Blood Pressure最新文献

Background: Weight loss after gastric bypass is associated with blood pressure (BP) reduction. However, the precise role of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) in this reduction remains unclear. We investigated the effect of RYGB-induced weight loss on the hemodynamic, hormonal and renal responses to an orthostatic stress induced by lower body negative pressure (LBNP).

Methods: We conducted a monocentric study comparing response to LBNP (-30 mbar) in two groups of obese participants the first group underwent RYGB surgery (RYGB group) and the second group received lifestyle counselling (control group). We studied urinary sodium excretion, hemodynamic and hormonal responses before, during and 1 h after orthostatic stress induced by LBNP at three timelines: one month before planned RYGB (intervention group), and 3 and 12 months after the intervention.

Results: Thirty-seven adult participants were enrolled: 25 patients (72% women, age: 42.1 ± 10.5 years old, BMI 43.0 ± 5.1 kg/m²) in the RYGB group and 12 in control group (58% women, age: 44.8 ± 13.6 years old, BMI 43.3 ± 5.3 kg/m²). At 12 months, mean weight decreased from 126.3 ± 23.2 kg to 116 ± 20.7 kg in the control group and from 120.9 ± 19.4 kg to 78.6 ± 14.0 kg in the RYGB group (p value < 0.01 between groups). During LBNP, the reduction in urinary sodium excretion (-1.98 mmol/h; CI95%: -3.72 to -0.30, p value = 0.02) and the increase in plasma aldosterone concentration (PAC; +9.94 pg/ml, CI 95%: 0.317-19.569, p value = 0.043) were more pronounced in the RYGB group.

Conclusions: Our study suggests that weight loss induced by RYGB increases aldosterone responsiveness to orthostatic stress and enhances the sodium tubular response during orthostatic stress.

Clinicaltrials.gov id: NCT02218112.

Purpose: Hypertension-induced vascular injury involves endothelial dysfunction, inflammation, oxidative stress, and mitochondrial damage. While remote ischaemic postconditioning (RIPost) and Enalapril independently offer vascular protection, their synergistic effects remain unclear. This study investigates the combined impact of RIPost and Enalapril on endothelial and mitochondrial function in spontaneously hypertensive rats (SHRs).

Methods: Male SHRs were divided into five groups: untreated SHR, RIPost-treated, Enalapril-treated, combination-treated (RIPost + Enalapril), and MitoQ-treated. Endothelial function was evaluated through histology and vascular relaxation assays. Inflammatory cytokines, oxidative stress indicators, and mitochondrial parameters were assessed via ELISA, Western blotting, and fluorescence-based assays.

Results: SHRs showed elevated blood pressure, endothelial damage, increased inflammatory cytokines (TNF-α, IL-6, IL-1β, MCP-1), oxidative stress (ROS, MDA), and mitochondrial dysfunction (reduced ATP, mtDNA, JC-1; altered MFN2, OPA1, FIS1, DRP1). Both RIPost and Enalapril individually ameliorated these effects, but the combined treatment produced significantly greater improvements. RIPost + Enalapril synergistically reduced blood pressure, restored endothelial integrity, suppressed inflammation and oxidative stress, and normalised mitochondrial dynamics more effectively than either intervention alone.

Conclusion: RIPost combined with Enalapril synergistically attenuates hypertension-induced vascular injury by reducing inflammation and oxidative stress while preserving mitochondrial function. These findings support the combined therapeutic strategy as a promising approach for comprehensive management of hypertensive vascular complications.

Background: Glomerular filtration rate (eGFR) derived from serum creatinine (eGFR_cr), cystatin C (eGFR_cys), or both (eGFR_cr-cys) by race-free equations are recommended staging chronic kidney disease (CKD). The current study aimed to compare these race-free eGFR equations for screening for low-grade CKD in Blacks and non-Blacks and to evaluate their association with mortality.

Methods: Race-free eGFR equations were evaluated in four studies with specific inclusion criteria based on the original research goals: African-PREDICT (341/380 healthy Black/White South Africans), FLEMENGHO (709 White community-dwelling Flemish), NHANES (1760/7931 Black and non-Black adult Americans), and 401 Black African patients hospitalised in Mbuji Mayi, Democratic Republic of Congo. The intraclass correlation coefficient and Bland and Altman statistics were used to assess consistency between eGFR equations and multivariable logistic or Cox regression to evaluate their association with mortality.

Results: Intraindividual discordance between eGFRs was larger in Black than non-Black NHANES and African-PREDICT participants. In NHANES, eGFR_cr-cys was greater than eGFR_cr, but smaller than eGFR_cys, and replacing eGFR_cr-cys by eGFR_cr moved 25% Blacks and 15% non-Blacks to a higher (worse) eGFR KDIGO stage. In African-PREDICT and FLEMENGO, half of the measured creatinine clearance to eGFR ratios fell outside the expected 1.1-1.2 band. In NHANES, multivariable hazard ratios for total and cardiovascular mortality in relation to CKD grade were all lower than unity for grade-1 CKD and greater than unity for grade ≥3 (p < 0.0001) without any racial difference (0.11≤p ≤ 0.98). These NHANES findings were consistent, if CKD stage was replaced by eGFR and in subgroup analyses. Whereas eGFR_cys and eGFR_cr-cys refined models, eGFR_cr did not.

Conclusions: The NHANES mortality outcomes support the use of eGFR_cys and eGFR_cr-cys. However, large intraindividual variability between eGFR estimates may lead to KDIGO eGFR stage misclassification and calls for caution in the opportunistic or systematic screening for CKD in asymptomatic individuals with prevention as objective.

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).