Journal of Hypertension最新文献

{"title":"Prevalence of hypertension and uncontrolled hypertension after solid organ transplantation: a 5-year follow-up of the Swiss Transplant Cohort Study.","authors":"Nora Schwotzer, Yimin Lu, Matthieu Halfon, Manuel Pascual, Pedro Marques-Vidal, Dela Golshayan, Gregoire Wuerzner","doi":"10.1097/HJH.0000000000003905","DOIUrl":"10.1097/HJH.0000000000003905","url":null,"abstract":"<p><strong>Objective: </strong>Hypertension (HTN) increases cardiovascular risk and is a frequent finding across all solid organ transplant recipients. We describe the prevalence of HTN and uncontrolled HTN, as well as details on pharmacologic treatment of HTN across solid organs transplant recipients up to five years after transplantation.</p><p><strong>Methods: </strong>This retrospective study is nested in the prospective Swiss Transplant Cohort Study ( www.stcs.ch ) that includes kidney, heart, lung, and liver transplantation. Data extraction from 2008 to 2019 was used for this study and follow-up data at 6, 12 and 60 months was analyzed.</p><p><strong>Results: </strong>A total of 3865 transplant recipients were included for analysis. The prevalence of HTN at 6 and 60 months was 88.9% and 90.4% in kidney ( P  = 0.21), 61.8% and 76.1% in liver ( P  < 0.01), 72.6% and 84.9% in lung ( P  < 0.01), and 89.3% and 85.8% in heart ( P  = 0.33) transplant recipients, respectively. The prevalence of uncontrolled HTN at 6 and 60 months was 40.3% and 38.9% in kidney ( P  = 0.48), 21.2% and 30.5% in liver ( P  = 0.05), 26.0% and 36.8% in lung ( P  = 0.03) and 38.9% and 18.5% in heart ( P  < 0.01) transplant recipients, respectively. At 12 months, compared to heart transplant recipients, kidney [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.1-2.1], liver (OR = 1.7, 95% CI 1.1-2.6) and lung (OR = 2.6, 95% CI 1.6-4.0) transplant recipients had a higher likelihood of presenting with uncontrolled HTN.</p><p><strong>Conclusion: </strong>HTN prevalence after solid organ transplantation is high. Uncontrolled and untreated HTN remain a major issue post transplantation, particularly in organ recipients not necessarily suffering from cardiovascular diseases such as liver or lung transplant recipients.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"397-404"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502020","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":"Reply to \"Investigating the mechanisms of PM2.5's impact on blood pressure: establishing a three-tier response strategy\" by Qiang et al.","authors":"Bin Yu, Yuchen Li, Peng Jia, Shujuan Yang","doi":"10.1097/HJH.0000000000003928","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003928","url":null,"abstract":"","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":"43 3","pages":"555-556"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066093","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":"Relationship between blood pressure variability and blood pressure phenotypes: a home blood pressure monitoring study.","authors":"Marco A M Alves, Rodrigo Bezerra, Christian S Dal Pont, Marco A Mota-Gomes, Annelise M G Paiva, Weimar S Barroso, Roberto D Miranda, Eduardo C D Barbosa, Andréa A Brandão, José L Lima-Filho, Antonio Coca, Andrei C Sposito, Audes D M Feitosa, Wilson Nadruz","doi":"10.1097/HJH.0000000000003925","DOIUrl":"10.1097/HJH.0000000000003925","url":null,"abstract":"<p><strong>Objective: </strong>Home blood pressure (BP) variability (BPV) and BP phenotypes such as white-coat hypertension (WCH), white-coat uncontrolled hypertension (WUCH), masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are predictors of adverse cardiovascular events. This study compared home BPV across BP phenotypes built from abnormal office BP (OBP) and home BP monitoring (HBPM) thresholds defined by three distinct societies [European Society of Hypertension (ESH): OBP ≥ 140/90 mmHg and HBPM ≥ 135/85 mmHg; American College of Cardiology/American Heart Association (ACC/AHA): OBP and HBPM ≥ 130/80 mmHg and Brazilian Society of Cardiology (BSC): OBP ≥ 140/90 mmHg and HBPM ≥ 130/80 mmHg].</p><p><strong>Methods: </strong>This cross-sectional study evaluated 51 194 treated (37% men, age = 61 ± 15 years) and 56 100 untreated (41% men, age = 54 ± 16 years) individuals from 1045 Brazilian centers who underwent OBP and HBPM measurements. Systolic and diastolic home BPV were estimated as the: standard deviation, coefficient of variation, and the variability independent of the mean of HBPM.</p><p><strong>Results: </strong>Results of adjusted analysis showed that home BPV parameters were significantly greater in individuals with WCH/WUCH according to the BSC criteria, in those with MH/MUCH defined by the ACC/AHA criteria, and tended to be greater in individuals with either MH/MUCH or WCH/WUCH defined by the ESH criteria.Furthermore, restricted cubic spline analysis showed a U-shaped association between BPV and the difference between OBP and HBPM in treated and untreated individuals.</p><p><strong>Conclusion: </strong>Home BPV was greater in WCH/WUCH and/or MH/MUCH depending on the criteria used to define abnormal OBP and HBPM thresholds. These findings underscore the need to standardize abnormal BP criteria in clinical practice.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"456-463"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621955","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":"Hypertension in Sri Lanka: a systematic review of prevalence, control, care delivery and challenges.","authors":"Priyanga Ranasinghe, Thilina Perera, Sandamini Liyanage, Minura Manchanayake, Nilushka Rupasinghe, David J Webb","doi":"10.1097/HJH.0000000000003953","DOIUrl":"10.1097/HJH.0000000000003953","url":null,"abstract":"<p><p>Hypertension (HTN) is recognized as a major modifiable risk factor for cardiovascular deaths in South Asia. Our aim was to furnish a comprehensive analysis of HTN prevalence, trends, control efforts, awareness, barriers in care delivery and associated factors, based on nationally derived evidence in Sri Lanka. A systematic search of online databases ( PubMed, Web of Science, Scopus ), local journals and repositories yielded 6704 results, of which 106 were included. Prevalence of HTN steadily increased from 23.7% (2005-2006) to 34.8% (2021). Associated factors identified were hyperhomocysteinaemia [odds ratio (OR) 2.80], overweight/obesity (OR 2.02), perceived job stress (OR 2.20-3.02), physical inactivity (OR 2.08-2.80), salt intake more than 5 g/day (OR 2.50), smoking (OR 2.31) and waist-to-height ratio more than or equal to 0.5 (OR 2.23). Cohort studies revealed poor blood pressure control and treatment adherence among patients. Pharmacological ( n  = 4) and nonpharmacological ( n  = 6) interventional studies were few. Studies on knowledge, attitudes and practices demonstrated a lack of public awareness. Despite the high prevalence of HTN in Sri Lanka, many cases remain undiagnosed, underscoring importance of targeted screening programmes and culture-specific public health education programmes.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"371-386"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950056","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":"Pharmacotherapy of arterial hypertension in patients with psoriasis.","authors":"Jozef Dodulík, Lenka Dodulíková, Jiří Plášek, Zdeněk Ramík, Jiří Vrtal, Jan Václavík","doi":"10.1097/HJH.0000000000003982","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003982","url":null,"abstract":"<p><p>Psoriasis is a chronic systemic autoimmune disease associated with an elevated risk of developing cardiovascular disease. In patients with psoriasis, arterial hypertension treatment requires careful selection of antihypertensive drugs, as some drugs may worsen the skin manifestations of psoriasis. In this review, we summarize the available evidence regarding the risks and benefits of each group of antihypertensive drugs. We also suggest a scheme for optimizing antihypertensive treatment in patients with psoriasis, with emphasis on achieving effective control of blood pressure and cardiovascular disease, while minimizing the worsening of cutaneous manifestations. Angiotensin receptor blockers appear to be the most appropriate treatment for hypertensive patients with psoriasis, with the potential addition of calcium channel blockers if blood pressure is not adequately controlled. Alternatives are angiotensin-converting enzyme inhibitors and/or mineralocorticoid receptor antagonists. Diuretics and beta blockers are associated with greater risk of worsening of psoriatic lesions.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457564","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":"Development of the European Society of Hypertension guidelines for the management of arterial hypertension: comparison of the helpfulness of ESH 2013, 2018, and 2023 guidelines.","authors":"Akos Koller, Zoltán Járai, Johanna Takács","doi":"10.1097/HJH.0000000000003985","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003985","url":null,"abstract":"<p><strong>Objective: </strong>Over the last decade, the European Society of Hypertension (ESH) published several guidelines (GLs) for the Management of Arterial Hypertension (2013, 2018, and 2023). We hypothesized that the GL has been improved because of the publications of new evidence. Thus, we aimed to examine the development of ESH guidelines (ESH GLs) by comparing their helpfulness regarding the diagnosis and treatment of hypertension.</p><p><strong>Methods: </strong>A novel mathematical analysis was used to compare ESH GLs. Not only the frequency of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) were examined but a newly developed certainty index (CI) was calculated. This CI allows the CLASS and LEVEL to be assessed together, providing a less biased assessment of GLs, than examining the CLASS and LEVEL independently or related to each other.</p><p><strong>Results: </strong>The number of recommendations showed continuous and significant increases from 2013 (N = 110) to 2018 (N = 169), and 2023 (N = 269). Examining the frequency of CLASS and/or LEVEL led to biased results, showing both improvements and/or worsening comparing years. However, based on the new analysis, a continuous improvement was shown in the percentage of certainty from 2013 to 2023 (2013: 60.5%, 2018: 72.1%, 2023: 75.3%). Accordingly, the CI was also significantly increased from 2013 (CI: 0.21), to 2018 (CI: 0.44), and to 2023 (CI: 0.51).</p><p><strong>Conclusion: </strong>The analysis shows that compared to previous GLs, the structure of the ESH 2023 GL has been rearranged and simplified. The higher number of Recommendations indicates a continuously accumulating knowledge regarding the mechanisms, clinical findings, and epidemiology of hypertension. Moreover, the ESH 2023 GL shows a higher degree of certainty and CI, corresponding to a higher level of helpfulness of the ESH 2023 GL for healthcare professionals to diagnose, prevent, and treat hypertension.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458309","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":"Accuracy of the smartphone blood pressure measurement solution OptiBP to track blood pressure changes in pregnant women.","authors":"Pedro Almeida, Alexia Cuénoud, Harry Hoang, Alexandra Othenin-Girard, Nadia Salhi, Andreas Köthe, Urvan Christen, Patrick Schoettker","doi":"10.1097/HJH.0000000000003956","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003956","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertensive disorders present significant morbidity and mortality during pregnancy. Although ambulatory blood pressure measurement remains the standard of care for normotensive women, self-monitoring at home is increasingly prevalent. The widespread use of smartphones worldwide has sparked interest in mobile applications that leverage the built-in hardware for blood pressure estimation, yet few trials have assessed their accuracy.</p><p><strong>Methods: </strong>This prospective, longitudinal and monocentric study evaluated the accuracy of the OptiBP algorithm against standard oscillometric blood pressure measurements in a sample of pregnant women. Patients scheduled for elective caesarean sections were enrolled during the preoperative anesthesia consultations. Paired blood pressure measurements using OptiBP and the reference method were obtained at multiple time-points in late pregnancy and the postpartum period. Agreement between methods was assessed using the AAMI/ESH/ISO 81060-2:2018 standard thresholds of 5 ± 8 mmHg for mean ± standard deviation of the error (criterion 1) and patient-specific standard deviation of the mean error (criterion 2) and represented graphically by Bland-Altman scatterplots.</p><p><strong>Results: </strong>Forty-eight women were enrolled of which 32 completed the protocol, yielding 338 total valid measurement pairs. Mean and standard deviation of the error were -1.78 ± 7.94 and 1.19 ± 7.59, and the patient-specific standard deviation of the mean error was 4.68 and 4.52, for SBP and DBP, respectively.</p><p><strong>Conclusion: </strong>Compared with blood pressure measurements taken with an oscillometric device, OptiBP's blood pressure estimates meet the AAMI/ESH/ISO 81060-2:2018 criteria.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382735","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":"Thermoneutral-housed rats demonstrate impaired perivascular adipose tissue and vascular crosstalk.","authors":"Melissa M Henckel, Ji Hye Chun, Leslie A Knaub, Gregory B Pott, Georgia E James, Kendall S Hunter, Robin Shandas, Lori A Walker, Jane E-B Reusch, Amy C Keller","doi":"10.1097/HJH.0000000000003948","DOIUrl":"10.1097/HJH.0000000000003948","url":null,"abstract":"<p><strong>Objective: </strong>Vascular pathology, characterized by impaired vasoreactivity and mitochondrial respiration, differs between the sexes. Housing rats under thermoneutral (TN) conditions causes vascular dysfunction and perturbed metabolism. We hypothesized that thoracic perivascular adipose tissue (tPVAT), a vasoregulatory adipose depot known to have a brown adipose tissue (BAT) phenotype, remodels to a mainly white adipose (WAT) phenotype in rats housed at TN, driving diminished vasoreactivity in a sex-dependent manner.</p><p><strong>Methods: </strong>Male and female Wistar rats were housed at either room temperature (RT) or TN. We measured changes in tPVAT morphology, vasoreactivity in vessels with intact tPVAT or transferred to tPVAT of the oppositely-housed animal, vessel stiffness, vessel mitochondrial respiration and cellular signaling.</p><p><strong>Results: </strong>Remodeling of tPVAT was observed in rats housed at TN; animals in this environment showed tPVAT whitening and displayed diminished aortae vasodilation (P < 0.05), different between the sexes. Juxtaposing tPVAT from RT rats onto aortae from TN rats in females corrected vasodilation (P < 0.05); this did not occur in males. In aortae of all animals housed at TN, mitochondrial respiration was significantly diminished in lipid substrate experiments (P < 0.05), and there was significantly less expression of phosphorylated endothelial nitric oxide synthase (peNOS) (P < 0.001).</p><p><strong>Conclusions: </strong>These data are consistent with TN-induced remodeling of tPVAT, notably associated with sex-specific blunting of vasoreactivity, diminished mitochondrial respiration, and altered cellular signaling.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382767","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":"Impact of kidney function on stiffness of small conduit arteries in hypertension and obesity.","authors":"Diego Moriconi, Monica Nannipieri, Smriti Badhwar, Stefano Taddei, Pierre Boutouyrie, Rosa Maria Bruno","doi":"10.1097/HJH.0000000000003957","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003957","url":null,"abstract":"<p><strong>Background: </strong>Arterial stiffness is a key cardiovascular risk factor influenced by conditions like hypertension, obesity and kidney function. Although large arteries have been extensively studied, small conduit arteries remain less investigated. This study aims to explore the impact of kidney function on small conduit artery stiffness in two distinct groups: normotensive individuals with severe obesity and normal-weight hypertensive individuals.</p><p><strong>Methods: </strong>Thirty-three severely obese (OB) individuals, 33 hypertensive (HT) individuals, and 33 normotensive, normal-weight control participants, matched for age and sex, were recruited. Eleven participants (33%) in both the OB and HT groups had estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2. Aortic stiffness (carotid-femoral pulse wave velocity) was recorded. Ultrasound images of common carotid, radial, and interdigital arteries were acquired for the assessment of geometry, distensibility coefficient, circumferential wall stress, and Young's elastic modulus (Einc).</p><p><strong>Results: </strong>The OB group exhibited higher radial stiffness (both Einc and distensibility coefficient) compared to the HT and control groups, independent of radial diameter adjustments. An inverse correlation between eGFR and radial Einc was noted only in the OB group (P = 0.002). Conversely, a direct correlation between eGFR and carotid distensibility coefficient was found only in the HT group (P = 0.001). In multivariable analysis, eGFR and BMI were the only predictors of radial Einc in the overall population.</p><p><strong>Conclusion: </strong>Severe obesity and reduced eGFR synergistically increase radial artery stiffness, a phenomenon not observed in essential hypertension. This study suggests that moderate chronic kidney disease exacerbates vascular alterations in obese individuals, highlighting the need for further research on the role of small conduit arteries in cardiovascular risk.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382755","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":"Hypothesis: reactive increases in plasma renin activity attenuate the fall in blood pressure caused by salt depletion and renin-angiotensin system inhibition.","authors":"Jean E Sealey, Jon D Blumenfeld","doi":"10.1097/HJH.0000000000003964","DOIUrl":"https://doi.org/10.1097/HJH.0000000000003964","url":null,"abstract":"<p><p>There are inconsistencies in the effect of raising or lowering body salt on blood pressure (BP). We hypothesize that they are caused in part by differences in plasma renin activity (PRA). PRA changes reciprocally with body salt. PRA is the rate limiting step in the formation of the vasoconstrictor peptide angiotensin II (Ang II) in the circulation where it cleaves Ang I from plasma angiotensinogen, and then Ang I is rapidly converted to Ang II by angiotensin-converting enzyme in plasma and vascular endothelial cells. We hypothesize that PRA levels above 0.65 ng/ml/h lead to sufficient Ang II production to cause vasoconstriction, whereas lower levels do not. PRA is usually more than 0.65 in normotensives who are not on a high-salt diet; in them, the increase in PRA/Ang II vasoconstriction caused by reduction in body salt (low-salt diet, diuretic use) is large enough to prevent BP from falling. By contrast, a similar reduction in body salt lowers BP in the 30% of hypertensive patients with low baseline PRA (<0.65 ng/ml/h), because vasoconstriction does not increase in that range. A similar reduction in body salt also lowers BP in the 60% of hypertensive patients with baseline PRA between 0.65 and 4.5 ng/ml/h, but for a different reason; the rise in PRA and the increase in vasoconstriction is too small to prevent BP from falling. However, after body salt has been reduced enough to raise PRA above 4.5 ng/ml/h, further salt depletion increases PRA to a greater extent, and BP does not fall. Renin-angiotensin system (RAS) inhibitors leave a small amount of renin unblocked. In salt-depleted hypertensive patients, they also raise PRA enough to prevent BP from falling significantly. We propose that this PRA/Ang II vasoconstrictor effect related to reactive increases in PRA can prevent or attenuate the decrease in BP caused by excessive salt depletion, even during concurrent RAS inhibition. This phenomenon, if confirmed, could inform new strategies to optimize the treatment of hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD).</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458228","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}