Maya Jälmby, Camilla Edvinsson, Despoina Lykou, Grigorios Karampas, Lena Erlandsson, Stefan R Hansson, Federica Piani
{"title":"Long-term microvascular and blood pressure dysregulation after Preeclampsia.","authors":"Maya Jälmby, Camilla Edvinsson, Despoina Lykou, Grigorios Karampas, Lena Erlandsson, Stefan R Hansson, Federica Piani","doi":"10.1038/s41440-025-02176-1","DOIUrl":"10.1038/s41440-025-02176-1","url":null,"abstract":"<p><p>Preeclampsia (PE) is a pregnancy disorder characterized by systemic endothelial damage that leads to long-term cardiovascular complications. The endothelial glycocalyx (EG) covers the luminal surface of endothelium playing a critical role in vascular homeostasis. In this study we aimed to evaluate EG thickness and blood pressure (BP) trends in women with a history of PE vs. normotensive pregnancy. Fifty-five women participated in the study (18 controls, 34 with PE, and 3 with gestational hypertension). Six years postpartum, we evaluated the sublingual microcirculation by sidestream dark-field microscopy, and assessed BP in the sitting and orthostatic position. At follow-up, women with PE had reduced EG thickness in vessels ≥ 8 µm, expressed by an increased perfused boundary region (PBR), compared to healthy controls (median 3.14 vs. 2.88 µm, p = 0.002). A trend towards increased red blood cell velocity in vessels ≥ 10 µm was also observed in PE vs. controls. The systolic and diastolic BP, as well as within-visit BP variability, were significantly higher in PE vs. controls. Adverse neonatal outcomes, umbilical artery Doppler and BP during both the pregnancy and the follow-up visit, were associated with maternal PBR value in vessels ≥ 8 µm. This study contributes to the existing literature on PE and the increased risk of future cardiovascular disease, highlighting the critical role of EG and BP regulatory mechanisms. Our results showed that the severity of hemodynamic and neonatal impairments during pregnancy may irreversibly affect the EG and thereby be associated with long-term maternal vascular dysfunction.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772005","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}
Kazuomi Kario, David E Kandzari, Felix Mahfoud, Michael A Weber, Roland E Schmieder, Konstantinos Tsioufis, Minglei Liu, Michael Böhm, Raymond R Townsend
{"title":"Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials.","authors":"Kazuomi Kario, David E Kandzari, Felix Mahfoud, Michael A Weber, Roland E Schmieder, Konstantinos Tsioufis, Minglei Liu, Michael Böhm, Raymond R Townsend","doi":"10.1038/s41440-025-02186-z","DOIUrl":"https://doi.org/10.1038/s41440-025-02186-z","url":null,"abstract":"<p><p>Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (-12.0 ± 17.1 mmHg), morning (-14.8 ± 20.0 mmHg), daytime (-13.8 ± 14.7 mmHg), and 24-h SBP (-13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (-23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772134","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}
Rodrigo Bezerra, Fernanda S Gorayeb-Polacchini, Flavio Teles, Luís Cláudio S Pinto, Wilson Nadruz
{"title":"Post-dialysis blood pressure: inaccuracy or lack of standardization?","authors":"Rodrigo Bezerra, Fernanda S Gorayeb-Polacchini, Flavio Teles, Luís Cláudio S Pinto, Wilson Nadruz","doi":"10.1038/s41440-025-02206-y","DOIUrl":"https://doi.org/10.1038/s41440-025-02206-y","url":null,"abstract":"","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772012","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}
Fotini Iatridi, Marieta P Theodorakopoulou, Pantelis Sarafidis
{"title":"Post-dialytic blood pressure in hemodialysis patients: still an inaccurate metric.","authors":"Fotini Iatridi, Marieta P Theodorakopoulou, Pantelis Sarafidis","doi":"10.1038/s41440-025-02193-0","DOIUrl":"https://doi.org/10.1038/s41440-025-02193-0","url":null,"abstract":"","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772130","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":"Home blood pressure-lowering effect of esaxerenone vs trichlormethiazide for uncontrolled hypertension: a prespecified subanalysis of the EXCITE-HT randomized controlled study by age subgroup","authors":"Kazuomi Kario, Hiroyuki Ohbayashi, Masami Hashimoto, Naoki Itabashi, Mitsutoshi Kato, Kazuaki Uchiyama, Kunio Hirano, Noriko Nakamura, Takahide Miyamoto, Hirotaka Nagashima, Hidenori Ishida, Yusuke Ebe, Tsuguru Hatta, Toshiki Fukui, Tomohiro Katsuya, Tatsuo Shimosawa, Takashi Taguchi, Ayumi Tanabe, Mitsuru Ohishi, on behalf of the EXCITE-HT investigators","doi":"10.1038/s41440-024-02078-8","DOIUrl":"10.1038/s41440-024-02078-8","url":null,"abstract":"This predefined subanalysis of the multicenter, randomized, open-label, parallel-group EXCITE-HT study aimed to determine whether the comparative efficacy and safety of esaxerenone and trichlormethiazide differs with age. Patients were divided into two age subgroups (<65 and ≥65 years). The non-inferiority of esaxerenone to trichlormethiazide was assessed based on the upper limit of the two-sided 95% confidence interval (CI) for the difference in systolic/diastolic blood pressure (SBP/DBP) changes. Esaxerenone was considered non-inferior if this value was <3.9/ < 2.1 mmHg; if it was <0 mmHg, esaxerenone was considered superior in its BP-lowering effect. The results showed that the least squares mean changes in morning home SBP/DBP from baseline to the end of treatment (primary endpoint) were −9.5/−5.7 with esaxerenone and −8.2/−4.9 mmHg with trichloromethiazide (between-group difference: −1.3 [95% CI, −3.3, 0.8]/−0.8 [ − 2.1, 0.5] mmHg) in the subgroup aged <65 years. These changes were −14.6/−7.2 and −11.5/−6.7 (−3.0 [−4.9, −1.2]/−0.5 [−1.5, 0.5] mmHg) in the subgroup aged ≥65 years. The incidences of serum potassium level ≥5.5 mEq/L were 2.2% and 1.9% in the esaxerenone-treated subgroups aged <65 and ≥65 years, respectively. In conclusion, esaxerenone achieved the pre-defined non-inferiority margin to trichlormethiazide in its BP-lowering effect regardless of age. In patients aged <65 years, esaxerenone achieved the non-inferiority margin to trichlormethiazide in lowering both SBP and DBP. In patients aged ≥65 years, esaxerenone was superior to trichlormethiazide in lowering SBP and achieved the non-inferiority margin to trichlormethiazide in lowering DBP. The impact of esaxerenone on serum potassium levels did not show a specific age-related effect. A subgroup analysis of the EXCITE-HT study according to age (<65 and ≥65 years) showed that esaxerenone achieved the pre-defined non-inferiority margin to trichlormethiazide in its BP-lowering effect regardless of age. In patients aged ≥65 years, esaxerenone achieved the superiority margin to trichlormethiazide in lowering SBP.","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":"48 4","pages":"1586-1598"},"PeriodicalIF":4.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41440-024-02078-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787348","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":"In the era of 100-year life spans, will esaxerenone be positioned as a second-line treatment for any age group?","authors":"Tetsuro Yoshida","doi":"10.1038/s41440-025-02133-y","DOIUrl":"10.1038/s41440-025-02133-y","url":null,"abstract":"","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":"48 4","pages":"1624-1626"},"PeriodicalIF":4.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41440-025-02133-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787378","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":"Correction: Personalised hypertension management with accurate blood pressure measurement: much achieved, much more to do.","authors":"James E Sharman","doi":"10.1038/s41440-025-02198-9","DOIUrl":"10.1038/s41440-025-02198-9","url":null,"abstract":"","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709761","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}
Kiki Sn Liu, Boyuan Wang, Ivy L Mak, Edmond Ph Choi, Cindy Lk Lam, Eric Yf Wan
{"title":"Early onset of hypertension and increased relative risks of chronic kidney disease and mortality: two population-based cohort studies in United Kingdom and Hong Kong.","authors":"Kiki Sn Liu, Boyuan Wang, Ivy L Mak, Edmond Ph Choi, Cindy Lk Lam, Eric Yf Wan","doi":"10.1038/s41440-025-02188-x","DOIUrl":"10.1038/s41440-025-02188-x","url":null,"abstract":"<p><p>This study aimed to evaluate the association between hypertension (HT) onset age and later risks of chronic kidney diseases (CKD) and mortality. Adult patients without CKD from 2008 to 2013 were identified using electronic medical records from United Kingdom (UK) and Hong Kong (HK). Patients newly diagnosed with HT and those without were included in the HT and control groups, respectively. All subjects were stratified into six age groups (18-39, 40-49, 50-59, 60-69, 70-79, ≥80). Multivariable Cox proportional hazard regression, adjusted with baseline characteristics and fine stratification weights, was conducted to investigate the association between HT onset and risks of CKD, renal decline, end-stage renal disease (ESRD), and all-cause mortality. Subjects were followed up from baseline until an outcome event, death, or administrative end of the cohort, whichever occurred first. A total of 4,413,551 and 3,132,951 subjects were included in the UK and HK cohorts, respectively. HT was significantly associated with increased risks of outcome, but the hazard ratios (HRs) decreased with increasing onset age. In the UK cohort, the HRs (95% confidence intervals) for subjects aged 18-39 and ≥80 were 3.69 (3.53, 3.86) and 2.01 (1.96, 2.06) for CKD, 3.83 (3.60, 4.07) and 3.17 (2.97, 3.38) for renal decline, 17.26 (14.34, 20.77) and 2.55 (2.12, 3.07) for ESRD, 2.88 (2.66, 3.11) and 1.09 (1.07, 1.12) for mortality. The HK cohort exhibited a similar pattern. Our study concluded that early onset of HT significantly affects renal health later in life, while the contribution decreases with the onset age of HT.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718747","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}