Journal of Clinical Hypertension最新文献

Our study aims to assess gender differences in blood pressure (BP) control among hypertensive patients in Jordan and identify factors influencing these differences. We conducted a cross-sectional study at Jordan University Hospital (JUH), collecting data from 601 hypertensive patients following up in JUH clinics. Patients were eligible if they were >18 years old, diagnosed with hypertension, taking anti-hypertensive medication for at least 6 months, and had no chronic kidney disease. BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg. Poor BP control was observed in 59.1% of females and 62.7% of males. Females demonstrated better BP control, even though they had lower incomes, lower education levels, and higher BMIs compared to males. Among females, good medication adherence (p = 0.042) was linked to improved control, while stress and a history of preeclampsia were negatively associated (p = 0.01 and p = 0.030, respectively). Among males, concurrent systemic medication use (p = 0.025) was a positive predictor of BP control, whereas smoking negatively impacted BP control (p = 0.019). Home BP monitoring was common but did not improve control in either gender. In conclusion, females showed better outcomes in BP management, largely due to treatment adherence. A history of preeclampsia and high stress was linked to poorer control in females. Both genders were aware of normal BP levels, but females were more preemptive in maintaining control. To improve hypertension care, we should consider these differences when treating patients.

Limited research has investigated the impact of antihypertensive medications on type 2 diabetes mellitus (T2DM) and whether gut microbiome (GM) mediates this association. Thus, we conducted a two-sample Mendelian randomization (MR) analysis to estimate the potential impact of various antihypertensive drug target genes on T2DM and its complications. Genetic instruments for the expression of antihypertensive drug target genes were identified with expression quantitative trait loci (eQTL) in blood, which should be associated with systolic blood pressure (SBP). Sensitivity analysis, including reverse causality detection, horizontal pleiotropy, phenotype scanning, and Bayesian colocalization, was used to validate our findings. We performed a two-step MR to detect the mediating role of GM. A 1-standard deviation (SD) decrease of KCNJ11 (acting on arteriolar smooth muscle, e.g., Pinacidil) gene expression was associated with lower SBP of 1.12 (95% confidence interval [CI], 0.93–1.31) mmHg, and a decreased risk of diabetic retinopathy (odds ratio [OR], 0.63; 95% CI, 0.52–0.76). Similarly, a 1-SD decrease of SLC12A2 (genetically a proxy for diuretics, for example, Torasemide) gene expression was correlated with a reduced risk of T2DM (OR, 0.88; 95% CI, 0.83–0.92). Interestingly, this causal effect was influenced by a decrease in the gut microbiota abundance of the genus Ruminococcus (effect proportion = 11.2%). Colocalization supports these results (KCNJ11: 98% for diabetic retinopathy; SLC12A2: 99% for T2DM). Findings provide novel targets for the treatment of T2DM and its complications, emphasize the importance of KCNJ11 and SLC12A2 in future drug development, and highlight the significant mediating role of the genus Ruminococcus.

Evidence suggests that approximately 63.0%–84.2% of stroke survivors have hypertension, yet there is currently no stroke prediction tool specifically designed for individuals with hypertension. Using data from 20 702 hypertensive patients from the China Stroke Primary Prevention Trial (CSPPT), we developed a 5-year stroke risk prediction model. This prospective study collected treated blood pressure every 3 months, resulting in 22 measurements over the study period. The model was internally validated using bootstrap resampling, and its predictive performance was assessed with the C-index and calibration curves. We also developed a random forest model to rank the variable importance. The 5-year stroke risk prediction model for hypertensive individuals includes 10 risk factors, ranked by importance as follows: average systolic blood pressure during treatment, age, average diastolic blood pressure during treatment, baseline systolic blood pressure, history of diabetes, baseline total cholesterol level, baseline folate level, self-reported stress, smoking, and folic acid supplementation or not. The C statistic of the equation was 0.74 and there were no significant differences by gender or treatment group. Calibration plots indicate good internal consistency between observed and predicted 5-year stroke risk. We also developed an online calculator to assist clinicians and patients (https://zhouziyi.shinyapps.io/CSPPT/). Our study indicates that for patients with hypertension, long-term posttreatment blood pressure is the primary predictor of stroke risk.

Trial Registration: The CSPPT (clinicaltrials.gov Identifier: NCT00794885).

In this study, we aimed to reveal the trends of self-measured blood pressure (SMBP) and SMBP-derived indices during pregnancy and the postpartum period. The Babies and Their Parents Longitudinal Observation in Suzuki Memorial Hospital in the Intrauterine Period (BOSHI) Study is a prospective cohort study in Japan. Participants were instructed to measure SMBP daily during pregnancy and for 1 month after delivery. Among 237 participants with normotensive blood pressure (BP) during pregnancy and the postpartum period who were analyzed using mixed-effects models for repeated measures, the SMBP was measured, on average, 14.3 times from the day before delivery to 28 days postpartum. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the day before delivery were 110.6 ± 1.0 and 68.1 ± 0.8 mmHg (estimate ± standard error). Postpartum BP increased from postpartum Days 3–8 in SBP and from Days 3–22 in DBP, compared to that on the day before delivery. The SBP and DBP were 4.9 and 4.7 mmHg higher on postpartum Days 8 and 7 than the day before pregnancy, respectively. During pregnancy, the pulse rate (PR) showed an inverted U-shaped trend and then sharply increased rapidly until the first postpartum day after delivery. The Shock Index showed a similar trend to that of the PR, decreased from labor until postpartum Day 8, and plateaued thereafter. The double product peaked during labor, remained higher than the prelabor levels for approximately 10 days, and then decreased in the postpartum period.

Early neurological deterioration (END) following endovascular treatment (EVT) in acute ischemic stroke (AIS) patients is associated with poor long-term outcomes. Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24 h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24 h post-EVT. Unexplained END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score 24 h after EVT without any identifiable cause. Two distinct SBP trajectories—high and low—were identified within 24 h post-EVT. The high-trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR] = 3.28, p < 0.01). SBPV alone was an independent risk factor for unexplained END (OR = 1.11, p < 0.05). Moreover, patients with both higher mean SBP and increased SBPV had a markedly greater risk of unexplained END (OR = 13.79, p < 0.05). Notably, the harmful threshold for SBPV was lower during nighttime compared to daytime. These findings suggest that increased SBPV, particularly when combined with elevated mean SBP, significantly heightens the risk of unexplained END post-EVT. Therefore, comprehensive post-EVT blood pressure management should address both absolute BP levels and BPV, with particular emphasis on nighttime monitoring, to optimize early neurological recovery.

Resistant hypertension (RH) may cause severe target organ damage and poses significant challenges in the field of hypertension prevention and treatment. Mining biological characteristics is crucial for exploring the pathogenesis of RH and for early diagnosis and treatment. Although several single-omics studies have been conducted on RH, its complex pathogenesis has only been partially elucidated. In this study, metabolomics, proteomics, and transcriptomics were jointly analyzed in healthy subjects and patients with hypertension and RH. The multi-omics analysis found that differential substances of RH were enriched in the HIF-1 signaling pathway and that differential substances such as ascorbic acid, reduced glutathione (GSH), choline, citric acid, transferrin receptor (TfR), Egl-9 family hypoxia-inducible factor 2 (EGLN2), and glutathione peroxidase 1 (GPX1) were screened out. The results of intergroup comparisons were as follows: RH versus N: ascorbic acid (Fold Change (FC):0.42, p < 0.01), GSH (FC:0.65, p < 0.05), choline (FC:1.32, p < 0.05), citric acid (FC:0.48, p < 0.001), TfR (FC2.32, p < 0.001), GPX1 (FC:16.02, p < 0.001), EGLN2 (FC:0.76, p < 0.001); RH versus EH: ascorbic acid (FC:0.52, p < 0.05), GSH (FC:0.55, p < 0.05), choline (FC:1.28, p < 0.05), citric acid (FC:0.59, p < 0.001), TfR (FC:1.71, p < 0.001), GPX1 (FC:2.11, p < 0.05), EGLN2 (FC:0.76, p < 0.05). These differential substances may reflect the biology of RH. This study provides multi-omics analysis for a deeper understanding of the complex molecular characteristics of RH, providing new insights into the pathogenesis, early diagnosis, and precise treatment of the disease.

Food security is one of the most researched social determinants of health (SDoH), however, there is a lack of literature on the impact of food security on cardiovascular disease in pregnancy. The primary objective was to examine the association between food security with hypertensive disorders of pregnancy. We performed a cross-sectional analysis of 2019–2022 data from the National Health Interview Survey. The study population included women of childbearing age who were either pregnant or recently pregnant. Logistic regression models were developed to examine the association between food security and hypertensive disorders of pregnancy. Of the 1635 women included in the analysis, the rate of hypertensive disorders  of pregnancy was 11.1% and the rate of low and very low food security was 5.3% and 4.0%, respectively. The prevalence was 5.8% for hyperlipemia, 0.3% for cardiovascular disease, and 10.5% for diabetes mellitus. The odds of hypertensive disorders of pregnancy were statistically significantly increased among women with low food security compared to women with high food security (odds ratio [OR] 2.40, 95% confidence interval [CI]: 1.19–4.81) after adjusting for age, race, ethnicity, insurance status, body mass index, hyperlipidemia, diabetes mellitus, and cardiovascular disease. Further studies are needed to elucidate the causes of hypertensive disorders of pregnancy and interventions to address including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and food pantries, as it may be more feasible to address issues of food security among pregnant women.

The relationship between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and kidney function in patients with primary aldosteronism (PA) is unclear. Therefore, this research explored the link between the UHR and kidney function in PAs. This research was conducted at the 2nd Affiliated Hospital of Nanchang University and involved PA individuals hospitalized between October 2017 and April 2022. A total of 653 eligible participants were included in the analysis for this research. The kidney function was assessed by the estimated glomerular filtration rate (eGFR), which is calculated using the modification of diet in renal disease (MDRD) equation. Chronic kidney disease (CKD) was defined as an eGFR <60 mL/min per 1.73 m² or the ratio of urine microalbumin to creatinine (UACR) ≥30 mg/g. The study used multivariable-adjusted linear regression analyses to investigate the association between log-transformed UHR levels and, eGFR and CKD. After multivariable adjustments, the results indicated an inverse association between Lg-UHR and eGFR (per SD increment; β: −9.02; 95% CI: −11.59, −6.46). Compared to PA patients with the lowest level of Lg-UHR (T1), patients with the highest level of Lg-UHR (T3) had a lower eGFR (β: −20.14, 95% CI: −26.25, −14.04). Conversely, Lg-UHR and CKD showed a positive association cross-sectionally (per SD increment; OR: 1.67; 95% CI: 1.26, 2.23). Compared to PA patients in T1 level, patients in T3 level had a higher prevalence of CKD (OR: 2.52, 95% CI: 1.26, 5.05). In patients with PA, UHR is inversely associated with eGFR and positively associated with CKD.

Hypertension is a prevalent health issue in Bangladesh, impacting a significant portion of the population. This meta-analysis explored how social status inequalities impact hypertension risk in Bangladesh. We systematically searched various electronic databases and rigorously selected 12 studies for inclusion in the analyses. The I² statistic measured between study heterogeneity, and pooled effect estimates were obtained using the DerSimonian and Laird random effects model to address this variability. Publication bias was assessed through a funnel plot and Egger's test. Sensitivity analysis was conducted to evaluate the robustness of the findings. All analyses were performed using STATA 17. The analyses indicated that females had a significantly higher risk of developing hypertension compared to males, with a pooled odds ratio (OR) of 1.15 (95% confidence interval [CI]: 1.02–1.27). Urban residents showed a pooled OR of 1.11 (95% CI: 1.03–1.19) compared to rural residents. The pooled ORs for hypertension were 1.02 (95% CI: 0.89–1.14) for primary education, 1.07 (95% CI: 0.94–1.21) for secondary education, and 1.25 (95% CI: 1.03–1.47) for higher secondary education, suggesting an increasing risk with higher education levels. Wealth status showed a pooled OR of 1.08 (95% CI: 0.87–1.29) for the poorer class, 1.13 (95% CI: 1.04–1.22) for the middle class, 1.38 (95% CI: 0.68–2.07) for the richer class, and 1.49 (95% CI: 0.97–2.00) for the richest class, indicating a greater risk of hypertension among wealthier individuals. Working individuals had a 39% lower risk of hypertension (OR = 0.61, 95% CI: 0.43–0.80) compared to nonworking individuals.

Hypertension is a multifactorial condition influenced by both genetic and environmental factors. Protein disulfide isomerase family A member 3 (PDIA3) is a key endoplasmic reticulum protein which may contribute to increased blood pressure. However, the relationship between PDIA3 polymorphisms and hypertension remain unclear. This study aims to explore the relationship between PDIA3 polymorphisms and hypertension. First, Mendelian randomization (MR) analyses were performed to assess the causal link between PDIA3 and hypertension. Second, key gene polymorphism on PDIA3 was identified using online databases and analyzed with Haploview software. Third, multivariate-adjusted logistic regression analyses were employed to evaluate the associations between PDIA3 rs2788 and hypertension. Finally, stratified analyses were conducted to further assess interactions between PDIA3 rs2788 and antihypertensive medications. MR analyses indicated a causal relationship between PDIA3 and hypertension. The rs2788 gene polymorphism locus on PDIA3 was identified using online databases and Haploview software. Multivariable-adjusted logistic regression analyses revealed that PDIA3 rs2788 was an independent risk for hypertension (OR: 4.603, 95% CI: 2.946–7.194; p < 0.001). Significant interactions were identified between PDIA3 and antihypertensive medications, particularly ACEI/ARB treatments (p = 0.013 for interaction). Similar findings were observed regarding the causal relationship between antihypertensive treatments and hypertension. PDIA3, particularly its rs2788 polymorphisms, may represent a novel biomarker for hypertension. These findings may contribute to the development of targeted screening strategies and personalized treatment approaches for hypertension management.