Journal of Hypertension最新文献

{"title":"Diagnostic and prognostic value of ECG-predicted hypertension-mediated left ventricular hypertrophy using machine learning.","authors":"Hafiz Naderi, Julia Ramírez, Stefan Van Duijvenboden, Esmeralda Ruiz Pujadas, Nay Aung, Lin Wang, Bishwas Chamling, Marcus Dörr, Marcello R P Markus, Choudhary Anwar A Chahal, Karim Lekadir, Steffen E Petersen, Patricia B Munroe","doi":"10.1097/HJH.0000000000004034","DOIUrl":"10.1097/HJH.0000000000004034","url":null,"abstract":"<p><strong>Objective: </strong>Four hypertension-mediated left ventricular hypertrophy (LVH) phenotypes have been reported using cardiac magnetic resonance (CMR): normal LV, LV remodelling, eccentric and concentric LVH, with varying prognostic implications. The electrocardiogram (ECG) is routinely used to detect LVH; however, its capacity to differentiate between LVH phenotypes is unknown. This study aimed to classify hypertension-mediated LVH from the ECG using machine learning and test for associations of ECG-predicted phenotypes with incident cardiovascular outcomes.</p><p><strong>Methods: </strong>ECG biomarkers were extracted from the 12-lead ECG of 20 439 hypertensive patients in UK Biobank (UKB). Classification models integrating ECG and clinical variables were built using logistic regression, support vector machine (SVM), and random forest. The models were trained in 80% of the participants, and the remaining 20% formed the test set. External validation was sought in 877 hypertensive participants from the Study of Health in Pomerania (SHIP). In the UKB test set, we tested for associations between ECG-predicted LVH phenotypes and incident major adverse cardiovascular events (MACE) and heart failure.</p><p><strong>Results: </strong>Among UKB participants 19 408 had normal LV, 758 LV remodelling, 181 eccentric and 92 concentric LVH. Classification performance of the three models was comparable in UKB. SVM (accuracy 0.79, sensitivity 0.59, specificity 0.87, AUC 0.69) was taken forward for external validation with similar results in SHIP. There was superior prediction of eccentric LVH in both cohorts. In the UKB test set, ECG-predicted eccentric LVH was associated with heart failure (hazard ratio 3.42, 95% CI 1.06-9.86).</p><p><strong>Conclusion: </strong>ECG-based ML classifiers represent a potentially accessible screening strategy for the early detection of hypertension-mediated LVH phenotypes.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"1327-1338"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127843","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":"The importance of experience: insights into optimal home-blood pressure monitoring regimens from the TASMINH4 Trial.","authors":"Emily C Morris, Katherine L Tucker, Richard J McManus, Richard J Stevens","doi":"10.1097/HJH.0000000000004062","DOIUrl":"10.1097/HJH.0000000000004062","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates how prior home blood pressure monitoring (HBPM) experience affects blood pressure variability and evaluates if reduced HBPM regimens could be recommended for experienced patients.</p><p><strong>Methods: </strong>This posthoc analysis of the TASMINH4 trial included self-monitored blood pressure (BP) data from 225 patients. The standard deviation of systolic BP recordings was calculated for each patient-week to assess how BP variability changes with HBPM duration. A subgroup of 84 patients, who submitted at least 1 reading a day for 7 days at months 1, 3, and 6, was analysed to assess the impact of reduced HBPM regimens on BP estimates.</p><p><strong>Results: </strong>Day 1 readings were significantly higher than day 2-7 in the first 3 months of HBPM: 1.1 (95% CI 0.4, 1.8) day 1 vs. day 2. This effect diminished after 6 months: 1.0 (95% CI -0.8, 2.8) day 1 vs. 2. Long term monitoring significantly reduced intra-week BP variability, with the standard deviation of systolic BP recordings within each patient-week significantly reduced after 6 months. After 6 months of HBPM, the inclusion of day 1 readings or use of an abbreviated monitoring regimen had a reduced impact on estimates of mean systolic and diastolic blood pressure.</p><p><strong>Conclusions: </strong>Long-term HBPM reduces intra-week BP variability, making day 1 readings insignificantly raised after 6 months of HBPM. This provides rationale for different HBPM recommendations: longer regimes, excluding day one readings, for diagnosis and short-term monitoring; and abbreviated regimes including day 1 for longer term monitoring in those with HBPM experience.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"1400-1406"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127846","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":"Maintenance of blood pressure by reactive increases in plasma renin activity during salt depletion and renin-angiotensin system inhibition.","authors":"Jean E Sealey, Jon D Blumenfeld","doi":"10.1097/HJH.0000000000004040","DOIUrl":"10.1097/HJH.0000000000004040","url":null,"abstract":"","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":"43 8","pages":"1457"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626537","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":"Breaking down resistance: novel aldosterone synthase inhibitors in the management of resistant hypertension.","authors":"Chai Eddison Chung Hung, Cyril Kocherry, Jacob George","doi":"10.1097/HJH.0000000000004055","DOIUrl":"10.1097/HJH.0000000000004055","url":null,"abstract":"<p><p>This review aims to evaluate the impact of novel aldosterone synthase inhibitors, the first new class of antihypertensives in more than 20 years, on the management of resistant hypertension. We highlight the problem of resistant hypertension in clinical practice and describe the challenging history and development of aldosterone synthase inhibitors. The review highlights clinical trial evidence to-date for all agents in this class, with a key focus on the two most mature agents baxdrostat and lorundrostat which are currently in pivotal Phase 3 trials. Both agents have demonstrated significant dose-dependent reductions in blood pressure, particularly in patients with resistant hypertension and crucially, with a minimal impact on cortisol levels. They have also shown promise with marked blood pressure reductions in patients with varying physiological profiles and few adverse events at optimised doses. However, as would be expected, both drugs are associated with increases in serum potassium levels, necessitating careful monitoring.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"1286-1295"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020931","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":"Increased formation of angiotensin II from angiotensin I in individuals of African descent.","authors":"Sanjay K Gandhi, Kyung-Soo Kim, K Bridget Brosnihan, Nancy J Brown","doi":"10.1097/HJH.0000000000004068","DOIUrl":"10.1097/HJH.0000000000004068","url":null,"abstract":"<p><strong>Objective: </strong>Activation of the renin-angiotensin-aldosterone system (RAAS) and African ancestry are both associated with increased end-organ damage in hypertension. An insertion (I)/deletion (D) polymorphism in the gene encoding the angiotensin-converting enzyme (ACE) has been associated with ACE activity. This study tested the hypothesis that ancestry or ACE I/D genotype affects the conversion of angiotensin (Ang) I to Ang II and blood pressure, renal plasma flow, and aldosterone during Ang I or II infusion.</p><p><strong>Methods: </strong>Ang I and Ang II were infused in graded doses from 1 to 20 ng/kg/min in a randomized, single-blind, crossover study in salt-replete normotensive participants of self-identified African (Black) or European (white) ancestry who were homozygous for the ACE I/I (7 Black, 8 white) or D/D (8 Black, 8 white) genotype.</p><p><strong>Results: </strong>ACE activity was significantly increased in ACE D/D vs. ACE I/I individuals regardless of ancestry. The conversion of Ang I to Ang II was increased in Black compared to in white participants, independent of genotype. The pressor and aldosterone responses to Ang I and Ang II did not differ by ancestry or ACE I/D genotype. Basal renal plasma flow was increased in individuals of ACE D/D genotype independent of ancestry but the renal vasoconstrictor response to Ang I and Ang II did not differ by ACE genotype.</p><p><strong>Conclusions: </strong>The conversion of infused Ang I to Ang II is increased in Black compared to in white individuals. Increased Ang II could contribute to attenuated responses to RAAS interfering drugs and end-organ damage in individuals of African ancestry.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"1436-1441"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284978","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":"Left ventricular hypertrophy by voltage criteria in hypertension: more than meets the eye?","authors":"Vellore J Karthikeyan","doi":"10.1097/HJH.0000000000004060","DOIUrl":"https://doi.org/10.1097/HJH.0000000000004060","url":null,"abstract":"","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":"43 8","pages":"1325-1326"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626536","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":"Overexpression of TLR7 contributes to the development of preeclampsia through suppression of the PI3K-Akt signaling pathway.","authors":"Xiaowei Zhang, Shilin Zhong, Ping Yang, Xinyang Liu, Jinli Lyu, Yuzhen Ding, Qiaoli Feng, Yiheng Liang, Ping Liu, Chunfeng Liu, Yanlan Wang, Yuxia Zhu, Liting Huang, Zhansong Xiao, Pingyue Zhao, Qing Li, Kaidong Ma, Shangrong Fan","doi":"10.1097/HJH.0000000000004099","DOIUrl":"https://doi.org/10.1097/HJH.0000000000004099","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to uncover key genes contributing to preeclampsia development and elucidate their underlying mechanisms.</p><p><strong>Methods: </strong>We conducted transcriptome analysis of placental tissues from preeclampsia patients and healthy pregnancies. Pregnant mice were administered a TLR7 agonist to induce preeclampsia-like symptoms. Additionally, we over-expressed TLR7 in HTR8/Svneo cells to assess its effects on cell functions. Co-analysis of transcriptomic differences between TLR7 agonist-treated mice, oe-TLR7 cells, and corresponding control groups was performed to identify key regulatory pathways.</p><p><strong>Results: </strong>Our findings revealed that the Toll-like receptor (TLR) signaling pathway may serve as a central network hub, with TLR7 being the only significantly altered TLR between preeclampsia and healthy pregnancies. In-vivo studies showed that TLR7 agonist administration in pregnant mice induced preeclampsia -like symptoms, including elevated blood pressure and increased levels of sFlt and sEng. In-vitro experiments demonstrated that over-expression of TLR7 in HTR8/Svneo cells resulted in reduced cell proliferation and migration. Transcriptomic analysis identified the PI3K-Akt signaling pathway as a central regulator that significantly altered following TLR7 over-expression. Activation of the P53 signaling pathway and decreased expression of THBS2/col-IV were found to be potentially regulated by PI3K-Akt signals, further suppressing trophoblast migration and invasion. These effects contribute to superficial placental implantation and compromised uterine perfusion, ultimately leading to the development of preeclampsia.</p><p><strong>Conclusion: </strong>Our study suggests that the over-activation of TLR7 may play a significant role in preeclampsia development and could be a potential therapeutic target, providing a theoretical basis for the development of novel treatments for preeclampsia.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698659","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":"Hemodynamic volatility in children and young adults with down syndrome during procedural sedation.","authors":"Justin Abe, Panteha Hayati Rezvan, Benjamin N Vogel, Lilia Kazerooni, Maeve C Lucas, Mariam M Yousuf, Mackenzie Silverman, Deepti Nagesh, Saba Jafarpour, Jonathan D Santoro","doi":"10.1097/HJH.0000000000004107","DOIUrl":"https://doi.org/10.1097/HJH.0000000000004107","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with Down syndrome (DS) have been reported to have lower systemic blood pressure compared to individuals without DS. This study sought to retrospectively evaluate biomedical parameters in patients with DS undergoing procedural sedation compared to non-DS controls.</p><p><strong>Methods: </strong>A retrospective observational study was performed comparing children and young adults with DS (n = 150) and age-matched non-DS patients (n = 146) who underwent procedural sedation. Demographics, comorbidities, and diagnostic studies were assessed, along with preprocedural baseline, median procedural, and procedural nadir systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). The average rate of change in SBP and DBP from baseline to nadir was also examined between the two groups.</p><p><strong>Results: </strong>Although baseline SBP, DBP, and PP were comparable between the two groups, individuals with DS showed lower median procedural SBP and DBP (P < 0.001) as well as lower procedural nadir SBP, DBP, and PP (P < 0.001). Consistent results were found for median SBP (P = 0.006) and nadir SBP (P = 0.006) percentiles. Notably, the reduction from baseline to nadir during sedation was larger in individuals with DS for both SBP (mean difference [95% CI]: -12.3 [-16.1, -8.6]) and DBP (-10.2 [-13.3, -7.0]) compared to the non-DS controls. These differences remained consistent even after adjusting for demographic factors.</p><p><strong>Conclusions: </strong>Children and young adults with DS exhibited significantly larger blood pressure drops during procedural sedation. Additional research is warranted to investigate the clinical significance of these findings, including the potential for decreased cerebral blood flow in this population during sedation.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698658","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":"Ventricular-arterial coupling is preserved in prematurely born 11-year-old children but calls for life-long prevention of hemodynamic deterioration.","authors":"Dong-Yan Zhang, De-Wei An, Dries S Martens, Yu-Ling Yu, Fang-Fei Wei, Tim S Nawrot, Art Schuermans, Wen-Yi Yang, Thomas Salaets, Yan Li, Karel Allegaert, Anke Raaijmakers, Jan A Staessen","doi":"10.1097/HJH.0000000000004102","DOIUrl":"https://doi.org/10.1097/HJH.0000000000004102","url":null,"abstract":"<p><strong>Background: </strong>Premature birth disrupts the intra-uterine structural and functional maturation of the left ventricle (LV) and arteries. The study investigated the impact of premature birth on ventricular-arterial coupling (VAC), a potential precursor of cardiovascular disease in adulthood.</p><p><strong>Methods: </strong>This case-control study in Northern Belgium (2011-2016) included 93 extremely-low-birth-weight (ELBW) cases and 87 sex and age-matched term-born controls. Main outcomes included SBP and DBP, central arterial properties, echocardiographic structure and function, and VAC.</p><p><strong>Results: </strong>Compared with controls, cases were shorter by 4.1 cm [95% confidence interval (95% CI): 1.3-7.0] and lighter by 4.1 kg (95% CI: 1.3-6.9). Cases had higher central SBP/DBP (+7.3/3.0 mmHg; 95% CI: 4.7-9.9/1.1-4.8), lower left ventricular end-diastolic and end-systolic dimensions, and 9.2 g (95% CI: 3.7-14.6) lower left ventricular mass. Left ventricular volumes and mass correlated with body size without significant between-group differences (P ≥ 0.12). Cardiac output was 0.38 l/min lower in cases, who also had higher arterial resistance (29.5 vs. 24.4 mmHg × min/l) and augmentation ratio (1.10 vs. 1.05). The tension-time index was 231 mmHg × ms (95% CI: 128-335) higher in cases. Ea and Ees were higher in cases (0.40 and 0.65 mmHg/ml, respectively), but VAC did not differ between groups (P = 0.48).</p><p><strong>Conclusion: </strong>Compensatory mechanisms maintain the anatomical and functional integrity of the cardiovascular system in ELBW youth, but mask their vulnerability to cardiovascular disease in adulthood and necessitate careful follow-up during adolescence.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698661","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":"The saline infusion test with mass spectrometric measurements of aldosterone to confirm primary aldosteronism.","authors":"Christina Pamporaki, Hanna Remde, Georgiana Constantinescu, Lydia Kürzinger, Carmina Fuss, Sybille Fuld, Mirko Peitzsch, Manuel Schulze, Francesco Alessi, Myron Lee, Jun Yang, Tracy Ann Williams, Denise Brüdgam, Martin Reincke, Sven Gruber, Felix Beuschlein, Jacques W M Lenders, Graeme Eisenhofer","doi":"10.1097/HJH.0000000000004098","DOIUrl":"https://doi.org/10.1097/HJH.0000000000004098","url":null,"abstract":"<p><strong>Objective: </strong>Confirmation of primary aldosteronism with the saline infusion test requires accurate measurements of plasma aldosterone, which is best achieved by mass spectrometry. Diagnostic performance, appropriate cut-offs and intra-patient variability of the test remain inadequately defined. The objective of this prospective multicenter cohort study was to address these limitations.</p><p><strong>Methods: </strong>Primary aldosteronism was confirmed and excluded using alternative criteria to confirmatory tests in 138 and 282 respective patients with suspected disease. Those criteria were not satisfied in 89 patients. Diagnostic performance of the saline infusion test and optimal cut-offs were determined from receiver operating characteristic curves. Intra-patient variability was determined in 57 patients.</p><p><strong>Results: </strong>Analysis of receiver operating characteristic curves indicated an area under the curve of 0.964 and a cut-off of 169 pmol/l for posttest aldosterone concentrations that provided 97% sensitivity and 89% specificity. A cut-off of 255 pmol/l enabled improved specificity of 95% at a sensitivity of 75%. Among the 57 patients in whom the saline infusion test was repeated, 15 (26%) had posttest aldosterone concentrations that were discordant using the 169 pmol/l cut-off. Eighty percent of the discordant results were from a single center. With exclusion of that center, which did not minimize ambulation during saline infusion, the area under the curve increased to 0.985 and an optimal cut-off of 169 pmol/l provided 96% specificity and sensitivity.</p><p><strong>Conclusion: </strong>The seated saline infusion test with mass spectrometric measurements of aldosterone and the cut-offs documented here provides a useful confirmatory test, although this requires adherence to standard-operating procedures.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698660","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}