Blood Pressure最新文献

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.

Background: Hypertension is the UK's most common treatable cause of mortality and morbidity, including cardiovascular disease (CVD), renal disease and dementia.

Objective: This systematic review has explored the efficacy and safety of commencing full-dose antihypertensive treatment in individuals with essential hypertension.

Method: Method16 randomised controlled trials (RCTs) were eligible for inclusion, with some RCTs assessing more than one treatment. The review assessed commonly used antihypertensive drugs (perindopril 8 mg, ramipril 10 mg, amlodipine 10 mg, losartan 100 mg, irbesartan 300 mg, candesartan 16 mg and candesartan 32 mg) compared to low starting doses or placebo RCTs. Eligible studies included 12 RCTs that compared full vs low doses and 19 RCTs that compared full starting doses vs placebo. The primary outcome was the difference in blood pressure reduction compared to controls (reported or calculated). ResultsUsing full doses compared to low doses led to better BP reduction (overall, 3.9/2.2 mmHg lower achieved BP) without an increase in adverse effects. This notion is supported by the changes achieved with full-dose treatment initiation compared to placebo (average over all studies: 11.4 [4.4]/6.5 [2.9] mmHg).

Conclusions: This review indicates that initiating full-dose antihypertensives for essential hypertension may be beneficial and safe. The available data are limited, and further RCTs are required to assess this in specific patient groups to assess safety and efficac.

BackgroundIntradialytic hypotension (IDH) is the most prevalent complication during hemodialysis (HD) sessions, affecting 10% to 12% of patients. It is linked with temporary ischemic stress in vital organs, increasing patient mortality. Various definitions of IDH have been proposed, and a strong correlation has been found between patient outcomes and the absolute lowest systolic blood pressure. The most probable underlying pathophysiology of IDH involves a reduced effective blood volume and decreased plasma tonicity. Optimizing the dialysis prescription and interventions during and after the dialysis session is sometimes effective for reducing IDH risk.Aim and MethodThis review discusses the pathophysiology, prevention, and therapy of IDH updates. To achieve this aim, Scopus, EMBASE, PubMed, Google, and Google Scholar were searched for articles published in the last two decades using phrases and keywords.ConclusionIntradialytic pathophysiology is ambiguous and unclear. The evidence for the effectiveness of the known therapies and maneuvers is limited. Ideally, IDH prevention should be the target; however, IDH management is sometimes needed. Different obstacles require further clinical research.

Objective: This study investigates the relationship between hypertension, dysregulation of the autonomic nervous system, heart rate variability (HRV), and chronic inflammation.

Methods: We analysed a cohort of 50 hypertensive patients treated at the affiliated Hospital of Jianghan University. The average systolic and diastolic blood pressures (BPs) in this group were 155.26 and 95.32 mmHg, respectively. A control group of 50 healthy volunteers, undergoing routine physical examinations at the same hospital, was also analysed.

Results: The average systolic BP of the control group was 115.64 ± 10.27 mmHg, and the average diastolic BP was 75.33 ± 8.25 mmHg. In contrast, the experimental group exhibited an average systolic BP of 155.26 ± 20.13 mmHg and an average diastolic BP of 95.32 ± 12.16 mmHg. Both systolic and diastolic BPs were significantly higher in the hypertensive group (p < 0.05). The experimental group also demonstrated reduced HRV and skin conductance response, alongside increased BP variability (BPV), urinary epinephrine levels and prolonged pupillary light reaction time compared to controls (p < 0.05). Notably, Standard Deviation of Normal to Normal Intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD) values were significantly lower in the experimental group (p < 0.05). Furthermore, levels of inflammatory markers such as CRP, TNF-α, IL-6 and IL-1β were markedly elevated in hypertensive patients (p < 0.05). Negative correlations were observed between systolic and diastolic BP with HRV metrics, while positive correlations were found between BP and BPV as well as urinary adrenaline levels.

Conclusions: The findings indicate that hypertension is closely associated with autonomic nervous system dysfunction, reduced HRV and increased chronic inflammation. A comprehensive approach to hypertension management should integrate these interrelated physiological and pathological mechanisms, with potential therapeutic interventions targeting autonomic function and inflammatory states.

Purpose: Socioeconomic status has been related to resting blood pressure (BP) levels at different stages of life. However, the association of childhood socioeconomic status (SES) and adulthood exercise BP is largely unknown. Therefore, we studied the association of childhood SES with adulthood maximal exercise BP.

Materials and methods: This investigation consisted of 373 individuals (53% women) participating in the Cardiovascular Risk in Young Finns Study who had data concerning family SES in childhood (baseline in 1980, at age of 6-18 years) and exercise BP response data in adulthood (follow-up in adulthood in 27-29 years since baseline). A maximal cardiopulmonary exercise test with BP measurements was performed by participants, and peak exercise BP was measured.

Results: In stepwise multivariable analysis including childhood risk factors and lifestyle factors (body mass index, systolic BP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, fruit consumption, vegetable consumption, and physical activity), lower family SES in childhood was associated with higher maximal exercise BP in adulthood (β value ± SE, 1.63 ± 0.77, p = 0.035). The association remained significant after further adjustment with participants SES in adulthood (β value ± SE, 1.68 ± 0.65, p = 0.011) and after further adjustment with adulthood body-mass index, systolic BP, maximal exercise capacity, and peak heart rate in exercise (β value ± SE, 1.25 ± 0.56, p = 0.027).

Conclusions: These findings suggest that lower childhood family SES is associated with higher maximal exercise BP in adulthood.

Objectives: Evidence suggests that renal function increasingly deteriorates in patients with apparently treatment-resistant hypertension (ATRH) in comparison with those who have non-resistant arterial hypertension (NAH). We aimed to assess the long-term decline in renal function between these patient groups and identify specific risk factors contributing to the progression of renal dysfunction. Methods: Data for 265 patients with ATRH and NAH in a hypertension excellence centre were retrospectively evaluated. Demographic characteristics, co-morbidities, laboratory findings, secondary causes of hypertension, medication and exposure to contrast agents were assessed. To address differences between groups, adjustment with linear mixed-effect models was used. Results: Data from the first 4 years of follow-up were evaluated. After adjustment for age and diabetes, which were identified as independent risk factors for renal dysfunction progression in the study cohort, the mean decrease in estimated glomerular filtration rate per year was steeper with ATRH than with NAH (-1.49 vs. -0.65 mL/min/1.73 m² per year; difference in slope, 0.83 mL/min/1.73 m² per year; 95% confidence interval [CI]: 0.25-1.41, p = 0.005). In subgroup analyses, without Holm-Bonferroni correction, the prescription of MRA indicated a faster decline in renal function in ATRH. Following correction, no specific therapeutic risk factor was associated with faster progression of renal dysfunction. Conclusions: Renal function declines twice as fast with ATRH compared with NAH, independently of age and diabetes. Larger studies are needed to reveal risk factors for renal dysfunction in patients with hypertension.