Hypertension最新文献

{"title":"Young Athlete With Hypertension and Hypokalemia.","authors":"Antoine-Guy Lopez,Dominique Guerrot","doi":"10.1161/hypertensionaha.124.23348","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23348","url":null,"abstract":"We describe a 17-year-old woman diagnosed with severe hypertension during routine follow-up after the prescription of a combined oral contraceptive pill. Initially, due to her age, the estradiol-containing contraception, and high-level sport practice, physicians suspected drug-induced hypertension. Blood tests showed hypokalemia, and further investigations revealed pseudoaldosteronism. After the exclusion of toxic causes, Liddle syndrome was suspected and confirmed by genetic testing. Optimal therapeutic management was limited by anti-doping rules. This case report emphasizes the need for an early and systematic workup for causes of secondary hypertension in young patients and underlines diagnostic and therapeutic challenges in the management of hypertension in athletes.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"23 1","pages":"2203-2208"},"PeriodicalIF":8.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447936","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":"Pediatric High Blood Pressure Recognition Associated With Electronic Decision Support: A Cohort Analysis.","authors":"Justin P Zachariah,Tavleen Singh,Shannon Collinson,Justin Rahman,Alisa Acosta,Jessica F Campbell,Mary Hoang,Katharine E Sigler,Elizabeth Onugha,Shweta Shah,S Kristen Sexson-Tejtel,Mark Farrior,Scott Watson","doi":"10.1161/hypertensionaha.124.23532","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23532","url":null,"abstract":"BACKGROUNDPediatric high blood pressure (BP) predicts future cardiovascular disease events. High BP is improperly measured, underrecognized, and undermanaged especially in disadvantaged populations. In a large, diverse, academic pediatric practice, we detail the associations of a comprehensive initiative with high BP provider recognition.METHODSA comprehensive BP initiative was promulgated including (1) retraining providers and staff on BP management; (2) deploying equipment at 55+ sites; and (3) electronic decision support tool alerting staff and clinicians and suggesting management. During the 14-month preintervention and 14-month postintervention periods, data on BP and patient characteristics were collected. The outcome was incident BP recognition defined as any of the following: BP-specific International Classification of Diseases, Tenth Revision, diagnosis; problem list entry; specialty referral; diagnostic testing; repeat visit; or antihypertensives. Dichotomized as underpre versus at or over 13 years of age, analyses utilized interrupted time series and multivariable-adjusted logistic regression.RESULTSFrom preintervention (children, n=105 674; adolescents, n=54 365) to postintervention (children, n=87 917; adolescents, n=56 470), the proportion measured with high BP declined in children and adolescents (30% versus 14% and 30% versus 15%, respectively, each P<0.001). Post-intervention, high BP provider recognition was 58% higher in children (4.6%-7.3%) and 43% higher in adolescents (7.9% versus 11.3%; P<0.001 for both). The improvement was not different in disadvantaged race, ethnicity, or zip codes.CONCLUSIONSA comprehensive BP initiative was associated with more appropriate high BP measurement and recognition including in disadvantaged populations. Future work may address the low overall and nonsustained recognition and consideration of electronic decision support for pediatric BP management and mitigating disparities.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"2 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443721","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":"Tackling POTS Needs More Than Just a Sympathetic Approach.","authors":"Melanie Dani,Artur Fedorowski","doi":"10.1161/hypertensionaha.124.23716","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23716","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"25 1","pages":"2248-2250"},"PeriodicalIF":8.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447937","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":"Transient High Salt Intake Promotes T-Cell-Mediated Hypertensive Vascular Injury.","authors":"Mina Yakoub,Masudur Rahman,Patricia Kleimann,Jasmina Hoffe,Milena Feige,Pascal Bouvain,Christina Alter,Jennifer-Isabel Kluczny,Sophia Reidel,Rianne Nederlof,Lydia Hering,Doron Argov,Denada Arifaj,Marta Kantauskaite,Jaroslawna Meister,Markus Kleinewietfeld,Lars Christian Rump,Jonathan Jantsch,Ulrich Flögel,Dominik N Müller,Sebastian Temme,Johannes Stegbauer","doi":"10.1161/hypertensionaha.124.23115","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23115","url":null,"abstract":"BACKGROUNDDietary high salt (HS) intake has a strong impact on cardiovascular diseases. Here, we investigated the link between HS-aggravated immune responses and the development of hypertensive vascular disease.METHODSApolipoproteinE-deficient mice were transiently treated with HS (1% NaCl) via drinking water for 2 weeks, followed by a washout period, and subsequent Ang II (angiotensin II) infusion (1000 ng/kg per min for 10 days) to induce abdominal aortic aneurysms/dissections and inflammation.RESULTSWhile transient HS intake alone triggered nonpathologic infiltration of activated T cells into the aorta, subsequent Ang II infusion increased mortality and the incidence of abdominal aortic aneurysms/dissections and atherosclerosis compared with hypertensive control mice. There were no differences in blood pressure between both groups. In transient HS-treated hypertensive mice, the aortic injury was associated with increased inflammation, accumulation of neutrophils, monocytes, CD69+CD4+ T cells, as well as CD4+ and CD8+ memory T cells. Mechanistically, transient HS intake increased expression levels of aortic RORγt as well as splenic CD4+TH17 and CD8+TC1 T cells in Ang II-treated mice. Isolated aortas of untreated mice were incubated with supernatants of TH17, TH1, or TC1 cells polarized in vitro under HS or normal conditions which revealed that secreted factors of HS-differentiated TH17 and TC1 cells, but not TH1 cells accelerated endothelial dysfunction.CONCLUSIONSOur data suggest that transient HS intake induces a subclinical T-cell-mediated aortic immune response, which is enhanced by Ang II. We propose a 2-hit model, in which HS acts as a predisposing factor to enhance hypertension-induced TH17 and TC1 polarization and aortic disease.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"57 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443726","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":"Evidence for Baroreceptor Activity During Carotid Artery Applanation.","authors":"Joshua M Cherubini,Genie J Y Lau,Elric Y Allison,Maureen J MacDonald","doi":"10.1161/hypertensionaha.124.23879","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23879","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"231 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443722","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":"Postpartum Blood Pressure Variability and Heart Rate Variability in Preeclampsia.","authors":"Anne-Sophie van Wingerden,Maria Katsidoniotaki,Noora Haghighi,Casandra Almonte,Helen Woolcock Martinez,Eduard Valdes,Pedro Castro,Aymen Alian,Whitney Booker,Natalie Bello,Randolph S Marshall,Ioannis A Kougioumtzoglou,Nils Petersen,Eliza Miller","doi":"10.1161/hypertensionaha.124.23321","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.23321","url":null,"abstract":"BACKGROUNDPreeclampsia is associated with autonomic dysregulation during pregnancy; however, less is known about autonomic function in the first week postpartum after preeclampsia.METHODSWe retrospectively analyzed data from a prospective cohort of women with and without preeclampsia. Continuous blood pressure and heart rate were measured with finger plethysmography within 7 days postpartum. Frequency-domain blood pressure and heart rate variability (HRV) were calculated using spectral analysis. Time-domain HRV was calculated as the root mean square of successive RR interval differences. We compared results between those with and without preeclampsia, as well as between those with new-onset preeclampsia, chronic hypertension with superimposed preeclampsia, and normotensive participants.RESULTSA total of 70 postpartum women were enrolled: 20 normotensive, 29 new-onset preeclampsia, and 21 superimposed preeclampsia. Both low- and high-frequency blood pressure variabilities were higher in those with preeclampsia compared with controls (P=0.04 and P=0.02, respectively). This difference was driven by those with new-onset preeclampsia. The preeclampsia group had lower high-frequency HRV (P<0.005), a higher low-/high-frequency ratio of HRV (P<0.005), and lower time-domain HRV (P=0.01); this difference was seen in those with and without chronic hypertension.CONCLUSIONSPostpartum patients with preeclampsia with and without chronic hypertension had lower HRV compared with normotensive postpartum controls. Higher blood pressure variability was observed only in those with nonsuperimposed preeclampsia, suggesting that the autonomic profile of preeclampsia may differ in patients with chronic hypertension.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"230 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439359","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":"Cathepsin L Promotes Pulmonary Hypertension via BMPR2/GSDME-Mediated Pyroptosis.","authors":"Zhouyangfan Peng,Xue-Yang Luo,Xinyi Li,Yapei Li,Yusi Wu,Yuyang Tian,Bingjie Pan,Aleksandar Petrovic,Djuro Kosanovic,Ralph Theo Schermuly,Clemens Ruppert,Andreas Günther,Zhen Zhang,Chengfeng Qiu,Ying Li,Jun Pu,Xiaohui Li,Alex F Chen","doi":"10.1161/hypertensionaha.124.22903","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.22903","url":null,"abstract":"BACKGROUNDPulmonary hypertension (PH) is a fatal progressive disease characterized by pulmonary endothelial injury and occlusive pulmonary vascular remodeling. Lysosomal protease cathepsin L degrades essential molecules to participate in the human pathophysiological process. BMPR2 (bone morphogenetic protein type II receptor) deficiency, an important cause of PH, results from mutational inactivation or excessive lysosomal degradation and induces caspase-3-mediated cell death. Given recent evidence that pyroptosis, as a new form of programmed cell death, is induced by caspase-3-dependent GSDME (gasdermin E) cleavage, we hypothesized that cathepsin L might promote PH through BMPR2/caspase-3/GSDME axis-mediated pyroptosis.METHODSCathepsin L expression was evaluated in the lungs and plasma of patients with pulmonary arterial hypertension. The role of cathepsin L in the progression of PH and vascular remodeling was assessed in vivo. Small interfering RNA, specific inhibitors, and lentiviruses were used to explore the mechanisms of cathepsin L on human pulmonary arterial endothelial cell dysfunction.RESULTSCathepsin L expression is elevated in pulmonary artery endothelium from patients with idiopathic pulmonary arterial hypertension and experimental PH models. Genetic ablation of cathepsin L in PH rats relieved right ventricular systolic pressure, pulmonary vascular remodeling, and right ventricular hypertrophy, also restoring endothelial integrity. Mechanistically, cathepsin L promotes caspase-3/GSDME-mediated endothelial cell pyroptosis and represses BMPR2 signaling activity. Cathepsin L degrades BMPR2 via the lysosomal pathway, and restoring BMPR2 signaling prevents the pro-pyroptotic role of cathepsin L in PAECs and experimental PH models.CONCLUSIONSThese results show for the first time that cathepsin L promotes the development of PH by degrading BMPR2 to induce caspase-3/GSDME-mediated endothelial pyroptosis.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"1 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439242","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":"Blood-Brain Barrier Integrity Decreases With Higher Blood Pressure: A 7T DCE-MRI Study.","authors":"Marieke van den Kerkhof, Joost J A de Jong, Paulien H M Voorter, Alida A Postma, Abraham A Kroon, Robert J van Oostenbrugge, Jacobus F A Jansen, Walter H Backes","doi":"10.1161/HYPERTENSIONAHA.123.22617","DOIUrl":"10.1161/HYPERTENSIONAHA.123.22617","url":null,"abstract":"<p><strong>Background: </strong>Blood-brain barrier (BBB) integrity is presumed to be impaired in hypertension, resulting from cerebral endothelial dysfunction. Hypertension precedes various cerebrovascular diseases, such as cerebral small vessel disease, and is a risk factor for developing neurodegenerative diseases for which BBB disruption is a preceding pathophysiological process. In this cross-sectional study, we investigated the relation between hypertension, current blood pressure, and BBB leakage in human subjects.</p><p><strong>Methods: </strong>BBB leakage was determined in 22 patients with hypertension and 19 age- and sex-matched normotensive controls (median age [range], 65 [45-80] years; 19 men) using a sparsely time-sampled contrast-enhanced 7T magnetic resonance imaging protocol. Structural cerebral small vessel disease markers were visually rated. Multivariable regression analyses, adjusted for age, sex, cardiovascular risk factors, and cerebral small vessel disease markers, were performed to determine the relation between hypertension status, systolic and diastolic blood pressure, mean arterial pressure, drug treatment, and BBB leakage.</p><p><strong>Results: </strong>Both hypertensive and normotensive participants showed mild scores of cerebral small vessel disease. BBB leakage did not differ between hypertensive and normotensive participants; however, it was significantly higher for systolic blood pressure, diastolic blood pressure, and mean arterial pressure in the cortex, and diastolic blood pressure and mean arterial pressure in the gray matter. Effectively treated patients showed less BBB leakage than those with current hypertension.</p><p><strong>Conclusions: </strong>BBB integrity in the total and cortical gray matter decreases with increasing blood pressure but is not related to hypertension status. These findings show that BBB disruption already occurs with increasing blood pressure, before the presence of overt cerebral tissue damage. Additionally, our results suggest that effective antihypertensive medication has a protective effect on the BBB.</p><p><strong>Registration: </strong>URL: https://trialsearch.who.int/; Unique identifier: NL7537.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"2162-2172"},"PeriodicalIF":6.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971011","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":"Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism.","authors":"Marco Marcelli, Caixia Bi, John W Funder, Michael J McPhaul","doi":"10.1161/HYPERTENSIONAHA.124.22884","DOIUrl":"10.1161/HYPERTENSIONAHA.124.22884","url":null,"abstract":"<p><strong>Background: </strong>In many practices, the screening for primary aldosteronism relies on a single-blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). ARR levels vary between expert centers and repeated assays in the same individual, emphasizing the potential variability of this screening approach. A suppressed PRA to <1 ng/mL per h has been proposed as an alternative test to the ARR.</p><p><strong>Methods: </strong>We compared 2 potential screening approaches to identify probable primary aldosteronism (ARR≥30 or ARR≥20 versus PRA suppressed below 1 ng/mL per h) in a cohort of 94 829 paired PRA and PAC samples submitted by clinicians to evaluate the presence of primary aldosteronism.</p><p><strong>Results: </strong>Of 94 829 patients, 20.3% tested positive based on ARR≥20 (95% CI, 20.0%-20.5%), 13.9% based on ARR≥30 (95% CI, 13.6%-14.1%), versus 45.9% based on suppressed PRA (<1 ng/mL per minute [95% CI, 45.5%-46.2%]). In the PRA group, a range of aldosterone levels was observed: 5.5% had PAC >15 ng/dL, 25.2% had PAC 5 to 15 ng/dL, and 15.2% had PAC <5 ng/dL, compared with 6%, 12.7%, and 1.6% in the ARR≥20 group and 4.7%, 8.5%, and 0.7% in the ARR≥30 group.</p><p><strong>Conclusions: </strong>In this cohort of individuals being screened for primary aldosteronism, substantially more individuals were identified using criteria focused on suppression of renin activity compared with using the aldosterone renin ratio as a screening tool.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"2072-2081"},"PeriodicalIF":6.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748034","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":"Cardiovascular Health Starts in the Womb.","authors":"Bonita Falkner, Barbara T Alexander, Anne-Monique Nuyt, Andrew M South, Julie Ingelfinger","doi":"10.1161/HYPERTENSIONAHA.124.21359","DOIUrl":"10.1161/HYPERTENSIONAHA.124.21359","url":null,"abstract":"<p><p>Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents-an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"2016-2026"},"PeriodicalIF":6.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787912","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}