Hypertension最新文献

{"title":"Failure of Antihypertensive Treatment to Restore Normal Sympathetic Activity.","authors":"Fosca Quarti-Trevano, Gino Seravalle, Rita Facchetti, Konstantinos Tsioufis, Kyriakos Dimitriadis, Eleni Manta, Giuseppe Mancia, Guido Grassi","doi":"10.1161/HYPERTENSIONAHA.124.24429","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24429","url":null,"abstract":"<p><strong>Background: </strong>Sympathetic deactivation represents a major goal of antihypertensive drug treatment. However, whether treatment normalizes the hypertension-related sympathetic cardiovascular overdrive remains uncertain.</p><p><strong>Methods: </strong>In 219 middle-aged essential hypertensives, we analyzed, along with office systolic and diastolic blood pressure (BP) and heart rate, muscle sympathetic nerve traffic (MSNA, microneurography) before and after 3-month treatment, either as monotherapy or as combination. Controls were represented by 100 age-matched normotensives.</p><p><strong>Results: </strong>Treatment caused, along with a small heart rate decrease, a clear BP reduction (from 160.5/95.5 to 142.3/85.0 mm Hg, <i>P</i><0.01) and a significant MSNA inhibition (from 70.7±11.5 to 65.0±10.2 bursts/100 heartbeats, mean±SD, <i>P</i><0.01). A similar pattern was detected in patients under monotherapy (n=81) or combination drug treatment (n=138). MSNA was significantly related to systolic BP before and during treatment but unrelated to heart rate. In treated patients achieving the lower BP (135.1/84.5 mm Hg, n=90), the MSNA reduction was greater than that detected in patients with the higher on-treatment BP (146.7/87.4 mm Hg, n=129). However, even in patients achieving a BP target <140/90 mm Hg, MSNA remained markedly higher (on average +66.4%) compared with controls. This was the case even when treated BP was <130/80 mm Hg. Data were similar for different antihypertensive drug classes.</p><p><strong>Conclusions: </strong>Thus, antihypertensive treatment, even when effective in achieving BP control, fails to restore the level of normotension-related MSNA, with a persistence of the pattern of heightened sympathetic influences typical of untreated patients with hypertension. Failure of normalization may contribute to the development of the residual cardiovascular risk reported in treated hypertensives.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"82 6","pages":"1024-1034"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Podometric Findings in Patients With Hypertension and Type 2 Diabetes: A Retrospective Analysis.","authors":"Christopher Paschen, Maximilian C Koeller, Helga Schachner, Maja Nackenhorst, Johannes Kläger, Andre Oszwald, Katharina Dörr, Michael Kammer, Nicolas Kozakowski, Andrew Rees, Renate Kain, Manfred Hecking, Rainer Oberbauer, Heinz Regele","doi":"10.1161/HYPERTENSIONAHA.124.24379","DOIUrl":"10.1161/HYPERTENSIONAHA.124.24379","url":null,"abstract":"<p><strong>Background: </strong>Arterial hypertension (HTN) and type 2 diabetes (T2DM) are contributors to chronic kidney disease leading to glomerulomegaly and podocyte loss. Enlarged glomeruli and podocyte depletion are associated with kidney disease progression. This retrospective study aimed to investigate morphometric changes in patients with HTN and the contribution of coexisting T2DM in HTN.</p><p><strong>Methods: </strong>Glomerular and podocyte structure was estimated stereologically in unaffected areas of tumor nephrectomies in 99 patients. Morphometric features between subjects with HTN (n=47), HTN+T2DM (n=32), and controls without HTN and T2DM (n=20) were compared by ANOVA. Linear regression models evaluated the effect of morphometric parameters on renal compensation after nephrectomy (change of estimated glomerular filtration rate from pre-nephrectomy to 12 months post-nephrectomy).</p><p><strong>Results: </strong>In total, 36% of the HTN and 50% of the patients with T2DM exhibited dipstick-positive proteinuria. Glomerular volume in HTN+T2DM was similar compared with controls (2.7±0.8 versus 2.3±0.8×10⁶ µm³; <i>P</i>=0.16) and to HTN only (2.7±0.9×10⁶ µm³; <i>P</i>=0.95). Podocyte density was reduced in HTN+T2DM versus controls (217±66 versus 279±75 per 10⁶ µm³; <i>P</i>=0.02) and not different to HTN only (233±87 per 10⁶ µm³; <i>P</i>=0.67). Podocyte nuclear volume was larger in HTN+T2DM versus controls (230±28 versus 201±32 µm³; <i>P</i>=0.004) and similar to HTN (221±33 µm³; <i>P</i>=0.39). Larger glomerular volume (<i>P</i>=0.009), reduced podocyte density (<i>P</i>=0.003), and nuclear hypertrophy (<i>P</i>=0.01) were associated with impaired compensation.</p><p><strong>Conclusion: </strong>The patterns of podocyte depletion and nuclear hypertrophy were independently observed in both HTN and HTN+T2DM versus controls. Coexisting T2DM exhibited no additional contribution to glomerular and podocyte alterations.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"1071-1080"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Cardio-Ankle Vascular Index and Heart-Thigh β Index in the MESA.","authors":"Hamed Tavolinejad, Kevin E Boczar, Bart Spronck, Hannah Maynard, Alain G Bertoni, Sanjiv J Shah, Julio A Chirinos","doi":"10.1161/HYPERTENSIONAHA.124.23970","DOIUrl":"10.1161/HYPERTENSIONAHA.124.23970","url":null,"abstract":"<p><strong>Background: </strong>The cardio-ankle vascular index (CAVI) and heart-thigh β index (htβ) assess arterial stiffness by correcting pulse wave velocity for blood pressure to achieve less dependency on blood pressure variations. Normative data for these markers among US communities are lacking. We aimed to assess the determinants and normative values of CAVI and htβ.</p><p><strong>Methods: </strong>MESA (Multi-Ethnic Study of Atherosclerosis) participants with CAVI and htβ measurements were included (N=2950). A subgroup selected to define normative values included only participants without previous cardiovascular disease, diabetes, smoking, antihypertensive use, and with blood pressure <140/90 mm Hg, body mass index <35 kg/m², and creatinine <1.5 mg/dL. Associations were assessed by multivariable linear regressions. All continuous variables were standardized.</p><p><strong>Results: </strong>Among 2950 participants (mean age, 73.6 years; 47.2% male), older age (β for CAVI=0.39, <i>P</i><0.001 and htβ=0.41, <i>P</i><0.001), and male sex (β for CAVI=0.30, <i>P</i><0.001 and htβ=0.11, <i>P</i><0.001) were associated with higher arterial indices. Participants with higher blood pressure, height, and diabetes exhibited higher CAVI and htβ. A higher waist circumference was associated with lower CAVI and htβ. Among the normative value subgroup (N=676), the mean CAVI was 8.7 (2 Z score range, 6.5-11.2), and the mean htβ was 8.9 (2 Z score range, 4.3-13.6). Among participants without cardiovascular disease, higher CAVI and htβ were associated with higher predicted 10-year cardiovascular risk estimated by pooled cohort equations (per SD of CAVI=3.6%, <i>P</i><0.001 and htβ=3.3%, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>We report determinants and normative values of CAVI and htβ in a multiethnic community-based US population. Future studies should focus on the prognostic utility of CAVI and htβ.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"1081-1094"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Priorities for Research on Hypertension Care Delivery: A WHO Report Executive Summary.","authors":"Kunihiro Matsushita, Sonia Y Angell, Lawrence J Appel, Helen Bygrave, Jennifer Cohn, Robert Kalyesubula, Prabhdeep Kaur, Andrew E Moran, Margaret Mswema, Veronica Schoj, Aletta E Schutte, Ruitai Shao, Xin-Hua Zhang, Pedro Ordunez, Taskeen Khan","doi":"10.1161/HYPERTENSIONAHA.125.24702","DOIUrl":"10.1161/HYPERTENSIONAHA.125.24702","url":null,"abstract":"<p><p>In 2024, the World Health Organization released a report on Priorities for Research on Hypertension Care Delivery; this article provides its executive summary. The World Health Organization and its technical experts formed a leadership team, developed a scope and objectives, created a thematic framework, developed a survey for each theme, and identified research priorities. The 5 themes included (1) Health care workforce for hypertension care delivery, (2) Service delivery system/models, (3) Patient retention/adherence, (4) Financing the care delivery system, and (5) Research gaps identified in the World Health Organization 2021 Hypertension Guideline. The leadership team received feedback from diverse experts through webinars and online surveys. The final report was peer-reviewed by external experts. According to postwebinar surveys, we identified 5 to 7 research priorities within each theme, totaling 29 research priorities. The 10 highest priorities were (1) Cost-effectiveness of combination therapy in low/middle-income countries, (2) A system allowing hypertension care closer to home, (3) Health system reform allowing trained community health workers to refill/initiate/titrate antihypertensive medications, (4) Health system reform allowing nurses to diagnose and treat hypertension, (5) Gaps in the medication supply chain, (6) New approaches integrating the management of hypertension and other diseases, (7) Digital approaches for improving medication adherence, (8) Optimal approaches to train health care workers, (9) Approaches to finance hypertension control programs, and (10) Implementation research on task-sharing approaches. These research priorities provide guidance to researchers, with immediate implications for substantially improve hypertension care and prevent its sequelae. We urge governments, funding agencies, and organizations to consider supporting these research topics.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"971-976"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversy in Hypertension: Pro-Side of the Argument Using Artificial Intelligence for Hypertension Diagnosis and Management.","authors":"Antonis A Armoundas, Faraz S Ahmad, Zachi I Attia, Dimitrios Doudesis, Rohan Khera, Konstantinos G Kyriakoulis, George S Stergiou, W H Wilson Tang","doi":"10.1161/HYPERTENSIONAHA.124.22349","DOIUrl":"10.1161/HYPERTENSIONAHA.124.22349","url":null,"abstract":"<p><p>Hypertension presents the largest modifiable public health challenge due to its high prevalence, its intimate relationship to cardiovascular diseases, and its complex pathogenesis and pathophysiology. Low awareness of blood pressure elevation and suboptimal hypertension diagnosis serve as the major hurdles in effective hypertension management. Advances in artificial intelligence in hypertension have permitted the integrative analysis of large data sets including omics, clinical (with novel sensor and wearable technologies), health-related, social, behavioral, and environmental sources, and hold transformative potential in achieving large-scale, data-driven approaches toward personalized diagnosis, treatment, and long-term management. However, although the emerging artificial intelligence science may advance the concept of precision hypertension in discovery, drug targeting and development, patient care, and management, its clinical adoption at scale today is lacking. Recognizing that clinical implementation of artificial intelligence-based solutions need evidence generation, this opinion statement examines a clinician-centric perspective of the state-of-art in using artificial intelligence in the management of hypertension and puts forward recommendations toward equitable precision hypertension care.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"929-944"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACE Inhibition to Distinguish Low-Renin Hypertension From Primary Aldosteronism.","authors":"Cheng-Hsuan Tsai, Jenifer M Brown, Stefanie Parisien-La Salle, Andrew J Newman, Vin-Cent Wu, Yen-Hung Lin, Anand Vaidya","doi":"10.1161/HYPERTENSIONAHA.125.24711","DOIUrl":"10.1161/HYPERTENSIONAHA.125.24711","url":null,"abstract":"<p><strong>Background: </strong>Primary aldosteronism (PA) is a distinct cause of low-renin hypertension (LRH), characterized by inappropriate aldosterone production. We investigated the distinction between LRH and PA by leveraging the physiological effects of angiotensin-converting enzyme inhibition.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including 756 patients with LRH who underwent a captopril challenge test (CCT) for evaluation of PA. The distinction between PA and LRH was assessed using 4 CCT criteria: (1) Post-CCT plasma renin activity <1 ng/mL per hour and plasma aldosterone concentration decrease <30%; (2) Post-CCT aldosterone-to-renin ratio (ARR) >30 ng/dL per ng/mL per hour; (3) Post-CCT plasma renin activity <1 ng/mL per hour; and (4) Post-CCT plasma aldosterone concentration >11 ng/dL. Longitudinal outcomes following aldosterone-targeted therapy were assessed using the Primary Aldosteronism Surgery Outcome and Primary Aldosteronism Medical Outcome criteria.</p><p><strong>Results: </strong>There was a continuous spectrum of nonsuppressible aldosterone production post-CCT. When interpreting CCT results based on both renin and aldosterone responses (criteria 1 or 2), 57.8% to 66.3% of patients were classified as having PA. In contrast, when based on aldosterone or renin responses alone (criteria 3 or 4), 82.5% to 95.1% of patients were classified as having PA. Complete or partial treatment response rates following aldosterone-targeted therapy were high, ranging from 86.5% to 91.7%, regardless of CCT interpretation.</p><p><strong>Conclusions: </strong>These findings highlight the blurred distinction between LRH and PA. Although persistently suppressed renin, or elevated aldosterone, following captopril facilitated the maximum capture of PA cases, the implementation of aldosterone-targeted therapy provided similar benefits to all patints, regardless of CCT interpretation. Empirical aldosterone-directed therapy for patients with LRH suspected of having PA may be an appropriate alternative to laborious diagnostics to confirm PA.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"1046-1055"},"PeriodicalIF":6.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Diuretics a Clandestine Risk Factor for Patients With Treatment-Resistant Hypertension?","authors":"Bertram Pitt, Christopher S Wilcox","doi":"10.1161/HYPERTENSIONAHA.125.24871","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.125.24871","url":null,"abstract":"<p><p>The control of blood pressure in patients with treatment-resistant hypertension is paramount and requires the use of thiazide or loop diuretics to enhance renal salt excretion and reduce expanded body fluid volumes. However, the use of diuretics in patients with treatment-resistant hypertension without suppressing the production of aldosterone and MR (mineralocorticosteroid receptor) activation and signaling may not be sufficient to prevent the development of heart failure and excessive cardiovascular mortality and the progression of chronic kidney disease. This review examines the evidence that diuretic therapy for treatment-resistant hypertension may constitute a risk factor for preventable cardiovascular and renal disease progression that is concealed by the strong offsetting effects of a fall in blood pressure. To gain the full benefits of diuretic therapy in treatment-resistant hypertension may require the earlier prescription of MR antagonists coincident with diuretics rather than delaying their use to fourth-line agents in those who remain uncontrolled. This will require testing in appropriate clinical trials.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperlipidemia Triggers Trophoblast Cell Dysfunction and Preeclampsia via the AMPK/GATA3/FTL Pathway.","authors":"Hanhui Nie,Xiufang Wang,Lei Guo,Jiachun Wei,Yiling Wei,Yudie Gao,Jian Wang,Ka Cheuk Yip,Xiaman Huang,Qiao Zhang,Feng Gao,Ruiman Li","doi":"10.1161/hypertensionaha.125.24839","DOIUrl":"https://doi.org/10.1161/hypertensionaha.125.24839","url":null,"abstract":"BACKGROUNDPreeclampsia, a severe pregnancy complication with an incompletely deciphered cause, is strongly associated with hyperlipidemia. Our previous studies demonstrated that FTL (ferritin light chain) expression was diminished in preeclampsia placentas and that FTL downregulation inhibited trophoblast invasiveness and migration while promoting apoptosis, contributing to preeclampsia development. However, the potential interplay between hyperlipidemia and FTL in the pathogenesis of preeclampsia, as well as the regulatory mechanism involved, remains to be elucidated.METHODSWe conducted Spearman correlation analysis, used a high-fat diet-fed mice model, cell culture, and molecular biology assays, including immunohistochemistry, chromatin immunoprecipitation, and dual-luciferase reporter gene assays, to explore the impact of hyperlipidemia on the development of preeclampsia and to elucidate the molecular mechanisms involved.RESULTSPregnant women with preeclampsia presented elevated serum total cholesterol, triglycerides, and low-density lipoprotein, with reduced high-density lipoprotein. Similarly, high-fat diet-fed mice exhibited dyslipidemia and preeclampsia-like characteristics. FTL expression was reduced in the placentas of patients with preeclampsia and high-fat diet-fed pregnant mice. In vitro, palmitic acid treatment reduced FTL expression, increased oxidative stress, and impaired trophoblast migration and invasion. GATA3 (GATA binding protein 3) was predicted to be an upstream transcription factor for FTL, with its knockdown reducing and its overexpression increasing FTL levels. Further analysis indicated that palmitic acid suppressed FTL expression by inhibiting GATA3 nuclear translocation and that AMPK (AMP-activated protein kinase) activation rescued FTL expression and restored trophoblast function.CONCLUSIONSThis study revealed that high lipid levels contribute to preeclampsia by downregulating FTL through the AMPK-GATA3 pathway, highlighting potential therapeutic targets for preeclampsia management.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"35 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incretin-Based Therapies: A Paradigm Shift in Blood Pressure Management?","authors":"Leonie Dreher,Dominik Kylies,A H Jan Danser,Ulrich O Wenzel","doi":"10.1161/hypertensionaha.125.25112","DOIUrl":"https://doi.org/10.1161/hypertensionaha.125.25112","url":null,"abstract":"In the management of hypertension, only limited advances have been made over the past decades. Recent studies highlight the potential of next-generation incretin-based therapeutics, such as GLP-1 RAs (glucagon-like peptide-1 receptor agonists) like semaglutide and dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor agonists like tirzepatide. These drugs not only promote weight loss but also substantially lower blood pressure (BP) and reduce cardiovascular end points. The extent to which incretin-based therapies improve disease outcomes via weight loss versus so-called direct tissue effects is the subject of great interest, not only for BP but also for other clinical outcomes. Although, incretin-based therapeutics were initially not designed to treat hypertension, clinical studies demonstrate an impressive reduction in BP in patients treated with these agents, with an even more pronounced effect in patients with obesity and hypertension. The current hypertension guidelines must address the robust evidence supporting the use of incretin-based therapeutics in patients with hypertension. A caveat is that no trial to date has used BP reduction as the primary end point when investigating the interaction between GLP-1 or GLP-1/GIP receptor agonists and antihypertensive medications. However, in patients with type 2 diabetes or a body mass index >27 kg/m2, these drugs are widely used and lower BP. Taken together, incretin-based therapeutics represent a promising therapeutic tool to improve both BP and cardiovascular outcomes and help evolve the landscape of hypertension treatment.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"57 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Placental Dysfunction Subtypes in Pregnancies With a Low PlGF Centile.","authors":"Kirsty M M Vincent,Terence Garner,Adam Stevens,Elizabeth C Cottrell,Jenny E Myers,Lucy E Higgins","doi":"10.1161/hypertensionaha.124.24440","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.24440","url":null,"abstract":"BACKGROUNDA low circulating placental growth factor (PlGF) concentration is considered a marker of placental dysfunction, the predominant cause of preeclampsia and fetal growth restriction. Besides iatrogenic delivery, there are no effective treatments, potentially due to its heterogeneity. We hypothesize that >1 subtype of placental dysfunction exists in pregnancies with a low circulating PlGF.METHODSMatched placental villous and maternal plasma samples (low PlGF <5th, n=19; normal PlGF ≥5th centile, n=20) were collected from uncomplicated pregnancies and those complicated by 1 or a combination of preeclampsia, fetal growth restriction, or chronic hypertension. Transcriptomic and metabolomic data sets were obtained from villous samples and used to perform cluster-of-cluster analysis. Clinical outcomes were compared between clusters, as well as subsequent pathway analysis.RESULTSMultiomic cluster-of-cluster analysis resulted in 3 molecular clusters. Cluster 1 predominantly consisted of those with a low PlGF (9/10); PlGF results in cluster 2 varied (low, n=8/20; normal, n=12/20), while cluster 3 mainly comprised of those with a normal PlGF result (n=7/9). Birthweight was significantly lower in cluster 1, as well as an increased incidence of early-onset preeclampsia. However, pathways commonly associated with placental dysfunction were only identified in cluster 2.CONCLUSIONSMultiomic analysis revealed 2 potential subtypes of placental dysfunction associated with a low circulating PlGF. These results support previous studies suggesting the existence of preeclampsia subtypes. Clinical outcome comparisons indicate cluster 1 as the severe subtype; however, pathway analysis contradicted this. Improved understanding of subtype etiology could enable a more personalized therapeutic approach for pregnancies complicated by placental dysfunction.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"18 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}