Journal of Clinical Hypertension最新文献

{"title":"Multiple factors are related to the development of exaggerated blood pressure response to exercise","authors":"Ali Çoner MD,&nbsp;Can Ramazan Öncel MD,&nbsp;Cemal Köseoğlu MD,&nbsp;Göksel Dağaşan MD","doi":"10.1111/jch.14899","DOIUrl":"10.1111/jch.14899","url":null,"abstract":"<p>To the Editor,</p><p>I read with great interest the article titled “Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing” by Efe et al. In their detailed statistical analysis, Efe et al. reported that myocardial work parameters such as global myocardial work index (GWI) might be used to identify early signs of myocardial involvement in normotensive patients with an exaggerated blood pressure response to exercise (EBPRE).<span>¹</span> Accordingly, the increase in GWI value predicts the presence of EBPRE. Myocardial work parameters are related to myocardial deformation and distortion independent from pressure and volume load which is different from previous myocardial performance parameters such as global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF).<span>²</span></p><p>In recent clinical studies, EBPRE has been found to be associated with subclinical target organ damage in normotensive individuals.<span>^{3, 4}</span> In addition, it has been suggested that EBPRE may be a predictor of future overt hypertension.<span>⁵</span> It is suggested that the most probable mechanism that plays a role in the development of EBPRE is the lack of enough decrement in peripheral vascular resistance in response to increased cardiac output with exercise. This inadequate decrease in peripheral vascular resistance may be related to endothelial dysfunction and subclinical vascular inflammation.<span>^{4, 6}</span> Closely related to this inadequate response in peripheral vascular resistance, various metabolic parameters (such as central adiposity, fasting blood sugar, triglyceride, total cholesterol, and impaired glucose tolerance) were also found to be associated with the development of EBPRE.<span>^{4, 6, 7}</span> When deciding whether the possible role of load-independent myocardial work parameters predicts the presence of EBPRE, metabolic variables that may accompany the pathophysiology should be taken into consideration and clinicians may also interact with the manageable metabolic variables to manage the personal risk stratification.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1322"},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Comparative Study of Mid-Term Outcomes of Atherectomy, Drug-Coating Balloon Angioplasty, and Plain Old Balloon Angioplasty for Isolated Atherosclerotic Popliteal Artery Lesions","authors":"Zhiyong Dong,&nbsp;Lianrui Guo,&nbsp;Zhu Tong,&nbsp;Shijun Cui,&nbsp;Xixiang Gao,&nbsp;Chengchao Zhang,&nbsp;Jianming Guo,&nbsp;Yongquan Gu","doi":"10.1111/jch.14908","DOIUrl":"10.1111/jch.14908","url":null,"abstract":"<p>We retrospectively reviewed the clinical data of 217 consecutive Chinese patients with isolated atherosclerotic popliteal artery lesions treated with atherectomy technique, DCB, and plain old balloon angioplasty from August 2017 to August 2022. There was no difference in the 48-month patency rate between the atherectomy, DCB, and POBA groups (65%, 56%, and 51%, respectively; <i>p</i> = 0.3), as well as in adjusted Cox regression. Similarly, no difference was observed in the 48-month clinically driven target lesion revascularization-free (CDTLR-free) rate among the groups (77%, 74%, and 65%; <i>p</i> = 0.34), confirmed by adjusted Cox regression. In the 48 months, a significant difference was observed in amputation-free rates between the atherectomy, DCB, and POBA groups (97%, 91%, and 83%, respectively; <i>p</i> &lt; 0.05). Adjusted Cox regression indicated POBA had worse outcomes than DCB and atherectomy. In the stenosis and occlusion subgroup, the 48-month primary patency rates were 65%, 70%, and 54% (<i>p</i> &gt; 0.9) and 65% versus 49% versus 49% (<i>p</i> = 0.3), showing no differences among the three groups. In the short lesion subgroup (&lt;10 cm), the 48-month primary patency rates were 65%, 66%, and 61% for atherectomy, DCB, and POBA, respectively (<i>p</i> = 0.7). In the long lesion subgroup (≥10 cm), the 48-month patency rates were higher in the atherectomy and DCB groups compared to POBA (64%, 44%, and 34%), with no significant difference among the groups (<i>p</i> = 0.13). DCB and atherectomy demonstrate improved short- and mid-term clinical outcomes compared to POBA in Chinese patients with popliteal artery disease.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1264-1273"},"PeriodicalIF":2.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint Modifiable Risk Factor Control and Incident Stroke in Hypertensive Patients","authors":"Xuefei Hou,&nbsp;Suru Yue,&nbsp;Zihan Xu,&nbsp;Xiaolin Li,&nbsp;Yingbai Wang,&nbsp;Jia Wang,&nbsp;Xiaoming Chen,&nbsp;Jiayuan Wu","doi":"10.1111/jch.14905","DOIUrl":"10.1111/jch.14905","url":null,"abstract":"<p>Recent guidelines have recognized several factors, including blood pressure (BP), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), smoking, and physical activity, as key contributors to stroke risk. However, the impact of simultaneous management of these risk factors on stroke susceptibility in individuals with hypertension remains ambiguous. This study involved 238 388 participants from the UK Biobank, followed up from their recruitment date until April 1, 2023. Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to illustrate the correlation between the joint modifiable risk factor control and the stroke risk. As the degree of risk factor control increased, a gradual reduction in stroke risk was observed. Hypertensive patients who had the optimal risk factor control (≥5 risk factor controls) had a 14.6% lower stroke risk than those who controlled 2 or fewer (HR: 0.854; 95% CI: 804–0.908; <i>p</i> &lt; 0.001). The excess risk of stroke linked to hypertension slowly diminished as the number of controlled risk factors increased. However, the risk was still 25.1% higher for hypertensive patients with optimal risk factor control as compared to the non-hypertensive population (HR: 1.251; 95% CI: 1.100–1.422; <i>p</i> &lt; 0.001). The protective effect of joint risk factor control against the stroke risk due to hypertension was stronger in medicated hypertensive patients than in those not medicated. This finding leads to the conclusion that joint risk factor control combined with pharmacological treatment could potentially eliminate the excess risk of stroke associated with hypertension.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1274-1283"},"PeriodicalIF":2.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal blood pressure control with fewer antihypertensive medications: Achieved mostly in low-risk hypertensive patients","authors":"Zhanyang Zhou MD,&nbsp;Huanhuan Miao MD,&nbsp;Shijie Yang MD,&nbsp;Zheng Yin MD,&nbsp;Yingjun Chen MD,&nbsp;Yuqing Zhang MD, PhD","doi":"10.1111/jch.14903","DOIUrl":"10.1111/jch.14903","url":null,"abstract":"<p>Recent studies indicate that intensive blood pressure (BP) targets can be reached with less than two medications. This cross-sectional study, involving 4991 individuals from the Majiapu community, assessed the correlation between BP control and the burden of antihypertensive drugs. Participants on medication were categorized into controlled (BP &lt; 140/90 mm Hg) and uncontrolled (BP ≥ 140/90 mm Hg) groups, with the former further divided into optimal (BP &lt; 130/80 mm Hg) and good control (BP &lt; 140/90 but &gt;130/80 mm Hg) subgroups. Multivariate logistic regression analyzed factors affecting hypertension control across these BP categories. The study found that, 54% of participants had hypertension. Of those treated (62.5%), 55.7% achieved BP control, including 23.15% maintaining BP below 130/80 mm Hg. The average number of antihypertensive medications was 1.61 for the controlled group (with an average BP of 126.6/76 mm Hg) and 1.75 for the uncontrolled group (with an average BP of 150.6/84.0 mm Hg). Additionally, the average number of antihypertensive medications was 1.66 in the good control group and 1.55 in the optimal control group. The uncontrolled group had a higher mean systematic coronary risk estimation (SCORE) of 5.59, against 3.97 and 2.5 in the good and optimal control groups, respectively. Key factors linked to poor BP control included age over 65, male sex, obesity, and former smoking, whereas lipid-lowering medication use was associated with better control. In conclusions, patients needing fewer antihypertensive drugs to achieve stricter targets may have a lower risk profile. Notably, only a small proportion of treated patients are low-risk individuals who can easily achieve BP levels below 130/80 mm Hg.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1284-1290"},"PeriodicalIF":2.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unattended Office Heart Rate Measurement: A New Challenge in Clinical Practice?","authors":"Paolo Palatini","doi":"10.1111/jch.14909","DOIUrl":"10.1111/jch.14909","url":null,"abstract":"&lt;p&gt;In recent times, a large body of evidence has shown that about one-third of patients with hypertension have persistent tachycardia and that a high resting heart rate (RHR), independent of the elevated blood pressure (BP), is a potent additional risk factor for cardiovascular disease and mortality [&lt;span&gt;1-4&lt;/span&gt;]. The pathophysiology of the detrimental effects of fast RHR has been well explored and documented by numerous experimental studies [&lt;span&gt;5&lt;/span&gt;]. For this reason, RHR has been included among the cardiovascular risk factors in the latest Guidelines of the European Society of Hypertension, which recommend always measuring also RHR when evaluating BP levels [&lt;span&gt;6&lt;/span&gt;]. However, many sources of variability, including psychic stimuli, environmental factors, and body position, may affect the assessment of heart rate in resting conditions [&lt;span&gt;7-9&lt;/span&gt;]. To minimize the effect of these variables, a consensus document of the European Society of Hypertension recommends that the measurement of RHR in the doctor's office should be strictly standardized [&lt;span&gt;9&lt;/span&gt;]. However, also in standardized conditions, both RHR and BP are influenced by the presence of healthcare personnel, and office measurements often overestimate the usual level of these hemodynamic variables as a consequence of the so-called white-coat effect [&lt;span&gt;7, 8, 10&lt;/span&gt;]. To overcome this drawback, strategies for assessing RHR and BP out of the office in the absence of the doctor have been devised, which led to a wide use of self-measurement and of ambulatory monitoring techniques, which have been shown to provide prognostic information over and above office measurement [&lt;span&gt;6&lt;/span&gt;]. Available data suggest that alike BP, RHR measured out of the office yields more meaningful clinical information than RHR measured by healthcare personnel [&lt;span&gt;11&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The advent of oscillometric sphygmomanometry as a replacement for the auscultatory measurement led to an improvement of office BP measurement, eliminating some errors related to the observer and allowing the recording of multiple readings automatically [&lt;span&gt;12&lt;/span&gt;]. However, in clinical practice, oscillometric measurements do not differ substantially from manual measurements as long as the medical staff remain in close proximity to the patient and thus cannot avoid the white-coat effect. A step forward with oscillometric BP measurement was taken with the introduction of devices capable of recording multiple BP and RHR readings automatically without the need to have a nurse or a doctor present during the measurements [&lt;span&gt;13, 14&lt;/span&gt;]. The effects of removing the healthcare personnel with the associated reduction of anxiety have been well documented by several studies that showed that routine office BP is substantially higher than unattended BP and similar to awake ambulatory BP [&lt;span&gt;13, 14&lt;/span&gt;]. In contrast, little is known on the comparability of unattended office RHR measurement wi","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1310-1312"},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum N-Terminal Pro-B-Type Natriuretic Peptide Is Associated With Insulin Resistance in Chinese: Danyang Study","authors":"Ziwen Zheng,&nbsp;Junya Liang,&nbsp;Yun Gao,&nbsp;Mulian Hua,&nbsp;Siqi Zhang,&nbsp;Ming Liu,&nbsp;Zhuyuan Fang","doi":"10.1111/jch.14906","DOIUrl":"10.1111/jch.14906","url":null,"abstract":"<p>The association of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) with insulin resistance (IR), as measured by homeostasis model assessment of insulin resistance (HOMA-IR), in the general population is unclear. Our study aimed to characterize its relationship in a large community-based population. Subjects were recruited from the Danyang city between 2017 and 2019. Serum NT-proBNP was measured using an enhanced chemiluminescence immunoassay. IR was defined by a HOMA-IR in the highest sex-specific quartile. Categorical and continuous analyses were performed with sex-specific NT-proBNP tertiles and naturally logarithmically transformed NT-proBNP (lnNTproBNP), respectively. The 2945 participants (mean age 52.8 years) included 1728 (58.7%) women, 1167 (39.6%) hypertensive patients, 269 (9.1%) diabetic patients, and 736 (25.0%) patients with IR. In simple and multivariate-adjusted regression analyses, serum lnNTproBNP were both negatively associated with HOMA-IR (<i>β = −</i>0.19 to −0.25; <i>p</i> &lt; 0.0001). Similar results were also obtained in multiple subgroup analyses. In multiple logistic regression analyses, elevated serum NT-proBNP was associated with lower risks of IR (odds ratios: 0.68 and 0.39; 95% confidence intervals: 0.61–0.74 and 0.30–0.50 for lnNTproBNP and top vs. bottom tertiles, respectively; <i>p</i> &lt; 0.0001). In conclusion, increased serum NT-proBNP level was strongly associated with a lower risk of IR in Chinese.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1256-1263"},"PeriodicalIF":2.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between fibrosis-4 index and cognitive impairment in elderly patients with hypertension: A cross-sectional study","authors":"Hong Ding MD,&nbsp;Jingtao Wang MD,&nbsp;Shu Liu MD,&nbsp;Yafei Xie MD,&nbsp;Xiaowei Zhang MD,&nbsp;Jing Yu MD","doi":"10.1111/jch.14890","DOIUrl":"10.1111/jch.14890","url":null,"abstract":"<p>The fibrosis-4 index (FIB-4) is a noninvasive fibrosis test that is recommended for patients who are at risk of developing hepatic fibrosis. The aim of the study was to explore the correlation between FIB-4 index and the decline of cognitive function among older patients with hypertension. The study used a cross-sectional design to analyze data obtained from the NHANES 2011–2014. The significance of the FIB-4 index correlation with cognitive function in individuals over the age of 60 was evaluated via multivariate regression models. The nonlinear link was described and fitted smoothed curves. There were a total of 2039 participants in the study, and those with a higher FIB-4 index were more susceptible to developing cognitive decline. In the completely adjusted model, the association remained statistically significant between the FIB-4 index and poor cognitive function as measured by CERAD: Total Score (OR = 0.72, 0.57−0.91), Animal Fluency Score (OR = 0.66, 0.48−0.91), and Digit Symbol Score (OR = 0.36, 0.17−0.77). A nonlinear association was found between the FIB-4 and poor cognitive ability: Total Score, CERAD: Score Delayed Recall, Digit Symbol Score, and Animal Fluency Score. In elderly patients with hypertension, a high FIB-4 index is correlated with an increased prevalence of cognitive decline. Hence, the FIB-4 index could potentially serve as a valuable tool for determining individuals with hypertension who are susceptible to both liver-related complications and cognitive impairment.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1246-1255"},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) among normotensive patients and risk of incident hypertension","authors":"Alexander R. Zheutlin MD, MS,&nbsp;Joshua A. Jacobs PharmD,&nbsp;Brian Stamm MD,&nbsp;Regina Royan MD, MPH","doi":"10.1111/jch.14904","DOIUrl":"10.1111/jch.14904","url":null,"abstract":"<p>Lipoprotein(a) has been shown to be disruptive to local endothelial cells, whose integrity is critical to blood pressure (BP) regulation. Cross-sectional analysis has shown an association between lipoprotein(a) and prevalent hypertension, though it is unclear if lipoprotein(a) increases risk of incident hypertension. To assess this, the authors measured baseline lipoprotein(a) among 5307 normotensive patients (median age 26 years (interquartile range [IQR] 12–50) and used Cox proportional hazard models to generate hazard rations (HR) with 95% confidence intervals (CI; median follow-up 10-years). The authors categorized lipoprotein(a) as &lt;15 mg/dL, 15–&lt;30 mg/dL, 30–50 mg/dL, &gt;50 mg/dL, and performed subgroup analysis of adults &gt;50 years at baseline. Incident hypertension was defined as a measured BP ≥140/90 mm Hg or a new ICD-9/10 code. After adjustment, hypertension for patients with baseline lipoprotein(a) 15–&lt;30 mg/dL, 30–50 mg/dL, and &gt;50 mg/dL was 0.91 (0.72–1.16), 1.05 (0.79–1.38), and 1.02 (0.83–1.26; vs. &lt;15 mg/dL). However, among adults &gt;50 years, lipoprotein(a) &gt;50 mg/dL was associated with increased incident hypertension (1.62 [1.17–2.26]).</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 11","pages":"1313-1317"},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic phenotypes in chronic kidney disease patients based on linear regression of blood pressure parameters","authors":"Katarzyna Cierpka‐Kmieć, Raissa Khursa, Dagmara Hering","doi":"10.1111/jch.14880","DOIUrl":"https://doi.org/10.1111/jch.14880","url":null,"abstract":"Classic and non‐classic cardiovascular (CV) risk factors accumulate in chronic kidney disease (CKD), contributing to vascular remodeling and hemodynamic abnormalities. This study aimed to determine hemodynamic phenotypes based on linear regression of blood pressure (BP) parameters in stage G3‐G4 CKD patients at very high CV risk. 24‐h ambulatory BP monitoring (ABPM), carotid‐femoral pulse wave velocity (PWV) and central BP were obtained from 52 patients (aged 60 ± 11 years, BMI 30 ± 6 kg/m<jats:sup>2</jats:sup>) with stage G3‐G4 CKD (eGFR 44 ± 12 mL/min./1.73 m<jats:sup>2</jats:sup>). Linear BP regression coefficients were generated to determine hemodynamic phenotypes using ABPM data. Coexisting hypertension was present in 45 (86%) patients, out of whom 33 (73%) had BP controlled. 24‐h mean systolic/diastolic BP was 128 ± 18/75 ± 12 mm Hg. Twenty‐six patients demonstrated the harmonious (H) and 26 patients diastolic dysfunctional (D) hemodynamic phenotypes. eGFR was not significantly different between both phenotypes. Compared to phenotype H, patients with phenotype D were older (57 ± 11 vs. 63 ± 10 years, <jats:italic>p</jats:italic> = .04), had higher PWV (8.2 [7.3–10.3] vs. 9.7 [8.3–10.9] m/s, <jats:italic>p</jats:italic> = .02), ambulatory arterial stiffness index (AASI) (0.31 ± 0.1 vs. 0.40 ± 0.1, <jats:italic>p</jats:italic> = .02), systolic BP (128 [122–130] vs. 137 [130–150] mm Hg, <jats:italic>p</jats:italic> = .001) and systolic BP variability (BPV) (11.7 ± 2.3 vs. 15.7 ± 3.4 mm Hg, <jats:italic>p</jats:italic> &lt; .0001). Our findings suggest that one in two patients with stage G3‐G4 CKD demonstrates an unfavorable D hemodynamic phenotype based on a linear regression model, associated with higher PWV, AASI, systolic BP, and systolic BPV. Further studies are required to assess the clinical utility of hemodynamic phenotypes and whether the D phenotype may predict latent circulatory disorders and outcomes.","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"21 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma renin activity as a marker for predicting the antihypertensive effect of switching to sacubitril/valsartan in treated hypertensive patients: Usefulness in daily clinical practice","authors":"Takeshi Horio MD, PhD,&nbsp;Yoshio Iwashima MD, PhD,&nbsp;Minoru Yoshiyama MD, PhD,&nbsp;Daiju Fukuda MD, PhD,&nbsp;Tatemitsu Rai MD, PhD,&nbsp;Kohei Fujimoto MD, PhD","doi":"10.1111/jch.14900","DOIUrl":"10.1111/jch.14900","url":null,"abstract":"<p>The authors investigated the antihypertensive effect of sacubitril/valsartan (Sac/Val) when switching from other drugs and assessed whether brain natriuretic peptide (BNP) or plasma renin activity (PRA) before drug switching was a predictor of blood pressure lowering after switching to Sac/Val. In 92 patients with treated hypertension, clinic blood pressure, plasma BNP, and PRA were examined before and after switching to Sac/Val. Clinic systolic and diastolic blood pressures significantly decreased after drug switching to Sac/Val (<i>p </i>&lt; .0001, respectively). The level before drug switching of BNP had no correlation with the change in systolic blood pressure (Δ-SBP) before and after switching to Sac/Val, but that of PRA was significantly correlated with Δ-SBP (<i>r</i> = .3807, <i>p </i>= .0002). A multiple regression analysis revealed that PRA before drug switching was an independent determinant of Δ-SBP. Our findings suggest that low PRA may become a useful marker to predict the antihypertensive effect of switching to Sac/Val in treated hypertensive patients.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 10","pages":"1196-1200"},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}