American Journal of Hypertension最新文献

Background: Preeclampsia (PE) is a pregnancy-specific condition characterized by hypertension and multi-organ dysfunction that can lead to severe maternal and perinatal complications. The miR-127-3p is down-regulated in PE, but the mechanism of action in PE is not yet clear.

Methods: The study enrolled 113 PE patients and 93 healthy controls. The expression level of miR-127-3p was evaluated by qPCR, its correlation with clinical indicators of PE was analyzed by correlation analysis, and the diagnostic value of miR-127-3p in PE was evaluated by the ROC curve. In vitro, HTR8/SVneo cells were treated with hypoxia/reoxygenation (H/R) and transfected with miR-127-3p mimics/inhibitors. The regulatory effects of miR-127-3p on the H/R-induced HTR8/SVneo model were verified by cell counting kit-8 (CCK-8), Transwell, and enzyme linked immunosorbent assay (ELISA). The interaction between KIF3B and miR-574-3p was confirmed through dual-luciferase reporter assays.

Results: The miR-127-3p expression was significantly down-regulated in PE patients and correlated with the severity and outcomes of PE. ROC analysis showed that miR-127-3p had a significant diagnostic value in PE. In vitro, miR-127-3p overexpression could restore trophoblast proliferation and invasion ability, and suppress pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) in HTR8/SVneo cells induced by H/R. KIF3B was confirmed as a downstream gene of miR-127-3p, and the regulatory relationship between miR-127-3p and KIF3B was confirmed.

Conclusion: In PE, downregulated miR-127-3p expression correlating with PE severity and outcomes could be used as a biomarker for PE auxiliary diagnosis. In vitro, miR-127-3p overexpression enhances trophoblast function and inhibits the inflammatory responses.

Background: Nocturnal hypertension (NH) is a significant risk factor for target organ damage and all-cause mortality. Post-saline infusion test plasma aldosterone concentration (post-SIT PAC) serves as an indicator of autonomous aldosterone secretion level, but its link to NH is uncertain. This study aims to explore the association between post-SIT PAC levels and NH in patients with suspected primary aldosteronism (PA).

Methods: Participants were classified into three groups after a saline infusion test (SIT): negative (post-SIT PAC < 5 ng/dL, n = 86), borderline (post-SIT PAC 5-10 ng/dL, n = 180), and positive (post-SIT PAC > 10 ng/dL, n = 75). Restricted cubic spline plots (RCS) were used to explore the dose-response relationship between post-SIT PAC and NH, while multivariable logistic regression models adjusted for potential confounders.

Results: In this retrospective study, the overall prevalence of NH was 70.4%. A positive, nonlinear association was identified between post-SIT PAC and NH (P-nonlinear < 0.05). After adjustment for multiple variables, post-SIT PAC remained significantly correlated with NH (OR = 1.08; 95% CI: 1.01-1.15; P < 0.05), while basal PAC was not. Additionally, guideline-defined subgroups with elevated post-SIT PAC demonstrated a higher prevalence of NH (P < 0.05). Specifically, NH prevalence was 81.3% (n = 75) in the positive subgroup, 72.2% (n = 180) in the borderline subgroup, and 57.0% (n = 86) in the negative subgroup.

Conclusions: The level of autonomous aldosterone secretion, rather than the basal aldosterone level, is relevant to potential PA patients at risk for NH. NH prevalence increases nonlinearly with higher post-SIT PAC levels.

Background: The choice of starting antihypertensive regimen is important because most patients remain on their initial treatment, even when their blood pressure (BP) remains high. We examined the expected BP lowering efficacy of antihypertensive regimens initiated among US Medicare beneficiaries.

Methods: We analyzed data on a 20% random sample of Medicare beneficiaries aged ≥65 years with a diagnosis of hypertension. The initial regimen comprised all fills within 7 days of the first antihypertensive claim in 2023 with no fills in the previous 365 days. The primary analysis was restricted to regimens including ≥1 drug class recommended in the 2025 American Heart Association/American College of Cardiology BP guideline and secondary analysis included all antihypertensive drug classes. Expected BP-lowering efficacy for each regimen was estimated using www.bpmodel.org, a model derived from 484 double-blind placebo controlled randomized trials.

Results: Among 52,031 Medicare beneficiaries initiating antihypertensive medications, 74% received monotherapy. In total, 1,060 distinct drug combinations and 2,836 unique drug-dose permutations were filled. The top twenty-five regimens accounted for 70% of initiations and conferred an average expected systolic BP reduction of 8 mmHg and diastolic BP of 4 mmHg. When including non-guideline recommended antihypertensive regimens, the top 25 regimens were filled by 67% of patients initiating treatment, with an average expected systolic/diastolic BP reduction of 6/3 mmHg.

Conclusions: Most antihypertensive regimens initiated among US Medicare beneficiaries were low efficacy monotherapy. Initiating more effective antihypertensive therapy has the potential to improve BP control in the US.

Background: Blood pressure (BP) variability and long-term BP exposure is associated with cardiorenal events. We investigated the associations of visit-to-visit BP variability and cumulative BP exposure with cardiorenal events in young adults with hypertension.

Methods: We identified adults aged 18-39 years with stage 1 or 2 hypertension between 2009-2019 from a large US integrated healthcare system. BP variability was assessed using coefficient of variation, and cumulative BP exposure was calculated as the time-weighted average over three years prior to the index date. Cox proportional hazards models assessed associations with incident cardiovascular and kidney events, adjusting for baseline BP and covariates.

Results: Among 151,692 young adults, 812 cardiovascular and 1,194 kidney events occurred over a median of 5.4 years. Both systolic BP (SBP) variability and time-weighted average SBP exhibited J-shaped or linear associations with cardiorenal events, especially among stage 1 hypertension. In this group, SBP variability at the 90th vs. 50th percentile was associated with increased risks of cardiovascular (HR = 1.25; 95%CI 1.07-1.46) and kidney events (HR = 1.24; 95%CI 1.09-1.41), after adjusting for baseline BP. Time-weighted average SBP of 140 vs. 120 mm Hg was associated with increased risks of cardiovascular (HR = 2.58; 95%CI 1.82-3.65) and kidney events (HR = 1.56; 95%CI 1.16-2.10). Time-weighted average diastolic BP of 90 vs. 80 mm Hg was associated with cardiovascular (HR = 3.65; 95%CI 2.18-6.14) and kidney events (HR = 1.53; 95%CI 0.96-2.42).

Conclusions: BP variability and cumulative BP exposure may be important prognostic markers for cardiorenal events in young adults, particularly those with stage 1 hypertension.

Background: Leucine-rich repeat-containing protein 8 A (LRRC8A) has been uncovered to play a role in pulmonary vascular remodeling during hypertension. The present study aims to investigate a novel mechanism involving LRRC8A in smooth muscle cell (SMC) phenotypic transformation under the hypertension context.

Methods: Angiotensin (Ang)-II-treated human aortic SMCs were established as the cell model under the hypertension context. Western blot and reverse-transcription quantitative polymerase chain reaction were used to detect the levels of target genes. Cell viability and proliferation were evaluated by cell counting kit 8 and 5-ethynyl-2'-deoxyuridine assays, and migration and invasion assays were applied to assess the abilities to migrate and invade of SMCs. The interaction between LRRC8A and ubiquitin-specific protein 8 (USP8) was predicted by the Ubibrowser database and verified by co-immunoprecipitation assay, respectively.

Results: LRRC8A was upregulated in Ang-II-treated SMCs, the silence of which reduced cell proliferation, migration, and invasion and increased the expression of contractile proteins (α-SMA, alpha-smooth muscle actin; SM22α, SM22 alpha). USP8 modulated the ubiquitination-modifying levels on LRRC8A protein, and USP8 promoted SMC phenotypic transformation depending on its deubiquitination function. LRRC8A overexpression reversed the repressed cell phenotypic transformation mediated by USP8 silence, and USP8 might accelerate vascular remodeling partly by activating the LRRC8A/PI3K/AKT axis during hypertension.

Conclusion: LRRC8A upregulation involves in SMC phenotypic transformation under the hypertension context; USP8 can modulate LRRC8A expression in a deubiquitination-dependent manner to further regulate the downstream PI3K/AKT axis during hypertension, which may provide novel therapeutic targets for hypertension management.

Background: Home blood pressure monitoring (HBPM) is an effective method for diagnosing and managing postpartum hypertension, a condition associated with increased health risks. A 5-min seated rest before home blood pressure (BP) measurement is recommended; however, compliance to this recommendation and its impact on HBPM reading in postpartum women is unknown.

Methods: A subset of participants enrolled in a pregnancy cohort were followed at 3 and 6 months postpartum. At each assessment, participants completed HBPM for seven days with an oscillometric device and concurrently wore an accelerometer on their thigh to assess postures. Mixed-effects models and intraclass correlation coefficients were utilized to analyze BP differences and measurement reliability between 5-min rest compliant and noncompliant readings, respectively.

Results: A total of 45 participants (mean age: 30.5 years) provided HBPM data at 3 and/or 6 months postpartum, with 90.2% of requested BP measures taken. Approximately 33% of readings adhered to the 5-min rest protocol. Compliant readings averaged lower systolic and diastolic BP values than noncompliant readings (SBP: 105.9 mmHg vs. 107.1 mmHg; DBP: 72.6 mmHg vs. 73.2 mmHg), but differences were not clinically relevant. Compliant DBP ICCs fell within the good reliability range (ICCs: 0.785-0.817), while other ICCs indicated moderate reliability.

Conclusions: Despite low compliance with 5 mins of seated rest prior to HBPM, the minimal impact on BP values suggests HBPM remains a useful monitoring strategy in postpartum women, even if the premeasurement rest is not always possible. Future research could evaluate whether shorter premeasurement rest recommendations produce similar findings.

Hypertensive disorders of pregnancy (HDPs) are a leading cause of maternal and perinatal morbidity and mortality globally, affecting up to 10% of pregnancies. As rates of obesity, chronic hypertension, and advanced maternal age continue to rise, the burden of HDPs is expected to escalate. This review provides a comprehensive overview of HDPs, encompassing updated classification systems, risk factors, and diagnostic approaches, including emerging biomarkers and predictive imaging tools. We highlight the complex pathophysiology involving impaired placentation, angiogenic imbalance, immune dysregulation, oxidative stress, mitochondrial dysfunction, and epigenetic modifications. Current management strategies are discussed alongside evolving therapeutic interventions, including low-dose aspirin, statins, and novel agents such as hydrogen sulfide donors and C-type natriuretic peptide. Special emphasis is placed on racial, ethnic, and socioeconomic disparities that contribute to disproportionate outcomes, particularly among Black and Indigenous women. We also explore the role of personalized medicine, predictive models, and digital health tools in transforming HDP care. By integrating mechanistic insight with public health strategies and clinical innovation, this review aims to inform multidisciplinary approaches to reduce the burden of HDPs and promote equitable maternal and neonatal outcomes.

Background: Hypertension, a prevalent cardiovascular disorder, exerts detrimental effects on the respiratory system. However, the underlying mechanisms remain incompletely elucidated.

Methods: We conducted comparative transcriptomic profiling via RNA sequencing (RNA-seq) of lung tissues from spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) controls. Additionally, we assessed the effects of angiotensin receptor blocker (ARB) and angiotensin receptor-neprilysin inhibitor (ARNI) interventions on mRNA and protein expression profiles in SHR pulmonary tissue using integrated omics approaches.

Results: Core differentially expressed genes (DEGs) identified in SHR versus WKY comparisons included Nuf2 and Cenpa, with significant enrichment in the PI3K/AKT signaling pathway. In SHR versus ARB-treated cohorts, hub genes Ccnb2 and Mad2l1 demonstrated primary pathway enrichment in cell-cycle regulation and human T-cell leukemia virus 1 infection. ARNI intervention yielded distinct hub genes (Gzma, Icam1) enriched in PI3K/AKT signaling and extracellular matrix (ECM)-receptor interactions. Proteomic analysis confirmed concordant expression patterns for EGFR and JUN proteins with transcriptomic findings.

Conclusions: ARB and ARNI therapies mitigate hypertension-induced pulmonary damage through divergent molecular mechanisms, with PI3K/AKT signaling and ECM-receptor interactions serving as central regulatory hubs in this protective process.