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A Retrospective Study to Investigate the Relationship Between Body Mass Index and Hemodynamic Characteristics in Hypertensive Patients 高血压患者体重指数与血流动力学关系的回顾性研究。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-10 DOI: 10.1111/jch.14946
Wenqi Xiao, Ping Han, Liping Song, Jingwen Yang, Lin Zhou, Xiangning Deng, Zheng J. Ma, Yukun Lang, Hai Zhao, Yuzhuo Zhao, Hui Chen, Wenjing Zhang, Huixian Huang, Ningling Sun

The relationship between hemodynamic parameters and body mass index (BMI) in the context of blood pressure regulation in hypertension is unclear. Here, we analyzed data from 1368 uncontrolled hypertensive patients, including key hemodynamic indicators such as heart rate (HR), cardiac index (CI), arterial stiffness (AS), systemic vascular resistance index (SVRI), and thoracic blood ratio (TBR). In this cohort, the average BMI across all hypertension patients was 26.859 ± 3.897 (kg/m2), with obese patients (BMI ≥ 28 kg/m2) averaging 31.01 ± 2.87 kg/m2 and non-obese (BMI<28 kg/m2) averaging 24.70 ± 2.28 kg/m2. Younger obese patients exhibited higher diastolic pressures than non-obese peers (p < 0.01). Hemodynamic analysis showed obese patients had increased HR and SVRI but lower CI and AS (p < 0.01). Hypertensive males aged under 60 with obesity displayed a more prominent peripheral vascular phenotype (p < 0.05) and volemic phenotype (p < 0.01) than non-obese males. Obese females aged under 60 showed a higher incidence of cardiac phenotype (p < 0.01). Across genders, obese hypertensive patients aged over 60 had a greater prevalence of volemic phenotype than non-obese patients (p < 0.05, p < 0.01, respectively). BMI inversely correlated with CI and positively with SVRI across age and gender categories (p < 0.01). Taken together, we find that patients with hypertension exhibit diverse hemodynamic profiles, and BMI significantly correlates with hemodynamic parameters such as SVRI and CI. Our research identifies BMI as a valuable target for personalized hypertension treatment.

在高血压血压调节的背景下,血液动力学参数和体重指数(BMI)之间的关系尚不清楚。在这里,我们分析了1368例未控制的高血压患者的数据,包括心率(HR)、心脏指数(CI)、动脉硬度(as)、全身血管阻力指数(SVRI)和胸血比(TBR)等关键血液动力学指标。在该队列中,所有高血压患者的平均BMI为26.859±3.897 (kg/m2),其中肥胖患者(BMI≥28 kg/m2)平均为31.01±2.87 kg/m2,非肥胖患者(BMI2)平均为24.70±2.28 kg/m2。年轻肥胖患者的舒张压高于非肥胖患者(p
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引用次数: 0
Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta-Analysis of Randomized Clinical Trials 与常规治疗相比,高血压标准化治疗方案的有效性和安全性:一项随机临床试验的荟萃分析
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-10 DOI: 10.1111/jch.14950
Gautam Satheesh, Rupasvi Dhurjati, Vivekanand Jha, Aletta E. Schutte, Bolanle Banigbe, Dorairaj Prabhakaran, Andrew E. Moran, Abdul Salam

Large gaps persist in the diagnosis, awareness, treatment, and control of hypertension globally. Standardized treatment protocols (STPs) have been widely proposed to guide hypertension treatment, particularly in primary healthcare settings. However, there has been no review that quantifies the effects of hypertension STPs on blood pressure (BP) reduction and control. We conducted a systematic review of randomized clinical trials (RCTs) among adults with hypertension, comparing hypertension STPs (intervention) with usual care (comparator) for effects on BP. Relevant RCTs were identified by searching multiple electronic databases. Random-effects meta-analyses were conducted to evaluate between-group differences in systolic BP reduction (primary outcome), diastolic BP reduction, BP control, and adverse events (AEs). Sixteen RCTs involving 59,945 participants (baseline mean BP: 149/91 mmHg) were included. Reductions in systolic and diastolic BP with STPs compared to usual care were 6.7 (95% CI 3.7–9.8) mmHg and 2.6 (1.2–4.1) mmHg, respectively (p < 0.001 for both). BP control achieved was 57% in the STP group compared to 24% in the usual care group (p < 0.001). The overall incidence of any AEs was 14.5% versus 13.5% (RR 1.27 [0.88–1.82]) with STPs and usual care, respectively. In summary, interventions involving hypertension STPs significantly reduce systolic and diastolic BP and improve BP control compared to usual care. STPs can, therefore, be an efficient strategy to implement evidence-based treatments and upscale treatment coverage, given the large untreated and uncontrolled hypertension burdens globally.

全球在高血压的诊断、认识、治疗和控制方面仍存在巨大差距。标准化治疗方案(stp)已被广泛提出,以指导高血压治疗,特别是在初级卫生保健机构。然而,尚无文献综述量化高血压stp对血压降低和控制的影响。我们对成人高血压患者的随机临床试验(rct)进行了系统回顾,比较高血压stp(干预)和常规护理(比较)对血压的影响。通过检索多个电子数据库确定相关rct。随机效应荟萃分析评估组间收缩压降低(主要结局)、舒张压降低、血压控制和不良事件(ae)的差异。纳入16项随机对照试验,涉及59,945名参与者(基线平均血压:149/91 mmHg)。与常规治疗相比,STPs组的收缩压和舒张压分别降低6.7 (95% CI 3.7-9.8) mmHg和2.6 (1.2-4.1)mmHg
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引用次数: 0
Association of Visceral Adipose Tissue With Hypertension: Results From the NHANES 2011–2018 and Mendelian Randomization Analyses 内脏脂肪组织与高血压的关联:来自NHANES 2011-2018和孟德尔随机化分析的结果
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-10 DOI: 10.1111/jch.14953
Jia Liao, Miaohan Qiu, Jing Li, Yi Li, Yaling Han

The causal relationship between visceral adipose tissue (VAT) and hypertension remains unclear. We aimed to examine the potential association between them using observational and two-sample Mendelian randomization (MR) analyses. Data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 were used, applying multivariable logistic regression analysis to investigate the association between VAT mass and hypertension risk. Independent genetic variants related to VAT mass were derived from genome-wide association studies (GWAS) in 325 153 UK Biobank participants. The primary analysis employed the random-effects inverse-variance weighted (IVW) method, with MR-Egger, weighted median, simple mode, and weighted mode as sensitivity analyses. A total of 7661 participants were included. After adjusting for confounding factors, increased VAT mass was associated with a higher risk of hypertension (quartile 4 vs. quartile 1: OR:1.85, 95% confidence intervals [CI]: 1.31–2.63). Furthermore, VAT mass exhibited greater accuracy than body mass index (BMI) in predicting hypertension (areas under the curve [AUC]: 0.701 vs. 0.676, p for comparison < 0.001). The MR analyses demonstrated a causal relationship between increased VAT mass and the risk of hypertension in primary analyses (odds ratio [OR]:1.768, 95% CI: 1.594–1.861). Consistent findings across various MR models substantiate the robustness and strength of this causal relationship. These analyses provide additional support for both the positive association and causal relationship between elevated VAT and the risk of developing hypertension, suggesting that targeted interventions for VAT may be beneficial in preventing hypertension.

内脏脂肪组织(VAT)与高血压之间的因果关系尚不清楚。我们的目的是通过观察性和双样本孟德尔随机化(MR)分析来检验两者之间的潜在关联。采用2011-2018年国家健康与营养检查调查(NHANES)数据,应用多变量logistic回归分析VAT质量与高血压风险之间的关系。与VAT质量相关的独立遗传变异来自325153名英国生物银行参与者的全基因组关联研究(GWAS)。初步分析采用随机效应反方差加权(IVW)方法,采用MR-Egger、加权中位数、简单模态和加权模态进行敏感性分析。共纳入7661名参与者。在调整了混杂因素后,VAT质量增加与高血压的高风险相关(四分位数4 vs四分位数1:OR:1.85, 95%可信区间[CI]: 1.31-2.63)。此外,VAT质量比身体质量指数(BMI)在预测高血压方面表现出更高的准确性(曲线下面积[AUC]: 0.701 vs. 0.676, p < 0.001)。MR分析显示,在初始分析中,VAT质量增加与高血压风险之间存在因果关系(优势比[OR]:1.768, 95% CI: 1.594-1.861)。各种MR模型的一致发现证实了这种因果关系的稳健性和强度。这些分析为VAT升高与高血压风险之间的正相关和因果关系提供了额外的支持,表明针对VAT的有针对性干预可能有助于预防高血压。
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引用次数: 0
Elevated Serum Extracellular Vesicle-Packaged SPARC in Hypertension: A Cross-Sectional Study in a Middle-Aged and Elderly Population 高血压患者血清细胞外囊泡包装SPARC升高:一项中老年人群的横断面研究
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-04 DOI: 10.1111/jch.14954
Xueying Chen, Han Guo, Xinwei Li, Yang Liu, Xinxin Li, Zhengshuo Cui, Huijuan Ma, Jianxun He, Zhechun Zeng, Huina Zhang

Elevated blood pressure has previously been associated with increased levels of circulating extracellular vesicles (EVs). However, studies on the relevance of EV cargos to hypertension are limited. Secreted protein acidic and rich in cysteine (SPARC) is involved in many metabolic diseases and endothelial dysfunction pathological processes. This study aimed to explore the association of serum EV-derived SPARC with hypertension incidence. We conducted a cross-sectional study on 125 Chinese, including 76 hypertension patients and 49 normotensive patients. Serum EVs were prepared via ultracentrifugation. The concentrations of serum EV-derived SPARC and serum SPARC were measured by Luminex Assay. The correlations between serum EV-derived SPARC and clinical variables were analyzed. Multivariate logistic regression analysis determined the association of serum EV-derived SPARC levels with hypertension. Interaction subgroup analysis was used to evaluate the interaction of the relevant baselines on the association between serum EV-derived SPARC levels and hypertension. Our findings revealed that the levels of SPARC derived from serum EVs were markedly elevated in individuals with hypertension, averaging 20.60 ng/mL (p < 0.01), when contrasted with the levels observed in normotensive subjects, which were 14.25 ng/mL (p < 0.01) in average. Multivariate logistic regression analysis revealed that serum EV-derived SPARC levels were positively associated with hypertension (odds ratio [OR] 1.095; 95% confidence interval [CI] = 1.031–1.163; p value, 0.003), after adjusting for confounding factors. Interaction subgroup analysis demonstrated that no significant interaction with hypertension was observed for any particular covariate. The present study reveals that the elevated levels of serum EV-derived SPARC were independently associated with hypertension.

血压升高与循环细胞外囊泡(EVs)水平升高有关。然而,关于EV货物与高血压相关性的研究有限。酸性和富含半胱氨酸的分泌蛋白(SPARC)参与了许多代谢疾病和内皮功能障碍的病理过程。本研究旨在探讨血清ev源性SPARC与高血压发病率的关系。我们对125名中国人进行了横断面研究,包括76名高血压患者和49名正常患者。采用超离心法制备血清EVs。采用Luminex法测定血清ev源性SPARC和血清SPARC浓度。分析血清ev源性SPARC与临床变量的相关性。多因素logistic回归分析确定了血清ev衍生的SPARC水平与高血压的关系。相互作用亚组分析用于评价血清ev源性SPARC水平与高血压相关性相关基线的相互作用。我们的研究结果显示,高血压患者血清EVs中SPARC的水平显著升高,平均为20.60 ng/mL (p < 0.01),而正常血压者的平均水平为14.25 ng/mL (p < 0.01)。多因素logistic回归分析显示,血清ev来源的SPARC水平与高血压呈正相关(优势比[OR] 1.095;95%置信区间[CI] = 1.031-1.163;P值,0.003),校正混杂因素后。相互作用亚组分析表明,没有观察到任何特定协变量与高血压的显著相互作用。目前的研究表明,血清中ev衍生的SPARC水平升高与高血压独立相关。
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引用次数: 0
Efficacy and Safety of Sacubitril/Valsartan Versus Amlodipine in Japanese Patients With Essential Hypertension: A Randomized, Multicenter, Open-Label, Noninferiority Study (PARASOL Study) Sacubitril/缬沙坦与氨氯地平在日本原发性高血压患者中的疗效和安全性:一项随机、多中心、开放标签、非劣效性研究(PARASOL研究)。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-04 DOI: 10.1111/jch.14938
Koichi Yamamoto, Daisuke Yarimizu, Ayano Shimanishi, Shunsuke Eguchi, Kazuma Iekushi, Yoichi Takami, Yoichi Nozato, Kazuomi Kario, Hiromi Rakugi

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has demonstrated a superior blood pressure-lowering effect compared with renin-angiotensin system inhibitors in several clinical trials. However, there has been no available evidence on the comparison between sacubitril/valsartan and calcium channel blockers (CCBs), a well-established class of antihypertensive drugs.

In this open-label, multicenter study, we aimed to demonstrate the efficacy and safety of sacubitril/valsartan versus amlodipine, one of the most widely used CCBs, after 8 weeks of treatment. A total of 359 Japanese patients with essential hypertension (office systolic blood pressure [SBP] ≥ 150 to < 180 mmHg), aged 18–79, were randomly assigned to receive either once-daily sacubitril/valsartan 200 mg or once-daily amlodipine 5 mg in a 1:1 allocation ratio. The primary endpoint was the noninferiority of sacubitril/valsartan compared with amlodipine in mean change in 24-h SBP from baseline to Week 8, followed by a significance test as a secondary endpoint analysis. The mean change in 24-h SBP in sacubitril/valsartan was noninferior to that in amlodipine (between-treatment difference −0.62 mmHg [95% confidential interval: −3.23 to 1.98; p = 0.003 for noninferiority; independent t-test with noninferiority margin 3.0 mmHg]), with no significant difference observed (p = 0.637). There was no significant difference in the incidence of adverse events (AEs). These results suggested that the blood pressure-lowering effect of sacubitril/valsartan is comparable to that of amlodipine, with no marked differences in tolerability between the two groups. Sacubitril/valsartan, a potent antihypertensive drug comparable to amlodipine, is expected to improve blood pressure control in clinical practice.

Sacubitril/缬沙坦是一种血管紧张素受体-neprilysin抑制剂,在几项临床试验中,与肾素-血管紧张素系统抑制剂相比,已显示出优越的降血压效果。然而,目前尚无证据表明苏比里尔/缬沙坦与钙通道阻滞剂(CCBs)(一种公认的降压药)之间的比较。在这项开放标签、多中心的研究中,我们的目的是在8周的治疗后,证明苏比里尔/缬沙坦与氨氯地平(最广泛使用的CCBs之一)的有效性和安全性。共有359例日本原发性高血压患者(办公室收缩压[SBP]≥150 ~
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引用次数: 0
Impact of Mediterranean Diet Adherence on the Incidence of New-Onset Hypertension in Adults With Obesity in Korea: A Nationwide Cohort Study 坚持地中海饮食对韩国肥胖成人新发高血压发病率的影响:全国队列研究》。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-11-27 DOI: 10.1111/jch.14951
Jung-Hwan Kim, Ji-Won Lee, Yaeji Lee, Chung-Mo Nam, Yu-Jin Kwon

This study investigated the association between adherence to the Mediterranean diet (MD) and new-onset hypertension (HTN) in a cohort of community-dwelling, middle-aged, older Korean individuals with obesity. We used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort study. The Korean version of the MD Adherence Screener was used to evaluate compliance with the MD. The primary endpoint was the incidence of new-onset HTN. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval for HTN incidence with increasing MD adherence. Data from 1995 participants with obesity without HTN at baseline were analyzed. After adjusting for confounders, participants with moderate (Group 2) and high adherence (Group 3) to the MD had HRs for new-onset HTN of 0.72 (0.57–0.90) and 0.73 (0.56–0.95), respectively, compared with those with low adherence (Group 1). Sex and age differences were associated with MD adherence and HTN incidence. The association between MD adherence and HTN incidence was only significant in males and in participants aged 40–64 years. There was no significant association between MD adherence and new-onset HTN in females or those aged ≥ 65 years. In conclusion, this study found a significant association between adherence to the MD and a reduction in new-onset HTN in Korean adults with obesity. Considering its value and sustainability, the adoption of the MD may contribute to the prevention of new-onset HTN in populations with obesity.

本研究调查了在社区居住的韩国中老年肥胖人群中坚持地中海饮食(Mediterranean diet,MD)与新发高血压(HTN)之间的关系。我们使用了韩国基因组与流行病学研究(Korean Genome and Epidemiology Study)的数据,这是一项基于人群的前瞻性队列研究。我们使用了韩国版的MD依从性筛选器来评估MD的依从性。主要终点是新发高血压的发生率。研究采用 Cox 比例危险模型估算了随着 MD 依从性的增加,高血压发生率的危险比(HR)和 95% 的置信区间。对 1995 名基线时无高血压的肥胖参与者的数据进行了分析。在对混杂因素进行调整后,与低依从性参与者(第1组)相比,中度依从性(第2组)和高度依从性(第3组)参与者新发高血压的HR分别为0.72(0.57-0.90)和0.73(0.56-0.95)。性别和年龄差异与坚持使用 MD 和高血压发生率有关。只有男性和年龄在 40-64 岁之间的参与者才会出现坚持服用 MD 与高血压发生率之间的显著相关性。在女性和年龄≥ 65 岁的人群中,坚持使用 MD 与新发高血压之间没有明显的关联。总之,本研究发现,在韩国肥胖成人中,坚持MD与减少新发高血压之间存在明显联系。考虑到 MD 的价值和可持续性,采用 MD 可能有助于预防肥胖人群中新发高血压。
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引用次数: 0
Renal Denervation: New Evidence Supporting Long-Term Efficacy, Alternative Access Routes, and Cost-Effectiveness 肾脏去神经支配:支持长期疗效、替代入路和成本效益的新证据。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-11-25 DOI: 10.1111/jch.14945
Tzung-Dau Wang
<p>The treatment landscape for uncontrolled and resistant hypertension continues to evolve, with renal denervation (RDN) emerging as an increasingly validated third pillar of therapeutic options, in addition to lifestyle modification and pharmacological therapy [<span>1, 2</span>]. Three recent studies published in this issue provide important new insights into the long-term efficacy, procedural innovations, and economic value of RDN, while highlighting areas requiring further investigation.</p><p>Brouwers et al. provide valuable 10-year follow-up data on RDN in real-world practice, demonstrating sustained blood pressure reductions and favorable safety outcomes [<span>3</span>]. Their findings show significant reductions in both office (approximately 20 mm Hg) and ambulatory (approximately 15 mm Hg) systolic blood pressure measurements maintained up to 10 years post-procedure, without significant changes in antihypertensive medication numbers. The study highlights an important evolution in RDN technology—the transition from first to second-generation devices. The authors found that controlled blood pressure at 1 year was more frequently achieved with the second-generation device (78% vs. 13%), associated with more ablation spots, including branch renal artery ablation [<span>3</span>]. This finding lends evidence that technological improvements and more comprehensive denervation approaches may enhance therapeutic success.</p><p>Zuo et al. introduce an important procedural innovation by demonstrating the feasibility and comparable efficacy of upper extremity access (UEA)—either transradial or transbrachial—compared to traditional transfemoral access (TFA) for RDN [<span>4</span>]. This alternative approach addresses TFA's limitation in accessing renal arteries in patients with unfavorable vascular anatomy. About 30% of patients had vascular morphology better suited to UEA, highlighting this technical advance's clinical relevance.</p><p>Kario et al. provide the first comprehensive cost-effectiveness analysis of RDN in an Asian healthcare setting [<span>5</span>]. Their finding that RDN is cost-effective in the Japanese healthcare system, with an incremental cost-effectiveness ratio well below the willingness-to-pay threshold, adds important economic validation to the growing clinical evidence.</p><p>Each study reveals important limitations that should inform future research. The long-term follow-up data's relatively small sample size and single-center experience may limit broader generalizability. Selection bias may explain why patients treated with second-generation devices showed better early hypertension control, yet systolic blood pressure reductions at 5–10 years (from first-generation devices) were similar to those at 2–4 years (from both generations) [<span>3</span>].</p><p>Although Zuo's investigation of alternative access routes represents an important technical advance, the retrospective design and non-randomized allocation introduce pote
不受控制和顽固性高血压的治疗前景不断发展,除生活方式改变和药物治疗外,肾去神经支配(RDN)逐渐成为治疗选择的第三支柱[1,2]。最近发表在本期杂志上的三项研究为RDN的长期疗效、程序创新和经济价值提供了重要的新见解,同时强调了需要进一步研究的领域。browwers等人在现实世界实践中提供了有价值的RDN 10年随访数据,显示持续的血压降低和良好的安全性结果[10]。他们的研究结果显示,手术后10年,办公室(约20毫米汞柱)和门诊(约15毫米汞柱)收缩压测量值均有显著降低,抗高血压药物数量无显著变化。该研究强调了RDN技术的一个重要演变——从第一代设备到第二代设备的过渡。作者发现,使用第二代装置1年时血压得到控制的频率更高(78%对13%),消融点更多,包括肾动脉分支消融[3]。这一发现为技术进步和更全面的去神经方法可能提高治疗成功率提供了证据。Zuo等人介绍了一项重要的程序创新,证明了与传统的经股入路(TFA)相比,上肢入路(UEA) -无论是经桡动脉还是经肱动脉-的可行性和相当的疗效。这种替代方法解决了TFA在血管解剖不良患者进入肾动脉时的局限性。大约30%的患者血管形态更适合UEA,突出了这项技术进步的临床意义。Kario等人首次在亚洲医疗环境中对RDN进行了全面的成本效益分析[10]。他们发现,RDN在日本医疗保健系统中具有成本效益,其增量成本效益比远低于支付意愿阈值,这为日益增长的临床证据增加了重要的经济验证。每项研究都揭示了重要的局限性,应该为未来的研究提供信息。长期随访数据相对较小的样本量和单中心经验可能限制更广泛的推广。选择偏倚可以解释为什么使用第二代设备治疗的患者表现出更好的早期高血压控制,但5-10年(从第一代设备开始)的收缩压降低与2-4年(从两代设备开始)相似。尽管左对可选通道的调查代表了一项重要的技术进步,但回顾性设计和非随机分配引入了潜在的选择偏差。6F肾双曲线导尿管[6],兼容第二代装置,可经TFA进入急性下起飞角肾动脉。根据我们的经验,98%以上的病例可以通过TFA成功进行RDN。成本效益分析做出了重大贡献,但依赖于基于模型的预测和关于长期耐久性的假设,随着数据的不断增加,凸显了持续进行经济评估的必要性。几个关键领域需要进一步调查。考虑到随机试验中降压反应率为65%-90%[8-10],患者选择仍然具有挑战性,没有可靠的成功预测指标[11]。血管解剖对手术计划和基线特征对结果的影响需要更好的描述。程序优化代表了另一个关键领域。目前的消融方案差异很大,关于最佳消融点的问题仍然存在。去神经支配有效性的实时评估正在研究中,尽管仍然难以捉摸,成像在手术指导中的作用需要进一步定义。设备技术在不断发展,但针对不同访问路径和传感/刺激功能集成的专用设备可以进一步提高程序成功率。RDN对心血管终点的影响需要更好的表征,特别是在特定人群中。夜间血压控制已成为RDN治疗的一个有趣方面,需要更好地了解机制和优化结果措施。医疗保健系统集成提出了实际挑战,需要关注不同设置的实施策略、培训要求、质量指标和资源利用优化[b]。这些研究为了解RDN在治疗未控制和顽固性高血压中的作用做出了重要贡献[3-5]。 持续疗效、程序创新和经济价值的证明加强了RDN作为一种治疗选择的地位。然而,关于患者选择、程序优化和长期结果的问题仍然存在。通过重点研究解决这些需求(表1)对于优化这种有前景的疗法至关重要。
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引用次数: 0
Rationale and Design of a Randomized, Open-Label, Parallel-Group Study of Esaxerenone Versus Angiotensin Receptor Blockers in Older Patients With Uncontrolled Hypertension on Calcium Channel Blocker Monotherapy (ESCORT-HT) 在接受钙通道阻滞剂单药治疗的高血压未得到控制的老年患者中开展埃沙塞酮与血管紧张素受体阻滞剂的随机、开放标签、平行分组研究 (ESCORT-HT) 的原理与设计。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-11-25 DOI: 10.1111/jch.14947
Kazuomi Kario, Tomohiro Katsuya, Tatsuo Shimosawa, Takashi Taguchi, Ayumi Tanabe, Mitsuru Ohishi, the ESCORT-HT investigators

Angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) are commonly prescribed as first- and second-line treatments for older Japanese patients with hypertension. However, due to age-related decline in renin activity, the effectiveness of ARBs may decrease. This highlights the need for other antihypertensive agents to be used in combination with CCBs to replace ARBs for more effective blood pressure (BP) control. The ESCORT-HT study is a multicenter, randomized, controlled, open-label, parallel-group study with a 4-week run-in period and 12-week treatment period. This study aims to evaluate the efficacy of esaxerenone as a second-line treatment for hypertension and to determine whether its BP-lowering effect is noninferior to that of ARBs in older patients with uncontrolled hypertension on CCB monotherapy. The safety profiles of esaxerenone and ARBs will also be evaluated. Patients will be randomly assigned in a 1:1 ratio to receive either esaxerenone or an ARB. The primary efficacy endpoint will be the change from baseline in morning home systolic BP at the end of the treatment period. The BP-lowering effect of esaxerenone will be considered noninferior to that of ARBs if the upper limit of the two-sided 95% confidence interval (CI) for the difference in systolic BP change between esaxerenone and ARB is <3.8 mmHg, and will be considered superior if the upper limit of the two-sided 95% CI is <0. The findings may elucidate the possible benefits of earlier use of mineralocorticoid receptor blockers in combination with CCBs in older patients with essential hypertension.

血管紧张素 II 受体阻滞剂(ARB)和钙通道阻滞剂(CCB)是日本老年高血压患者常用的一线和二线治疗药物。然而,由于年龄增长导致肾素活性下降,ARBs 的疗效可能会降低。这就凸显出需要将其他降压药与 CCBs 联用,以取代 ARBs,从而更有效地控制血压(BP)。ESCORT-HT 研究是一项多中心、随机对照、开放标签、平行组研究,分为 4 周磨合期和 12 周治疗期。该研究旨在评估埃沙塞伦龙作为高血压二线治疗药物的疗效,并确定其降压效果是否不劣于单用CCB的未控制高血压老年患者使用的ARBs。此外,还将评估埃沙塞酮和ARBs的安全性。患者将按1:1的比例随机分配接受艾沙塞酮或ARB治疗。主要疗效终点是治疗期结束时清晨家庭收缩压与基线相比的变化。如果埃沙塞酮与 ARB 之间收缩压变化差异的双侧 95% 置信区间 (CI) 上限为
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引用次数: 0
Obesity, aldosterone excess, and mineralocorticoid receptor activation: Parallel or intersected circumstances? 肥胖、醛固酮过量和矿皮质激素受体激活:并行还是交叉?
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-11-25 DOI: 10.1111/jch.14898
Houry Puzantian PhD, FAHA, Raymond Townsend PhD, FAHA, Shweta Bansal MBBS, FASN

The obesity pandemic, with its associated comorbidities of hypertension and diabetes, constitutes a global public health issue. Importantly, there is an increasing prevalence of aldosterone excess related to obesity and resultant poor health outcomes. Nevertheless, the association between aldosterone and obesity still needs to be clarified. In this review, the authors discuss the role of white adipose tissue in linking obesity, aldosterone excess, and hypertension. The consequences of aldosterone excess in obesity are presented as genomic, non-genomic, and non-epithelial effects. Moreover, the authors emphasize the value of interference with aldosterone pathophysiology (as with mineralocorticoid antagonists) in obesity, thus reducing the adverse clinical impact of aldosterone in myocardial infarction, heart failure, kidney dysfunction, and associated mortality.

肥胖症及其相关的高血压和糖尿病并发症是一个全球性的公共卫生问题。重要的是,与肥胖有关的醛固酮过量发病率越来越高,并导致不良的健康后果。然而,醛固酮与肥胖之间的关系仍有待澄清。在这篇综述中,作者讨论了白色脂肪组织在肥胖、醛固酮过量和高血压之间的关系。文章以基因组、非基因组和非上皮效应的形式阐述了肥胖症中醛固酮过量的后果。此外,作者还强调了干预肥胖症醛固酮病理生理学(如使用矿物质皮质激素拮抗剂)的价值,从而减少醛固酮对心肌梗死、心力衰竭、肾功能障碍和相关死亡率的不良临床影响。
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引用次数: 0
Catheter-Based Renal Denervation for Resistant Arterial Hypertension: 10-Year Real-World Follow-Up Data 基于导管的肾脏去神经治疗难治性动脉高血压:10 年真实世界随访数据。
IF 2.7 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-11-20 DOI: 10.1111/jch.14931
Sofie Brouwers, Giulia Botti, Matthias Verbesselt, Lucio Addeo, Marta Belmonte, Kostas Bermpeis, Dario Tino Bertolone, Chiara Valeriano, Michele Mattia Viscusi, Eric Wyffels

This analysis of real-world data examines the efficacy, safety, and long-term outcomes of renal denervation in hypertensive patients for up to 10 years. Sixty-five consecutive patients underwent renal denervation (RDN) (single operator) for uncontrolled resistant hypertension. Efficacy was defined as the interindividual change of office (OBPM) and ambulatory blood pressure monitoring (ABPM) at 1, 6, 12 months, 2–4 and 5–10 years after RDN. Medication changes, renal function, and device generation disparities were analyzed. Of these patients, 42 received RDN with a first-generation device, while 23 underwent the procedure with a second-generation device. Baseline demographics included a predominantly male cohort (57.6%) with an average age of 60.3 years. The mean number of medications at baseline was 4.3. OBPM at baseline was 169.0/87.4 mmHg, and ABPM at baseline was 153.4/88.4 mmHg. Post-procedure, significant reductions in systolic blood pressure (SBP) were observed in both OBPM and ABPM at 1 month (OBPM 147.9/82.8 mmHg; ABPM 141.3/83.0 mmHg [SBP, p < 0.001]), sustained up to 10 years (OBPM 153.1/84.3 mmHg; ABPM 138/80.1 mmHg [SBP, p < 0.001]). After 1 year around half of patients had a controlled OBPM and 24 h ABPM < 135/85 mmHg, which was associated with a higher number of ablation spots (31.5±14.8 vs. 15.5 ± 6.5, p = 0.002) and occurred more often when treated with a second-generation device (2 [12.5%] vs. 7 [77.8%], p = 0.002). Renal function displayed a minor physiological decline over 5–10 years. No major complication occurred. Renal denervation demonstrated sustained significant reductions in systolic OBPM and ABPM up to 10 years post-procedure. Controlled blood pressure at 1 year was associated with a higher number of mean ablated spots and the use of a second-generation device. The procedure exhibited a favorable safety profile, indicating its viability in managing hypertension without significant renal function compromise.

本研究对真实世界的数据进行了分析,探讨了肾脏神经支配对高血压患者长达 10 年的疗效、安全性和长期疗效。65 名连续接受肾脏去神经支配(RDN)治疗的患者(单人操作)均患有无法控制的抵抗性高血压。疗效定义为 RDN 后 1、6、12 个月、2-4 年和 5-10 年的诊室血压 (OBPM) 和非卧床血压监测 (ABPM) 的个体间变化。对用药变化、肾功能和设备生成差异进行了分析。在这些患者中,42 人使用第一代设备进行了 RDN,23 人使用第二代设备进行了手术。基线人口统计学特征包括男性居多(57.6%),平均年龄为 60.3 岁。基线时的平均服药次数为 4.3 次。基线时的 OBPM 为 169.0/87.4 mmHg,基线时的 ABPM 为 153.4/88.4 mmHg。手术后 1 个月,OBPM 和 ABPM 的收缩压 (SBP) 均有明显降低(OBPM 为 147.9/82.8 mmHg;ABPM 为 141.3/83.0 mmHg [SBP, p
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引用次数: 0
期刊
Journal of Clinical Hypertension
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