Journal of Clinical Hypertension最新文献

Type 2 diabetes (T2D) and hypertension often coexist, and insulin resistance (IR) plays an important role in their pathological progression. An increasing number of studies have focused on the relationship between different IR indices and hypertension. A natural log transformation of the glucose disposal rate (log_e GDR) has been proposed as a new model for insulin sensitivity in patients with T2D. The study aimed to explore the relationship between log_e GDR and hypertension in T2D patients. This cross-sectional study included 1544 Chinese T2D patients. Clinical and biochemical characteristics were collected. The log_e GDR was calculated based on triglycerides, urinary albumin to creatinine ratio, gamma-glutamyl transferase, and body mass index. Patients were categorized into hypertension and nonhypertension groups stratified by gender. Among both females and males, compared with the nonhypertension group, the level of log_e GDR was significantly decreased in the hypertension group (both p < 0.001). As the log_e GDR increased, the levels of systolic and diastolic blood pressure, and the prevalence of hypertension were obviously increased (all p < 0.001). Univariate analysis displayed that log_e GDR was negatively related to hypertension (correlation coefficient: −0.243, p < 0.001 in females; correlation coefficient: −0.181, p < 0.001 in males). Furthermore, the logistic regression analysis showed that log_e GDR was independently associated with hypertension (OR: 0.456; 95% CI: 0.224–0.927 in females; OR: 0.544; 95% CI: 0.314–0.941 in males). This study revealed that log_e GDR was closely related to hypertension, which might help monitor and manage hypertension in T2D patients.

Riociguat is a drug that improves hemodynamic parameters and increases the exercise capacity of patients with chronic thromboembolic pulmonary hypertension (CTEPH). This meta-analysis evaluated cohort studies that measured changes in parameters such as the 6-minute walk distance (6MWD), mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output (CO), and pulmonary arterial wedge pressure (PAWP). The study utilized cohort studies with a paired samples group design to measure the changes in these parameters. We searched for articles containing the keywords “Riociguat” and “Chronic thromboembolic pulmonary hypertension” in their titles in PubMed, Web of Science, Scopus, and ScienceDirect databases until May 2024. We conducted five meta-analyses to combine the mean difference values. We identified nine studies that examine the effects of Riociguat on patients. Analyzing data from 565 patients revealed that Riociguat increases the distance walked during the 6MWD test by an average of 35.86 m. After analyzing data from 717 patients, it was found that Riociguat reduces mPAP by an average of 9.23 mm Hg. Analyzing data from 586 patients, it was found that Riociguat reduces PVR by an average of 220.11 $��\mathrm{dyn}�.�s�.�c�m^{�-�5�}�$. Moreover, analyzing data from 643 patients showed that Riociguat increases CO by an average of 0.49 L/min. Finally, after analyzing data from 645 patients, it was concluded that Riociguat treatment did not have a statistically significant effect on PAWP. Our findings indicate that Riociguat improved certain hemodynamic parameters and exercise capacity in CTEPH patients.

Chlorthalidone (CLTD) and hydrochlorothiazide (HCTZ) are widely used thiazide diuretics for hypertension management. This study aimed to evaluate and compare the cardiovascular outcomes of patients treated with CLTD versus HCTZ. This multicenter, retrospective cohort study utilized data from the Korea University Medical Center, derived from electronic health records. A total of 14 257 hypertensive patients treated with either CLTD (n = 1920) or HCTZ (n = 12 337) were identified. Patients were matched 1:1 using propensity scores, resulting in 1606 patients in each treatment group. Demographic and clinical characteristics, incidence of major adverse cardiovascular events (MACE), and safety profiles were analyzed. Baseline characteristics after propensity score matching were well balanced between the two groups. The average age was 61.8 ± 14.6 years for CLTD users, with 59.3% being male. The 3-year MACE occurred in 1.2% of the CLTD group compared with 1.4% of the HCTZ group (hazard ratio 0.91, p = 0.77). For secondary outcomes, cardiovascular mortality was 0.2% in both groups (p = 0.92). Myocardial infarction occurred in 0.3% of CLTD users and 0.4% of HCTZ users (p = 0.65). The incidence of hypokalemia was 19.2% in the CLTD group versus 16.7% in the HCTZ group (p = 0.07). In conclusion, in hypertensive patients, CLTD and HCTZ showed comparable cardiovascular outcomes and safety profiles.

We sought to investigate whether mild COVID-19 impairs cardiac baroreflex sensitivity (cBRS), using the modified Oxford protocol, in young healthy men and women 12–14 weeks after recovering from the infection. Participants were distributed into two groups: Non-COVID-19 group (NCG: men n = 6 [30 ± 3years; 26 ± 1 kg/m²] and women n = 5 [25 ± 1 years; 25 ± 1 kg/m²]) and recovered from COVID-19 group (RCG: men n = 6 [29 ± 3 years; 25 ± 1 kg/m²] and women n = 10 [32 ± 4 years; 22 ± 1 kg/m²]), the RCG tested positive (RT-PCR) 12 to 14 weeks before the protocol. Beat-to-beat finger blood pressure (BP) and heart rate (HR) were measured during a bolus of sodium nitroprusside (SNP) and phenylephrine (PHE), in a control condition and during cold pressor test (CPT) and moderate dynamic handgrip exercise (GRIP). Resting systolic BP was higher in the RCG (135 ± 14 mmHg vs. 122 ± 12 mmHg, p = 0.01). Both CPT and GRIP maneuvers increased HR and BP; the bolus of SNP diminished BP and evoked a reflex-mediated increase in HR; PHE increased BP, resulting in a reflex-mediated decrease in HR. Of note, cBRS for decrease or increase of BP did not differ between groups under the studied conditions: control (SNP, p = 0.39; PHE, p = 0.50); CPT (SNP, p = 0.09; PHE: p = 0.82); and GRIP (SNP, p = 0.35; PHE, p = 0.53). In conclusion, mild COVID-19 did not seem to impair cBRS in healthy young men and women 12–14 weeks after recovering from the infection.

A lower blood pressure threshold (≥130/80 mmHg) to define hypertension has been proposed in several hypertension guidelines. This study assessed the relationship between hyperuricemia and incident hypertension, examining serum uric acid (SUA) cut-offs using both traditional and new definitions in a large Taiwanese cohort. This observational cohort study enrolled 26 973 participants from the Taiwan Biobank (TWB), followed for a median of 4 years. Regarding traditional definition (140/90 mmHg), hyperuricemia (odds ratio [OR], 1.297), quartile 3 of SUA (OR, 1.211), quartile 4 of SUA (OR, 1.495), and high SUA (OR, 1.127) were significantly associated with incident hypertension in males, and hyperuricemia (OR, 1.198), quartile 4 of SUA (OR, 1.359), and high SUA (OR, 1.099) were significantly associated with incident hypertension in females. As for new definition (130/80 mmHg), hyperuricemia (OR, 1.376), quartile 3 of SUA (OR, 1.229), quartile 4 of SUA (OR, 1.554), and high SUA (OR, 1.139) were associated with incident hypertension in males, and hyperuricemia (OR, 1.249), quartile 3 of SUA (OR, 1.253), quartile 4 of SUA (OR, 1.429), and high SUA (OR, 1.096) were associated with incident hypertension in females. The interaction between hyperuricemia and sex on incident hypertension was significant for both traditional (140/90, p < 0.001) and new (130/80, p = 0.001) definitions. Hyperuricemia was significantly associated with incident hypertension under both traditional and new definitions. A significant interaction between hyperuricemia and sex was noted, although the differences were not so great.

This study aimed to investigate the correlation of the increased volume index of epicardial adipose tissue (EAT) and left ventricular hypertrophy (LVH) in patients with Hypertension (HTN). A total of 209 HTN patients and 50 healthy controls, who underwent cardiovascular magnetic resonance (CMR) at two medical centers in China between June 2015 and October 2024, were enrolled for this study. Postprocessing and imaging analysis were conducted and EAT measurements were performed. Restricted cubic splines (RCS) were used to explore the potential relationship with LVH. Binary logistic regression models and mediation analyses were employed to evaluate the association between EAT volume and CMR parameters as well as LVH. Hypertensive patients with LVH exhibited larger indexed EAT volumes, more pronounced diffuse fibrosis, and reduced left ventricular strain compared to hypertensive patients without LVH (all p < 0.001), with results remaining stable after adjusting for confounding factors. The variables that were significant in the univariate regression were included in the multivariate logistic regression model, indicating that indexed EAT volume (p = 0.001), extracellular volume (ECV) (p = 0.012), and global longitudinal strain (GLS) (p = 0.024) were independently associated with LVH. These associations remained stable after adjusting for confounding factors. Mediation analysis further revealed that the relationship between increased EAT volume and LVH was mediated by ECV, native T1, GLS, global circumferential strain (GCS), and global radial strain (GRS) (p < 0.05). These findings imply that EAT is independently linked to LVH in hypertensive patients. The association between EAT and LVH in hypertensive patients may be mediated by myocardial fibrosis or dysfunction.

The platelet-to-lymphocyte ratio (PLR) has been proposed as a promising inflammatory biomarker, with potential implications for cardiovascular prognosis. However, its association with mortality outcomes in hypertensive individuals is not fully elucidated. This investigation sought to clarify the linkage between PLR and both overall and cardiovascular mortality in hypertensive individuals. Data from 15 483 hypertensive adults in the NHANES (2005–2018) were analyzed. Mortality data, including all-cause and cardiovascular deaths, were sourced from the National Death Index (NDI) up to December 31, 2019. The linkage between PLR and mortality risk was depicted using restricted cubic spline (RCS) models. Cox proportional hazards regression models assessed the independent association of PLR with mortality risk, with adjustments incrementally applied: Model 1 without adjustments; Model 2 adjusted for age and sex; Model 3 adjusted further for age, gender, race, marital status, diabetes, alcohol intake, smoking status, body mass index (BMI), history of cardiovascular disease (CVD), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG), and creatinine (CR). Over a median follow-up of 79 months, there were 2820 all-cause deaths and 758 cardiovascular deaths. The multivariate Cox analysis showed that those in the highest PLR quartile had significantly elevated risks of all-cause mortality (Model 1: HR = 1.28, 95% CI 1.16–1.42, p < 0.001; Model 2: HR = 1.14, 95% CI 1.03–1.26, p = 0.014; Model 3: HR = 1.16, 95% CI 1.05–1.29, p = 0.004)and cardiovascular mortality (Model 1: HR = 1.59, 95% CI 1.30–1.94, p < 0.001; Model 2: HR = 1.38, 95% CI 1.13–1.68, p = 0.001; Model 3: HR = 1.47, 95% CI 1.20–1.80, p < 0.001). The study reveals a U-shaped relationship between PLR and all-cause mortality, alongside a linear association with cardiovascular mortality. A PLR threshold of 118.83 has been identified as indicative of an adverse prognosis for all-cause mortality. Elevated PLR independently predicts heightened risks of both all-cause and cardiovascular mortality among hypertensive patients.