Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.

The correlation between serum uric acid/creatinine (SUA/Cr) ratio and hypertension risk has not been well studied. This study aims to examine whether the SUA/Cr ratio is a predictor of hypertension. This cohort study comprised 171 men aged 64 ± 11 (mean ± standard deviation) years and 266 women aged 65 ± 10 years recruited for a survey at the community-based annual medical check-up. The main outcome was the presence of hypertension (antihypertensive medication) and having systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg. The baseline SUA/Cr ratio was significantly correlated only with DBP at 3 years in men (r = 0.217, P = 0.004) and women (r = 0.126, P = 0.040), and with both SBP (r = 0.103, P = 0.031) and DBP (r = 0.15, P = 0.001) in the overall participants of men and women. A plausible prognostic cut-off of SUA/Cr ratio (≥ 7.41) was found and was the same in women and in all participants. Multivariable logistic regressions showed that SUA/Cr ratio was significantly linked with hypertension (as a categorical variable, SUA/Cr ratio-2 vs. SUA/Cr ratio-1: odds ratio [OR], 1.68; 95% confidence interval [CI], 0.66-4.30; P = 0.275, SUA/Cr ratio-3 vs. SUA/Cr ratio-1: OR, 2.86; 95% CI, 1.08-7.60; P = 0.035, SUA/Cr ratio-4 vs. SUA/Cr ratio ratio-1: OR, 4.05; 95% CI, 1.32-12.5; P = 0.031, and SUA/Cr ratio ≥ 7.41 vs. SUA/Cr ratio < 7.41: OR, 2.25; 95% CI, 1.32-3.84; P = 0.003). Significant ORs were found for age < 65 years, women, and BMI <25 kg/m2, but no interactions were identified within each group. These results suggest that the baseline SUA/Cr ratio could be an important predictor for the incidence of hypertension in Japanese community-dwelling persons.

This study aimed to evaluate the progress of treatment with intensive targeted therapy in high-risk pulmonary arterial hypertension (PAH) patients and focused on setting an appropriate hemodynamic target of pulmonary vascular resistance (PVR) ≤4 Wood units (WU) and mean pulmonary arterial pressure (mPAP) ≤ 40 mmHg. We retrospectively evaluated high-risk PAH patients who were administered treprostinil at a single tertiary pulmonary hypertension center between January 2020 and December 2022. Echocardiography, right heart catheterization, 6-minute walk distance (6MWD), and blood tests were obtained 6 and 12 months after the initiation of parenteral treprostinil administration. Twelve patients (1 male and 11 female; median age, 47.0 years [interquartile range, 33.8-49.8 years]) were included. Five of the 12 patients had 6- and 12-month follow-up data. The median PVR decreased by 22.9% at 6 months and 50.6% at 12 months compared to baseline. The median mPAP decreased by 24.6% at 6 months and 29.8% at 12 months. Importantly, the 6MWD showed a significant improvement of 55.7%, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels demonstrated a notable decrease of 16.0%, reflecting substantial enhancements in patients' functional status and heart health. Three of these 5 patients reached the hemodynamic target by 12 months and successfully transitioned from parenteral treprostinil to oral selexipag. This study showed that 3 of 5 patients (60.0%) with high-risk PAH reached PVR ≤ 4 WU and/or mPAP ≤ 40 mmHg by receiving intensive parenteral treprostinil therapy with significant improvements in 6MWD and NT-proBNP levels, and successfully transitioned to oral selexipag. We proposed that transition strategies from parenteral treprostinil to selexipag aiming at hemodynamic targets.

BackgroundEssential hypertension is a most prevalent global health concern. Despite extensive research, the exact mechanisms contributing to essential hypertension remain unclear. Several factors contribute to the pathogenesis of essential hypertension. Klotho, a membrane-bound and soluble protein, has been found to modulate hypertension through physiological processes like vascular function and sodium balance. This study aimed to determine the association of klotho protein with essential hypertension.MethodsThe study included 164 hypertensive cases and 164 normotensive controls, after imposing certain inclusion and exclusion criteria with written consent from all subjects. Subject’s details were obtained using structured proforma to account for potential confounding variables. To estimate klotho protein activity using sandwich enzyme-linked immunosorbent assay, 2 mL blood was collected in a plain vial. All data were tested at a 5% significance level.ResultsThe analysis revealed a significant decrease in klotho protein levels in cases compared to controls (1.52 ± 0.87 vs. 2.45 ± 0.90, P < 0.001), suggesting an inverse relationship of klotho protein with risk of essential hypertension. All indices in the structural equation model have suggested that the final model fitted the data reasonably (chi-square to df ratio, 1.153; goodness of fit index, 0.990; adjusted goodness of fit index, 0.945; normed fit index, 0.936; standardized root mean square residual, 0.953; root mean square error of approximation, 0.031). Also, klotho was negatively associated with blood pressure. The area under the receiver operating characteristic curve for klotho and blood pressure was 0.765 (95% confidence interval, 0.716–0.815; P < 0.001).ConclusionsKlotho levels were significantly reduced in essential hypertension cases compared to controls, Also, klotho had a negative direct association with essential hypertension indicating a potential role for klotho as a prognostic and predictive marker for essential hypertension. This suggests that klotho may have a role in the pathogenesis of essential hypertension. Understanding klotho’s role in essential hypertension may lead to the development of novel therapeutic strategies for this disease.Graphical

BackgroundThe triglyceride-glucose (TyG) index is an alternative biomarker of insulin resistance that may be associated with elevated blood pressure. However, the relationship between the TyG index and the risk of prehypertension remains unclear. This longitudinal, retrospective cohort study aimed to investigate the connection between the TyG index and the risk among Japanese population.MethodsWe enrolled 17,758 participants who underwent medical health checkups in 2017 (baseline) and 2022. At baseline, all participants were normotensive and normoglycemic state, and none were using triglyceride-lowering medications. Participants were divided into four groups according to quartiles of the TyG index at baseline. The risk of progressing to prehypertension was evaluated using multivariable Cox proportional hazard models. In addition, multivariate restricted cubic spline analysis was conducted to examine the dose–response relationship. Furthermore, receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of the TyG index for progression to prehypertension.ResultsCompared with the lowest quartile (Q1) of the TyG index group, the adjusted hazard ratios (95% confidence intervals) for progression to prehypertension in the Q2, Q3, and Q4 groups were 1.05 (0.95–1.19), 1.14 (1.02–1.30), and 1.28 (1.11–1.50), respectively. The restricted cubic spline analysis demonstrated a dose–response relationship between the TyG index and the risk of prehypertension. The area under the ROC curve was 0.60 (0.59–0.61), demonstrating a sensitivity of 56.2% and specificity of 58.8%.ConclusionsThe findings suggest that an elevated TyG index may be independently and positively associated with an increased risk of progression to prehypertension in the Japanese population.

BackgroundWe aimed to assess the incidence of infective endocarditis (IE) and evaluate the impact of hypertension (HTN) with underweight on the risk of IE among patients with diabetic mellitus (DM) using a nationwide population-based cohort in Korea.MethodsWe identified 2,603,012 participants (57.4 ± 12.3 years) in the national health insurance database. Of these, 374,586 were normotensive, 750,006 were at pre-HTN status, and the remainder had HTN. The risk of IE was compared between the groups, and the impact of being underweight (body mass index < 18.5) was also evaluated.ResultsDuring follow-up (7.14 years; interquartile range 6.01–8.08 years), 1,703 cases of IE occurred; 168 (0.0647 person per 1000 person-years [PY]), 303 (0.05836 per 1000 PY), and 1,232 (0.12235 per 1000 PY) in normotensive, pre-HTN and HTN group, respectively. Hypertensive participants presented a higher risk of IE (subdistribution hazard ratio, 1.360; 95% confidence interval, 1.152–1.607) than normotensive participants. Being underweight increased the risk of IE by 90% among subjects with HTN. In subgroup analysis, age, duration of DM, insulin use, and habitual factors were not associated with the incidence of IE.ConclusionsDiabetic patients may require rigorous blood pressure control and simultaneous avoidance of excessive weight loss to prevent IE.Graphical abstract

BackgroundIn Korea, chronic kidney disease (CKD) is increasingly prevalent among adults with hypertension, of which approximately 30% of the population is affected. Despite the recognized benefits of adherence to physical activity (PA) recommendations, including aerobic and muscle-strengthening activities (MSA), the impact of such adherence on the prevalence of CKD in individuals with hypertension has not been extensively studied. This study aimed to investigate the association between aerobic PA and MSA levels, and the prevalence of CKD in individuals with hypertension.MethodsThis study included 5,078 individuals with hypertension using data from the Korean National Health and Nutrition Examination Survey (2019–2021). PA levels were measured as min/week of moderate-to-vigorous PA (MVPA) based on self-reports, and MSA was quantified as the number of days per week. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Logistic regression analysis evaluated the association between meeting PA guidelines and CKD after adjusting for potential confounders. Additionally, a joint analysis was conducted to assess the combined effects of MVPA and MSA on CKD.ResultsAfter adjusting for all covariates, higher MVPA was associated with a lower prevalence of CKD. Compared to the group with inactive, the group with MVPA 1–149 min/week had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.61–1.05), the group that met the MVPA 150–299 min/week criteria had an OR of 0.85 (95% CI, 0.62–1.17), and the group that met the MVPA ≥ 300 min/week criteria had an OR of 0.53 (95% CI, 0.37–0.76). MSA alone did not show a significant association with CKD. In the joint analysis, the group that met the MVPA and MSA guidelines had the lowest OR of 0.54 (95% CI, 0.34–0.86), compared to the group that did not meet either.ConclusionsMVPA was associated with the prevalence of CKD in participants with hypertension but not in those with MSA alone. However, compared with the group that did not meet both guidelines, the group that met both guidelines showed the lowest prevalence of CKD.

BackgroundThis study aimed to investigate the prognostic value of age and blood pressure stratified healthy vascular aging (HVA) defined in the North Shanghai Study (NSS), and illustrate its relationship with organ damage (OD).MethodsThis study enrolled 3590 community-dwelling elderly Chinese aged over 65 years and finally 3234 participants were included. 3230 individuals were included in the final analysis, with 4 participants lost to follow-up. NSS HVA was defined as low carotid-femoral pulse wave velocity (PWV) which had a higher cutoff value with advanced age and level of blood pressure. OD was thoroughly assessed and classified into vascular, cardiac and renal OD. Primary endpoints were major adverse cerebrocardiovascular events (MACCE) and all-cause mortality.ResultsNine hundred seventy-eight participants out of 3234 participants (43.1%) were identified as having NSS HVA. The NSS HVA group exhibited a younger age, lower blood pressure levels, lower body mass index, and milder OD compared to the non-NSS HVA group. Over follow-up of 5.7 ± 1.8 years, 332 MACCE (1.82 per 100 person-year) and 212 all-cause deaths (1.14 per 100 person -year) occurred. NSS HVA was associated with a reduced risk of MACCE (HR [95% CI] = 0.585, 0.454–0.754) and all-cause death (HR [95%CI] = 0.608 [0.445, 0.832]), especially in those subgroups without clinical diagnosed cardiovascular disease (CVD) or diabetes mellitus but with at least one type of OD. Moreover, NSS HVA exhibited improved prognostic value for MACCE, all-cause death and CVD death compared to other definitions of HVA.ConclusionsAge and blood pressure stratified NSS HVA could serve as an improved indicator against serious adverse events in the community-dwelling elderly Chinese.Trial registrationPrognosis in the Elderly Chinese: The Northern Shanghai Study (NSS), NCT02368938, https://clinicaltrials.gov/study/NCT02368938?cond=NCT02368938&rank=1.

BackgroundHypertension is a significant risk factor for cardiovascular disease (CVD), with hypertension-related deaths increasing annually. While South Korea uses the Korean Society of Hypertension (KSH) guideline of 140/90 mmHg, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their guidelines in 2017 to 130/80 mmHg. This study evaluates the cost-effectiveness of transitioning to the 2017 ACC/AHA guidelines by estimating early treatment impacts and potential CVD risk reduction.MethodsA Markov state-transition simulation model with a 10-year horizon was used to estimate cost-effectiveness, focusing on strengthening target blood pressure. Quality-adjusted life years (QALYs) served as the measure of effectiveness. Cohorts of 10,000 individuals representing South Koreans in their 20s through 80s were compared in scenario analyses from the healthcare system perspective. A 4.5% annual discount rate was applied to costs and effectiveness. Primary outcomes were incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay (WTP) threshold was < KRW 30,000,000/QALY gained. Probabilistic sensitivity analyses (PSAs) addressed model input parameter uncertainties.ResultsThe base-case analysis showed an ICER value of KRW 1,328,395/QALY gained across all populations. ICER values increased with age, from − KRW 3,138,071/QALY for 20-year-olds to KRW 16,613,013/QALY for individuals over 80. The 60s age group showed the greatest benefit with an incremental QALY gain of 0.46. All scenarios had ICERs below the WTP threshold, with a PSA probability of 98.0% that strengthening blood pressure classification could be cost-effective.ConclusionsThis economic evaluation found that adopting the 2017 ACC/AHA guidelines may result in early treatment, reduce the potential incidence of CVD events, and be cost-effective across all age groups. The study findings have implications for policymakers deciding whether and when to revise official guidelines regarding target blood pressure levels, considering the impacts on public health and budgetary concerns.

BackgroundThe use of calcium channel blockers is associated with primary open-angle glaucoma (POAG) in a statistically meaningful but minor way. In general, those who had received calcium channel blocker medication were at a 23% increased risk of developing glaucoma in comparison to those who had never taken the antihypertensive drugs. We wished to confirm this association and examine POAG genes that might be involved, since the genetics has not yet been analyzed.MethodsWe used MedWatch and UK Biobank data to evaluate the effects of amlodipine on POAG and intraocular pressure (IOP). We analyzed three POAG-associated single-nucleotide polymorphisms: rs9913911, an intron variant in growth arrest-specific 7 (GAS7), one of the genes that influences IOP; rs944801, an intron variant within CDKN2B-AS1, and rs2093210, an intron variant within SIX6, known to be associated with vertical cup-disc ratio, an important optic nerve head parameter that is often used to define or diagnose glaucoma.ResultsAmlodipine use in MedWatch doubled the prevalence of POAG, from 0.0805 to 0.177%, a small but significant increase. Multivariate analysis by logistic regression of UK Biobank data revealed that POAG risk was significantly increased with age, male sex, major alleles of rs9913911 (GAS7) and rs944801 (CDKN2B-AS1), and minor allele of rs2093210 (SIX6). Amlodipine increased POAG risk by 16.1% (P = 0.032). Amlodipine has not been associated with increased IOP. We confirmed this lack of association and in addition found that GAS7, associated with IOP, was not associated with POAG risk and amlodipine. But CDKN2B-AS1 and SIX6, POAG genes not associated with IOP, were associated with POAG and amlodipine.ConclusionsAmlodipine, a frequently prescribed drug and first line treatment for hypertension, has a potentially hazardous relationship with POAG. Knowledge of this link can guide the prescribing of alternate drugs for hypertensive individuals who have glaucoma or are at risk for it. Diuretics and β-blockers are not associated with POAG or increased IOP and could be substituted for amlodipine in hypertensive patients at risk POAG.Trial registrationNone.Graphical