Blood Pressure最新文献

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.

Background: The May Measurement Month (MMM) initiative is an annual global screening campaign started in 2017 by the International Society of Hypertension highlighting the importance of regular measurements of blood pressure (BP). Here we report on the results of the MMM campaign done in Belgium during the month of May in 2017, 2018, 2019, 2022 and 2023.

Methods: Participants ≥18 years were recruited through opportunistic sampling in 12 sites (mostly hospital entrances) across Belgium. Apart from standardised BP recordings by trained staff, data were collected on demographics, lifestyle factors and comorbidities. Hypertension was defined as raised BP (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) and/or taking antihypertensive medication.

Results: Data were collected from 5,926 participants aged 51.5 years on average. Mean (SD) systolic and diastolic BP were 125.9 (17.6) mmHg and 79.4 (10.9) mmHg with 25.8% exceeding the 140/90 mmHg threshold. Age-standardised prevalences of hypertension were 45.4% in men and 36.9% in women. Among the 2,468 individuals with hypertension, 78.5% had been previously diagnosed and 1,578 of those with known hypertension, received antihypertensive treatment. Only about half of those being treated (56.3%) did achieve the target of systolic/diastolic BP <140/90 mmHg. Inadequate therapeutic control was independently associated with increasing age and higher body mass index. Untreated hypertension was significantly associated with male sex, age, body mass index and alcohol use.

Conclusion: Despite the limited representativeness of the sample, these data suggest that the 'rule of halves' for hypertension no longer holds true in Belgium and that therapeutic control of hypertension is still suboptimal.

Background: Recently, both international and Chinese guidelines have mentioned for the first time that blood pressure (BP) target range is more reasonable and workable than BP target in clinical practice, and time in target range (TTR) could become a potential evaluation indicator for long-term blood pressure management. Until now, there was no research on the long-term effects of antihypertensive treatment on systolic BP (SBP) TTR. The objective, therefore, is to observe the impact of long-acting calcium channel blockers (CCBs) on BP TTR in Chinese patients with hypertension (HTN).

Methods: A retrospective observational study was conducted using data from the China Cardiovascular Association Hypertension Centre, including 36,153 adult patients diagnosed with primary HTN and treated with amlodipine-based antihypertensive therapy between 1 January 2018 and 31 December 2022. The primary endpoint was the SBP TTR. Other endpoints included the annual trend of SBP TTR, factors influencing SBP TTR, etc.

Results: Results showed an overall SBP TTR was 80.42 ± 21.97%. The SBP TTR at 1, 2 and 3 years of follow-up was 79.49 ± 26.16%, 81.86 ± 25.10% and 82.79 ± 25.77%, respectively, showing a significant difference (p < 0.001). Seven factors were positively correlated with SBP TTR, while three factors were negatively correlated with SBP TTR including heart failure, high baseline SBP level, and high LDL-C level.

Conclusion: Long-term and continuous use of amlodipine-based antihypertensive therapy could improve SBP TTR. This finding may relate to the characteristic of amlodipine which is a long-acting drug due to pharmacokinetic properties.

Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2400090150.