Nico Malan, Gavin R Norton, Carlos D Libhaber, Vernice Peterson, Hamza Bello, Mohlabani Masiu, Daniel Da Silva Fernandes, Nonhlanhla H Mthembu, Keneilwe N Mmopi, Grace Tade, Ferande Peters, Patrick H C Dessein, Pinhas Sareli, Angela J Woodiwiss
{"title":"非洲非洲血统的抵抗性或难治性高血压患者的全身血流量显著增加。","authors":"Nico Malan, Gavin R Norton, Carlos D Libhaber, Vernice Peterson, Hamza Bello, Mohlabani Masiu, Daniel Da Silva Fernandes, Nonhlanhla H Mthembu, Keneilwe N Mmopi, Grace Tade, Ferande Peters, Patrick H C Dessein, Pinhas Sareli, Angela J Woodiwiss","doi":"10.1097/HJH.0000000000004114","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>A distinct volume-dependent increase in systemic blood flow has recently been demonstrated to contribute to hypertension in groups of African ancestry. We determined whether systemic blood flow contributes to resistant or refractory hypertension (RHTN).</p><p><strong>Methods: </strong>We compared the multivariate adjusted haemodynamic correlates of blood pressure in RHTN ( n = 100) on diuretic and other therapy, to those in age and sex-matched normotensives (NT, n = 128), untreated hypertensives (Untreat-HTN, n = 124), and treated-controlled hypertensives (Control-HTN, n = 74) of African ancestry in South Africa. Haemodynamics were determined from velocity and diameter measurements in the left ventricular outflow tract, and central arterial pressures.</p><p><strong>Results: </strong>All hypertensives had higher stroke volume (SV), cardiac output (CO) and peak aortic flow (Q) compared to NT ( P < 0.05 to <0.0001). However, RHTN had higher SV, CO and Q than Untreat-HTN and Control-HTN ( P < 0.0001). Proximal aortic characteristic impedance (Zc) in RHTN was similar to Untreat-HTN, but greater than NT ( P < 0.005), and Control-HTN ( P < 0.05). In RHTN, systemic vascular resistance was lower compared NT, Untreat-HTN and Control-HTN ( P < 0.005 to <0.0001), and total arterial compliance was higher compared to Untreat-HTN and Control-HTN ( P < 0.02 to <0.0001). The pressure generated by the product of Q and Zc (P QxZc ) and hence aortic pulse pressure were higher in RHTN compared to NT, Untreat-HTN and Control-HTN ( P < 0.0001), effects attributed primarily to increases in SV and Q.</p><p><strong>Conclusions: </strong>Despite the use of diuretic therapy, increases in systemic blood flow are the main determinant of RHTN in groups of African ancestry in South Africa. Novel approaches to targeting volume-dependent increases in blood flow in this population are therefore required.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":" ","pages":"1711-1720"},"PeriodicalIF":4.1000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Marked increases in systemic blood flow in resistant or refractory hypertensives of African ancestry in Africa.\",\"authors\":\"Nico Malan, Gavin R Norton, Carlos D Libhaber, Vernice Peterson, Hamza Bello, Mohlabani Masiu, Daniel Da Silva Fernandes, Nonhlanhla H Mthembu, Keneilwe N Mmopi, Grace Tade, Ferande Peters, Patrick H C Dessein, Pinhas Sareli, Angela J Woodiwiss\",\"doi\":\"10.1097/HJH.0000000000004114\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>A distinct volume-dependent increase in systemic blood flow has recently been demonstrated to contribute to hypertension in groups of African ancestry. We determined whether systemic blood flow contributes to resistant or refractory hypertension (RHTN).</p><p><strong>Methods: </strong>We compared the multivariate adjusted haemodynamic correlates of blood pressure in RHTN ( n = 100) on diuretic and other therapy, to those in age and sex-matched normotensives (NT, n = 128), untreated hypertensives (Untreat-HTN, n = 124), and treated-controlled hypertensives (Control-HTN, n = 74) of African ancestry in South Africa. Haemodynamics were determined from velocity and diameter measurements in the left ventricular outflow tract, and central arterial pressures.</p><p><strong>Results: </strong>All hypertensives had higher stroke volume (SV), cardiac output (CO) and peak aortic flow (Q) compared to NT ( P < 0.05 to <0.0001). However, RHTN had higher SV, CO and Q than Untreat-HTN and Control-HTN ( P < 0.0001). Proximal aortic characteristic impedance (Zc) in RHTN was similar to Untreat-HTN, but greater than NT ( P < 0.005), and Control-HTN ( P < 0.05). In RHTN, systemic vascular resistance was lower compared NT, Untreat-HTN and Control-HTN ( P < 0.005 to <0.0001), and total arterial compliance was higher compared to Untreat-HTN and Control-HTN ( P < 0.02 to <0.0001). The pressure generated by the product of Q and Zc (P QxZc ) and hence aortic pulse pressure were higher in RHTN compared to NT, Untreat-HTN and Control-HTN ( P < 0.0001), effects attributed primarily to increases in SV and Q.</p><p><strong>Conclusions: </strong>Despite the use of diuretic therapy, increases in systemic blood flow are the main determinant of RHTN in groups of African ancestry in South Africa. Novel approaches to targeting volume-dependent increases in blood flow in this population are therefore required.</p>\",\"PeriodicalId\":16043,\"journal\":{\"name\":\"Journal of Hypertension\",\"volume\":\" \",\"pages\":\"1711-1720\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hypertension\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/HJH.0000000000004114\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HJH.0000000000004114","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的:一个明显的体积依赖性全身血流量增加最近被证明有助于高血压的群体非洲血统。我们确定了全身血流是否有助于抵抗性或难治性高血压(RHTN)。方法:我们比较了在南非接受利尿剂和其他治疗的RHTN (n = 100)与年龄和性别匹配的血压正常者(NT, n = 128)、未治疗的高血压患者(untreatment - htn, n = 124)和治疗控制的高血压患者(Control-HTN, n = 74)的多因素校正血流动力学相关因素。血流动力学是通过左心室流出道流速和直径测量以及中心动脉压来确定的。结果:与NT相比,所有高血压患者的脑卒中容量(SV)、心输出量(CO)和主动脉流量峰值(Q)均较高(P)。结论:尽管使用利尿剂治疗,但全身血流量的增加是南非非洲裔人群RHTN的主要决定因素。因此,需要新的方法来针对这一人群的容量依赖性血流量增加。
Marked increases in systemic blood flow in resistant or refractory hypertensives of African ancestry in Africa.
Aims: A distinct volume-dependent increase in systemic blood flow has recently been demonstrated to contribute to hypertension in groups of African ancestry. We determined whether systemic blood flow contributes to resistant or refractory hypertension (RHTN).
Methods: We compared the multivariate adjusted haemodynamic correlates of blood pressure in RHTN ( n = 100) on diuretic and other therapy, to those in age and sex-matched normotensives (NT, n = 128), untreated hypertensives (Untreat-HTN, n = 124), and treated-controlled hypertensives (Control-HTN, n = 74) of African ancestry in South Africa. Haemodynamics were determined from velocity and diameter measurements in the left ventricular outflow tract, and central arterial pressures.
Results: All hypertensives had higher stroke volume (SV), cardiac output (CO) and peak aortic flow (Q) compared to NT ( P < 0.05 to <0.0001). However, RHTN had higher SV, CO and Q than Untreat-HTN and Control-HTN ( P < 0.0001). Proximal aortic characteristic impedance (Zc) in RHTN was similar to Untreat-HTN, but greater than NT ( P < 0.005), and Control-HTN ( P < 0.05). In RHTN, systemic vascular resistance was lower compared NT, Untreat-HTN and Control-HTN ( P < 0.005 to <0.0001), and total arterial compliance was higher compared to Untreat-HTN and Control-HTN ( P < 0.02 to <0.0001). The pressure generated by the product of Q and Zc (P QxZc ) and hence aortic pulse pressure were higher in RHTN compared to NT, Untreat-HTN and Control-HTN ( P < 0.0001), effects attributed primarily to increases in SV and Q.
Conclusions: Despite the use of diuretic therapy, increases in systemic blood flow are the main determinant of RHTN in groups of African ancestry in South Africa. Novel approaches to targeting volume-dependent increases in blood flow in this population are therefore required.
期刊介绍:
The Journal of Hypertension publishes papers reporting original clinical and experimental research which are of a high standard and which contribute to the advancement of knowledge in the field of hypertension. The Journal publishes full papers, reviews or editorials (normally by invitation), and correspondence.