Blood Pressure最新文献

Purpose: Ventricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature review explores the changes in VAC with ageing and various cardiovascular diseases (CVDs).

Materials and methods: This literature review covers studies on changes in VAC with age and common CVDs, such as arterial hypertension, atrial fibrillation (AF) and heart failure with preserved and reduced ejection fraction and aortic stenosis (AS). The review discusses traditional measures of VAC, including arterial elastance (Ea) and ventricular elastance (Ees), as well as emerging parameters, such as global longitudinal strain (GLS) and pulse wave velocity (PWV). The review introduces the PWV/GLS ratio as a novel method for assessing VAC.

Results: With ageing, both Ea and Ees increase, while the Ea/Ees ratio remains relatively stable, reflecting balanced arterial and ventricular adaptations. Novel measures, such as PWV/GLS ratio, show greater impairment in older adults and provide a comprehensive evaluation of VAC.

Conclusions: Ageing disrupts VAC through arterial stiffening and reduced heart function, often exacerbated by CVDs. Novel metrics like PWV/GLS may improve VAC assessment, helping clinicians manage age-related cardiovascular issues by identifying risks earlier and guiding treatment to support efficient heart-artery interaction.

Purpose: The accuracy of the Omron J760 electronic blood pressure (BP) monitor for upper arm BP measurement in the adult general population was validated following the AAMI/ESH/ISO (ISO 81060-2:2018) + Amd1:2020 protocol. We expect that this device can be used for home blood pressure monitoring, with its measurements serving as a clinical reference.

Methods: Subjects meeting the age, gender, BP, and cuff distribution criteria as specified by the AAMI/ESH/ISO (ISO 81060-2:2018) + Amd1:2020 were recruited. BP measurements were conducted using the same-arm sequential method. The test device cuff was suitable for arm circumferences ranging from 22.0 cm to 42.0 cm.

Results: Eighty-nine participants were initially recruited, 85 were evaluated after excluding 4 participants. The mean age of the participants was 48.5 ± 15.17 years. For validation criterion 1, the mean ± standard deviation (SD) of the differences between the test device and the reference BP measurements were 0.2 ± 5.74 mmHg for systolic BP and -0.9 ± 4.69 mmHg for diastolic BP. These results met the AAMI/ESH/ISO (ISO 81060-2:2018)+Amd1:2020 standard, which requires differences of ≤5 ± ≤8 mmHg. For validation criterion 2, the mean differences between the test device and the reference device were 0.2 ± 5.10 mmHg for systolic BP and -0.9 ± 4.30 mmHg for diastolic BP. This criterion was satisfied with criterion 2 of ≤6.95 mmHg for systolic BP and ≤6.88 mmHg for diastolic BP.

Conclusion: The Omron J760 electronic BP monitor meets the requirements of the AAMI/ESH/ISO (ISO 81060-2:2018)+Amd 1:2020 validation standard.

Purpose: The central augmentation index (cAIx) is an indirect measure of arterial stiffness. The influence of heart rate variability (HRV) on cAIx remains unexplored in a military cohort and was the aim of this analysis.

Method: The first follow-up data from the ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study were analysed. Participants were male British servicemen who served in Afghanistan (2003-2014) and were divided into two groups at recruitment: injured (who sustained severe combat injury) and uninjured. The uninjured were frequency-matched to the injured by age, rank, role-in-theatre and deployment. HRV was reported as root-mean-square-of-successive-differences (RMSSD) using a five-minute single-lead electrocardiogram. The cAIx was measured using pulse waveform analysis and was adjusted for heart rate at 60 beats/minute (cAIx@60). Effect modification by injury was assessed via interaction analysis. Linear models reported the association between RMSSD (HRV) and cAIx@60 adjusting for a priori confounders.

Results: 1052 participants (injured n = 526; uninjured 526; median age at follow-up 37.4 years) were examined. Effect modification by injury was not statistically significant; therefore, was adjusted for along with other confounders. RMSSD and cAIx@60 exhibited a moderate inverse correlation (-0.40; p < 0.001). The association between natural log-transformed RMSSD (LnRMSSD) and cAIx@60 was non-linear and statistically significant, suggesting that a 10% decrease in LnRMSSD would be associated with 0.30% increase in cAIx@60.

Conclusion: Lower RMSSD (HRV) is associated with an increase in cAIx@60, independent of injury status and other traditional cardiovascular risk factors. The efficacy of positive HRV modification on cardiovascular risk in military populations needs to be examined.

Introduction: Pregnancy-associated thrombotic microangiopathy (TMA) is potentially life-threatening disorder which refers to endothelial injury as the main culprit. Our case demonstrates true severity of pregnancy-associated TMA in postpartum period and diagnostic challenges in obtaining correct diagnosis.

Case presentation: The 32-year-old woman, with no previous record of gestational hypertension, underwent C-section in 30^th week of 1^st pregnancy due to preeclampsia. Postpartum period was complicated with TMA and continuous need for antihypertensive therapy. Due to suspicion of thrombotic thrombocytopenic purpura (TTP), plasmapheresis was started. After dismissing TTP diagnosis, plasmapheresis was continued while perusing other possible pregnancy-associated TMAs. After a period of stabilisation, anaemia and thrombocytopenia worsened with signs of renal impairment and the patient experienced hypertensive crisis, culminating with grand mal epileptic seizure. She was sedated and treated with intravenous antihypertensive therapy in the Intensive care unit setting. Anti-complement therapy was obtained due to high suspicion of atypical haemolytic uraemic syndrome (aHUS) but ultimately was not delivered due to the rapid improvement in clinical and laboratory findings. No high-risk polymorphism for aHUS were detected, rather multiple common risk variants for complement mediated TMA. The patient experienced full clinical recovery with minimal residual renal impairment.

Conclusion: this case is an example of pregnancy-associated TMA in the setting of preeclampsia in postpartum period which progressed to eclampsia due to the uncontrolled arterial hypertension. Upon vigorous blood pressure management, signs of TMA fully subsided.

Background: Hypertension (HTN) is a leading contributor to cardiovascular disease (CVD). Green tea has been proposed as a natural intervention for blood pressure (BP) management due to its antioxidant content. This study aimed to systematically evaluate the effect of green tea supplementation on systolic (SBP) and diastolic blood pressure (DBP) using a meta-analysis of randomised controlled trials (RCTs).

Methods: Eligibility criteria were defined using the PICOS framework. PubMed, Scopus, and Web of Science were searched through January 2024 for randomised controlled trials in adults (≥18 years) comparing green tea supplementation with control or placebo, reporting pre- and post-intervention systolic and diastolic blood pressure (SBP and DBP). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were pooled using random-effects models. Subgroup analyses and dose-response analyses were performed.

Results: A total of 36 RCTs were included. Green tea reduced SBP (WMD: -1.08 mmHg; 95% CI: -1.98, -0.18; I² = 85.0%) and DBP (WMD: -1.09 mmHg; 95% CI: -1.67, -0.50; I² = 74.0%). Subgroup analyses showed stronger effects in participants with elevated baseline BP (SBP ≥120 mmHg), those consuming <500 mg/day green tea, studies ≤8 weeks, Asian populations, and women. No clear association was found between BP changes and tea dose or intervention duration.

Conclusion: Green tea supplementation is associated with modest reductions in SBP and DBP. Given the heterogeneity and lack of clear dose-duration effects, green tea is better considered a complementary approach for managing blood pressure.

Purpose: There is currently no specific treatment for nocturnal hypertension (HT). By improving sleep quality and drug-specific mechanisms, hypnotics have been suggested as a potential treatment for nocturnal HT, but this has never been investigated by a systematic review and meta-analysis.

Materials and methods: Multiple databases were searched since inception till 19 November 2024. Only randomised controlled trials (RCTs) comparing oral hypnotics administration for ≥1 week versus placebo and reporting nocturnal systolic blood pressure (SBP) or diastolic blood pressure (DBP) were included. Study selection, data extraction and quality assessment (by the Cochrane risk-of-bias tool) were conducted by two independent reviewers. Pairwise meta-analysis using a random effect model pooled weighted mean BP difference.

Results: Eight studies including 414 participants were included. Hypnotics did not significantly impact on nocturnal SBP (-3.24 mmHg; 95% confidence interval [CI]: -8.55, 2.06; I²: 89.4%), nocturnal DBP (-0.97 mmHg; 95% CI: -2.79, 0.85; I²: 74.6%) and daytime/24-h/office SBP/DBP except for nonbenzodiazepine benzodiazepine receptor agonists (NBZRAs), which may reduce 24-h SBP. Benzodiazepines increase 24-h/daytime/nighttime heart rate. Seven included studies had unclear to high risk of bias. Strength of evidence was ranked very low to low. This is the first meta-analysis to investigate the effects of hypnotics on nocturnal BP, highlighting the lack of adequately powered and low-risk-of-bias studies, especially in patients with HT and insomnia, who may experience preferential nocturnal BP reduction with hypnotics, but this hypothesis is currently supported only by two RCTs involving NBZRAs.

Conclusions: Despite limited data, hypnotics appear to have neutral effects on BP, including nocturnal SBP and DBP, and currently have no role in clinical practice for the treatment of HT (PROSPERO no.: CRD42023490914).

Introduction: Acute ischaemic stroke (AIS) patients in the intensive care unit (ICU) face high mortality. This study examined the association between systolic blood pressure variability (SBPV), specifically average real variability (SBP-ARV), and short-term mortality in critically ill AIS patients.

Methods: We conducted a retrospective cohort study using the MIMIC-IV database. The primary outcomes were 28-day and 90-day all-cause mortality. Cox regression, Kaplan-Meier curves, restricted cubic spline (RCS) models, and subgroup analyses were used to assess associations.

Results: A total of 861 AIS patients were included. The 28-day and 90-day mortality rates were 20.9% and 23.3%, respectively. Higher SBP-ARV was independently associated with increased mortality. Compared with the lowest tertile, the highest tertile of SBP-ARV had significantly increased 28-day mortality (HR: 1.53; 95% CI: 1.03-2.27; p = 0.035). SBP-ARV as a continuous variable was also significantly associated with 28-day and 90-day mortality. RCS analysis showed that mortality risk increased when SBP-ARV exceeded 11.63.

Conclusion: Our findings suggest that elevated systolic blood pressure variability, particularly higher SBP-ARV within the first 24 h of ICU admission, is significantly associated with increased 28-day and 90-day mortality in AIS patients. SBP-ARV may serve as a valuable prognostic marker for risk stratification and early clinical intervention in critically ill stroke patients.

Objective: This randomised, double-blind, placebo-controlled trial aimed to evaluate the efficacy and safety of Salvia miltiorrhiza (Dan Shen) in the management of primary hypertension.

Methods: From April 2023 to September 2024, 320 patients aged 30-75 years with diagnosed primary hypertension were enrolled at Ganzhou Hospital of Southern Medical University (Ganzhou People's Hospital). Patients were randomised to receive either intravenous Salvia miltiorrhiza (20 mL diluted in 200 mL of 5% glucose daily for 12 weeks) or a placebo with identical appearance and administration. Primary outcomes included changes in blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM). Secondary outcomes included symptom scores, lipid and glucose profiles and health-related quality of life (QoL) assessed using validated laboratory measures and the SF-36 questionnaire.

Results: A significant reduction in systolic and diastolic blood pressure (DBP) was observed in the intervention group from week 4, reaching 136.78 ± 10.28 and 85.36 ± 8.37 mmHg by week 12, respectively - both significantly lower than in the control group (p < 0.01). Symptom scores for headache, dizziness and fatigue decreased by 1.2, 1.1 and 1.2 points (p < 0.01), with no significant changes in the control group. Lipid profiles improved notably: total cholesterol (TC), LDL-C and triglycerides (TGs) declined by 9.8%, 10.7% and 17.1%, respectively, while HDL-C increased by 17.0% (all p < 0.05). Fasting glucose levels fell by 4.3% (p < 0.05). QoL, assessed via SF-36, improved significantly, particularly in vitality (+20.9) and physical functioning (+18.6). Adverse events (AEs) were mild to moderate, mainly gastrointestinal discomfort and dizziness, and did not result in dropout. Treatment adherence was high, with 94.2% of participants completing at least 80% of the protocol.

Conclusion: Dan Shen significantly reduced both systolic and DBP, alleviated hypertension-related symptoms, improved lipid and glucose metabolism, and enhanced QoL in patients with primary hypertension.

Background: The diagnosis and treatment of hypertension rely on the accuracy of blood pressure (BP) measurements obtained both in and out of the office during awake and sleep periods.

Objective: To evaluate whether a home blood pressure monitoring (HBPM) protocol incorporating morning, afternoon, and evening measurements supports the assessment of blood pressure behaviour during sleep and enhances the diagnosis of hypertension.

Methods: This cross-sectional study included 40 patients (73% women; age = 62.0 ± 13.2 years) who underwent 24-h ambulatory blood pressure monitoring (ABPM) and (five-day HBPM) with measurements taken across three time periods. The association between the sleep-wake dip recorded by ABPM and the night-day difference measured by HBPM was examined. Additionally, the sensitivity, specificity, predictive values, concordance index, Kappa coefficient, and area under the ROC curve (AUC) of mean BP values obtained from HBPM were compared with those from ABPM.

Results: Mean BP values obtained from HBPM were 126.2 ± 13.3/79.2 ± 9.1 mmHg, (daytime), 125.9 ± 16.4/78.7 ± 10.5 mmHg (evening), and 126.1 ± 14.3/78.9 ± 9.6 mmHg (total). For ABPM, mean values were 120.3 ± 12.5/74.5 ± 8.9 mmHg (awake), 116.5 ± 10.9/69.3 ± 8.0 mmHg (asleep), and 119.4 ± 11.4/73.4 ± 8.0 mmHg (total). Total HBPM outperformed daytime and evening HBPM in detecting abnormalities on ABPM (daytime, night-time, and 24 h), with higher sensitivity, negative predictive value (NPV), AUC, concordance index, and Kappa coefficient. The correlation between the day-night dip in ABPM and the night-day difference in HBPM was weak.

Conclusion: Including night-time measurements in the HBPM protocol improves the accuracy of hypertension diagnosis when compared to ABPM. However, the night-day BP difference captured by HBPM does not correspond to the day-night dip measured by ABPM.