Essential Hypertension Research Articles

Patient characteristics and incidence of cardiac amyloidosis: an observational study in the UK clinical setting using electronic health records

Abstract Background Cardiac amyloidosis (CA) is associated with a high mortality rate due to sudden or progressive heart failure. It is often misdiagnosed due to non-specific symptoms, and its true incidence and prevalence in the United Kingdom (UK) remain uncertain. Purpose To describe patient characteristics and incidence of CA in the UK clinical setting using electronic health records. Methods In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES) were used to describe individuals diagnosed with CA. The CPRD database contains de-identified patient data sourced from a sample of general practitioner (GP) practices in the UK. Patients aged 18 years and older with a recorded Read or SNOMED-CT diagnosis code for CA or record of treatment with tafamidis (a licensed but not reimbursed treatment for transthyretin amyloid cardiomyopathy, ATTR-CM in the UK) in the period between January 2004 to December 2021 were included. The index date was defined as the earliest recorded date of CA diagnosis or tafamidis treatment. Demographic and clinical data were summarised using descriptive statistics. Incidence rates were reported per 100,000 person-years (PY). Results There were a total of 3,788 patients with CA (mean age: 67 years; 61% males) of which only 277 were coded as having wild-type transthyretin (ATTRwt) CA in mostly older patients (mean age: 79 years). The low patient counts of ATTRwt amyloidosis could be attributed to the lack of specificity in CA types and the low utilisation of ATTR amyloidosis codes. Heart Failure, essential hypertension and dyspnoea were the most common clinical presentations recorded in the 12 months to first diagnosis code or tafamidis prescription for CA (Table). The incidence of CA varied from 0.75 in 2004 to a peak of 1.96 in 2021, per 100,000 PY; a 2.9-fold increase in newly coded diagnoses in CA. There was a slight decline in the rates in 2020 and 2021 (Figure). Incidence rates in males and females increased over the 17-year period, with males consistently having higher rates than females. The incidence rate in females started from a lower base at 0.62/100,000 PY in 2004, increased by a factor of 1.9 to 1.1/100,000 PY, whereas in males it started at 0.88/100,000 PY and rose by a factor of 2.9 to 2.5 /100,000 PY. Incidence rates in subgroup populations have also been analysed. Conclusions In the UK clinical setting, the incidence rate of newly coded CA increased overall between 2004 and 2021, as well as in both male and female subgroups. The data suggest CA is becoming more common, or that awareness has improved, and there is now an urgent need for enhanced methods of detection, characterisation, and the need for thorough data capture to shape future pathway advancements.

More hypertensive crises in women than in men in a single emergency department

Abstract Introduction Hypertensive crises are a common presenting complaint in the emergency department. A hypertensive crisis includes hypertensive urgencies defined as a systolic and/or diastolic blood pressure greater than 180/120 mmHg and hypertensive emergencies with additional hypertension-mediated organ damage (HMOD). In the literature there is very little data regarding the distribution between men and women in hypertensive crises. Most data suggest a balanced distribution or a higher frequency in men, especially compared to premenopausal women. Methods We retrospectively analysed patient data in our hospital information system from 2022 using ICD-10 diagnoses at discharge. We included inpatient as well as outpatient cases that presented to our emergency department between 01/01/2022 and 31/12/2022 with one of the following ICD-diagnoses at discharge: - I10.01, Benign essential hypertension With mention of hypertensive urgency - I10.91, Essential hypertension, unspecified With mention of hypertensive urgency - I11.01, Hypertensive heart disease with (congestive) heart failure With mention of hypertensive urgency - I11.91, Hypertensive heart disease without (congestive) heart failure With mention of hypertensive urgency - R03.0, Elevated blood-pressure reading, without diagnosis of hypertension Then we compared the difference of the median age at presentation between men and women using the independent t-test. Results We identified 397 patients with a hypertensive crisis in the year of 2022. Overall the percentage of women in the collective of patients with any type of hypertensive crisis diagnosis was 73.0 % and thus a lot higher than the percentage of men. Women were on average 7.7 years older at presentation (p < 0.0001). Discussion: On the basis of the available data the causes for the distribution between men and women in hypertensive crises can only be speculated. On the one hand women may measure their blood pressure more frequently than men and the urge to call an ambulance or seek medical attention may be higher. On the other hand it could be possible that arterial hypertension in general has differences in the course and underlying mechanism with a higher frequency in blood pressure peaks, symptoms at lower blood pressure values and antihypertensive medication could be less effective depending on the type of drug. Also arterial hypertension may be underdiagnosed in women. The difference in the age at presentation is probably due to a later hormonal adjustment after the menopause as shown in the literature. The findings of this small observational study should be further investigated in larger trials.

Degree of joint risk factor control and incident all cause dementia in hypertensive patients

Abstract Background Hypertension (HT) is a known modifiable risk factor for dementia. This study evaluates the impact of effectively controlling multiple modifiable risk factors in HT patients on the incidence of dementia. Methods Data from the UK Biobank (2006-2010) were used in this longitudinal study, including essential HT patients and non-HT participants, excluding those with pre-existing dementia or less than two years of follow-up. The study focused on seven risk factors: physical activity, smoking status, blood pressure, body mass index, glycosylated hemoglobin levels, lipids, and urinary Albumin-to-Creatinine Ratio. The Cox model evaluated the association between the degree of risk factor control and the incidence of dementia, while linear regression models analyzed the brain abnormalities among different risk factor control groups. Results Of 291,720 participants, 86,675 had HT. Over a median follow-up of 14.3 years, dementia developed in 2,002 HT and 1,379 non-HT participants. Compared with non-HT individuals, a gradual decrease in dementia risk in HT patients with the number of well-controlled risk factors was observed (hazard ratio: 2.01 [95% confidence interval (CI) 1.73-2.34] to 1.25 [95% CI 1.13-1.40]). While within HT patients, with the highest level of control lowering the risk to 0.63 (95% CI [0.54-0.73]). Moreover, HT patients with better well-controlled risk factors had lower geometric mean for white matter hyperintensity volume and increased total brain parenchymal volume, gradually narrowing the gap with non-HT individuals. Conclusion In HT patients, a higher degree of well-controlled risk factors seemed to be associated with progressively lower risks of dementia and brain abnormalities.HRs of all-cause dementia in patientsGMRs of different risk factors on target

The influence of the daily salt-intake on the antihypertensive action and atrial natriuretic peptide level in patietns with angiotensin receptor neprilysin inhibition

Abstract Background The angiotensin receptor–neprilysin inhibitor (ARNI) is a drug which acts through angiotensin receptor blocking effect and the increase in atrail natriuretic peptide (ANP) through neprilysin inhibitor in hypertension (HT). These combined effects result in a reduced risk of hospitalization for heart failure or death from cardiovascular causes. ANP is also known for its various cardioprotective effects including vasodilator and natriuretic action. Acording to Guyton's pressure-natriuresis curve, the efficacy of angiotensin receptor blocker drugs is diminished in HT cases with high daily salt inatke. However, whether the effect of ARNI on HT is attenuated in patients with high daily salt intake remains unclear. Purpose The present study investigated the influence of a daily salt intake on the antihypertensive action and ANP level in patients with ARNI. Methods Fourty-four consecutive essential HT patients on ARNI were enrolled. Blood pressure and ANP level were measured at baseline (before taking ARNI) and 3 weeks later. ARNI (200mg) was prescribed and maintained during the study. In addtion, the daily salt intake was calculated using creatinine and natrium levels in urine, age, and body weight according to Japanese hypertensive guideline at baseline and 3 weeks later. Results The average age was 70±8 years old. About 50% (N=23) was male. The mean sytolic and diastolic blood pressure was 148±14mmHg and 89±10mmHg, respectively. The mean daily salt intake was 9.5±2.2 g/day at baseline. The mean ANP level was 529±300pg/ml. At follow up (3 weeks later), the mean systolic and diastolic blood pressure significanly went down to 132± 18 mmHg and 70± 9 mmHg, respectively (p=0.03). ANP level also increased from 529±300pg/ml to 793±580pg/ml. However, the mean daily salt intake was almost same as the baseline at 9.4±3.2 g/day. The patients were divided into 2 groups; high daily salt intake (N=20 with mean daily salt intake 10.5±1.7g/day)) and low daily salt intake (N=24 with 8.4±3.1g/day) groups compared to the baseline. The absolute and percentage changes in systolic blood pressure were almost same in the high and low daily salt intake groups (-12.7±15.8mmHg vs -13.7±14.2mmHg, p=0.75; -5.8±6.5% vs.-7.0±9.6%, p=0.58, respectively). However, the change rate in ANP level was significantly higer in the high daily salt intake group than in the low daily salt intake group (155±63 vs. 12±16%, p=0.01). Conclusion ARNI demonstrates effectiveness in lowering the blood pressure even in patients with higher salt intake, unlike angiotensin receptor blocker. In cases with high salt intake, the notable increase in ANP levels may contribute to decreasing blood pressure through vasodilator and natriuretic action.

Post-exercise hypotension after different volumes of combined calisthenic and walking exercises in older adults with hypertension: a randomized controlled trial.

This study aimed to analyze the acute effects of combined calisthenic and walking exercises using different volumes on blood pressure (BP) in aging adults with primary hypertension. A total of 48 participants with primary hypertension aged 50-80 years were randomly assigned into two groups that performed two experimental sessions each: a non-exercising CONTROL session and a LOW (group 1) or HIGH (group 2) volume exercise session. The order of these sessions was randomized. The exercise protocols lasted 30 min (LOW) or 60 min (HIGH) and consisted of calisthenic exercises combined with continuous walking or jogging. Exercise intensity was controlled using a rating of perceived exertion (RPE) scale. BP was measured at baseline and after each session for 60 min. Results showed that systolic BP was lower after the HIGH session at post 30' (p = 0.03), post 40' (p = 0.03), post 50' (p = 0.04), and post 60' (p < 0.02), and after the LOW session at post 30' (p = 0.02), post 40' (p < 0.01), post 50' (p < 0.01), and post 60' (p < 0.01) when compared to the corresponding CONTROL at the same time point. There were no significant differences in systolic and diastolic BP between the HIGH and LOW sessions. In conclusion, a pragmatic combined training session using different volumes acutely reduces BP in older adults with primary hypertension.

Long Term Cardiovascular Outcomes Between Sleep Surgery and Continuous Positive Airway Pressure.

Individuals with obstructive sleep apnea (OSA) suffer from a multitude of concurrent morbidities including cardiovascular disease (CVD). Limited data exists comparing long term cardiovascular disease (CVD) clinical outcomes for patients treated with surgical intervention versus continuous positive airway pressure (CPAP). The purpose of this study was to compare CVD outcomes at multiple time points comparing those treated with sleep surgery versus CPAP alone. A research database was used to assess outcomes: death, myocardial infarction, atrial fibrillation, heart failure, essential hypertension, and pulmonary hypertension at 5, 8, and 20 years for patients with OSA treated with surgical interventions (upper airway stimulation [UAS], uvulopalatopharyngoplasty [UPPP], and tonsillectomy) or CPAP alone. Subjects were identified using ICD and CPT codes and analyses were conducted with and without propensity score matching for age, sex, race, BMI, myocardial infarction (MI), essential hypertension, pulmonary hypertension, atrial fibrillation, and heart failure. All surgical interventions demonstrated benefit over CPAP alone at most time points for most surgical interventions. At 8 years, for all sleep surgeries (UAS or UPPP or tonsillectomy) (n = 6627) versus treatment with CPAP alone (n = 6627), matched subjects demonstrated decreased risk (odds ratios) and superior survival (hazard ratios and log ranks tests) for death (OR = 0.49 [0.39, 0.62] P ≤ .0001, HR = 0.29 [0.23, 0.37], χ2 = 109.58 P ≤ .0001), myocardial infarction (OR = 0.67 [0.54, 0.84] P = .0005*, HR = 0.48 [0.38, 0.60], χ2 = 42.40 P ≤ .0001), atrial fibrillation (OR = 0.70 [0.59, 0.83] P ≤ .0001, HR = 0.54 [0.45, 0.64], χ2 = 51.53 P ≤ .0001), heart failure (OR = 0.55 [0.47, 0.64] P ≤ .0001, HR = 0.41 [0.35, 0.47], χ2 = 137.416 P ≤ .0001), essential hypertension (OR = 0.88 [0.82, 0.94] P = .0002, HR = 0.78 [0.74, 0.82], χ2 = 76.38 P ≤ .0001), and pulmonary hypertension (OR = 0.51 [0.40, 0.65] P ≤ .0001, HR = 0.38 [0.29, 0.48], χ2 = 60.67 P ≤ .0001) where P ≤ .00037 indicated statistical significance*. This investigation suggests surgical management of obstructive sleep apnea may contribute to the mitigation of long-term clinical CVD morbidity.

Use of Beta-Blockers as a First-Line Treatment for Primary Hypertension

Background: Even though beta-blockers had been used as a first-line therapy for hypertension, since the late 1960s, the Eighth Joint National Committee, JNC 8, decided to recommend them no longer. This decision was based on relatively weak evidence from previous studies, which found that first-line beta-blockers were less effective in reducing stroke and heart failure, the main outcomes of hypertension. Despite the general perception, the most common events caused by hypertension are death and MI, not stroke or heart failure. Therefore, this study aimed to clarify beta-blocker efficacy by incorporating the data from all relevant beta-blocker trials, using the composite outcome of major cardiovascular events. Method: A search was conducted on MEDLINE, PubMed, Embase, and the Cochrane Library, restricted to published, peer-reviewed, human, meta-analysis, and controlled clinical trials. The term words used were “beta-blockers or adrenergic beta antagonists”, “hypertension”, and “death or coronary heart disease or stroke or congestive heart failure or myocardial infarction”. For this research, we selected six randomized controlled trials, and three meta-analyses were also chosen. Results: The results showed that beta-blockers were as effective as other first-line medications in younger hypertensive patients. On the other hand, in the patients aged above 60, the results were mixed. Beta-blockers were more effective than diuretics, but inferior to angiotensin receptor blockers. Also, beta-blockers were as safe and effective as angiotensin-converting enzyme inhibitors in reducing coronary heart disease, myocardial infarction, heart failure, and sudden death. However, beta-blockers were inferior to calcium channel blockers in reducing strokes. Conclusions: Beta-blockers were found to be the most effective in many aspects except for strokes. Further studies are needed to assess beta-blockers’ effectiveness in treating primary hypertension.

Essential thrombocythemia complicated by multivessel intracranial dolichoectasia with subarachnoid hemorrhage and recurrent cerebral infarction

BackgroundPatients with essential thrombocythemia (ET) can develop systemic thrombotic and hemorrhagic vascular complications due to increased and dysfunctional platelets.Case presentationWe encountered a 49-year-old Japanese woman with a history of essential ET, cerebral infarction, hypertension, and hyperlipidemia. She had been taking anagrelide (2.5 mg/day) and aspirin (100 mg/day) and had vomited at home. At the time of admission to our hospital, she was in a deep stupor. We thought these symptoms were caused by intracranial hypertension. Head computed tomography showed severe subarachnoid hemorrhage (SAH) at the interhemispheric fissure, hematoma at the corpus callosum, and intraventricular hemorrhages. Digital subtraction angiography demonstrated multiple dilated, stenotic, tortuous intracranial arteries, and a dissecting aneurysm at the right anterior cerebral artery (ACA). The dissecting aneurysm measured 7.7 × 15.5 mm, and a bleb was observed. Our diagnosis was ruptured ACA dissecting aneurysm and diffuse intracranial arterial dolichoectasia (DIADE). We performed stent-assisted coil embolization of the aneurysm. She remained apathetic and manifested unilateral apraxia and alien limb syndrome due to a partial callosal disconnection. Two months thereafter her symptoms gradually improved, her consciousness level and limb function improved, and her modified Rankin scale (mRS) score was 2. However, when we tapered her antiplatelet therapy, she again developed an acute cerebral infarct.ConclusionsThis is the first presentation of a patient with ET complicated by DIADE, both of which can result in ischemic and hemorrhagic vascular complications including SAH. As antithrombotic therapy in patients with DIADE and ET may be associated with higher hemorrhage rates, its effects must be monitored carefully.

Neuro- and vasoprotective potential of neuropeptide Y Y2 receptor agonist, NPY13-36, against transient focal cerebral ischemia in spontaneously hypertensive rats

Numerous in vitro and in vivo experimental studies indicate that neuropeptide Y Y2 receptors (Y2R) are potential targets for neuroprotective therapy, including neuroprotection against ischemic stroke in healthy rats. Since stroke in humans is typically associated with comorbidities and long-term hypertension is the most common comorbidity leading to stroke, this study aimed to assess the neuroprotective potential of the Y2R agonist NPY13–36 in the rats with essential hypertension (SHR) subjected to 90 min middle cerebral artery suture occlusion with subsequent reperfusion (MCAOR). The cerebrocortical microflow in the ischemic focus and penumbra was continuously monitored with a Laser-Doppler flowmeter. NPY13–36 (10 μg/6 μl physiological saline solution) was administered intracerebroventricularly (i.c.v.) during ischemia or early reperfusion. The infarct area (triphenyltetrazolium chloride staining), behavioral tests (gait, mobility, and sensorimotor functions), and the response of the cerebrocortical microcirculation in the penumbra to hypercapnia and to the inhibition of the synthesis of nitric oxide were studied. Our results demonstrate that administration of NPY13-36 reduces the size of the infarct, improves motor functions, and restores microcirculatory response to the blockade of nitric oxide synthase when administered during reperfusion. The novelty of this study is a finding of the vasoprotective effect of NPY13-36 in brain ischemia/reperfusion. Moreover, this study provides evidence of the beneficial effects of NPY13-36 in animals with essential hypertension and indicates that Y2R ligands may be promising candidates for treating the ischemic brain in the case of this disease.

Shorter Leukocyte Telomere Length Is Associated with Increased Major Adverse Cardiovascular Events or Mortality in Patients with Essential Hypertension.

The association between leukocyte telomere length (LTL) alteration and major adverse cardiovascular events (MACE) or mortality in patients with hypertension is still unclear. 20,034 patients with essential hypertension were enrolled from UK biobank. Multivariable COX regression models were performed to assess the association. LTL was shorter in hypertensive patients with MACE compared to those without MACE. Hypertensive patients in the lowest LTL quartile were at higher risk to develop MACE (adjusted HR 1.15 [95%CI 1.02-1.29], vs top LTL quartile, p-trend = 0.03). Similarly, shorter LTL was related with increased mortality (adjusted HR 1.18[95% CI 1.06-1.3], lowest vs top LTL quartile, p-trend < 0.001). This investigation demonstrated that shorter LTL is associated with increased risk of MACE or mortality in patients with essential hypertension, which indicates that LTL may be a potential predictor of prognosis or underlying therapeutic target for hypertension.

Genomic Exploration of Essential Hypertension in African-Brazilian Quilombo Populations: A Comprehensive Approach with Pedigree Analysis and Family-Based Association Studies.

Essential Hypertension (EH) is a global health issue. Despite extensive research, much of EH heritability remains unexplained. We investigated the genetic basis of EH in African-derived individuals from partially isolated quilombo populations in Vale do Ribeira (SP-Brazil). Samples from 431 individuals (167 affected, 261 unaffected, 3 unknown) were genotyped using a 650k SNP array. Estimated global ancestry proportions were 47% African, 36% European, and 16% Native American. We constructed six pedigrees using additional data from 673 individuals and created three non-overlapping SNP subpanels. We phased haplotypes and performed local ancestry analysis to account for admixture. Genome-wide linkage analysis (GWLA) and fine-mapping via family-based association studies (FBAS) were conducted, prioritizing EH-associated genes through systematic approach involving databases like PubMed, ClinVar, and GWAS Catalog. Linkage analysis identified 22 regions of interest (ROIs) with LOD scores ranging 1.45-3.03, encompassing 2363 genes. Fine-mapping (FBAS) identified 60 EH-related candidate genes and 117 suggestive/significant variants. Among these, 14 genes, including PHGDH , S100A10 , MFN2 , and RYR2 , were strongly related to hypertension harboring 29 suggestive/significant SNPs. Through a complementary approach - combining admixture-adjusted GWLA based on Markov chain Monte Carlo methods, FBAS on known and imputed data, and gene prioritizing - new loci, variants, and candidate genes were identified. These findings provide targets for future research, replication in other populations, facilitate personalized treatments, and improve public health towards African-derived underrepresented populations. Limitations include restricted SNP coverage, self-reported pedigree data, and lack of available EH genomic studies on admixed populations for independent validation, despite the performed genetic correlation analyses using summary statistics.

Diagnostic performance of single-lead electrocardiograms for arterial hypertension diagnosis: a machine learning approach.

Awareness and early identification of hypertension is crucial in reducing the burden of cardiovascular disease (CVD). Artificial intelligence-based analysis of 12-lead electrocardiograms (ECGs) can already detect arrhythmias and hypertension. We performed an observational two-center study in order to develop a machine learning algorithm to proactively detect arterial hypertension from single-lead ECGs. This could serve as proof of concept with an eye towards todays wearables that record single-lead ECGs. In a prospective observational study, we enrolled 1254 consecutive subjects (539 male, aged 60.22 ± 12.46 years), with and without essential hypertension, and no indications of CVD. A 12-lead ECG of 10 seconds duration in resting position was performed on each subject using a digital electrocardiograph and lead I was isolated for analysis using a calibrated Random Forest (RF). Our RF model classified hypertensive from normotensive subjects on a hold-out test set, with 75% accuracy, ROC/AUC 0.831 (95%CI: 0.781-0.871), sensitivity 72%, and specificity 82% (sensitivity and specificity calculated using a threshold of 0.675). Increasing age, larger values of body mass index, the area under the T wave divided by the QRS complex area, and the area under QRS segment adjusted for BMI, were the four most important features that drove the classification decisions of our model. This study demonstrates the potential to opportunistically detect an undiagnosed hypertension, using a single-lead ECG. While studies with data from wearables are required to translate our findings to actual smartwatch settings, our results could pave the way to innovative technologies for hypertension awareness.

Development and Worsening of Hypertension with Age in Male Wistar Rats as a Physiological Model of Age-Related Hypertension: Correction of Hypertension with Taxifolin

To preclinically study the effectiveness of new antihypertensive drugs, various animal hypertension models are used. However, most of them do not correspond to primary hypertension, which develops in people with age. We used male Wistar rats of 4, 10, 12 and 18 months old. The animals were divided according to systolic blood pressure (SBP) into normotensive (SBP ≤ 114 mmHg) or hypertensive (SBP ≥ 115 mmHg). Within hypertensive animals, two cohorts were distinguished—with SBP below and above 125 mmHg. The animals received 100 µg/kg of taxifolin intraperitoneally for 7 days. A significant difference was shown between animals with SBP above and below 115 mmHg, as well as between cohorts of hypertensive animals with SBP above and below 125 mmHg within each age. The number of animals with elevated SBP increased with age both for clusters with an SBP above 115 mmHg and for cohorts with an SBP above 125 mmHg. Administration of taxifolin led to a significant decrease in the SBP only in hypertensive animals. A physiological model of age-related hypertension was obtained in male Wistar rats. It has been shown that hypertension develops and worsens with age. In preclinical studies, it should be taken into account that drugs may have different effects depending on the initial SBP of the animals.

MFRP GENE MUTATION: NOVEL MANIFESTATION AND INSIGHTS ON PATHOPHYSIOLOGY - A CASE REPORT.

The aim of this study is to delineate a novel manifestation linked to the mutation of the MFRP gene: a macular neovascular membrane (MNV). The authors provide detailed insights into this rare condition, shedding light on a previously unreported observation and proposing potential pathophysiological mechanisms. A single case report from a tertiary center in Brazil was conducted for evaluation. A female patient presenting with microphthalmos, retinal pigmentary alterations, and optic disc drusen, which had previously been misdiagnosed as Intracranial Idiopathic Hypertension (IIH), was diagnosed with MNV and inherited retinal dystrophy. Genetic testing confirmed the presence of an MFRP mutation, revealing novel manifestation of heterozygous gene mutations (c.498del p. Asn167Thrfs*25 and c.650G>A p. Gly217Glu). MNV in the context of retinal dystrophies is a rare occurrence and has not been previously associated with an MFRP mutation. The documentation of this novel observation is crucial for enhancing our understanding of the potential disease presentations, aiding in diagnosis, elucidating the underlying pathophysiology, and guiding appropriate management strategies in such cases.

Differences in sex and age response to single pill combination based antihypertensive therapy reflecting in blood pressure and arterial stiffness.

There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women. Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years. Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline. The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness. ClinicalTrials.gov identifier NCT03738761.

Does greater adherence to a healthy dietary pattern correspond to a better body composition and cardiorespiratory fitness in adults with overweight and primary hypertension? Data from the EXERDIET-HTA study.

Cardiovascular events are positively associated with primary hypertension (HTN), obesity, and low cardiorespiratory fitness (CRF) and negatively with healthy dietary patterns, such as Healthy Diet Indicator (HDI), Mediterranean diet (MD), and the Dietary Approaches to Stop Hypertension (DASH). The aim is to analyze the association between healthy dietary patterns with body composition and CRF. Body composition (bioimpedance) and CRF [peak oxygen uptake (V̇O2peak)] were assessed in 165 participants with HTN and overweight/obesity. There were (1) a positive association (unadjusted) between fat-free mass (%) with DASH and MD (P = 0.03) and a negative association between fat mass (%) and MD (P = 0.03); (2) positive associations (adjusted) between V̇O2peak (l·min-1) with DASH (P = 0.007), HDI (P = 0.017), and MD (P = 0.010) and V̇O2peak (ml·kg-1·min-1) with DASH (P = 0.005); (3) a negative relationship (unadjusted and adjusted) between energy intake and DASH (P = 0.004). In conclusion, these findings highlight the cardiovascular health protection provided by healthy dietary patterns associated with healthier CRF and body composition in people with a profile of HTN and overweight.

Perbedaan Perubahan Tekanan Darah Antara yang Diberikan Jus Mentimun (Cucumis Sativus Linn) dengan Jus Pepaya (Carica Papaya) Terhadap Penderita Hipertensi Primer di Wilayah Kerja Puskesmas Ampenan

Hypertension is the leading cause of death in Indonesia and has a high risk of heart failure, stroke, kidney failure and myocardial infarction. Management of hypertension includes lifestyle changes, diet, stress management and others. In addition, giving cucumber juice and papaya juice is also recommended as a nursing management to lower blood pressure because the content of potassium, magnesium, phosphorus can treat hypertension. The purpose of this study was to determine the difference in blood pressure changes between those given cucumber juice (cucumis sativus linn) and papaya juice (carica papaya) for patients with primary hypertension in the Ampenan Health Center work area. The research method used was a Quasy Experimental study with a pretest-posttest control group design with a quantitative approach in the cucumber juice group and the papaya juice group with a control group without treatment. Random sampling technique was used to obtain 30 respondents divided into 3 groups. The results of the study showed that the results of the dependent t test showed a p value = &lt;0.05 so that there was a difference in blood pressure reduction between those given cucumber juice and those given papaya juice in patients with hypertension.

StratosPHere 2: study protocol for a response-adaptive randomised placebo-controlled phase II trial to evaluate hydroxychloroquine and phenylbutyrate in pulmonary arterial hypertension caused by mutations in BMPR2

BackgroundPulmonary arterial hypertension is a life-threatening progressive disorder characterised by high blood pressure (hypertension) in the arteries of the lungs (pulmonary artery). Although treatable, there is no known cure for this rare disorder, and its exact cause is unknown. Mutations in the bone morphogenetic protein receptor type-2 (BMPR2) are the most common genetic cause of familial pulmonary arterial hypertension. This study represents the first-ever trial of treatments aimed at directly rescuing the BMPR2 pathway, repurposing two drugs that have shown promise at restoring levels of BMPR2 signalling: hydroxychloroquine and phenylbutyrate.MethodsThis three-armed phase II precision medicine study will investigate BMPR2 target engagement and explore the efficacy of two repurposed therapies in pulmonary arterial hypertension patients with BMPR2 mutations. Patients will be stratified based on two BMPR2 mutation classes: missense and haploinsufficient mutations. Eligible subjects will be randomised to one of the three arms (two active therapy arms and a placebo arm, all plus standard of care) following a Bayesian response-adaptive design implemented independently in each stratum and updated in response to a novel panel of primary biomarkers designed to assess biological modification of the disease.DiscussionThe results of this trial will provide the first randomised evidence of the efficacy of these therapies to rescue BMPR2 function and will efficiently explore the potential for a differential response of these therapies per mutation class to address causes rather than consequences of this rare disease.Trial registrationThe study has been registered with ISRCTN (ISRCTN10304915, 22/09/2023).

Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism.

The new Japanese guidelines for primary aldosteronism introduce a category in the judgment of functional confirmatory tests that is called the "borderline range," which is rare in the other international guidelines. The clinical characteristics of this borderline group are not yet understood. To investigate whether this borderline group has any significant differences in terms of target organ damage, we used data from a Japanese nationwide registry (JPAS-II) of individuals with primary aldosteronism or essential hypertension to compare the borderline group with the definitive-positive group and the negative group. We analyzed the cases of 1785 patients based on their captopril-challenge test results. Since the JPAS-II database contains plasma aldosterone concentration values obtained based on both radioimmunoassay (n = 1555) and chemiluminescent enzyme immunoassay (n = 230) principles, we converted these values to their equivalents as if measured by chemiluminescent enzyme immunoassay and conducted all analyses under the simulated condition. Multicovariate-adjusted models revealed significant prevalance odds ratios for chronic kidney disease (2.01, 95% confidence interval: 1.13 to 3.61), electrocardiographic abnormalities (1.66, 95% confidence interval: 1.16 to 2.37). No significant difference was observed between the borderline and negative groups in these assessments (odds ratio [95% confidence interval] for chronic kidney disease: 0.73 [0.26 to 2.02] and electrocardiographic abnormalities: 1.01 [0.60 to 1.70]). We confirmed that the prevalence of target organ damage increases linearly as the aldosterone-to-renin ratio rises following the captopril challenge test. These results provide material to consider regarding the significance of the provisionally established borderline group.

Temporal Trends and Mortality Patterns in Peripheral Arterial Disease: A Comprehensive Analysis of Hospitalized Patients in Kazakhstan between 2014 and 2021.

Peripheral artery disease (PAD) is a global health concern associated with arterial narrowing or blockage, leading to significant morbidity and mortality. The aim of this study is to assess the disease burden and trends in mortality utilizing nationwide administrative health data. This retrospective study utilized data from the Unified National Electronic Healthcare System (UNEHS) from 2014 to 2021. Patients meeting PAD criteria were included, with demographic and clinical data analyzed. Cox regression and Competing Risk Analysis assessed mortality risks. Between 2014 and 2021, 19,507 individuals were hospitalized due to PAD, with 8,332 (43%) being women and 11,175 (57%) men. The incidence of PAD increased markedly over the observation period, rising from 79 individuals per million population (PMP) in 2014 to 309 PMP in 2021. Concurrent heart failure (HF), acute myocardial infarction (AMI), diabetes, and essential hypertension were prevalent in 50%, 27%, 27%, and 26% of the PAD patients, respectively. Competing Risk Analysis showed a subdistribution hazard ratio (SHR) of 6.53 [95% CI: 4.65-9.19] for individuals over 80 years. Heart failure was associated with lower all-cause HR [0.80, 95% CI: 0.76-0.86, p < 0.001] but higher SHR [1.30, 95% CI: 1.18-1.44, p < 0.001]. Comorbidities such as heart failure, stroke, and acute myocardial infarction significantly increased mortality risks, while essential hypertension was associated with lower risk of death. The significant rise in the incidence rate of PAD underscores the growing burden of the disease, highlighting the urgent need for targeted preventive and management strategies in Kazakhstan.