Blood Pressure最新文献

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: 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..

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.

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.

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: 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: 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.