Blood Pressure最新文献

Background: The optimum systolic blood pressure (BP) after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluate the safety and efficacy of more intensive BP management compared to less intensive BP management.

Methods: We searched various electronic databases to retrieve relevant RCTs on the clinical effects of more intensive BP management after endovascular thrombectomy compared to the less intensive management. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes.

Results: Our meta-analysis included four RCTs with a total of 1560 patients. More intensive BP management (<140 mmHg) was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale [mRS] score = 0-2) at 90 days (OR 0.69; CI = 0.51-0.94). Regarding 90-day mortality, our pooled results showed no statistically significant difference between the two groups (OR 1.21; CI = 0.89-1.65). There was no statistically significant difference between the two groups regarding the incidence of intracerebral haemorrhage (ICH) (OR 1.09; CI = 0.85-1.39) and the incidence of symptomatic intracerebral haemorrhage (sICH) (OR 1.11; CI = 0.75-1.65).

Conclusion: According to our meta-analysis, the intensive BP lowering group decreased the number of patients showing functional independence at 90 days. We found no benefit of the intensive lowering of BP on mortality rates and incidence of ICH compared to the conservative BP management. Future large-scale trials should focus on other interventions to improve prognosis in these patients.

Introduction: To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit (ICU).

Methods: Patients with a diagnosis of hypertension and dialysis who received antihypertensive agents during hospitalisation were included. Based on whether treated with ACEI/ARB, patients were divided to ACEI/ARB group and non- ACEI/ARB group. In-hospital mortality and 30-day all-cause mortality were compared between the two groups in the overall participants and after propensity score matching.

Results: The study included 647 patients, among which 227 (34.70%) were treated with ACEI/ARB. Compared to the non-ACEI/ARB group, fewer patients in the ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, p < 0.001). The overall hospital mortality rate was 5.1%, and 9.0% of patients died during the 30-day follow-up period. ACEI/ARB group were with better clinical outcomes during hospitalisation (2.2% vs 6.7%, p = 0.023) and after 30-day follow-up (5.3% vs 11.0%, p = 0.016). ACEI/ARB treatment was independently associated with lower risk of hospital mortality (OR 0.24, 96% CI: 0.051 - 0.82, p = 0.038) and 30-day mortality (HR 0.36, 95% CI:0.15-0.89, p = 0.029) after adjusting confounding factors. After propensity score matching (PSM, 112 pairs), the ACEI/ARB group showed higher in-hospital (99.1% vs 91.1%, p = 0.013) and 30-day (95.5% vs 88.4%, p = 0.048) survival rates compared to the control group. ACEI/ARB was identified as an independent protector for 30-day mortality in the matched cohort (HR 0.33, 95% CI: 0.11-0.95, p = 0.041).

Conclusion: ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day outcomes in dialysis patients with hypertension in the ICU.

Background: Transportation noise seems to be inherent in modern urban living. However, many studies indicate that it can unfavorably affect human health, especially by influencing the cardiovascular outcome. The large number of people exposed to noise in the European Union becomes relevant to public health. This requires the creation and implementation of laws that aim to reduce the burden of adverse environmental factors, such as noise, air pollution, and light pollution. Road noise, aircraft, and railway noise have been shown to increase the incidence of hypertension, myocardial infarction, and mortality.

Aim and method: This narrative review presents possible mechanisms of adverse effects of noise on the body that lead to increased cardiovascular risk, its potential reversibility, and methods of mitigating noise influence.

Conclusions: Comprehensive multidisciplinary efforts are needed to reduce the impact of noise on Europeans and thereby reduce cardiovascular risk. Authorities, institutions, and healthcare providers play an important role in mitigating noise impact and promoting awareness, emphasizing the importance of continuous monitoring and preventive screening for especially vulnerable people in areas of high exposure..

Aims: To assess perceptions, motivations and barriers to treatment adherence depending on emotional, lifestyle, medical and non-adherence risk profiles in hypertensive patients.

Methods and results: Cross-sectional data were obtained using an online anonymous survey. Four distinct global risk scores (medical, lifestyle, emotional and quality of life (QoL) and non-adherence risk scores) were calculated based on the responses to specific groups of questions. A total of 2615 treated hypertensive patients (≥18 years of age) from 5 European countries completed the questionnaire. Mean (SD) age was 69.6 years (5.8); 54% males. Overall, antihypertensive therapy represented a low burden in patients' daily life (2.9/10 in the Likert scale). Perfect self-reported adherence was claimed by 59.8% of participants. Reporting of non-adherence episodes to physicians was low (13% always/often). Participants with a high non-adherence risk score had a greater number of associated diseases (obesity, sleep disturbances, depression and cardiac complications), a higher treatment-associated burden on daily life, a greater stress level and more antihypertensive pills per day (p < 0.001 for all). No correlation was found between the clinical and lifestyle risk scores and the risk of non-adherence. The emotional score correlated significantly with the non-adherence risk score (p < 0.001). Comparing patients with a low/middle risk to those with a high risk of non-adherence, female gender and age >65 years were associated with a lower odd ratio of non-adherence whereas depression, stress, family hardships, negative information on drugs and poor information were associated with higher odds of non-adherence.

Conclusions: This large survey reveals several underestimated issues regarding patients' perspective in hypertension. It highlights the impact of emotions, exposure to family hardships, and stress on the risk of non-adherence. Non-adherence is underreported by patients; hence it remains mostly unrecognised.

Purpose: The Portuguese Society of Hypertension is responsible for the Mission 70/26 Project, a movement that aims to achieve 70% control of hypertensive patients aged 18-65 years old, under Primary Healthcare by 2026. To reach the general population, different activities were done, in this article we will describe one in particular, the campaign called 'Pela Saúde de Portugal'.

Materials and methods: From December 2023 to July 2024, there were nine screenings for hypertension done in eight cities in Portugal. Volunteers were asked about medical history, their weight and blood pressure were assessed and they were informed about Hypertension (HTN) and target organ damage.

Results: 479 screenings were performed. Of the participants, 243 (51%) were female. History of hypertension was reported in 34,7% of them and 32,4% of these were taking medication. There was a significant blood pressure (BP) reduction from the first to the third measurement and both systolic and diastolic BP (mean of the second and third measurements) were higher in hypertensive patients. There were significant BP differences between the cities.

Conclusion: 'Pela Saúde de Portugal' was not a study of the prevalence of hypertension but merely an awareness campaign with HTN screening done all around the country. This type of campaign is important to draw attention to HTN and other risk factors, improving health literacy in this field. The analysis of the volunteer's characteristics is important to design future interventions.

Background: Myocardial infarction (MI) remains a leading global cause of morbidity and mortality, with rising prevalence in China. Hypertension persists as a predominant modifiable risk factor. This study investigates MI prevalence, trends and risk factors using data from China CDC's Chronic Disease Surveillance program. Methods: Data from 258,742 participants (2021-2023) were analysed. Demographic characteristics, risk factors and gender/urban-rural disparities in MI prevalence were assessed. Multivariate logistic regression identified significant risk factors. Results: Hypertension was the leading MI risk factor (64.3%), followed by dyslipidaemia (58.6%) and smoking (42.3%). Men had higher MI prevalence than women (58.2% vs. 41.8%), and urban residents surpassed rural residents (56.7% vs. 43.3%), with significant lifestyle disparities (e.g. physical inactivity and smoking). Multivariate analysis identified age ≥ 60 years (OR = 2.75, 95% CI: 2.46-3.08), hypertension, dyslipidaemia, smoking and obesity (BMI ≥ 25) as key risk factors. MI incidence increased by 3.14% nationally from 2021 to 2023. Conclusions: China's MI burden is escalating, with notable gender, age and residence disparities. Older adults and individuals with hypertension, dyslipidaemia, smoking or obesity face elevated risks. Hypertension contributes to nearly two-thirds of MI cases, emphasising the urgency for targeted prevention strategies, particularly in high-risk groups (hypertensive individuals, older adults and urban populations).

Objective: This study aimed to investigate the relationship between exaggerated hypertensive response to exercise (EHRE), mobile phone screen time and daily physical activity levels, with a focus on potential lifestyle-related factors that contribute to cardiovascular risk.

Methods: This observational case-control study enrolled 85 participants, who were categorised into an Exaggerated Hypertensive Response to Exercise (EHRE) group (n = 33) and a normotensive control group (n = 52). Participants underwent a standardised treadmill exercise test to identify EHRE. Objective data on daily mobile phone screen time and step counts were collected directly from the smartphones' native tracking applications.

Results: Compared to controls, participants with EHRE exhibited significantly higher daily mobile phone screen time (6.1 ± 1.2 h/day vs. 4.7 ± 0.9 h/day; p < .001), greater weekly screen time in dim-light conditions (e.g. in bed at night) (14.5 ± 3.4 h/week vs. 7.0 ± 2.1 h/week; p < .001), a longer duration of mobile phone usage (19.7 ± 1.9 years vs. 17.7 ± 1.5 years; p = .002) and notably lower daily step counts (4120 ± 950 steps/day vs. 6830 ± 1120 steps/day; p < .001).

Conclusion: Increased mobile phone screen time and reduced physical activity levels were significantly associated with EHRE, suggesting that these factors are relevant as modifiable behavioural risk factors. These findings support the integration of digital behavioural metrics into preventive cardiovascular risk management strategies.

Introduction: Catheterisation of the right adrenal vein during adrenal venous sampling (AVS) is technically challenging and may fail.

Purpose: We hypothesised that, in selected patients with primary aldosteronism who have a right adrenal gland adenoma on imaging, left-sided suppression on AVS could be sufficient to qualify the patient for successful surgical treatment.

Methods: We identified 77 patients referred to the Hypertension Inpatients Clinic at the Medical University of Gdańsk between 2015 and 2023 with suspected primary aldosteronism, subsequently confirmed by an intravenous saline suppression test. All patients underwent AVS, and management (surgical or pharmacological) was guided by the results. The effectiveness of surgical treatment was assessed by improvements in blood pressure control and reductions in serum aldosterone concentration.

Results: Of the 77 patients with confirmed primary aldosteronism, 13 (mean age 59.5 ± 10.1 years; 2 women) had a focal lesion in the right adrenal gland. In this subgroup, catheterisation of the right adrenal vein was unsuccessful in 4 patients (mean age 64.8 ± 6.5 years; 1 woman) due to anatomical factors; therefore, only the contralateral suppression index was calculated (mean 0.31). In view of their clinical histories and the right adrenal lesion on CT, all 4 patients were referred for adrenalectomy, and histology confirmed an aldosterone-producing adenoma. Following surgery, a significant decrease in serum aldosterone concentration (mean reduction 36.5 ± 18 ng/dL) and improved blood pressure control were observed.

Conclusion: In selected patients with primary aldosteronism - those with a typical right adrenal adenoma on CT and left-sided suppression on AVS- the suppression index may be considered a sufficient criterion for proceeding to adrenalectomy.

Background: Ambient fine particulate matter (PM2.5) is a major environmental risk factor for hypertension, yet the renal sodium-handling mechanisms remain incompletely understood. This study investigates the role of G protein-coupled receptor kinase 4 (GRK4) and its downstream signalling axis in PM2.5-induced hypertensive pathogenesis.

Methods: Male Sprague-Dawley rats were exposed to PM2.5 (10 or 40 mg/kg) via intratracheal instillation for 12 weeks. Hemodynamic parameters, renal function, and molecular alterations were analysed using immunohistochemistry, Western blot, qPCR, and co-immunoprecipitation. GRK4 expression was manipulated via lentiviral vectors to validate its role in blood pressure regulation.

Results: PM2.5 exposure induced dose-dependent hypertension, renal dysfunction, and sodium retention. Mechanistically, PM2.5 upregulated renal GRK4 expression through promoter hypomethylation, enhancing its interaction with Nedd4L (a ubiquitin ligase). Phosphorylated Nedd4L (p-Nedd4L) reduced epithelial sodium channel (ENaC) ubiquitination, leading to ENaC accumulation and sodium reabsorption. GRK4 overexpression exacerbated hypertension and sodium retention, whereas GRK4 knockdown attenuated these effects.

Conclusion: This study identifies a novel signalling axis-GRK4/Nedd4L/ENaC-in PM2.5-induced hypertension, highlighting epigenetic and post-translational regulatory mechanisms. These findings provide mechanistic insights into environmentally mediated hypertensive pathogenesis and suggest potential therapeutic targets for PM2.5-related cardiovascular diseases.

Objective: The optimal level of home blood pressure (HBP) for the prevention of cardiovascular complications is unknown. The Home Blood Pressure Intervention in the Community Trial (HomeBP, [NCT05858944]) is addressing this issue by randomising elderly hypertensive patients to standard or tight HBP control.

Methods and analysis: HomeBP is an investigator-initiated randomised clinical trial with open design and blinded endpoint evaluation. Eligible patients of either sex, aged 60-80 years, having uncontrolled home hypertension (≥135/85 mm Hg) after medication for at least 2 weeks will be recruited nationwide in China at up to 200 community healthcare centres. After stratification for centre and the presence of office hypertension (≥140/90 mm Hg), 10,000 patients will be randomised in a 1:1 proportion to a target HBP of 125-134/75-84 mm Hg or <125/75 mm Hg and followed up for 4 years. The primary outcome is a composite of cardiovascular death, non-fatal myocardial infarction, coronary revascularisation, unstable angina pectoris or heart failure requiring hospitalisation, and non-fatal stroke. Follow-up visits are scheduled monthly for 3 months after randomisation and 3-monthly thereafter. Patients record HBP for 7 consecutive days before every visit. A unique feature of the trial is the information technology setup, allowing the secure and instantaneous flow of HBP and other data to the study coordinating centre, where a standardised HBP report is generated. Hypertension specialists at Ruijin Hospital, Shanghai and at local tertiary hospitals provide treatment recommendations, which are transmitted to the caregivers at the community centres, who then fine-tune the treatment recommendations in a shared decision process with the patients to meet the values and clinical needs of the patients. Currently, 2281 patients have been randomised with no between-group differences in the baseline characteristics.

Trial registration number. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05858944.