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.
{"title":"A Retrospective Study to Investigate the Relationship Between Body Mass Index and Hemodynamic Characteristics in Hypertensive Patients","authors":"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","doi":"10.1111/jch.14946","DOIUrl":"10.1111/jch.14946","url":null,"abstract":"<p>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/m<sup>2</sup>), with obese patients (BMI ≥ 28 kg/m<sup>2</sup>) averaging 31.01 ± 2.87 kg/m<sup>2</sup> and non-obese (BMI<28 kg/m<sup>2</sup>) averaging 24.70 ± 2.28 kg/m<sup>2</sup>. Younger obese patients exhibited higher diastolic pressures than non-obese peers (<i>p</i> < 0.01). Hemodynamic analysis showed obese patients had increased HR and SVRI but lower CI and AS (<i>p</i> < 0.01). Hypertensive males aged under 60 with obesity displayed a more prominent peripheral vascular phenotype (<i>p</i> < 0.05) and volemic phenotype (<i>p</i> < 0.01) than non-obese males. Obese females aged under 60 showed a higher incidence of cardiac phenotype (<i>p</i> < 0.01). Across genders, obese hypertensive patients aged over 60 had a greater prevalence of volemic phenotype than non-obese patients (<i>p</i> < 0.05, <i>p</i> < 0.01, respectively). BMI inversely correlated with CI and positively with SVRI across age and gender categories (<i>p</i> < 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta-Analysis of Randomized Clinical Trials","authors":"Gautam Satheesh, Rupasvi Dhurjati, Vivekanand Jha, Aletta E. Schutte, Bolanle Banigbe, Dorairaj Prabhakaran, Andrew E. Moran, Abdul Salam","doi":"10.1111/jch.14950","DOIUrl":"10.1111/jch.14950","url":null,"abstract":"<p>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 (<i>p</i> < 0.001 for both). BP control achieved was 57% in the STP group compared to 24% in the usual care group (<i>p</i> < 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Association of Visceral Adipose Tissue With Hypertension: Results From the NHANES 2011–2018 and Mendelian Randomization Analyses","authors":"Jia Liao, Miaohan Qiu, Jing Li, Yi Li, Yaling Han","doi":"10.1111/jch.14953","DOIUrl":"10.1111/jch.14953","url":null,"abstract":"<p>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, <i>p</i> 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Elevated Serum Extracellular Vesicle-Packaged SPARC in Hypertension: A Cross-Sectional Study in a Middle-Aged and Elderly Population","authors":"Xueying Chen, Han Guo, Xinwei Li, Yang Liu, Xinxin Li, Zhengshuo Cui, Huijuan Ma, Jianxun He, Zhechun Zeng, Huina Zhang","doi":"10.1111/jch.14954","DOIUrl":"10.1111/jch.14954","url":null,"abstract":"<p>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 (<i>p</i> < 0.01), when contrasted with the levels observed in normotensive subjects, which were 14.25 ng/mL (<i>p</i> < 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; <i>p</i> 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Efficacy and Safety of Sacubitril/Valsartan Versus Amlodipine in Japanese Patients With Essential Hypertension: A Randomized, Multicenter, Open-Label, Noninferiority Study (PARASOL Study)","authors":"Koichi Yamamoto, Daisuke Yarimizu, Ayano Shimanishi, Shunsuke Eguchi, Kazuma Iekushi, Yoichi Takami, Yoichi Nozato, Kazuomi Kario, Hiromi Rakugi","doi":"10.1111/jch.14938","DOIUrl":"10.1111/jch.14938","url":null,"abstract":"<p>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.</p><p>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; <i>p</i> = 0.003 for noninferiority; independent <i>t</i>-test with noninferiority margin 3.0 mmHg]), with no significant difference observed (<i>p</i> = 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Impact of Mediterranean Diet Adherence on the Incidence of New-Onset Hypertension in Adults With Obesity in Korea: A Nationwide Cohort Study","authors":"Jung-Hwan Kim, Ji-Won Lee, Yaeji Lee, Chung-Mo Nam, Yu-Jin Kwon","doi":"10.1111/jch.14951","DOIUrl":"10.1111/jch.14951","url":null,"abstract":"<p>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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<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
{"title":"Renal Denervation: New Evidence Supporting Long-Term Efficacy, Alternative Access Routes, and Cost-Effectiveness","authors":"Tzung-Dau Wang","doi":"10.1111/jch.14945","DOIUrl":"10.1111/jch.14945","url":null,"abstract":"<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","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1528-1530"},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14945","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"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)","authors":"Kazuomi Kario, Tomohiro Katsuya, Tatsuo Shimosawa, Takashi Taguchi, Ayumi Tanabe, Mitsuru Ohishi, the ESCORT-HT investigators","doi":"10.1111/jch.14947","DOIUrl":"10.1111/jch.14947","url":null,"abstract":"<p>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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Obesity, aldosterone excess, and mineralocorticoid receptor activation: Parallel or intersected circumstances?","authors":"Houry Puzantian PhD, FAHA, Raymond Townsend PhD, FAHA, Shweta Bansal MBBS, FASN","doi":"10.1111/jch.14898","DOIUrl":"10.1111/jch.14898","url":null,"abstract":"<p>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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1384-1390"},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14898","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Catheter-Based Renal Denervation for Resistant Arterial Hypertension: 10-Year Real-World Follow-Up Data","authors":"Sofie Brouwers, Giulia Botti, Matthias Verbesselt, Lucio Addeo, Marta Belmonte, Kostas Bermpeis, Dario Tino Bertolone, Chiara Valeriano, Michele Mattia Viscusi, Eric Wyffels","doi":"10.1111/jch.14931","DOIUrl":"10.1111/jch.14931","url":null,"abstract":"<p>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, <i>p</i> < 0.001]), sustained up to 10 years (OBPM 153.1/84.3 mmHg; ABPM 138/80.1 mmHg [SBP, <i>p</i> < 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, <i>p</i> = 0.002) and occurred more often when treated with a second-generation device (2 [12.5%] vs. 7 [77.8%], <i>p</i> = 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1521-1527"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}