Blood Pressure最新文献

Inroduction : Scleroderma Renal Crisis (SRC) is characterised by acute hypertension, haemolytic anaemia (HA), and acute kidney injury (AKI). Often presenting as the first manifestation of scleroderma, it is frequently mistaken for malignant hypertension (MHT). Rapid recognition and differentiation of SRC from other hypertensive emergencies are essential for improving patient outcomes.We present two clinical cases that illustrate the diagnostic challenges of SRC in the context of MHT.

Case 1: A 53-year-old man presented with severe hypertension (238/127 mmHg) and AKI (creatinine 390 μmol/L). He was diagnosed MHT due to the presence of grade III hypertensive retinopathy and HA. . However, a urine dipstick test detected haematuria, leading to further immune testing and, a renal biopsy, which confirmed SRC. Treatment with high-dose ramipril led to a sustained recovery of kidney function, 221 μmol/L after five years).

Case 2: A 52-year-old man presented with chest pain, severe hypertension (253/132 mmHg), and AKI (creatinine 183 μmol/L). Initially managed as MHT, his kidney function worsened, prompting further investigation, which revealed haematuria and positive anti-nuclear antibodies. A renal biopsy confirmed SRC. High-dose ramipril was reintroduced, leading to partial kidney function recovery (creatinine 218 μmol/L after five years).

Key findings : These cases underscore the importance of early detection of hematuria and autoimmune markers to expedite diagnosis of SRC in case of MHT. When SRC is suspected, high-dose angiotensin-converting enzyme inhibitors (ACEi) should be initiated immediately, even before biopsy confirmation and continued despite initial kidney function decline. Early intervention is crucial for optimising kidney outcomes and achieving effective blood pressure control.

Purpose: This study examined temporal trends in hypertension prevalence across China (2002-2019), analyzing age-, sex-, and region-specific disparities and identifying key risk factors.

Materials and methods: A retrospective analysis was conducted using data from the China Chronic Disease and Risk Factor Surveillance (CCDRFS) program, involving 120,000 adults aged ≥18 years. Descriptive statistics were used to calculate prevalence rates, and multivariable logistic regression analyzed associations with age, sex, BMI, smoking, alcohol consumption, and physical inactivity.

Results: Hypertension prevalence increased significantly from 18.9% (2002) to 29.6% (2019) (P<0.001). The sharpest rise occurred among adults aged 18-44 years, tripling from 5.3% to 12.8%. By 2019, prevalence was higher in men (34.2%) than women (25.4%), with the western regions showing the highest rates (32.9%). Key risk factors included aging (OR=1.72), elevated BMI (OR=1.85), smoking (OR=1.32), alcohol use (OR=1.28), and physical inactivity (OR=1.18) (P<0.05 for all).

Conclusions: Hypertension prevalence in China has surged over two decades, disproportionately affecting younger adults and men. Regional disparities and modifiable lifestyle factors underscore the urgency for tailored prevention strategies targeting high-risk populations. Future research should explore mechanisms driving these trends and optimize integrated interventions to curb this public health burden.

Background: Acute blood pressure (BP) elevations are common in emergency settings and are traditionally classified into hypertensive urgencies (HU) and hypertensive emergencies (HE). Malignant hypertension (MHT) represents a severe form of HE characterised by small vessel damage. Although international guidelines provide clear definitions and treatment strategies, real-world data have shown persistent fragmentation and heterogeneity in the diagnosis and management of these patients.

Methods: A web-based, anonymous survey promoted by the European Society of Hypertension (ESH) was distributed among physicians from 18 European and 4 non-European countries. The questionnaire assessed definitions, diagnostic work-up, BP measurement practices, and therapeutic strategies for HU, HE, and MHT.

Results: Sixty-four participants in 56 centres completed the survey. HU was correctly defined as a severe BP elevation without acute clinically symptomatic hypertension-mediated organ damage (A-HMOD) by 45.3% of respondents. Small cuffs were available to 79.7% and extra-large cuffs to 70.3% of respondents.. Intravenous antihypertensive therapy was used for HE by 88.7% of participants, while 20.6% also used intravenous drugs for HU. Parenteral clonidine and sublingual nifedipine were prescribed by 29.7% and 26.6% of respondents, respectively. Definitions and therapeutic approaches for MHT varied substantially, with 62.9% adopting a recently proposed definition involving at least three target organ damages in patients with BP >200/120 mmHg.

Conclusions: This international survey highlights considerable variability in the definition, diagnostic work-up, and therapeutic management of acute BP elevations, emphasising the need for harmonised protocols and further education.

Objectives: To study the prevalence and severity of right ventricular hypertrophy (RVH) in relation to left ventricular hypertrophy (LVH) among individuals with hypertension during their lifetime using post-mortem examination records.

Methods: In total, 647 autopsy protocols for individuals with systematic hypertension during their lifetime were investigated at forensic laboratories in Semey (Kazakhstan). Associations between right ventricular wall thickness (RVWT) and left ventricular wall thickness (LVWT) adjusted for age, sex, and ethnic background were studied using multiple quantile regression. LVH and RVH as categorical variables were analysed using chi-square tests and multivariable Poisson regression. Prevalence ratios (PR) were calculated using 95% confidence intervals (CI) with robust standard errors.

Results: The right ventricle hypertrophy during systemic hypertension has been less extensively studied, particularly using post-mortem examination data. The prevalence of LVH and RVH were 100% and 87.2%, respectively. A positive correlation was observed between RVWT and LVWT (r = 0.66, p < 0.001). LVWT was the strongest predictor of RVH (PR = 1.27, 95% CI: 1.19- 1.36). Moreover, male sex (PR = 1.08, 95% CI: 1.01- 1.15) and Russian ethnicity (PR = 1.11, 95% CI: 1.03- 1.20) but not age were associated with RVH in the multivariable model. LVWT was the only significant predictor of RVWT as a continuous dependent variable.

Conclusions: Right ventricular hypertrophy is common in hypertension and is more frequent and pronounced among men and ethnic Russians in Eastern Kazakhstan. Our findings corroborate the existing evidence suggesting that remodelling of the left and right ventricles occurs concurrently.

Aims: Explore the association between short sleep and hypertension risk in the Chinese population.

Methods: Data from the 2020 Chinese Psychological and Behavioural Study of the Population were utilised. Restricted cubic spline models assessed dose-response relationships between sleep duration and hypertension risk. A binary logistic regression model, incorporating propensity score matching, explored the true association between short sleep duration and hypertension risk in the Chinese population. In addition, using binary logistic regression models examined the association between >5 h of sleep and hypertension risks and the impact of health behaviours on hypertension risk among short sleepers.

Results: Sleep duration and hypertension risk exhibited a non-linear U-shaped pattern. ≤5-hour sleepers had a 32% reduced hypertension risk per additional hour of sleep post-matching. >5-hour sleep didn't affect hypertension risk. Among ≤5-hour sleepers, smoking and prolonged fixed position work increased hypertension risk by 128 and 103.4%, respectively, while engaging in physical activity for over six months reduced it by 63.7%.

Conclusion: The 5-hour sleep threshold represents a significant turning point for hypertension risk in the Chinese population studied and could serve as a criterion for defining short sleep. Lifestyle modifications such as quitting smoking, adjusting posture during work, and maintaining regular exercise routines can mitigate hypertension risk among individuals with short sleep duration.

Background: The interrelationships between physical activity (PA), sleep disorders, and hypertension remain incompletely characterised, particularly regarding potential interactions between PA and sleep disorders on hypertension risk. This study aimed to investigate these associations using complementary epidemiological approaches.

Methods: We conducted a population-based observational analysis of 18,052 adults aged ≥18 years using data from the National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey (2005-2018). Weighted multivariate logistic regression models were used to examine the associations between PA, sleep disorders, and hypertension, as well as the interaction effect of PA and sleep disorders on hypertension. Additionally, we performed a two-sample Mendelian randomisation (MR) analysis was conducted to assess the causal relationship between PA, sleep disorders, and hypertension.

Results: The analysis of observational data shows that sleep disorders are significantly associated with a higher risk of hypertension, with an odds ratio (OR) of 1.61 (95% CI: 1.10-2.35, p = 0.015). Restricted Cubic Spline (RCS) analysis revealed an S-shaped dose-response relationship between PA and hypertension (P-non-linear < 0.001). The MR analysis results were consistent with these findings.

Conclusions: Convergent evidence from observational and genetic analyses identified sleep disorders as an independent risk factor for hypertension. The non-monotonic S-shaped association between PA and hypertension underscored the importance of personalised activity prescriptions for cardiovascular risk optimisation. Notably, no significant interaction was observed between PA and sleep disorders, suggesting that their effects on hypertension are likely independent.

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.