The optimal blood pressure (BP) target in patients with type 2 diabetes mellitus (T2DM) continues to be debated. The 2022 guidelines from the Korean Society of Hypertension (KSH) recommend intensive BP lowering only for patients with diabetes who are at high cardiovascular (CV) risk. However, recent trials have demonstrated favorable outcomes associated with intensive BP lowering in T2DM. In response, the updated KSH consensus statements provide evidence-based recommendations supporting the implementation of intensive BP control strategies in hypertensive patients with diabetes, including those at low to moderate CV risk. The KSH consensus statements are as follows: 1) Hypertension is a common comorbidity of T2DM, with a prevalence of 59.6% among adults with diabetes aged 30 years and older in Korea. 2) In patients with T2DM, coexisting hypertension increases the risk of both macrovascular and microvascular complications; however, tight BP control reduces diabetes-related morbidity and mortality. 3) Recent guidelines advocate tailored BP targets based on individual CV risk profiles to balance treatment safety and effectiveness, and recommend a BP target of < 130/80 mmHg for patients with T2DM. 4) The BPROAD (Intensive Blood-Pressure Control in Patients with Type 2 Diabetes) trial provides the strongest evidence for intensive BP control in patients with T2DM, while the STEP (Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension) and the ESPRIT (Effects of Intensive Blood Pressure Lowering Treatment in Reducing the Risk of Cardiovascular Events) trials support intensive BP lowering in high-risk diabetic patients and extend the findings to broader high-risk populations, respectively. 5) A nationwide Korean study suggests that, if patients with T2DM can safely tolerate it, lower BP levels in patients with T2DM may provide protection even without established CV disease. 6) As white coat hypertension becomes more frequent following treatment in diabetic patients, precise BP measurement is essential to avoid overtreatment, particularly in real-world clinical settings. 7) The proportion of patients with T2DM who are at low to moderate risk is small. Accordingly, the updated consensus statement from the KSH recommends a target BP of 130/80 mmHg for most patients with T2DM, provided that this target is well tolerated.

BackgroundSeveral inflammatory cytokines (ICs) have been implicated in the development of hypertensive disorders. This study aimed to establish a causal relationship between 91 ICs and hypertensive disorders using Mendelian randomization (MR).MethodsSingle nucleotide polymorphisms associated with 91 ICs, hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were obtained from publicly available genome-wide association studies. MR analyses were conducted using inverse variance weighting as the primary method, complemented by MR-Egger and weighted median approaches. Significant ICs were further analyzed through Gene Ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) network analyses.ResultsA total of 18 ICs exhibited significant associations with at least 1 hypertensive disorder, with 8, 7, 7, and 5 ICs associated with hypertension, SBP, DBP, and MAP, respectively. Among these, fibroblast growth factor 5 (FGF5) was uniquely associated with all 4 hypertensive conditions. Additionally, FGF5 was identified as a central hub in the PPI network. KEGG pathway analysis highlighted the involvement of the mitogen-activated protein kinase (MAPK) signaling pathway.ConclusionsThis study underscores the pivotal role of FGF5 and MAPK signaling pathway in the pathogenesis of hypertensive disorders. Targeting inflammatory pathways may offer therapeutic strategies for hypertension management.

BackgroundBlood pressure (BP) control remains a therapeutic challenge in kidney transplant recipients (KTRs). Sodium-glucose cotransporter-2 inhibitors (SGLT2is) lower BP in diabetic and chronic kidney disease patients. Whether this effect extents to KTRs remains to be fully established. We explored the BP lowering potential of SGLT2i, by examining their effects on BP and their influence on antihypertensive drugs prescriptions.MethodsUsing the French observational multicenter ASTRE database, we collected systolic BP (SBP), diastolic BP (DBP), weight and drugs, at baseline and at 3 and 6 months after SGLT2i initiation. To evaluate the impact of SGLT2i on other anti-hypertensive drugs management, we used metric such as the defined daily dose (DDD) and the hypertensive index (HTi).ResultsTwo hundred thirty-four patients were included in the analysis, nearly all had hypertension and 63% had diabetes. By the 3-month mark, there was a significant 4 mmHg reduction in SBP and DBP, which was sustained at 6 months, with decreases of 2.5 mmHg and 3 mmHg (respectively for SBP and DBP). The DDD remained stable. HTi decreased by 14 and 9.5 points at 3 and 6 months, respectively. In multivariate analysis, female sex was associated with a more significant reduction in SBP and HTi.ConclusionsIn KTRs newly treated with SGLT2i, BP decreased at 3 and 6 months, while the overall antihypertensive load, as assessed by DDD, remained stable. Similar effects were observed on HTi. These findings suggest SGLT2i as an effective adjunctive therapy for lowering BP in hypertensive KTRs, regardless of diabetes status.

BackgroundHypertension is a common health issue among elderly populations, substantially increasing morbidity and mortality risks. This meta-analysis aimed to determine optimal systolic blood pressure (SBP) targets in elderly hypertensive patients and their effects on clinical outcomes.MethodsWe conducted a systematic search of PubMed, Embase, and the Cochrane Library to identify randomized controlled trials involving antihypertensive therapy in participants aged 60 years and older. Mortality, cardiovascular events, and significant adverse events data were extracted and analyzed using random-effects models.ResultsThe analysis included 24 studies, with 9 specifically examining elderly participants aged 60 and older. Targeting a lower SBP of less than 140 mmHg was associated with significant reductions in primary outcome events (relative risk [RR], 0.69; 95% confidence interval [CI], 0.56–0.86), all-cause mortality (RR, 0.64; 95% CI, 0.49–0.83), cardiovascular mortality (RR, 0.59; 95% CI, 0.39–0.87), and stroke (RR, 0.68; 95% CI, 0.47–0.98; I2 = 0%). Achieving an intensive SBP target in the pooled range less than 130 mmHg reduced the risks of primary outcome events (RR, 0.73; 95% CI, 0.62–0.85), heart failure (RR, 0.57; 95% CI, 0.38–0.84), and stroke (RR, 0.72; 95% CI, 0.53–0.96), though it also led to an elevated risk of hypotension (RR, 1.43; 95% CI, 1.18–1.73).ConclusionsIn elderly hypertensive patients, lower SBP targets correlate with improved clinical outcomes, including reduced mortality and cardiovascular events. Nonetheless, the heightened risk of adverse effects underscores the need for careful, individualized treatment strategies. Additional research is warranted to refine these targets and achieve a balance between therapeutic efficacy and safety.

[This corrects the article e8 in vol. 31, PMID: 40083595.].

[This corrects the article 6 in vol. 30, PMID: 38424656.].

BackgroundRenin-angiotensin system (RAS) inhibitors have shown potential chemopreventive effects against colorectal cancer (CRC). However, little is known about the impact of RAS inhibitors on the risk of colorectal precancerous lesions.MethodsPreclinically, we established mouse models of colitis-associated colon cancer and xenografts: vehicle, 1 mg/kg, 5 mg/kg enalapril groups. Body weight, colon length, and colorectal tumor size were evaluated on the euthanization day. Clinically, we retrospectively recruited 8,388 asymptomatic adults undergoing their first-ever colonoscopy for health check-ups (index cohort). From the index cohort, we selected individuals undergoing follow-up colonoscopy (follow-up cohort). The study outcome was incidental and recurrent colorectal neoplasms, including CRC. We evaluated the prevalence and risk of colorectal neoplasms associated with RAS inhibitor use of ≥ 1 year.ResultsIn the experimental study, enalapril administration significantly attenuated weight loss and colon shortening, reduced tumor numbers in colitis-associated colon cancer models, and decreased tumor volume in the xenografts. In the index cohort, while the initial analysis showed a positive association with the RAS inhibitor use (unadjusted odds ratio [OR], 1.22), this shifted toward an inverse trend after adjusting for confounders (adjusted OR, 0.91). During follow-up (median, 41.0 months), incidental and recurrent colorectal neoplasms were less common in the RAS inhibitor group (32.6%) than in the other anti-hypertensives group (39.1%) (P < 0.001), despite similar intervals between the index and follow-up endoscopies. In the follow-up cohort, hypertension itself was a risk factor for colorectal neoplasm development (adjusted hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.00–2.53; P = 0.049), whereas RAS inhibitor use was significantly associated with a 27% lower risk (adjusted HR, 0.73; 95% CI, 0.59–0.95; P = 0.035).ConclusionsLong-term, regular use of RAS inhibitors independently reduces the risk of colorectal neoplasms, irrespective of dosage or drug type. Given their potential chemopreventive effects on colorectal neoplasms, RAS inhibitors may serve as a preventive strategy starting from the precancerous stage.

BackgroundThis subanalysis of BENEFIT-KOREA cohort assessed the impact of baseline pulse rate (PR) and posttreatment PR reduction on the blood pressure (BP)-lowering efficacy of nebivolol in patients with hypertension.MethodsSouth Korean patients with hypertension were enrolled in the BENEFIT-KOREA study; 3,011 patients received nebivolol as monotherapy/add-on therapy. Time-averaged BP, calculated by sum of the product of BPs at weeks 12 and 24 corrected for number of participants at these timepoints, was evaluated with/without adjustment for baseline BP. Change in BP in baseline PR groups of < 70, 70–79, and ≥ 80 beats/min and posttreatment PR reduction groups of < 1, 1–9, and ≥ 10 beats/min at 24 weeks were evaluated.ResultsThe unadjusted time-averaged systolic BP (SBP) at 24 weeks was not significantly different within baseline PR groups or posttreatment PR reduction groups, but the unadjusted time-averaged diastolic BP (DBP) was significantly different within both baseline PR (P < 0.001) and posttreatment PR reduction groups (P < 0.001). Significant differences were observed in adjusted time-averaged SBP (≥ 10 beats/min group: β, −3.4148; P = 0.006) and time-averaged DBP (≥ 10 beats/min: β, −4.5781; P < 0.001) only within the posttreatment PR reduction groups. The majority of adverse events reported with nebivolol were mild.ConclusionsThe efficacy of nebivolol for BP reduction seems to be indicated not by baseline PR but by posttreatment PR reduction. These findings suggest the presence of other mechanisms in addition to sympathetic inhibition which potentially weaken the relationship between baseline PR and BP reduction.Trial RegistrationClinicalTrials.gov Identifier: NCT03847350

This study evaluated the effectiveness of inspiratory muscle strength training (IMST) as a time-efficient alternative to widely recommended aerobic exercise (AE) for reducing and maintaining blood pressure in hypertensive patients. Twenty-eight hypertensive patients (aged 61 ± 7 years) were randomly assigned to IMST (n = 14) and AE (n = 14) groups. The IMST performed 30 breaths/session at 75% of maximal inspiratory pressure (PImax), totaling about 8 minutes, 5 days/week. The AE group exercised at 70% of heart rate reserve for 30 minutes/session, 5 days/week. Both supervised interventions lasted 8 weeks, followed by a 4-week detraining period. Brachial and central systolic blood pressure (SBP) were taken at baseline, 8-week post-intervention, and post-detraining. The mean (standard deviation) change in brachial SBP from baseline to 8 week post-intervention significantly decreased in both the IMST group [-9.1 (12.1) mmHg, P = 0.01] and the AE group [-6.2 (7.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.46). Central SBP also significantly reduced in the IMST group [-9.0 (11.9) mmHg, P = 0.01] and in the AE group [-5.7 (6.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.37). However, the IMST group did not show significant persistence in SBP reduction, whereas the AE group did. Both IMST and AE effectively reduced brachial and central BP after 8-week interventions in hypertensive patients. While IMST presents a time-efficient adjunctive option to AE, its long-term effectiveness remains uncertain.