Blood Pressure最新文献

Introduction: Radiofrequency renal denervation (RF RDN) is a catheter-based therapy for uncontrolled hypertension. This model-based analysis examined the cost-effectiveness of RF RDN in Sweden.

Methods: Clinical events, costs, quality-adjusted life-years (QALYs) were projected over 10-year and lifetime horizons using a decision-analytic Markov model. Primary health states, included hypertension alone, myocardial infarction (MI), stroke, other symptomatic coronary heart disease (CHD), heart failure (HF), end-stage renal disease (ESRD), and death. Health state transitions were informed by multivariate risk equations. Clinical evidence from the SPYRAL HTN-ON MED trial informed the treatment effect modelled (-4.9 mmHg reduction in office systolic blood pressure (SBP) vs. sham). The base case was conducted from the Swedish healthcare payer perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER),RF RDN vs. standard of care (SoC), evaluated against an assumed willingness-to-pay threshold of SEK 500,000 per QALY gained. Extensive sensitivity analyses were performed.

Results: At 10-years, the relative risks with RF RDN were 0.80 for stroke, 0.88 for MI, 0.89 for CHD, 0.72 for HF, 0.96 for ESRD, 0.86 for cardiovascular death and 0.93 for all-cause death. Over lifetime, RF RDN led to incremental costs of SEK 63,136 (total costs SEK 497,498 vs. SEK 434,362) and incremental QALY gain of 0.45 (14.79 vs. 14.34), yielding an ICER of SEK 139,280 per QALY gained. RF RDN was cost-effective across all scenarios and sensitivity analyses.

Conclusion: Model projections suggest RF RDN to be a cost-effective therapy for uncontrolled including resistant hypertension in Sweden based on contemporary clinical evidence.

Background: Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability.

Objective: We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques.

Methods: Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH).

Results: In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV.

Conclusions: BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.

Aims: We investigated on-treatment systolic BP (SBP) <130, 130-139 and ≥140 mmHg related to nephroprotection in 3065 patients with proteinuria and 10,738 patients without proteinuria in the VALUE Trial.

Method and results: Worsened kidney function (WKF) was ≥50% increase in serum creatinine, and end-stage kidney disease (ESKD) was dialysis/transplantation. Cox proportional hazards models were adjusted for covariates in the on-treatment SBP groups. Lower SBP was significantly related to less WKF (p < .001) in patients with proteinuria, both at <130 mmHg (n = 14/529, 2.6%) and 130-139 mmHg (n = 46/1176, 3.9%) compared to ≥140 mmHg (n = 145/1358, 10.7%). None of the 532 patients with proteinuria had ESKD at <130 mmHg, and only 11/1194 (0.9%) at 130-139 mmHg (p = .098) compared to 39/1339 (2.9%) at SBP ≥ 140 mmHg. In patients without proteinuria the relation between lower SBP and WKF was not significant (p = .23) at <130 mmHg (n = 24/1927, 1.2%) but significant (p = .04) at 130-139 mmHg (n = 74/4611, 1.6%) compared to SBP ≥ 140 mmHg (n = 117/4199, 2.8%). ESKD was 0.2%, 0.2% and 0.4% in the SBP groups, respectively. WKF fell from 12.1% in Q1 (highest SBP quartile) to 6.1% in Q2 (p = .023), 4.2% in Q3 (p = .006) and 2.8% in Q4 (p < .001) in patients with proteinuria and ESKD from 3.5% (Q1) to 1.6% (Q2) (p = .13), 0.7% (Q3) (p = .027) and 0.1% in Q4 (p = .009). In the patients without proteinuria, neither WKF nor ESKD showed statistically significant changes between SBP quartiles.

Conclusions: Our data suggest that, compared to SBP ≥ 140 mmHg, on-treatment SBP <130 and 130-139 mmHg were strongly related to nephroprotection in hypertensive patients with proteinuria.

Purpose: Primary aldosteronism (PA) is recognised as the most prevalent form of secondary hypertension. This study aims to provide a concise summary of one year's data from Czech registries concerning newly diagnosed cases of PA, accompanied by a brief clinical characterisation of these patients.

Materials and methods: Newly diagnosed patients with primary aldosteronism were included from five separate centres across the Czech Republic during the first year of the PA registry's existence. Additionally, data on PA diagnoses were obtained from the National Health Information and Statistics Institute of the Ministry of Health of the Czech Republic. The diagnosis of PA in the centres was established in a hospital setting in accordance with international guidelines.

Results: In the first year of the registry, 84 new cases of primary aldosteronism were identified (mean age 50.0 years; range 18-76), including 29 women (35%). Notable differences were observed among the five hypertensive centres. All patients with PA presented with hypertension, and positive adrenal imaging was found in 54% of cases. Adrenal venous sampling was performed in 85% of the patients. According to data from the Institute of Health Information and Statistics, newly diagnosed hypertension was recorded in 157,000 subjects, and PA was registered in 666 cases nationwide during the same year, with the first diagnosis of PA recorded in 153 patients. Measurements of aldosterone and renin were performed in 9,579 and 17,152 cases, respectively, throughout the Czech Republic during this period.

Conclusions: Data from Czech registries indicate a relatively low number of newly detected PA cases within one year. This finding contrasts with the current notion and may be partially attributed to infrequent laboratory screening among hypertensive patients.

Aim: To investigate age-related differences in the pharmacokinetics (PK) and pharmacodynamics (PD) of perindopril.

Methods: We compared the PK/PD of perindopril between younger (<50 years) and older (>70 years) participants in a prospective study. The primary outcome was the difference in area under the concentration-time curve (AUC), both dose uncorrected (AUC_24h, in µg/L/24h) and dose corrected (AUC_cor, in µg/L/24h/mg). We calculated the AUCs of both perindopril and its metabolite perindoprilat. Secondary outcomes included the difference in blood pressure (BP) drop between the two groups, using ΔBP between blank (pre-perindopril) and nonblank (post-perindopril).

Results: We included 26 participants, of whom 15 (58%) were aged <50 years. The median age in the younger group was 34 years (interquartile range [IQR] = 27 - 41) and 74 in the older group (IQR = 71 - 77). For both the perindopril AUC_24h and AUC_cor we did not find statistically significant differences between the younger and older group. For perindoprilat AUC_24h, there was a statistically significant difference in the median between the younger [45.8, IQR = 32.0 - 57.4] and the older group [77.0, 62.5 - 96.5; P = 0.008], as well as for perindoprilat AUC_cor [15.2, 12.2 - 20.0 and 23.1, 18.5 - 23.5; P = 0.027], respectively. We found a higher but statistically nonsignificant median Systolic BP drop between the blank and nonblank measurements in the older versus younger group (-9 mmHg vs -5 mmHg; P > 0.05).

Conclusion: Older adults exhibited higher perindoprilat exposure than younger adults, alongside an exploratory, nonsignificant trend toward greater systolic BP reduction. Given the limited sample size, no causal inference can be drawn from our data; nevertheless, these findings support consideration of age-related factors and individualized dosing in hypertension management.

Background: Heart failure (HF) is an increasing health problem globally. Profound sex-related differences have been observed regarding the cause, treatment, and prognosis of HF.

Aim: To assess baseline predictors for achieving optimal medical treatment (OMT) and the prognostic importance of OMT for male and female patients who have attended a HF clinical program (HFCP).

Methods: OPTIHEART was a retrospective study that included 870 consecutive patients with left ventricular ejection fraction (LVEF)≤40% discharged from HFCP in 2018, 2019 or 2020 and followed in registers for a mean of 1083(SD 11.3) days. OMT was defined as receiving an angiotensin-converting-enzyme-inhibitor (ACEi), angiotensin-receptor blocker (ARB) or angiotensin-II-receptor blocker and nephrylisin-inhibitor (ARNI) AND a betablocker (BB) both in doses ≥ 50% of target doses.

Results: Achieving OMT was associated with male sex (OR: 2.05 95%CI 1.44-2.97; p < 0.0001) independently of younger age, higher diastolic blood pressure (DBP), and lower creatinine. A lower rate of 5-point MACE was associated with achieved OMT (HR: 0.67 95%CI 0.50-0.90; p = 0.007) independently of female sex (HR: 0.64 95%CI 0.48-0.84; p = 0.002), younger age, never smoking and NYHA ≤ 2. The beneficial effect of OMT was insignificantly more pronounced in patients with male sex, older age, higher creatinine, lower DBP, and body mass index ≤25kg/m².

Conclusion: OMT was more frequently achieved in patients with male sex independently of age, DBP, and creatinine. Achieving OMT was associated with less 5-point MACE independently of female sex, younger age, never smoking and NYHA ≤ 2.