Hypertension最新文献

{"title":"PRERISK Study: A Randomized Controlled Trial Evaluating a sFlt-1/PlGF-Based Calculator for Preeclampsia Hospitalization.","authors":"Anna C M Kluivers,Rugina I Neuman,Langeza Saleh,Henk Russcher,Ingrid A Brussé,Jerome M J Cornette,Eric A P Steegers,Marijke C van der Weide,Joris van Drongelen,Ralph R Scholten,Antonius E van Herwaarden,Sanne J Gordijn,Anneke C Muller Kobold,Wessel Ganzevoort,Sharon M Wesselius,Maurits C F J de Rotte,Robert Aardenburg,Maarten Raijmakers,Willy Visser,A H Jan Danser","doi":"10.1161/hypertensionaha.124.24386","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.24386","url":null,"abstract":"BACKGROUNDA model based on the soluble Fms-like tyrosine kinase-1/placental growth factor ratio, gestational age, and the urinary protein-to-creatinine ratio (PRERISK calculator) has been developed to predict preeclampsia-related maternal-fetal complications. Here, we tested whether this model can reduce hospital admissions without increasing complication rates among women with suspected or confirmed preeclampsia.METHODSIn this multicenter, open-label, randomized controlled trial conducted at 5 Dutch medical centers, women with suspected or confirmed preeclampsia were randomly assigned to the intervention group, where admission was guided by the PRERISK score using a 5% cutoff, or to the control group receiving routine care with a concealed PRERISK score. Two co-primary outcomes were the incidence of maternal-fetal preeclampsia-related complications (noninferiority) and the proportion of women with a hospitalization ratio (=admission days/inclusion days) ≤0.05 (superiority).RESULTSThe intervention and control groups included 442 and 435 women, respectively. In the intention-to-treat analysis, complications occurred in 41.6% of the intervention group versus 39.5% of the control group (adjusted relative risk 1.06 [95% CI, 0.92-1.22]; P=0.43). The proportion of women achieving a hospitalization ratio ≤0.05 was 23.6% in the intervention group and 26.3% in the control group (adjusted relative risk, 0.89 [95% CI, 0.71-1.13]; P=0.34). The latter was comparable in the per-protocol analysis (adjusted relative risk, 0.87 [95% CI, 0.64-1.19]; P=0.38), while in this analysis, complications occurred in 47.8% of the intervention group (n=251) versus 41.7% of the control group (n=365; adjusted relative risk 1.19 [95% CI, 1.03-1.38]; P=0.02).CONCLUSIONSRoutine screening with the PRERISK score and a 5% cutoff in patients with suspected or confirmed preeclampsia does not decrease hospitalization and is therefore not recommended.REGISTRATIONURL: https://onderzoekmetmensen.nl/nl/trial/48687; Unique identifier: NL63386.078.17, NL-OMON48687.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"20 1","pages":"827-838"},"PeriodicalIF":8.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846377","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":"Left Ventricular Hypertrophy or Not Left Ventricular Hypertrophy in Women With Prior Preeclampsia.","authors":"Erik Hedström","doi":"10.1161/hypertensionaha.124.24426","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.24426","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"108 1","pages":"784-786"},"PeriodicalIF":8.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846375","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":"Cuffless Blood Pressure Measurement: Where Do We Actually Stand?","authors":"Ramakrishna Mukkamala,Sanjeev G Shroff,Konstantinos G Kyriakoulis,Alberto P Avolio,George S Stergiou","doi":"10.1161/hypertensionaha.125.24822","DOIUrl":"https://doi.org/10.1161/hypertensionaha.125.24822","url":null,"abstract":"Cuffless blood pressure (BP) measurement offers considerable potential for clinical practice but is a challenging technological field. Many are investigating pulse wave analysis with or without pulse arrival time in which machine learning is applied to pulsatile waveforms obtained with mobile devices (eg, wristbands, smartphones) to estimate BP. These methods generally require individual user calibration with cuff BP measurements or demographics (eg, age, sex). This calibration makes it difficult to evaluate the method's accuracy, and many studies claiming accuracy used inadequate testing procedures. Yet, publications and regulatory-cleared devices continue to rise, seemingly implying technological advancements. An update is provided on the flurry of activity in cuffless BP technologies over the last 2 to 3 years, covering the clinical need, the latest devices, recent publications based on pulse wave analysis and pulse arrival time, progress in developing validation standards for cuffless BP devices, and recent publications on other cuffless BP measurement principles. Despite the high volume of research and development, to date, there is no compelling evidence that pulse wave analysis and pulse arrival time can provide significant added value in BP measurement accuracy beyond the cuff BP or demographic data for calibration. Thus, it is reasonable to at least be skeptical of published and future studies on pulse wave analysis and pulse arrival time for cuffless BP measurement with uncertain testing procedures. It is important to focus on establishing robust validation standards for cuffless BP devices requiring individual user calibration and also pursuing cuffless and calibration-free BP measurement methodologies going forward.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"6 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836493","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":"Asian Expert Consensus on Nocturnal Hypertension Management.","authors":"Jing Liu,Yan Li,Kei Asayama,Xin-Jun Zhang,Hao-Min Cheng,Sungha Park,Kazuomi Kario,Erkin Mirrakhimov,Ji-Guang Wang","doi":"10.1161/hypertensionaha.124.24026","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.24026","url":null,"abstract":"There is consistent and strong evidence that nighttime blood pressure is a better predictor of target organ damage and cardiovascular events, and the prevalence of nocturnal hypertension is high in all populations but higher in Asians than Europeans. Excessive salt intake and salt sensitivity have long been believed to be risk factors for elevated nighttime blood pressure in Asians. For various reasons, the control rate of nocturnal hypertension is low, for example, insufficient monitoring and inappropriate therapeutic regimens. With the increasing evidence and possibility of management, it is highly relevant to have thorough discussions among Asian experts and to reach a consensus on major aspects in regard to the management of nocturnal hypertension. The consensus involves 5 aspects, including definitions and diagnosis, epidemiology, risk and risk factors, treatment, and future perspectives.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"26 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822608","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":"Endothelial SMAD4 Deficiency Promotes Pulmonary Hypertension by Impairing Cell Adhesion and Extracellular Matrix Organization.","authors":"Wenyu Lv,Xinyu Gu,Lei Zeng,Keli Liu,Yunhua Li,Xun Chen,Xuan Zhang,Xuetong Zhou,Jiaqi He,Yong Dai,Jingfeng Wang,Feng Zhang,Yangxin Chen","doi":"10.1161/hypertensionaha.124.22782","DOIUrl":"https://doi.org/10.1161/hypertensionaha.124.22782","url":null,"abstract":"BACKGROUNDAberrant BMPR2 (bone morphogenetic protein receptor 2) signaling is associated with the pathogenesis of pulmonary hypertension. SMAD4 is an essential downstream effector of BMPR2 signaling, but whether and how it participates in pulmonary hypertension are unclear.METHODSGlobally and vascular cell-specifically inducible knockout mouse models were used to examine the role of SMAD4 deficiency in differential cell compartments in the development of pulmonary hypertension. Single-cell transcriptomic analysis in combination with in vitro cell function measurements was conducted to provide mechanistic insights into pulmonary hypertension pathogenesis.RESULTSAdult mice with Smad4 global deletion or endothelial cell-specific deletion spontaneously developed pulmonary hypertension manifestations, characterized by elevated right ventricle systolic pressure and excessive muscularization in pulmonary distal vessels, which were accompanied by other cardiovascular abnormalities. By contrast, mice with smooth muscle cell-specific Smad4 deletion had no pulmonary hypertension but rather displayed evident aortic aneurysm and dissection. At the cellular level, SMAD4 deficiency led to impairment of both endothelial cell-cell and cell-matrix adhesions and disorganized ECM (extracellular matrix), resulting in increased vascular leak and weakened endothelium-matrix attachment. Notably, endothelial Itgb1 deletion mimicked the impact of endothelial Smad4 loss on pulmonary hypertension. Finally, enhancing endothelial cell adhesion and ECM assembly by administrating an MMP (matrix metallopeptidase) inhibitor ilomastat could alleviate the pulmonary hypertension manifestations caused by endothelial SMAD4 deficiency.CONCLUSIONSSMAD4 deficiency in endothelial cells, but not smooth muscle cells, plays a pathogenic role in pulmonary hypertension, via dampening endothelial cell-cell and cell-matrix adhesions and ECM organization.","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"101 1","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822609","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":"Role of Ciliary Neurotrophic Factor in Angiotensin II-Induced Hypertension.","authors":"Sebastian A Potthoff, Ivo Quack, Yuri Mori, Guang Yang, Denada Arifaj, Ehsan Amin, Jaroslawna Meister, Sven G Meuth, Marta Kantauskaite, Doron Argov, Ioana Alesutan, Jakob Voelkl, Joon-Keun Park, Lars C Rump, Marc Rio, Gervaise Loirand, Ralf A Linker, Johannes Stegbauer","doi":"10.1161/HYPERTENSIONAHA.124.22845","DOIUrl":"10.1161/HYPERTENSIONAHA.124.22845","url":null,"abstract":"<p><strong>Background: </strong>Ciliary neurotrophic factor (CNTF), mainly known for its neuroprotective properties, belongs to the IL-6 (interleukin-6) cytokine family. In contrast to IL-6, the effects of CNTF on the vasculature have not been explored. Here, we examined the role of CNTF in AngII (angiotensin II)-induced hypertension.</p><p><strong>Methods: </strong>Hypertension was chronically induced with AngII (1000 ng/kg per minute, osmotic mini-pumps, 14 days) in CNTF-knockout and wild-type mice (with or without nephrectomy and 1% NaCl drinking water). Blood pressure was measured by tail-cuff and radiotelemetry. Effects of CNTF on vascular function and the JAK2/STAT3 pathway were measured in vivo, in the isolated perfused kidney, and in mouse and human vascular smooth muscle cells.</p><p><strong>Results: </strong>At baseline, systolic blood pressure was similar between both groups. During AngII infusion, blood pressure increase was significantly attenuated and hypertensive heart and kidney damage was significantly attenuated in CNTF-knockout compared with wild-type mice. Accordingly, renal pressor response to AngII but not KCl or phenylephrine was significantly decreased in CNTF-knockout compared with wild-type mice. Acute CNTF (5 µmol/L) administration nearly restored the AngII-dependent renal pressor response. Chronic CNTF treatment in CNTF-knockout mice increased blood pressure response to AngII to levels observed in wild-type mice. CNTF augments AngII-induced activation of the JAK2/STAT3 pathway in vitro in vascular smooth muscle cells. The significance of this interaction was shown, as the increase in renal pressor response by CNTF was abolished by JAK2/STAT3 inhibitors.</p><p><strong>Conclusions: </strong>Our results demonstrate a major impact of CNTF on blood pressure regulation by modulating AngII-induced pressor response via a JAK2/STAT3-dependent mechanism and indicate that CNTF is an important regulatory cytokine in hypertension.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"652-664"},"PeriodicalIF":6.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028638","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":"Clonal Hematopoiesis of Indeterminate Potential and Incident Hypertension: Results From the Women's Health Initiative.","authors":"Bernhard Haring, Aaron K Aragaki, Daichi Shimbo, Stephen R Rapp, Charles B Eaton, Michael J LaMonte, Jean Wactawski-Wende, Matthew A Allison, Aladdin H Shadyab, Jacques E Rossouw, Eric A Whitsel, Nora Franceschini, Charles Kooperberg, Pinkal Desai, Michael S Simon, Michael Böhm, Pradeep Natarajan, Sylvia Wassertheil-Smoller, JoAnn E Manson","doi":"10.1161/HYPERTENSIONAHA.124.24482","DOIUrl":"10.1161/HYPERTENSIONAHA.124.24482","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"82 4","pages":"e70-e72"},"PeriodicalIF":6.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663564","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":"Hypotensive Episodes on 24-Hour Ambulatory Blood Pressure and Cognitive Function: Insights From the SPRINT Study.","authors":"Wenxin Zhang, Susan Redline, Anand Viswanathan, Simon B Ascher, Darshana Hari, Stephen P Juraschek, Christophe Tzourio, Paul E Drawz, Lewis A Lipsitz, Murray A Mittleman, Yuan Ma","doi":"10.1161/HYPERTENSIONAHA.124.24222","DOIUrl":"10.1161/HYPERTENSIONAHA.124.24222","url":null,"abstract":"<p><strong>Background: </strong>Hypotensive episodes detected by 24-hour ambulatory blood pressure (BP) monitoring capture daily cumulative hypotensive stress and could be clinically relevant to cognitive impairment, but this relationship remains unclear.</p><p><strong>Methods: </strong>We included participants from the Systolic Blood Pressure Intervention Trial (receiving intensive or standard BP treatment) who had 24-hour ambulatory BP monitoring measured near the 27-month visit and subsequent biannual cognitive assessments. We evaluated the associations of hypotensive episodes (defined as systolic BP drops of ≥20 mm Hg between 2 consecutive measurements that reached <100 mm Hg) and hypotensive duration (cumulative time of systolic BP <100 mm Hg) with subsequent cognitive function using adjusted linear mixed models. We further assessed 24-hour average BP and variability.</p><p><strong>Results: </strong>Among 842 participants with treated hypertension (mean age, 71±9 years; 29% women), the presence (versus absence) of recurrent hypotensive episodes (11%) was associated with lower digit symbol coding scores (difference in <i>Z</i> scores, -0.249 [95% CI, -0.380 to -0.119]) and their faster declines (difference in <i>Z</i> score changes, -0.128 [95% CI, -0.231 to -0.026]). A consistent dose-response association was also observed for longer hypotensive duration with worse Montreal Cognitive Assessment and digit symbol coding scores. The association with digit symbol coding scores remained significant after further adjusting for 24-hour average BP and variability and was not observed for hypotension defined by clinic, orthostatic, or 24-hour average BP. Intensive BP treatment increased 24-hour hypotensive episodes and modified its association with the decline in digit symbol coding score.</p><p><strong>Conclusion: </strong>Twenty-four-hour hypotensive episodes were associated with worse cognitive function, especially in processing speed, and could be a novel marker for optimal BP control and dementia prevention.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"627-637"},"PeriodicalIF":6.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004612","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":"Contemporary Use of an Old Drug: Minoxidil for Resistant Hypertension.","authors":"Michael Bursztyn, Iddo Z Ben-Dov","doi":"10.1161/HYPERTENSIONAHA.124.23976","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23976","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":"82 4","pages":"543-548"},"PeriodicalIF":6.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663565","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":"Environmental Hypertensionology and the Mosaic Theory of Hypertension.","authors":"Sanjay Rajagopalan, Robert D Brook, Thomas Münzel","doi":"10.1161/HYPERTENSIONAHA.124.18733","DOIUrl":"10.1161/HYPERTENSIONAHA.124.18733","url":null,"abstract":"<p><p>Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":" ","pages":"561-572"},"PeriodicalIF":6.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448949","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}