Blood Pressure最新文献

Purpose: The implementation of hypertension guidelines into the everyday practice of general practitioners (GPs) have an outmost importance to provide optimal care for patients. The aim of our study was, on the one hand to gain insight about the relationship between hypertension societies and GP societies, and on the other hand, to get feedback about the use of single pill combinations (SPC) in each country, as an indicator of guideline implementation.

Materials and methods: The European Society of Hypertension (ESH) GP Nucleus initiated a survey containing 17 questions about the existence and number of national hypertension and GP societies, the relationship between them and with pharmacists and nurse associations, the authors of national guidelines and the availability of SPCs. The survey was sent to the national hypertension society representatives of ESH. Additionally, data about the number of SPCs sold yearly was also checked using IQVIA database.

Results: Responses were collected from 25 European countries. In most of the countries there is only one hypertension society (23/25) and one GP society (18/25), most of which having a relationship with each other (22/25). Of the countries with national hypertension guidelines most of them are written by the national hypertension society (45%) followed by the GP society (27%) or by public administration (27%). Two thirds of the national hypertension societies (16/25) have relationship with nurse societies and half of them (12/25) with pharmacists. In 65% (15/23) of the guidelines dual SPC therapy is recommended for treatment initiation however, marked differences are present in the number of yearly sold SPCs in different countries.

Conclusions: National hypertension societies have remarkable impact on GPs for the management of hypertensive patients. However, improvement is needed in the collaboration with nurse and pharmacist societies and in some countries in the use of SPCs for hypertension therapy.

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.

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.

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.

Objectives: This study investigates the effects of whole-body vibration (WBV) training on arterial stiffness (AS) in adults.

Methods: We primarily evaluated pulse wave velocity (PWV) as the main outcome, while augmentation index (AIx), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were secondary measures. Data analysis was conducted using RevMan 5.4.1 software, employing a random effects model for pooled effect sizes, reported as weighted mean differences (WMD) with 95% confidence intervals (95% CI).

Results: Seven randomised controlled trials (RCTs) involving 174 subjects were included. WBV training significantly reduced PWV (-0.68 m/s [95% CI: -0.81 to -0.54], p < 0.00001), AIx (-5.81% [95% CI: -7.51 to -4.11], p < 0.00001), SBP (-4.82 mmHg [95% CI: -7.71 to -1.94], p = 0.001), and DBP (-1.90 mmHg [95% CI: -3.71 to -0.09], p = 0.04).

Conclusions: Long-term WBV training significantly improves arterial health by reducing PWV, AIx, SBP, and DBP in adults. These findings support WBV training as a beneficial intervention for cardiovascular health management.

Purpose: This study aimed to investigate the effects of public health nursing combined with dietary intervention on metabolic control, self-management abilities, and quality of life in patients with both diabetes mellitus (DM) and hypertension (HTN).

Materials and methods: A total of 120 patients with DM and HTN were randomly classified into a control group or an intervention group. Baseline data, SBP, DPB, FPG, 2hPG, and HbA1c were compared between the two groups before and after the intervention. Disease knowledge was assessed using the Diabetes Knowledge Questionnaire (DKQ). Dietary behaviour management was evaluated using a 5-point Likert scale and management norms for DM and HTN. Quality of life was assessed utilising the GQOLI-74. Self-management ability was recorded as the proportion of patients meeting the established criteria. Patient satisfaction was compared using a hospital-developed satisfaction questionnaire.

Results: Following the intervention, the intervention group demonstrated notably lower levels of SBP, DPB, FPG, 2 hPG, and HbA1c (p < 0.01). The intervention group exhibited significant improvements in DKQ scores, dietary behaviour, and GQOLI-74 scores, as well as significantly higher compliance rates across all dimensions of self-management ability (p < 0.01). Moreover, overall patient satisfaction was significantly higher in the intervention group (p < 0.01).

Conclusion: Public health nursing combined with dietary interventions can effectively improve blood pressure, glycemic control (FPG, 2hPG, HbA1c), disease knowledge, dietary behaviour, and self-management ability, while also enhancing quality of life and patient satisfaction in patients with DM and HTN.

Objective: To determine the prevalence rate and risk factors for systemic arterial hypertension in infants with congenital heart diseases.

Methods: A retrospective cohort study of postoperative systemic arterial hypertension incidence in infants who underwent cardiac surgery was conducted. The primary diagnosis was retrieved. The general characteristics, surgical information, and blood pressure data at five periods were also collected. The five periods were at admission, 48 hours after cardiac surgery (postoperative), at discharge, at full-time, and at any time during hospitalisation. The risk factors for postoperative hypertension and hypertension at discharge were determined by multivariate logistic regression.

Results: This study enrolled 1205 eligible infants. The age and weight at surgery were 27.0 (13.0, 59.0) days and 3.53 ± 0.96 kg, respectively. The prevalence rates of postoperative hypertension and hypertension at discharge were 12.8 (10.9-14.7)% and 6.9 (5.5-8.3)%, respectively. The incidence of postoperative hypertension varies greatly across different types of congenital heart diseases. A low weight Z score, preoperative hypertension, patent ductus arteriosus, and coarctation of the aorta were risk factors for postoperative hypertension, whereas transposition of the great arteries grouped with pulmonary atresia, pulmonary stenosis, and total anomalous pulmonary venous connection was a protective factor. The ventricular septal defect was a risk factor for postoperative hypertension but not for hypertension at discharge.

Conclusions: The incidence of postoperative systemic arterial hypertension is high in infants after cardiac surgery. The prevalence of hypertension decreased at discharge. Prospective long-term follow-up studies are needed to delineate the natural history of hypertension in high-risk children.

Background: High blood pressure variability (BPV) is associated with cerebrovascular damage and dementia, but it is unknown whether short-term BPV during hospitalisation is also associated with cerebral white matter (WM) damage. We examined whether BPV, measured in-hospital using continuous monitoring, is associated with WM microstructural integrity in COVID-19 patients.

Methods: We included hospitalised COVID-19 patients from the CORONavirus and Ischemic Stroke (CORONIS) study who underwent continuous vital signs monitoring using a wearable device during hospital admission and had an MRI shortly after discharge. Systolic BPV was calculated as Average Real Variability (ARV) and Coefficient of Variation (CV) with 1-, 5- and 20-minute intervals. We used diffusion tensor imaging to assess fractional anisotropy (FA) and peak width of skeletonised mean diffusivity (PSMD) as markers of WM integrity. Associations between BPV and WM integrity were examined with linear regression adjusted for age, mean systolic blood pressure (BP), number of BP measurements and type of respiratory support.

Results: We included 47 COVID-19 patients (mean age: 59.6 years). BP was measured 6306 ± 4343 times per patient (median admission: 11 days (Interquartile Range [IQR] 7.5-15.0). Both higher ARV and CV were associated with lower WM microstructural integrity, reflected by lower FA (ARV: β = -0.40, p = .010; CV: β = -0.33, p = 0.026) and higher PSMD (CV: β = 0.28, p = .038) after adjustment for confounders. Correction for WM hyperintensities did not change these results.

Conclusions: High BPV during hospitalisation is associated with lower WM integrity in COVID-19 patients, although causality needs to be demonstrated. Our findings need validation in hospitalised patients without COVID-19 to examine generalisability.

Background: The weight-adjusted waist index (WWI) is a novel obesity measure standardizing waist circumference by body weight. While linked to cardiometabolic disorders, its association with hypertension (HTN) and the mediating role of systemic inflammation remain unclear. This study investigated the WWI-HTN relationship and the mediating effects of C-reactive protein-albumin-lymphocyte ratio (CALLY), C-reactive protein-albumin ratio (CAR), and lymphocyte-C-reactive protein ratio (LCR).

Methods: We analyzed data from 10,869 adults (≥20 years) in NHANES 1999-2010. Associations of WWI with HTN and inflammatory markers were examined using multivariable regression, restricted cubic splines (RCS), and generalized additive models (GAM). Mediation was evaluated through bootstrap analysis.

Results: Higher WWI was strongly associated with HTN risk (OR = 1.79; 95% CI: 1.66-1.93; P < 0.001). Participants in the highest quartile had nearly fourfold greater risk than those in the lowest (OR = 3.79; 95% CI: 3.04-4.72). The relationship remained robust after adjusting for inflammatory markers (OR = 1.62; 95% CI: 1.49-1.75). Elevated log-CALLY and log-LCR were protective, whereas higher log-CAR increased HTN risk. Mediation analyses showed CALLY, LCR, and CAR explained 12.81%, 12.54%, and 15.89% of the association, respectively, with a combined effect of 13.91%. Subgroup analyses confirmed WWI as a consistent risk factor, and RCS/GAM demonstrated a nonlinear positive association with a threshold at WWI = 11.70.

Conclusion: WWI is independently and nonlinearly associated with hypertension risk, particularly when WWI ≤11.70. Systemic inflammation partially mediates this association, underscoring its role in obesity-related hypertension.