Blood Pressure最新文献

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.

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.

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.

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.

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.