Journal of Clinical Hypertension最新文献

Vascular compliance is an important predictor of cardiovascular disease and mortality. Pulse pressure index (PPI) is a reliable indicator for evaluating vascular compliance. However, the association between PPI, all-cause mortality (ACM), and cardiovascular mortality (CVM) in patients with hypertension is still unclear. In this study, we aimed to investigate the association of PPI with ACM and CVM in patients with hypertension. Kaplan–Meier survival curves, Cox proportional hazards regression models, restricted cubic splines, and subgroup and interaction analyses were used to investigate the association of PPI with ACM and CVM. U-shaped associations were observed between PPI and both ACM and CVM, and the inflection points for ACM and CVM were at PPI values of 0.327 and 0.363, respectively. Time-dependent receiver operating characteristic curves indicated that PPI showed good predictive value for both ACM and CVM occurrence at 1, 3, 5, and 10 years, and its predictive value was higher than PP for ACM and CVM at 5 and 10 years. These results showed that PPI can be used to identify patients with hypertension who are at a high risk of mortality and can guide more aggressive anti-hypertensive treatment strategies. Moreover, these findings demonstrate that PPI is a superior vascular compliance indicator than PP.

Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a severe complication of preeclampsia (PE), with a higher incidence rate in people living at high altitudes, such as Tibet area. Maternal HELLP syndrome is associated with an elevated neonatal mortality rate. The purpose of this study was to investigate the predicting factors for neonatal outcomes with maternal HELLP syndrome. We collected 49 PE with HELLP cases and stratified them into the Survival Group (n = 28) and Death Group (n = 21) based on the neonatal outcomes. We compared the basic characteristics and laboratory indicators using the Student's t-test or the Mann–Whitney U test, followed by univariate and multivariate logistic regression analysis to detect the independent predicting factors for neonatal outcomes. Subsequently, we performed the receiver operating characteristics (ROC) analysis to predict the prognostic power of the variables with a cutoff value. The results indicated that levels of neutrophil-to-lymphocyte ratio (NLR), serum creatinine (Scr), lactic dehydrogenase (LDH), and brain natriuretic peptide (BNP) were significantly elevated, while gestational age (GA) at delivery and alkaline phosphatase (AP) level was significantly decreased in the Death Group. The multivariate regression analysis indicated that only GA at delivery was able to predict the neonatal outcome. The cutoff value was 32.6 weeks on the ROC curve, with both 85.7% sensitivity and 85.7% specificity (AUC: 0.927, 95% CI: 0.856–0.998, p < 0.001). Thus, it was concluded that GA at delivery less than 32.6 weeks was an independent predictor of neonatal death for maternal HELLP syndrome.

Hypertensive disorders in pregnancy (HDPs) are a leading cause of poor maternal and birth outcomes worldwide. Prompt management of these disorders is usually recommended to optimize outcomes. Administration of pharmacotherapeutic agents is critical in the prevention and management of these disorders. The services of the pharmacist are required to maximize the benefits of drug therapy during prevention and management. There is a paucity of data on the effectiveness of pharmacist-led interventions in the management of these disorders in Ghana.

This study investigated the effect of a pharmacist-led intervention on knowledge, adherence to antihypertensive medication, and blood pressure (BP) control among pregnant women.

A quasi-experimental study was conducted. The study was carried out among pregnant women with moderate to high risk of developing HDPs and seeking antenatal care at a university hospital in Kumasi, Ghana. The pharmaceutical care model comprising health education, counseling, and medication administration reminders was provided fortnightly to study participants till delivery. Differences in pre- and post-intervention median scores were compared using the Wilcoxon signed-rank test.

The mean age was 35.7 years (± 1.2). The overall median knowledge and adherence scores increased significantly after the intervention by 11 versus 17 (p < 0.001) and 5 versus 9 (p < 0.001), respectively. Pharmaceutical intervention increased the proportion of mothers who were adherent by 68.9% (95% CI, 53.9–83.8%; p < 0.001). The commonest side effect of the two first-line antihypertensives (nifedipine and methyldopa) was headache. About 91% of the women delivered vaginally, and almost all (97.8%) of all deliveries were live births.

Pharmacist-led interventions had a positive impact on the knowledge of HDPs and adherence to antihypertensive medication in the study setting. Thus, incorporating pharmaceutical care into antenatal care would be worthwhile.

Preeclampsia (PE) is a pregnancy-specific disorder characterized by an unclearly understood pathogenesis and poses a great threat to maternal and fetal safety. Cuproptosis, a novel form of cellular death, has been implicated in the advancement of various diseases. However, the role of cuproptosis and immune-related genes in PE is unclear. The current study aims to elucidate the gene expression matrix and immune infiltration patterns of cuproptosis-related genes (CRGs) in the context of PE. The GSE98224 dataset was obtained from the Gene Expression Omnibus (GEO) database and utilized as the internal training set. Based on the GSE98224 dataset, we explored the differentially expressed cuproptosis related genes (DECRGs) and immunological composition. We identified 10 DECRGs conducted Gene Ontology (GO) function, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, and a protein–protein interaction (PPI) network. Furthermore, patients with PE were categorized into two distinct clusters, and an investigation was conducted to examine the status of immune cell infiltration. Additionally, the application of Weighted Gene Co-expression Network Analysis (WGCNA) was utilized to differentiate modules consisting of co-expressed genes and conduct clustering analysis. The intersecting genes were obtained by intersecting differently expressed genes in PE and PE clusters. The most precise forecasting model was chosen by evaluating the effectiveness of four machine learning models. The ResNet model was established to score the hub genes. The prediction accuracy was assessed by receiver operating characteristic (ROC) curves and an external dataset. We successfully identified five key DECREGs and two pathological clusters in PE, each with distinct immune profiles and biological characteristics. Subsequently, the RF model was deemed the most optimal model for the identification of PE with a large area under the curve (AUC = 0.733). The five genes that ranked highest in the RF machine learning model were considered to be predictor genes. The calibration curve demonstrated a high level of accuracy in aligning the predicted outcomes with the actual outcomes. We validate the ResNet model using the ROC curve with the area under the curve (AUC = 0.82). Cuproptosis and immune infiltration may play an important role in the pathogenesis of PE. The present study elucidated that GSTA4, KCNK5, APLNR, IKZF2, and CAP2 may be potential markers of cuproptosis-associated PE and are considered to play a significant role in the initiation and development of cuproptosis-induced PE.

Essential hypertension is one of the most common conditions managed in pediatric cardiology and can result in lasting deleterious effects on the cardiovascular system. Pediatric hypertension is so prevalent in the United States that it is often referred to as a public health challenge.

Social determinants of health (SDH) are the cultural, economic, educational, healthcare accessibility, and political influences in the environment in which an individual is born or lives, all of which can affect that individual's overall health. This study investigated the impact of social determinants such as rurality, food insecurity, transportation challenges, minority status, income, and race on cardiovascular outcomes in adolescent patients with essential hypertension.

This study utilizes multiple validated tools including those from the United States Census and the United States Department of Agriculture (USDA). Using these tools, the patients were scored on their social vulnerability based on home address. These scores were then compared with their echocardiographic data, focusing on measures of end-organ damage known to occur in the setting of hypertension, including but not limited to indexed left ventricular (LV) mass. LV mass is an independent risk factor for future adverse cardiovascular events.

In this study, more social vulnerability and low income were associated with a greater indexed LV mass (r = 0.18, p = 0.008). African American race was associated with a higher left atrial (LA) volume (p = 0.03). These findings substantiate that adolescents with essential hypertension are not only impacted by biological factors but also a combination of intersecting social constructs. The results of this study provide both a deeper understanding of the challenges these patients face and the opportunity to develop real-life interventions that can optimize clinical outcomes.

This first-in-man (FIM) study evaluated the feasibility and safety of a new peripheral plaque atherectomy system in patients with symptomatic lower extremity artery disease (LEAD). Ten patients with symptomatic LEAD (Rutherford class 2–5) were enrolled in a prospective, single-center study from March to April 2024. Patients aged 18–85 years with target lesions showing ≥70% stenosis and reference vessel diameters ≥1.8 mm underwent treatment using a novel atherectomy device with a “shaving” mechanism to excise calcified plaques. Outcomes included post-procedural stenosis improvement, 6-month primary patency rate, and safety endpoints such as thrombosis, vasospasm, acute occlusion, and distal embolization. Statistical analysis used SPSS 23.0. Ten male patients (mean age: 61.4 ± 9.2 years) were treated. Most had diabetes (80%), hypertension (70%), and hyperlipidemia (80%). Pre-procedural ankle-brachial index (ABI) averaged 0.50 ± 0.14. Angiographic analysis showed 60% of lesions in the femoral artery and 40% as chronic total occlusions. No major adverse events occurred, with 100% technical success. Post-procedural ABI improved to 0.92 ± 0.12 (p < 0.05). At 6 months, the primary patency rate was 100%, with no clinically-driven revascularization or adverse cardiovascular events. Mortality was 0%. All patients reported significant improvement in symptoms and walking distance, as well as enhanced quality of life and reduced pain during physical activity. The novel atherectomy device showed promising safety and efficacy for treating calcified LEAD. Larger-scale trials are needed to confirm these outcomes.

This study aimed to assess the correlation between estimated pulse wave velocity (ePWV) and mortality rates related to all-cause and cardiovascular disease (CVD) among individuals diagnosed with chronic kidney disease (CKD) in the United States.

A total of 4669 participants with CKD were identified from the National Health and Nutrition Examination Survey conducted between 1999 and 2018. We calculated the incidence of CKD using an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m². Our study examined the association between ePWV and mortality risk based on weighted Kaplan–Meier plots and multivariate Cox regression. Linear testing between ePWV and mortality from all causes and CVD was performed using restricted cubic splines and Cox regression. This study included 4669 patients with CKD from the NHANES, representing 37 million Americans with CKD. There was a mean age of 71.9 years, and 48.1% of participants were male. With every increase of 1 m/s in ePWV measurement, there is a corresponding 31% (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.28–1.34) increase in the rate of mortality from all causes and a 32% (HR: 1.32, 95% CI: 1.27–1.37) increase in the rate of mortality from CVD. A significantly higher rate of cardiovascular and all-cause mortality was observed in patients with CKD with elevated ePWV than in those with lower ePWV, as shown in the weighted Kaplan–Meier plots. Patients with CKD have a significant relationship between ePWV and all-cause and cardiovascular mortality.

Sex hormone-binding globulin (SHBG) regulates sex hormone availability and is influenced by metabolic factors. Variations in SHBG levels during pregnancy may affect the development of hypertensive disorders such as gestational hypertension (GH) and preeclampsia (PE). This systematic review and meta-analysis explores the potential of SHBG as a biomarker for predicting GH and PE. A search of PubMed, Embase, and Web of Science was conducted to identify studies evaluating the association between SHBG levels and the risk of HDP, including GH and PE. Inclusion criteria encompassed observational studies reporting quantitative risk estimates (risk ratios, odds ratios, or hazard ratios) for SHBG levels. Results were pooled using a random-effects meta-analysis in R software (V 4.4), with the I² statistic assessing heterogeneity. Eight studies were included in the systematic review from a total of 592 screened records. The association between SHBG levels and the risk of any HDP showed a pooled OR of 0.875 (95% CI: 0.772–0.993), for PE 0.890 (95% CI: 0.767–1.032), and for GH 0.729 (95% CI: 0.442–1.205), suggesting significant association between SHBG and HDP. Sensitivity analysis validated the robustness of the findings. This meta-analysis found potential significant association between higher SHBG levels and risk of HDP. Further high-quality research is required to better understand the role of SHBG in pregnancy-related hypertensive disorders. Future studies should consider larger sample sizes, more precise measurement techniques, and explore potential confounding factors to clarify the potential utility of SHBG as a biomarker for predicting GH and PE.

This study aimed to evaluate the visualization of right adrenal vein (RAV) in non-contrast-enhanced multi-detector computed tomography (MDCT) and its guiding role for right adrenal venous sampling (AVS) in patients with primary aldosteronism (PA). A total of 237 patients diagnosed with PA who underwent successful AVS procedures from January 2020 to March 2021 were retrospectively analyzed. The non-contrast-enhanced MDCT image features of RAV included the degree of visualization and the position of RAV orifice. Subsequently, the concordance degree between RAV in non-contrast-enhanced MDCT and AVS images was calculated to evaluate its guiding effect for right AVS. The visualization rate of RAV in non-contrast-enhanced MDCT was 81.9% (n = 194), with 73.7% (n = 143) clearly displayed and 26.3% (n = 51) generally displayed. In 6.2% (n = 12) of patients who can display RAV, RAV formed a common trunk with the accessory hepatic vein and then merged into the inferior vena cava. Non-contrast-enhanced MDCT revealed that RAV orifice was located between the 10th thoracic vertebra (T10) and the 1st lumbar vertebra (L1), with 85.1% (n = 165) located from the lower 1/3 of T11 to the lower 1/3 of T12. The concordance of imaging anatomy of RAV between non-contrast-enhanced MDCT and AVS image was found to be at a high rate of 94.3% (n = 183). Non-contrast-enhanced MDCT provides excellent visualization of RAV and clearly depicts its anatomical characteristics. Furthermore, RAV images obtained from non-contrast-enhanced MDCT are highly consistent with those from AVS, indicating that interpretation of non-contrast-enhanced MDCT before AVS can reduce the failure rate of RAV cannulation.

Self-efficacy is tightly intertwined with person-centered care and correlates with engaging in self-care behaviors, an important part of hypertension treatment. Evidence indicates that e-Health-based self-management interventions could increase self-efficacy. The objectives of this study were to investigate whether an intervention with a person-centered approach supported by e-Health technology can impact self-efficacy. Furthermore, to examine the impact of self-efficacy on hypertension management, and assess if self-efficacy can indicate which patients might see the greatest improvement on blood pressure from an e-Health-based self-management intervention for hypertension. This multicenter randomized controlled trial included 949 primary healthcare patients with hypertension. After exclusions, data was analyzed for 862 patients. The intervention group used an e-Health-based self-management system for 8 weeks. Self-efficacy was measured with the general self-efficacy (GSE) scale at inclusion, 8-week follow-up and 1-year follow-up. A significant increase in the mean GSE score in the intervention group was identified (p 0.042). No significant association between self-efficacy and blood pressure control was found. GSE scores did not significantly differ between the patients that had the best effect on blood pressure and those that had none. This study showed a significant increase in self-efficacy after the intervention. Self-management-based e-Health interventions might have a role in clinical practice to increase self-efficacy and improve general health. We found no association between self-efficacy and achieving a blood pressure below 140/90. Furthermore, no support was found to claim that self-efficacy would be an indicator of which patients might have the greatest effect from a self-management-based e-Health intervention for hypertension.