Blood Pressure最新文献

Objective: In this study, we aimed to determine the prevalence and spectrum of secondary hypertension among patients with apparently resistant arterial hypertension (aRH) and to compare the rate of decline in estimated glomerular filtration rate (eGFR) between those with primary aldosteronism (PA) and true resistant arterial hypertension (RAH).

Methods: This retrospective cohort study involved 790 patients with aRH referred to a hypertension excellence centre. All patients fulfilled pharmacological criteria for aRH and underwent a screening protocol to evaluate secondary hypertension. We compared clinical and laboratory markers of patients with PA to those with RAH, with a median follow-up of 7 years.

Results: Secondary hypertension was identified in 213 patients (27%), with PA being the most common cause (17%), followed by renovascular hypertension (4.1%) and renal parenchymal disease (3.7%). Compared to RAH patients, those with PA had significantly fewer cardiovascular comorbidities. Patients with RAH exhibited a faster decline in renal function, specifically an additional 0.7 mL/min/1.73 m² reduction per year (95% confidence interval: 0.05-1.35, p = .03), despite similar baseline eGFR and blood pressure (BP) control. In RAH, a continuous association between higher average 24-h systolic BP and a faster decline in renal function was observed.

Conclusion: Systematic screening in aRH reveals a high prevalence of secondary hypertension, particularly PA. Patients with RAH showed significantly worse renal outcomes compared to those with PA, with faster renal decline associated with higher BP within the RAH group, underscoring the need for early diagnosis and strict BP management.

Purpose: Pulse wave velocity (PWV) is a measure of arterial stiffness that reflects vascular ageing and predicts risk for cardiovascular disease. We developed a PWV measurement method that uses dual-impedance cardiography (d-ICG) to address limitations of other common methods (e.g. ultrasound, tonometry, etc.), as well as to enable PWV assessments across a broader range of populations. This pre-registered, cross-sectional study tested for the first time the extent to which d-ICG PWV associates with cardiometabolic risk factors (i.e. blood pressure and other metabolic syndrome components) and vascular markers of preclinical atherosclerosis (i.e. carotid-artery intima-media thickness [C-IMT] and plaque).

Methods: Participants were 366 healthy adults (aged 28-57; 63.4% female). In a subsample (N = 179), estimates of d-ICG PWV were compared for the first time against carotid-femoral PWV (cfPWV) measured by a Complior device.

Results: d-ICG PWV and cfPWV measures were comparably associated with age and blood pressure (r's ≥ .28, p's ≤ .001), and they exhibited moderate consistency (ICCs = 0.51 to 0.55, p's < .001). Across all cardiometabolic risk factors and markers of preclinical atherosclerosis, there were no clinically meaningful differences in the average composite (Fisher's Z-score) correlations with arterial stiffness measured by d-ICG and cfPWV based on Cohen's q values (q's = 0.042 to 0.097).

Conclusion: d-ICG PWV may be a low-cost, reliable, and alternative method for obtaining estimates of arterial stiffness that track with cardiometabolic risk factors and preclinical atherosclerosis.

Background: Isolated systolic hypertension (ISH), defined as blood pressure of ≥140/<90 mmHg, is associated with an increased risk of cardiovascular complications yet few estimates of prevalence are recorded globally. Data on blood pressure measurements of adult Filipinos were taken as one of the variables in the National Nutrition Survey; however, the prevalence of ISH and its associated risk factors has not been investigated. This study aimed to determine the prevalence and factors associated with ISH among middle-aged (40-59 years) and older (60 and above) Filipinos.

Methods: A secondary data analysis of the cross-sectional survey design of the 2018, 2019, and 2021 Expanded National Nutrition Survey (ENNS) of the Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI) was utilized in the study. Multivariable logistic regression analysis was employed to determine the factors significantly associated with ISH.

Results: The prevalence of ISH from the pooled data was 9.10% (95% CI: 8.68─9.53) and increased significantly with age. After adjustment, multivariable analysis identified several factors significantly associated with ISH, the factors included: age, with those 70 years old of age or older exhibiting the highest odds [AOR 11.71 (95% CI: 8.38─16.35)], having little to no formal education [AOR 1.39 (95% CI: 1.18─1.64)], the presence of diabetes [AOR 1.62 (95% CI: 1.38─1.90)], or prediabetic [AOR 1.37 (95 CI: 1.13─1.66)], a family history of hypertension [AOR 2.26 (95% CI: 2.03─2.52)], and current alcohol drinker [AOR 1.24 (95% CI: 1.08─1.43)].

Conclusion: ISH was prevalent among middle-aged and older Filipino population across the three survey periods. Given the impact of ISH on cardiovascular outcomes, these findings may provide crucial data on its prevalence and determinants, which can assist policymakers in formulating targeted interventions centered on lifestyle modifications.

Background: Baroreflex activation therapy (BAT) has emerged as a device-based therapy for resistant hypertension. Comparative evidence between first-generation (Rheos®) and second-generation (Barostim neo™) BAT systems remains limited.

Methods: We retrospectively analyzed all patients who underwent BAT implantation between 2006 and 2015 (n = 54) at our center. The primary outcome was the change in 24h ambulatory blood pressure monitoring (ABPM) between device generations. Secondary outcomes included adverse events, major adverse cardiovascular events (MACE), kidney function, and device-related complications. Office blood pressure, 24h ABPM, and heart rate (HR) were assessed at baseline and during follow-up. Patients with insufficient 24h ABPM follow-up data were excluded from the primary endpoint analysis.

Results: In patients with ABPM data (n = 33), BAT significantly reduced 24h diastolic blood pressure (DBP), 24h systolic blood pressure (SBP), and HR (all p < 0.05). Daytime SBP, DBP, and HR decreased significantly. At night, SBP declined from 165 to 151 mmHg (p = 0.004) and DBP from 98 to 88 mmHg (p = 0.003), while HR remained unchanged. Rheos® was associated with significant reductions in 24h and night-time SBP; daytime SBP decreased numerically but did not reach statistical significance. Barostim neo™ (n = 14) reduced 24h and daytime HR (p = 0.006 and p = 0.009) but showed no statistically significant BP reduction. No significant differences were observed between devices in complication rates, kidney function, or MACE.

Conclusion: Baroreflex activation was safe and associated with reductions in 24h blood pressure and heart rate in patients with resistant hypertension. The first-generation Rheos® system demonstrated more pronounced blood pressure-lowering effects, whereas the second-generation Neo™ system was associated primarily with heart rate reduction without a significant effect on blood pressure. Although Rheos® is no longer commercially available, these findings highlight the importance of electrode design, implantation strategy, and patient selection in optimizing the efficacy of contemporary BAT.