Blood Pressure最新文献

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.

Background: Hypertension is a global health concern, and antihypertensive medications are vital for its management. This study examined evolving trends in antihypertensive medication usage among adults with hypertension from 1999 to 2020.

Methods: Data from 10 National Health and Nutrition Examination Survey (NHANES) survey cycles were obtained for adults aged 18 years and older with hypertension. The study analysed demographic, drug classification and demographic variables. All statistical analyses, including logistic regression, were used to assess trends.

Results: Among 18,221 hypertensive participants, diverse characteristics were observed. The use of angiotensin-converting enzyme inhibitors increased from 26.18% in 1999 to 32.76% in 2020 (linear p = 0.001). Angiotensin receptor blocker use rose from 10.36% to 26.57%. Beta blocker usage increased from 28.98% in 1999 to 42.50% in 2010, plateauing at approximately 40% from 2011 to 2020 (quadratic p < 0.001). Calcium channel blocker (CCB) utilisation increased from 16.70% in 1999 to 20.46% in 2020 (linear p < 0.001). Diuretic (DU) use decreased from 32.70% in 1999 to 26.34% in 2020 (quadratic p = 0.009). The use of antihypertensive medications varies across different demographic groups and comorbidities.

Conclusions: ACEI, ARB and CCB usage increased, while DU usage decreased. BB utilisation stabilised at a high rate. Antihypertensive drug use displayed diverse trends across demographic groups and comorbidities.

Objective: To investigate the prevalence and clinical characteristics of primary aldosteronism (PA) in patients with hypertension and obstructive sleep apnoea (OSA) in a newly established cohort, given inconsistencies in previous studies and intolerance to drug washout in some cases.

Design and method: A single-centre cross-sectional study enrolled 316 hypertensive patients diagnosed with OSA via polysomnography. All participants underwent PA screening, followed by confirmatory testing for positive cases. Patients with confirmed PA underwent further subtype diagnosis and were assigned to the OSA and PA group. Those unable to undergo antihypertensive drug washout but with a high clinical suspicion of PA were categorised into the OSA and suspected PA group.

Results: Among 316 patients, 41 (13.0%) were PA. The prevalence was 4.8% in OSA alone, and 50.0% in OSA with hypokalaemia. Compared to the OSA group, the OSA and PA group had a lower proportion of current smokers, a longer duration of hypertension, lower serum triglycerides, lower serum potassium, higher plasma aldosterone concentration, urinary aldosterone excretion, and lower renin. Multivariable logistic regression showed that the diagnosis of PA in OSA patients was positively associated with hypertension duration, and negatively associated with serum potassium levels and smoking.

Conclusions: PA screening may be considered in patients with hypertension and OSA; however, given the relatively low prevalence in those with OSA alone, routine screening may not be cost-effective. In contrast, the presence of hypokalaemia was strongly associated with a higher prevalence of PA, suggesting that targeted screening is warranted in this subgroup.

Background/aim: Higher blood pressure (BP) variability (BPV) has been associated with cardiovascular organ damage in cross-sectional studies. Less is known about short-term BPV and organ damage during long-term management of young ischaemic stroke survivors.

Methods: Short-term weighted systolic BPV was assessed from ambulatory 24-hour BP recordings three months after the index stroke in 283 ischaemic stroke survivors aged 15-60 years in the prospective Norwegian Stroke in the young study (NOR-SYS). Organ damage was identified as carotid-femoral pulse wave velocity > 10 m/s, carotid intima-media thickness (cIMT) > 0.9 mm, carotid plaque, and abnormal left ventricular (LV) geometry (LV hypertrophy or concentric LV remodelling). Associations of systolic BPV with organ damage at baseline and after five years were identified in logistic regression analyses.

Results: Weighted systolic BPV was associated with all types of organ damage both at baseline and at 5-year follow-up in univariable analyses. When adjusted for other cardiovascular risk factors, weighted systolic BPV at baseline remained associated with presence of cIMT > 0.9 mm at follow-up (p = 0.03), independent of BP, body mass index and tobacco smoking at follow-up. Associations with all other organ damage outcomes were lost when adjusted for BP in multivariable analysis. In contrast, systolic BP remained associated with all types of organ damage both at baseline and follow-up (all p < 0.05).

Conclusions: In NOR-SYS, the association of higher weighted systolic BPV with cardiac and arterial organ damage was mostly explained by higher systolic BP both at baseline and at 5-year follow-up.

Background: Blood pressure (BP) monitoring is crucial for the management of hypertensive disorders of pregnancy. Cuffless, continuous BP-monitoring devices have been developed, but have yet to be validated during pregnancy.

Objectives: To describe the case of a 37-year-old patient presenting primary hyperaldosteronism, who suffered from severe preeclampsia during her first pregnancy. She chose to wear a cuffless BP monitoring device (AKTIIA) during her second pregnancy while undergoing three 24-h ABPM sessions. She developed preeclampsia, leading to hospitalisation and premature birth at 32 weeks of pregnancy. We aimed to compare the results obtained with these two methods for BP monitoring.

Methods: We described the pregnancy and medication evolution. We compared results obtained during the same 24-hour period with the AKTIIA device and ABPM device, on two occasions during pregnancy and at 6 months postpartum. Mean daytime, nighttime and 24-hour blood pressure values were calculated during these three sessions, and the difference in paired BP values illustrated with a Bland and Altmann plot. Individual BP readings aquired by both devices within the same 5-minute intervals were also compared.

Results and conclusions: For three 24-h ABPM sessions, daytime mean BP values were comparable between the ABPM cuff and the AKTIIA device, but we noted noted significant differences between the ABPM and AKTIIA's measurements during nighttime. The AKTIIA device helped to ensure closer monitoring of her blood pressure. Our results highlight the need for formal validation of such devices during pregnancy.