Current Hypertension Reports最新文献

{"title":"Managing Hypertension in Older Adults.","authors":"Brent M Egan, Holly J Mattix-Kramer, Jan N Basile, Susan E Sutherland","doi":"10.1007/s11906-023-01289-7","DOIUrl":"10.1007/s11906-023-01289-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease.</p><p><strong>Recent findings: </strong>Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"157-167"},"PeriodicalIF":5.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139039641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preeclampsia and the Retina.","authors":"Safiya Soullane, Marc-André Rhéaume, Nathalie Auger","doi":"10.1007/s11906-023-01290-0","DOIUrl":"10.1007/s11906-023-01290-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes key findings relating to the association between preeclampsia and retinal disorders.</p><p><strong>Recent findings: </strong>Preeclampsia is a major cause of maternal morbidity. Pregnant women with preeclampsia frequently describe having visual disturbances. Retinal changes can be identified on fundoscopy in most patients with preeclampsia. While retinal pathology secondary to preeclampsia usually resolves postpartum, there is growing evidence that women with preeclampsia have a higher long-term risk of developing retinal disorders after pregnancy. Pregnant women often experience visual changes. While these symptoms may be benign, careful attention should be paid to exclude retinal disorders secondary to preeclampsia. Pregnant women complaining of new-onset or worsening blurry vision, scotomata, diplopia, or photopsia require rapid and thorough evaluation to rule out hypertensive disorders. Management of preeclampsia, including administration of magnesium sulfate and delivery of the fetus, can reverse retinal pathologies in most cases.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"169-174"},"PeriodicalIF":5.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slow on the Draw-ED Management of Elevated BP in Older Adults.","authors":"Kianna Eurick-Bering, Brett Todd, Lauren Cameron-Comasco","doi":"10.1007/s11906-023-01284-y","DOIUrl":"10.1007/s11906-023-01284-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this study is to review data surrounding the emergency department management of elevated blood pressure in older adults, including the management of hypertensive crisis and outpatient management of markedly elevated blood pressure.</p><p><strong>Recent findings: </strong>Acute lowering of blood pressure in older adults with markedly elevated blood pressure may lead to serious complications without improvements in hospital length of stay, return visits, or mortality. Older adults presenting with elevated blood pressures without evidence of end-organ damage should be referred for outpatient management of their blood pressure. Treatment of hypertensive emergency should follow standard guidelines with additional considerations for aging physiology. Acute lowering of elevated blood pressure in older adults without evidence of end-organ damage has the potential for harm. If the emergency physician opts to acutely treat, they should consider the increased risk of side effects in older adults and avoid Beers list medications including short-acting nifedipine and clonidine.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"107-117"},"PeriodicalIF":5.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138175866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Management of Elevated BP in Children in the ED.","authors":"Lilian Awad, Usha Sethuraman","doi":"10.1007/s11906-023-01283-z","DOIUrl":"10.1007/s11906-023-01283-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Pediatric hypertension has been on the rise over the past four decades. While most cases are evaluated and managed in the primary healthcare setting, some children may be referred to the emergency department (ED) for an expedited workup of elevated blood pressure or for management of hypertensive crisis.</p><p><strong>Recent findings: </strong>Acute severe hypertension without end-organ damage and hypertensive emergency are life-threatening conditions that healthcare providers must be prepared to accurately recognize and treat as pediatric hypertension increases in prevalence. In this article, we review the most recent definitions of elevated blood pressure and hypertension and discuss the updated literature on the evaluation and management of hypertension and hypertensive crisis of children in the ED.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"99-105"},"PeriodicalIF":5.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136396771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underlying Mechanisms and Treatment of Hypertension in Glomerular Diseases.","authors":"Sahar H Koubar, Alejandro Garcia-Rivera, Muner M B Mohamed, John E Hall, Michael E Hall, Mohamed Hassanein","doi":"10.1007/s11906-023-01287-9","DOIUrl":"10.1007/s11906-023-01287-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to explore the underlying mechanisms that lead to hypertension in glomerular diseases and the advancements in treatment strategies and to provide clinicians with valuable insights into the pathophysiological mechanisms and evidence-based therapeutic approaches for managing hypertension in patients with glomerular diseases.</p><p><strong>Recent findings: </strong>In recent years, there have been remarkable advancements in our understanding of the immune and non-immune mechanisms that are involved in the pathogenesis of hypertension in glomerular diseases. Furthermore, this review will encompass the latest data on management strategies, including RAAS inhibition, endothelin receptor blockers, SGLT2 inhibitors, and immune-based therapies. Hypertension (HTN) and cardiovascular diseases are leading causes of mortality in glomerular diseases. The latter are intricately related with hypertension and share common pathophysiological mechanisms. Hypertension in glomerular disease represents a complex and multifaceted interplay between kidney dysfunction, immune-mediated, and non-immune-mediated pathology. Understanding the complex mechanisms involved in this relationship has evolved significantly over the years, shedding light on the pathophysiological processes underlying the development and progression of glomerular disease-associated HTN, and is crucial for developing effective therapeutic strategies and improving patients' outcomes.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"119-130"},"PeriodicalIF":5.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review","authors":"James P. Sheppard, Athanase Benetos, Jonathan Bogaerts, Danijela Gnjidic, Richard J. McManus","doi":"10.1007/s11906-024-01293-5","DOIUrl":"https://doi.org/10.1007/s11906-024-01293-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>To summarise the evidence regarding which patients might benefit from deprescribing antihypertensive medications.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Older patients with frailty, multi-morbidity and subsequent polypharmacy are at higher risk of adverse events from antihypertensive treatment, and therefore may benefit from antihypertensive deprescribing. It is possible to examine an individual’s risk of these adverse events, and use this to identify those people where the benefits of treatment may be outweighed by the harms. While such patients might be considered for deprescribing, the long-term effects of this treatment strategy remain unclear.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Evidence now exists to support identification of those who are at risk of adverse events from antihypertensive treatment. These patients could be targeted for deprescribing interventions, although the long-term benefits and harms of this approach are unclear.</p><h3 data-test=\"abstract-sub-heading\">Perspectives</h3><p>Randomised controlled trials are still needed to examine the long-term effects of deprescribing in high-risk patients with frailty and multi-morbidity.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":"38 1","pages":""},"PeriodicalIF":5.6,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of the Effects of Mindfulness on Sleep and Hypertension.","authors":"Daniel A Kusko, Jason Blake, Rebecca Williams","doi":"10.1007/s11906-023-01279-9","DOIUrl":"10.1007/s11906-023-01279-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>The prevalence of both insomnia and hypertension in the general population is vast and the health implications to individuals and society are costly. The current pharmacological treatment options for insomnia and hypertension are limited and patients are becoming increasingly interested in non-pharmacological treatment options. Mindfulness, a disciplined mental training practice rooted in Eastern traditions, has become a widely popular treatment method for multiple chronic health problems. The aim of this paper was to review research on mindfulness-based intervention effects on sleep, insomnia, and hypertension from the past 3 years. Theoretical foundations of mindfulness are discussed. Empirical evidence and potential mechanisms of how mindfulness impacts sleep and hypertension are provided.</p><p><strong>Recent findings: </strong>Our findings suggest that mindfulness-based interventions are safe and effective for people with insomnia and hypertension. We saw consistent, albeit small to moderate, effects of mindfulness-based interventions on reducing insomnia symptoms, improving sleep quality, and lowering systolic and diastolic blood pressure readings. While mindfulness interventions have shown to be effective for improving sleep and lowering hypertension, future research is needed to further evaluate their efficacy on larger samples of patient populations with long-term follow-up measures. These high-quality studies could help researchers and clinicians identify treatment response tendencies in patient populations which can lead to better tailoring of mindfulness-based interventions for specific health concerns.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"91-97"},"PeriodicalIF":5.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71434065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the Timing of Intense Physical Activity on Hypertension Risk in a General Population: A UK-Biobank Study.","authors":"Xiaying Li, Jingjing Zeng, Bo Chen, Menglin Fan, Jie Wang, Lingqi Wei, Yong Ren, Shaoyong Xu","doi":"10.1007/s11906-023-01278-w","DOIUrl":"10.1007/s11906-023-01278-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>It has recently been suggested that the timing of exercise is important in the subsequent development of hypertension. We used the UK Biobank database which prospectively collates data in over 500,000 people aged between 40 and 69 years to determine the relationship between the chronoactivity pattern of exercise and the risk of incident hypertension.</p><p><strong>Recent findings: </strong>We analyzed data from 70,617 participants with 7-day Axivity AX3 triaxial accelerometry information available. Comparisons were made by a K-means clustering analysis separating groups according to the daily timing of physical activity and intensity. Subgroup, sensitivity analyses, and Cox proportional hazard model were performed. The mean age of the cohort was 61.17 (± 7.89) years with 40.05% men, and there was a mean follow-up of 7.54 (± 1.65) years. Participants were separated into 4 clusters with 6341 developing hypertension. Cluster 1 (early morning physical activity) and Cluster 2 (early morning and later physical activity) had a significantly reduced risk of incident hypertension (adjusted HR 0.870 [95%CI 0.812-0.932) vs. 0.895 [95%CI 0.825-0.972], respectively) when compared with Cluster 3 (physical activity intensity spread evenly throughout the day). Cluster 1 and Cluster 2 cases with High Intensity physical activity had a lower risk of hypertension; however, Low Intensity physical activity in Cluster 1 still reduced the risk of incident hypertension. There was a lower risk of hypertension in Cluster 1 and Cluster 2 in both morning and evening sleep chronotypes. The development of incident hypertension is significantly reduced in those who engage in some level of physical activity earlier in the day. Hypertension (high blood pressure) is a global problem with a high economic health burden that has been shown to be a major risk factor for diabetes, cardiovascular, and kidney disease. Our study has used a large maintained UK biological database to determine the impact of physical exercise on reducing the subsequent development of hypertension during follow-up from data provided by more than 70,000 participants. When we segregated patients into clusters of exercise timing, we found that the risk of developing hypertension over time was reduced for patients who performed exercise earlier in the morning than at other times of the day. This benefit was still evident even when the intensity of regular physical activity was low.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"81-90"},"PeriodicalIF":5.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72013879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance of Nocturnal Hypertension and Nighttime Blood Pressure Dipping in Hypertension.","authors":"Panagiota Anyfanti, Anastasia Malliora, Agapi Chionidou, Konstantinos Mastrogiannis, Antonios Lazaridis, Eugenia Gkaliagkousi","doi":"10.1007/s11906-023-01277-x","DOIUrl":"10.1007/s11906-023-01277-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review article aims to discuss more recent evidence, current challenges, and future perspectives regarding the clinical importance of nocturnal hypertension and nighttime blood pressure dipping, with particular reference to diagnosis, prognostic value, and therapeutic approach.</p><p><strong>Recent findings: </strong>The importance of nighttime blood pressure and nighttime blood pressure dipping has been demonstrated in decades. Increased nighttime blood pressure has been acknowledged as an unfavorable clinical trait. However, more recent evidence suggests that the abolishment of normal circadian blood pressure rhythm is not always a solid predictor of adverse cardiovascular events and needs to be interpreted in the light of each patients' individual characteristics. Physicians treating hypertensive patients with adverse nighttime blood pressure profiles often face the dilemma of chronotherapy. This has been a blurred field for years, yet very recent evidence from appropriately designed studies attempts to shed light on this puzzling question. As 24-h ambulatory blood pressure monitoring is being increasingly recommended and applied in real-world practice for the diagnosis and monitoring of hypertension, information on nighttime blood pressure and nocturnal dipping profile is collected but is not always easy to interpret.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"69-80"},"PeriodicalIF":5.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71421566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Conducting Clinical Trials for Preeclampsia.","authors":"T Caroline Bank, Diana Kline, Maged M Costantine","doi":"10.1007/s11906-023-01276-y","DOIUrl":"10.1007/s11906-023-01276-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review recent data describing the challenges and innovations in therapeutic research focused on the prevention and treatment of preeclampsia.</p><p><strong>Recent findings: </strong>Pregnant individuals have traditionally been excluded from therapeutic research, resulting in a paucity of innovation in therapeutics for pregnancy-specific medical conditions, especially preeclampsia. With the increased awareness of maternal morbidity and mortality, there is significant interest among researchers to expand therapeutic research in pregnancy. Several medications, including aspirin, pravastatin, metformin, and esomeprazole, which are commonly used in non-pregnant populations, are now being investigated for preeclampsia prevention. However, given the historic precedent of exclusion, along with the regulatory, ethical, and feasibility concerns that accompany this population, the study of these and novel medications has been complicated by numerous challenges. While complex, and laden with challenges, there is great ongoing need for therapeutic research to address preeclampsia. Aspirin, pravastatin, metformin, and esomeprazole have all shown promise as potential therapeutic agents; however, their use remains to be optimized, and innovative therapeutics need to be developed.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":" ","pages":"59-68"},"PeriodicalIF":5.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136396770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}