American Journal of Hypertension最新文献

Background: Global longitudinal strain (GLS) of the left ventricle (LV), derived from speckle-tracking echocardiography (STE), has shown efficacy in reliably detecting LV systolic malfunction in diverse cardiovascular diseases. Ventricular-arterial coupling (VAC) is an indispensable indicator of cardiovascular efficacy. However, the relationship between GLS and VAC remains inadequately understood. Accordingly, we aimed to examine the connection between VAC and GLS in hypertensive patients with a preserved LV ejection fraction (EF).

Methods: This cross-sectional study included 104 individuals with primary hypertension and 40 normotensive controls. Echocardiography-derived VAC was calculated as the quotient of effective arterial elastance (Ea) and end-systolic elastance (Ees)(Ea/Ees). In addition to conventional echocardiography, GLS was evaluated with two-dimensional (2D) STE. Ees, Ea, and the Ea/Ees ratio were calculated. Participants were categorized into tertiles according to their Ea/Ees values.

Results: Median Ea/Ees values for the low, middle, and high tertile groups were 0.48 (0.46-0.50), 0.56 (0.55-0.58), and 0.67 (0.63-0.70), respectively. Simple regression analysis revealed a significant negative connection between GLS and Ea/Ees tertile (β = -0.276, P = 0.005). The link remained statistically significant subsequent to the adjustment for important confounding variables in the multiple regression analysis (β = -0.237, P = 0.007). The area under the ROC curve (AUC) for Ea/Ees in predicting abnormal GLS (absolute GLS < 20) was 0.656 (P = 0.010).

Conclusions: Ea/Ees is independently linked to GLS in hypertensive individuals with LV preserved EF. This suggests that Ea/Ees may serve as a predictor of LV subclinical systolic dysfunction, as evaluated through GLS. Registration No. NCT04573257.

Background: The impact of different fluctuation patterns of blood pressure (BP) on episodic memory remains underexplored, and the role of cumulative BP in this association remains unclear.

Methods: Using data from the China Health and Retirement Longitudinal Study, 6563 participants aged 45 years or more were analyzed. BP was measured in wave 1 (2011), wave 2 (2013), and wave 3 (2015). Cumulative systolic BP (SBP) during wave 1-3 (area under the curve) and the SBP difference between wave 1-2 and wave 2-3 were calculated. Then, SBP differences in the two intervals were used to identify patterns by K-means cluster analysis. Episodic memory, including immediate and delayed memory, was assessed in wave 4 (2018). Linear regression and mediation analysis were conducted, with multivariable adjustment.

Results: Three fluctuation patterns of SBP were identified, characterized as an increase-decrease (19.9%), decrease-increase (25.7%), and stable (54.4%) pattern. Before cumulative SBP adjustment, compared to the stable SBP pattern, the β (95% CIs) for episodic memory at wave 4 was -0.14 (-0.27, -0.01) for immediate memory, -0.12 (-0.31, 0.06) for delayed memory, and -0.27 (-0.57, 0.03) for total memory in the increase-decrease SBP pattern, and -0.06 (-0.18, 0.07), 0.01 (-0.15, 0.18), and -0.03 (-0.30, 0.25) in the decrease-increase SBP pattern. The overall association between the increase-decrease SBP pattern and immediate memory was partly mediated by cumulative SBP (29%).

Conclusions: The increase-decrease pattern of SBP was associated with lower immediate memory three years later, and cumulative SBP partly mediated the association.

Background: There has been incongruent evidence on the outcomes relating to whether continuing or withholding renin-angiotensin-aldosterone system inhibitors (RAASi) preoperatively. This study aimed to systematically analyze the effect of preoperative RAASi on perioperative and postoperative outcomes in patients undergoing noncardiac surgeries.

Methods: PubMed, Scopus, ScienceDirect, and Cochrane databases were used with no limitation of the starting date, till 30th September 2024. The revised Cochrane risk-of-bias tool (RoB-2) and the Newcastle-Ottawa Scale were used for quality assessment. The primary study outcomes were hemodynamic outcomes while the secondary outcomes included postoperative 30-day mortality, myocardial infarction (MI), stroke and postoperative atrial fibrillation (POAF).

Results: Among 1897 articles, 6 eligible randomized control trials and 6 observational studies were enrolled. The patients preoperatively continuing RAASi had a higher risk of intraoperative hypotension [OR (odds ratio) = 1.54; 95% CI (confidence interval) = 1.31, 1.82], along with lower systolic and diastolic blood pressures compared to those withholding RAASi. Postoperative complications including 30-day mortality, MI, stroke, atrial fibrillation, acute kidney injury, septicemia, myocardial injury, postoperative hypertension and unplanned ICU admission, showed no significant differences. However, there was a marginal significance in lower POAF in the RAASi-continuing group (OR = 0.73, 95% CI = 0.52, 1.02).

Conclusions: Withholding RAASi prior to noncardiac operation significantly reduced the risk of intraoperative hypotension but may increase the chance to develop POAF without significant impact on 30-day mortality and other postoperative complications. Discontinuation of RAASi before noncardiac surgery is recommended unless obligate indication.

Background: Cerebral microbleeds (CMBs) have been found to promote Alzheimer's disease (AD) progression. Hypertension (HTN) is one of the major etiological factors for CMBs and an important risk factor for AD. However, the association between HTN-related CMBs and AD pathology remains undetermined. This study aims to identify the relationship between HTN-related CMBs and amyloid-β 42 (Aβ42) and β-site amyloid precursor protein cleaving enzyme 1 (BACE-1) levels in plasma astrocyte-derived exosomes (ADEs).

Methods: In total, 88 HTN participants including 30 with deep/infratentorial (D/I) CMBs, 30 with mixed CMBs, and 28 without CMBs were analyzed. Susceptibility-weighted imaging was performed to assess the location, presence, and number of CMBs. ELISA kits for BACE-1 and Aβ42 were employed to evaluate the levels of astrocyte-derived exosomal proteins.

Results: The results indicated that plasma ADE levels of Aβ42 were reduced in the HTN + D/I CMBs and HTN + Mixed CMBs groups relative to the HTN-CMBs group. Furthermore, the plasma ADE levels of Aβ42 were significantly associated with CMBs in patients with HTN. However, no significant differences were found in the plasma ADE levels of BACE-1 among the HTN + D/I CMBs, HTN + Mixed CMBs, and HTN-CMBs groups.

Conclusions: The study revealed that reduced plasma ADE levels of Aβ42 were significantly associated with CMBs in HTN patients. This finding suggests a potential link between HTN-related CMBs and AD-related amyloid-β pathology, offering novel insights into the mechanisms by which HTN-related CMBs promote AD progression.

Background: The prognostic significance of BP changes during exercise remains unclear. This study investigated the association between exercise-related BP and long-term mortality.

Methods: We analyzed 19,110 individuals (mean age 57.9 years, 61.9% men) who underwent clinically indicated treadmill exercise testing. The recordings of BP throughout the test were obtained, and maximal and recovery changes in SBP (ΔSBPmax and ΔSBPrec) were calculated. Mortality and cardiovascular (CV) death were obtained via linkage to the National Death Registry.

Results: During a mean follow-up of 4.4 ± 2.6 years, there were 649 deaths and 134 CV deaths. Higher resting SBP, recovery SBP, maximal exercise SBP, peak heart rate, ΔSBPmax, and ΔSBPrec were inversely associated with CV and all-cause mortality. In contrast, a drop in recovery SBP below resting levels was associated with higher mortality. After multivariable adjustment for age, sex, lipid profiles, diabetes, use of antihypertensive agents, resting SBP, and metabolic equivalents, both ΔSBPmax and ΔSBPrec remained independently predictive. Specifically, for per 1-SD increase, ΔSBPmax was associated with a hazard ratio (HR) of 0.80 (95% CI, 0.67-0.97) for CV death and 0.88 (95% CI, 0.80-0.96) for all-cause death. Similarly, ΔSBPrec was associated with an HR of 0.75 (95% CI, 0.62-0.90) for CV death and 0.85 (95% CI, 0.77-0.93) for all-cause death.

Conclusions: Greater SBP increases during exercise and recovery were associated with lower CV and all-cause mortality, while a drop in recovery SBP identified elevated risk. Exercise BP responses may serve as simple, clinically relevant prognostic markers.

Background: Blood pressure (BP) is not steady. It varies over intervals from months to consecutive cardiac cycles, and this variation contains meaningful information beyond mean BP. Variability over multiple clinic visits (VVV-BP) and during 24-h ambulatory monitoring (ABPV) is positively related to risk of stroke and coronary artery disease and negatively associated with cognitive performance. Beat-to-beat BP variation, often quantified as low frequency variability (0.04-0.15 Hz, LF-BPV), is less well-studied. Here, we examine the relationship between LF-BPV and cognitive outcomes in 1953 participants from the Midlife in the US study.

Methods: Participants completed the Brief Test of Adult Cognition by Telephone from which we derived episodic memory (EMF) and executive function (EFF) factors and a composite index. With participants in the seated position, the continuous BP signal was recorded noninvasively with a Finometer. The resultant time series was submitted to Fourier-based spectral analysis to compute LF-BPV. Linear regression models estimated the associations with cognitive indices.

Results: Systolic (LF-SBPV) and diastolic (LF-DBPV) were positively associated with EFF (b = 0.073 ± 0.033, P = 0.02), EMF (b = 0.079 ± 0.036, P = 0.04), and the composite index (b = 0.101 ± 0.035, P = 0.004) after adjustment for age, sex, education, and income. Findings were similar for LF-DBPV.

Conclusions: This positive association is consistent with evidence demonstrating that LF blood pressure variability contributes to increased delivery of oxygenated blood to the brain and clearance of metabolic and cellular waste via the brain's glymphatic system and intramural periarterial drainage pathway, both of which contribute to superior cognitive performance.

Background: Increased variability in central aortic systolic pressure (CASP) and pulse pressure (PP) are predictors of poor cardiovascular disease outcomes. Low-level tragus stimulation (LLTS) is a noninvasive method to reduce sympathetic tone via vagal afferent fibers. It is unknown if LLTS has a favorable effect on elevated variability in CASP and PP in patients with acute decompensated heart failure (HF) (ADHF).

Methods: Patients hospitalized for ADHF after initial stabilization (median 80 years, males 60%) were randomly assigned to active or sham group, and LLTS (20 Hz, 1 mA) was delivered using an ear clip attached to the tragus (active group) or the earlobe (sham group) for 1 hour daily over 5 days. The variability of PP and CASP was measured before and after each stimulation.

Results: Each of SD, CV, and δ in PP, CASP, radial augmentation index (rAI), %PP variation (PPV), and PP × heart rate (HR) was significantly decreased after stimulation in the active group (n = 8) (all P < 0.05), while δ in CASP was significantly increased after stimulation in the sham group (n = 8) (P < 0.05). All the changes in SD, CV, and δ in PP, CASP, rAI, %PPV, and PP × HR before and after stimulation were also significantly different between active and sham groups (all P < 0.05).

Conclusions: In this proof-of-concept study, LLTS led to a better hemodynamic profile, as evident in variability reduction in PP, CASP, and rAI. Further studies are warranted to study the long-term hemodynamic effects of LLTS on HF.Clinical trial registration: UMIN000044121.