemodynamic measures were measured baseline and post-training. The analysis included 15 African American and 14 Caucasian women aged 32.2 ± 5.5 years. No significant changes were observed for FRAP or hemodynamic measures. However, significant negative correlations between ∆FRAP and ∆SBP, ∆DBP, and MAP, as well as a positive correlation with ∆SAEI and ∆LAEI were observed. ∆SBP, ∆DBP, and ∆MAP were each modeled with three multiple regression models: (1) ∆FRAP, ∆SAEI, and ∆LAEI as independent variables. All models had significant R². ∆FRAP was significantly related to ∆DBP and ∆MAP after adjusting for ∆SAEI and ∆LAEI (partial R −0.38 and −0.32 respectively). ∆SAEI was independently related to ∆SBP (partial −0.32) and ∆MAP (partial −0.34). ∆LAEI was independently related to ∆SBP (partial −0.36) and ∆MAP (partial −0.40). ∆FRAP is significantly associated with lowered blood pressure and elevated arterial elasticity. While multiple regression analysis suggests that at least some of the lowered blood pressure is achieved through processes associated with increased arterial elasticity.

Increased arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) is a well-known risk factor for hypertension and future cardiovascular events. The relationship between serum calcium levels and increased arterial stiffness is not well understood. Individuals undergoing baPWV measurements as part of a generalized health examination, with normal serum calcium (8.5–10.5 mg/dL) and phosphate levels and no significant renal dysfunction, were selected from the Korea Initiatives on Coronary Artery (KOICA) registry. The cross-sectional relationship between serum calcium levels and baPWV, and the longitudinal effect of baseline serum calcium levels on baPWV progression in those with repeated baPWV measurements, were analyzed using multivariable regression models. A total of 9150 individuals with baseline baPWV and 2329 individuals (5451 PWV measurements) with follow-up baPWV were selected for cross-sectional and longitudinal analyses, respectively. After adjustment for confounders, higher serum calcium levels were associated with increased baseline baPWV (β-coefficient per 1 mg/dL increase, 19.61; 95% CI 7.77–31.45; p = 0.001). Higher serum calcium was also independently associated with a greater annualized baPWV progression rate longitudinally (β-coefficient per 1 mg/dL increase, 5.17; 95% CI, 1.82–8.67; p = 0.004). Subgroup analysis showed that the effect of serum calcium on baPWV progression had a significant interaction with baseline baPWV, systolic blood pressure, and the presence of diabetes (interaction p < 0.001). In conclusion, higher serum calcium levels within the normal range were associated with faster arterial stiffness progression measured by baPWV. Further studies are required to explore the potential for modulating calcium metabolism to slow arterial stiffness progression.

Emerging evidence links the Endothelial Activation and Stress Index (EASIX) and mortality risk in coronary artery disease, but its relevance in hypertensive patients remains unclear. This study examines the association between EASIX and all-cause and cardiovascular mortality in hypertensive individuals. The analysis included 6138 hypertensive patients from seven National Health and Nutrition Examination Survey (NHNES) cycles (2003–2016), with mortality data obtained from the National Death Index (NDI). Over a median follow-up of 98 months, 1435 (23.4%) participants died, including 400 (6.5%) from cardiovascular causes. Restricted cubic spline analysis revealed a positive association between EASIX and both all-cause and cardiovascular mortality. Weighted multivariable Cox regression indicated that each 1-unit increase in EASIX corresponding to a 25% and 23% rise in mortality risk, respectively. Based on the optimal cutoff value determined using the maximally selected rank statistics method, participants were stratified into higher (>0.79) and lower (≤0.79) EASIX groups. Higher EASIX was significantly associated with increased all-cause mortality risk (HR 1.46, 95% CI 1.23–1.73, p < 0.0001). Higher EASIX scores were associated with increased cardiovascular mortality, especially in former/current smokers and those with diabetes/prediabetes. Time-dependent receiver operating characteristic analysis assessed the predictive accuracy of EASIX, yielding area under the curve (AUC) for 1-, 3-, 5-, and 10-year survival of 0.71, 0.67, 0.67, and 0.67 for all-cause mortality and 0.79, 0.73, 0.73, and 0.71 for cardiovascular mortality. In conclusion, elevated EASIX is independently associated with increased all-cause and cardiovascular mortality in hypertensive patients, suggesting its potential as a predictive biomarker in clinical practice.

Visit-to-visit blood pressure variability (BPV) has been recognized as a cardiovascular risk factor, but its association with new-onset atrial fibrillation (AF) remains underexplored. This study investigated the relationship between BPV and AF incidence among hypertensive patients using data from the Systolic Blood Pressure Intervention Trial (SPRINT). Visit-to-visit BPV was quantified using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic and diastolic blood pressure measurements. Participants were stratified into three groups based on systolic BPV tertiles. AF cases were identified via follow-up electrocardiograms and reports of AF-related serious adverse events. After excluding individuals with baseline AF or missing BPV data, 7378 patients were analyzed over a median follow-up of 3.8 years. The incidence of new-onset AF increased across ascending tertiles of systolic BPV (CV), with rates of 2.5% (62 cases), 4.1% (104 cases), and 5.2% (127 cases) observed in the lowest to highest tertiles, respectively. After adjusting for age, race, blood pressure, and cardiovascular risk factors, the hazard ratios for AF in the second and third tertiles compared to the lowest tertile were 1.52 (95% CI: 1.10–2.09) and 1.83 (95% CI: 1.34–2.49), respectively. Consistent trends were noted for systolic BPV measured via SD and ARV, as well as diastolic BPV. These findings indicate that elevated visit-to-visit BPV independently predicts AF development in hypertensive populations. Assessing BPV may enhance risk stratification and identify patients at heightened risk for AF, underscoring its clinical relevance in hypertension management.

This study aims to investigate the causal relationship between obesity and essential hypertension, and evaluate the mediation effect of visceral adipose tissue (VAT) by Mendelian randomization (MR) analysis. We included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), WC adjusted for BMI (WCadjbmi), and WHR adjusted for BMI (WHRadjbmi) as obesity-related anthropometric traits. In the bidirectional MR analyses, we found that higher BMI (OR, 1.638; p = 3.97 × 10⁻¹⁹), WC (OR, 1.702; p = 1.45 × 10⁻¹²), and WHR (OR, 1.863; p = 1.84 × 10⁻⁸) were significantly associated with increased risk of essential hypertension, while no evidence of reverse causality was observed. Then, in the two-step MR analyses, all five anthropometric traits had a positive and significant association with VAT mass, especially WC (OR, 2.315; p = 1.00 × 10⁻²¹⁰). Meanwhile, higher predicted VAT mass was significantly associated with increased risk of essential hypertension (OR, 1.713; p = 1.18 × 10⁻³⁸). Furthermore, the mediation analyses revealed that VAT had a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension, and mediated proportions in BMI, WC, and WHR were 77.8%, 80.1%, and 41.4%, respectively. Finally, the sensitivity analyses using two other datasets showed a similar result. In conclusion, our results showed that BMI, WC, and WHR have a positive and significant association with increased risk of essential hypertension. Moreover, VAT has a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension. Our study provided important statistical evidence suggesting that VAT may play a crucial meditation role in the occurrence and development of obesity-related hypertension.

Pulse pressure (PP) is a recognized marker of cardiovascular risk in the general population. However, its role as an independent predictor of recurrent cardiovascular events following myocardial infarction (MI) and whether there are age-dependent differences in this relationship remains uncertain. We analyzed data from 4091 participants with a history of MI were enrolled in the Kailuan Study. Univariate and multivariable Cox models were used to analyze the associations between PP and primary outcome (composite cardiovascular events, a composite of all-cause death, nonfatal recurrent MI, nonfatal hospitalization for heart failure or nonfatal stroke) and secondary outcomes (each individual components of composite endpoint) after MI. Over a median follow-up of 7.8 years, 1610 composite cardiovascular events occurred. The mean baseline PP was 54.2 ± 16.1 mmHg. Compared with individuals in the first PP quartile, those in the fourth quartile had significantly greater risks of composite cardiovascular events (adjusted HR: 1.20; 95% CI: 1.03–1.41; p = 0.02) and recurrent MI (adjusted HR: 1.56; 95% CI: 1.03–2.36; p = 0.04). A linear, dose–response relationship was observed between PP and the risk of adverse cardiovascular outcomes (all p ≤ 0.02), except for stroke (p = 0.36). Subgroup analyses indicated that the association between PP and adverse outcomes was stronger among participants aged <60 years compared with older individuals. Elevated PP is an independent predictor of recurrent cardiovascular outcomes in post-MI patients, with particularly stronger associations observed in younger and middle-aged adults.

Trial Registration: ChiCTR-TNRC-11001489

To the Editor,

I read with interest the article by Xu and colleagues [1]. The authors evaluated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for elderly patients with hypertension. They compared the change of blood pressure before and after the KAP intervention for a period of 1 year. The blood pressure control rate and the mean values of systolic (SBP) and diastolic blood pressure (DBP) improved significantly, and they concluded that the community physician-led KAP intervention model was effective in the management of hypertension in the elderly. I have some concerns about their study.

Loucks and colleague [2] conducted a 2-year follow-up study to investigate the effect of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on SBP, regardless of whether they were prescribed antihypertensive medications. MB-BP was significantly associated with a reduction in SB. Although KAP and MB-BP are different concepts, a non-pharmacological approach to blood pressure management may contribute to reducing the risk of hypertension. Medical treatment and non-pharmacological approaches such as KAP and MB-BP would integrate the efficacy of reducing blood pressure.

I think that elderly hypertensive patients should pay attention to emotional disorders such as depression. Regarding the effect of mental disorder on hypertension, Jeon and colleagues [3] reported that the adjusted hazard ratios (95% confidence intervals) of moderate and severe depressive symptoms for incident hypertension were 1.12 (1.02–1.24) and 1.29 (1.10–1.50). They also clarified that high blood pressure was associated with a decreased risk of developing depressive symptoms. This means that depressive status would affect subsequent increase in blood pressure, and mental care is important to prevent hypertension.

Finally, Mir and colleagues [4] reviewed the effect of mindfulness-based meditation (MBM) on blood pressure among adults with elevated blood pressure and hypertension. MBM interventions are effective for preventing hypertension and reducing elevated blood pressure. According to a meta-analysis by Chen and colleagues [5], significant reductions in SBP and DBP were observed by MB interventions regardless of gender and baseline blood pressure. I suppose that KAP would become a fundamental basis to improve the efficacy of MB-BP intervention. A randomized control trial with sufficient statistical power and long-term follow-up is needed to understand the combined effect of KAP and MBM intervention on subsequent advantages for controlling hypertension.

The author declares no conflicts of interest.

Abdominal fat distribution, particularly the visceral-to-subcutaneous fat area ratio (V/S ratio), offers a promising avenue for exploring the development of hypertension. However, there is a paucity of quantitative studies examining the relationship between the V/S ratio and the risk of hypertension in individuals with prediabetes, especially within the Chinese population. This cross-sectional study was conducted at the Health Management Center of Henan Provincial People's Hospital, involving 4071 participants with prediabetes. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using computed tomography (CT) scans, and the V/S ratio was calculated. Statistical analyses, including multivariable logistic regression, restricted cubic spline regression models, and subgroup analyses, were employed to investigate the relationship between the V/S ratio and hypertension in individuals with prediabetes. The prevalence of hypertension among the 4071 prediabetic participants was 35.54%. Prediabetic individuals with elevated V/S ratios had a significantly higher risk of developing hypertension (Q4 vs. Q1: odds ratio [OR] = 2.78, 95% confidence interval (CI) = 2.03–3.82, p < 0.001; p _{for trend} < 0.001), a relationship that remained statistically significant after adjusting for other variables. Importantly, a non-linear association between the V/S ratio and hypertension risk was observed, indicating a notable increase in hypertension risk when the V/S ratio exceeded 1.80 (OR = 1.21, 95% CI: 1.06–1.39, p < 0.05). These findings underscore the importance of abdominal fat distribution in improving metabolic health outcomes in individuals with prediabetes. Monitoring abdominal fat distribution is essential for prediabetic patients to mitigate the risk of hypertension.

This study aims to elucidate the underlying mechanisms of pyroptosis in hypertension through bioinformatics and machine learning approaches. R language was utilized to integrate differentially expressed genes (DEGs) between hypertension samples and healthy control samples in GSE24752 and GSE75360 datasets, followed by GO analysis, KEGG enrichment analysis, and GSEA. Key genes were screened based on the expression levels of DEGs using logistic regression, LASSO regression, and support vector machine (SVM). A visualized protein–protein interaction regulatory network was constructed, and immune cell infiltration analysis was performed on integrated GEO datasets of hypertensive samples. Collect serum samples from hypertensive subjects and healthy control subjects for RT-qPCR detection of key gene expression. A total of 1005 DEGs were obtained from peripheral blood samples of 13 hypertension cases and 14 control samples. GO analysis, KEGG enrichment analysis, and GSEA revealed that the DEGs function synergistically in various biological pathways. LASSO regression and SVM identified six key genes related to pyroptosis (CASP7 (caspase-7), CYBB, NEK7, NLRP2, RAB5A, VDR (vitamin D receptor)). Immune infiltration analysis showed that activated B cell, effector memory CD8 T cell, immature B cell, MDSC, and T follicular helper cell accounted for the largest proportion of immune cells. RT-qPCR results indicated significantly higher relative expression levels of caspase-7 and vitamin D receptor in hypertensive samples compared to controls. These findings suggest that CASP7 and the vitamin D receptor gene may offer new research targets for the diagnosis and treatment of hypertension, and they also provide fresh evidence for the involvement of pyroptosis in hypertension.