Hypertension Research Research Articles

AI, Machine Learning, and ChatGPT in Hypertension.

Hypertension, a leading cause of cardiovascular disease and premature death, remains incompletely understood despite extensive research. Indeed, even though numerous drugs are available, achieving adequate blood pressure control remains a challenge, prompting recent interest in artificial intelligence. To promote the use of machine learning in cardiovascular medicine, this review provides a brief introduction to machine learning and reviews its notable applications in hypertension management and research, such as disease diagnosis and prognosis, treatment decisions, and omics data analysis. The challenges and limitations associated with data-driven predictive techniques are also discussed. The goal of this review is to raise awareness and encourage the hypertension research community to consider machine learning as a key component in developing innovative diagnostic and therapeutic tools for hypertension. By integrating traditional cardiovascular risk factors with genomics, socioeconomic, behavioral, and environmental factors, machine learning may aid in the development of precise risk prediction models and personalized treatment approaches for patients with hypertension.

“They should’ve talked to us more”: lay health advisors’ experiences with community-engaged hypertension research

BackgroundLay health advisors (LHAs) are increasingly being used to increase patient and public involvement in research, disseminate health information, and work toward preventing health disparities within communities at risk. This research explored LHAs’ experiences with training and recruiting for a hypertension research project which ended due to minimal enrollment.MethodsThe methodological design was qualitative description. One face-to-face semi-structured focus group was held with eight African American LHAs in Cleveland, Ohio, in the fall of 2019. The focus group was digitally recorded and transcribed by a professional transcriptionist and thematically analyzed.ResultsTrainees reflected on how much they learned from the training and described feeling passionate and excited about their community work for the project. We identified three key themes from the data: (1) Systemic and Institutional Factors Affected LHAs’ Experiences (subthemes: Unnecessarily Burdensome Requirements and Exploitation of Community Members for Research Gain; (2) Feeling Used Yet Unseen: Exclusion from Decision-Making Processes; (3) Worrying that Project Termination Damaged their Reputation; and (4) Disengaging from Research. We share lessons learned, including the need for LHAs’ expertise to be integrated into research studies, and for projects to establish clear communication and expectations regarding research rigor and requirements.ConclusionOur results have implications for future studies attempting to build equitable and strong academic-community relationships to yield rigorous and useful research to reduce health disparities.

Sir William Stanley Peart. 31 March 1922—14 March 2019

Sir Stanley Peart began his academic career with two fine original pieces of work: elucidating the neurotransmitter discharged from sympathetic nerves to the viscera; and characterizing the amino-acid sequence of angiotensin, the peptide released by the action of the enzyme renin. The influence of both these lines of work has been profound. First, on the understanding of neurotransmission in the autonomic nervous system, the peripheral nervous system that regulates involuntary processes in the viscera. Second, on the control of the vascular system; on hypertension and the design of antihypertensive drugs; on creation of analogues and antagonists of angiotensin; and on the therapeutic potential of inhibitors of angiotensin-converting enzyme. These achievements required intense application, originality of ideas and technique and good scientific taste in the choice of collaborators. However, he chose not to remain in the laboratory, but explicitly to be a clinician scientist, with his research growing from and illuminated by clinical practice. He created a fruitful and durable school of research in hypertension and the related subjects, inspiring and influencing a generation of clinician scientists. Among his strengths were the ability to analyse and constructively criticize research, and to recognize the aptitudes and abilities of all who had the pleasure of working with him. His academic career began as a medical student at St Mary's Hospital Medical School in London, and he spent almost all of his career at St Mary's, including 31 years as professor of medicine.

The relationship between hyperuricemia and hypertension: a short review of current evidence

The investigation of the relationship between hyperuricemia and hypertension is a captivating field in hypertension research. The final product of purine metabolism is uric acid (UA), and the elevation of serum UA (SUA) levels directly contributes to the development of hypertension. Numerous studies have substantiated that hyperuricemia is a significant risk factor for hypertension. Furthermore, initial clinical trials have demonstrated that therapeutic interventions aimed at reducing SUA levels lower blood pressure (BP) in individuals with hypertension attributed to hyperuricemia. Recent research has demonstrated that hyperuricemia can facilitate the onset of hypertension via multiple mechanisms, including oxidative stress, inflammation, diminished nitric oxide (NO) synthesis, activation of reactive oxygen species (ROS), insulin resistance, vascular smooth muscle proliferation, and renal impairment. Given the interconnectedness between hyperuricemia and hypertension, it is advantageous to identify potential therapeutic approaches for timely intervention in order to impede the advancement of hypertension in individuals with hyperuricemia. This article reviews the research progress on the pathogenesis of hyperuricemia-induced hypertension.

Animal models of hypertension: A concise review

Hypertension (HTN), a prevalent cardiovascular disorder, poses a significant global health burden. Understanding the intricate mechanisms underlying HTN is crucial for developing effective therapeutic strategies. Experimental animal models play a pivotal role in HTN research, providing valuable insights into the pathophysiology, etiology, and potential treatment options. This concise review examines the various animal models employed to study HTN, highlighting their strengths, limitations, and contributions to our understanding of this complex condition.

Unlocking the potential of genetic research in pulmonary arterial hypertension: Insights from clinicians, researchers, and study team.

Genetic research and testing are increasingly important for understanding and treating pulmonary arterial hypertension. We aimed to explore how attitudes toward genetic research among clinical and research teams impacted the engagement in genetic research and the integration of genetic insights into clinical practice. We conducted 53 semistructured interviews and focus groups with patients, clinicians, and researchers from nine UK Pulmonary Hypertension centers, who had genetic research experience. Transcripts were thematically coded using inductive analysis. In this study, we focus on the researchers', clinicians', and study team's perspectives. From the interview data, several key themes emerged, ranging from study design, recruitment, and consent procedures to the return of individual genetic results. Additionally, participants reflected on both the successes of these studies and the future directions of genetic research. The analysis highlighted the critical importance of fostering collaborative networks firmly rooted in existing clinical and research infrastructure in rare disease study setups. Furthermore, the significance of trust-building, personalized communication, and transparency among stakeholders was underscored. The study offered valuable insights into the motivating and hindering factors to participant recruitment and consent procedures. Lastly, the findings gathered from processes surrounding the return of individual genetic results, genetic counselling, and the recruitment of relatives provided invaluable lessons regarding the integration of genetics into clinical practice. This in-depth analysis yields a crucial understanding of attitudes to genetic research among various stakeholders and sheds light on the complexities of genetic research and the evidence-practice gap.

Comparing emergency department versus high school-based recruitment for a hypertension research study with adult-youth dyads.

Dyads can be challenging to recruit for research studies, but detailed reporting on strategies employed to recruit adult-adolescent dyads is rare. We describe experiences recruiting adult-youth dyads for a hypertension education intervention comparing recruitment in an emergency department (ED) setting with a school-based community setting. We found more success in recruiting dyads through a school-based model that started with adolescent youth (19 dyads in 7 weeks with < 1 hour recruitment) compared to an ED-based model that started with adults (2 dyads in 17 weeks with 350 hours of recruitment). These findings can benefit future adult-youth dyad recruitment for research studies.

Trends in exercise for hypertension: a bibliometric analysis.

To investigate development trends and research hotspots of exercise for hypertension research and provide researchers with fresh perspectives for further studies. Articles and reviews regarding exercise and hypertension spanning May 1st 2003 to May 18th 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. VOSviewer and Citespace were mainly used to perform and visualize co-authorship, co-citation, and co-occurrence analysis of countries, institutions, authors, references and keywords in this field. A total of 1,643 peer-reviewed papers were identified, displaying a consistent increasing trend over time. The most prolific country and institution were Brazil and University of Sao Paulo, respectively. And we identified the most productive author was lrigoyen, Maria Claudia C, while Pescatello Linda S was the most co-cited author. Journal of hypertension was the most prominent journal, and Hypertension was the journal which was the most co-cited. And this field can be divided into 3 research themes: exercise interventions for hypertension, age-specific relevance of exercise for hypertension, and the global burden of hypertension and the role of exercise. According to the result of keywords analysis, epidemiological information, types of exercise, target population, mechanism, and study design are significant research areas. "Resistance training", "adults", and "heart rate variability" were identified as the major future research foci. The findings offer a scientific insight into exercise for hypertension research, presenting researchers with valuable information to understand the current research status, hotspots, and emerging trends for future investigation.

Advances in the research of sulfur dioxide and pulmonary hypertension.

Pulmonary hypertension (PH) is a fatal disease caused by progressive pulmonary vascular remodeling (PVR). Currently, the mechanisms underlying the occurrence and progression of PVR remain unclear, and effective therapeutic approaches to reverse PVR and PH are lacking. Since the beginning of the 21st century, the endogenous sulfur dioxide (SO2)/aspartate transaminase system has emerged as a novel research focus in the fields of PH and PVR. As a gaseous signaling molecule, SO2 metabolism is tightly regulated in the pulmonary vasculature and is associated with the development of PH as it is involved in the regulation of pathological and physiological activities, such as pulmonary vascular cellular inflammation, proliferation and collagen metabolism, to exert a protective effect against PH. In this review, we present an overview of the studies conducted to date that have provided a theoretical basis for the development of SO2-related drug to inhibit or reverse PVR and effectively treat PH-related diseases.

2023 update and perspectives.

Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.

Reimagining Global Hypertension Research: From Helicopter Science to Meaningful Partnerships.

Reimagining Global Hypertension Research: From Helicopter Science to Meaningful Partnerships.

Exploring the Effects of Elevated Serum Uric Acid Levels on Hypertension: A Scoping Review of Hyperuricemia.

Hypertension (HTN) is a global health concern due to its increasing prevalence and association with life-threatening complications.An intriguing area of investigation in HTN research is the relationship between HTN and hyperuricemia. In light of this, we conducted areview to summarize the relevant studies exploring the link between elevatedserum uric acid (sUA) concentration and new-onset HTN. Through a comprehensive search of PubMed Central, MEDLINE, and PubMed databases, we identified 20 studies that met our inclusion criteria. The research encompassed various study designs, including cohort studies, cross-sectional studies, reviews, and clinical trials. Pathologically, theelevated sUA levels activatethe renin-angiotensin systemand also causethe formation of urate crystals, triggering inflammation in the kidneys.Additionally, direct effects on the endothelium contribute to inflammation, oxidative stress, nitric oxide depletion, and smooth muscle cell proliferation, ultimately leading to atherosclerosis.These diverse mechanisms collectively play a role in the pathogenesis of HTN. Interestingly, lowering sUA has been shown to reverse early-stage HTN dependent on uric acid. However, this effect is not observed in the uric acid-independent second stage of HTN.Various studies have demonstrated an independent and dose-dependentassociation betweensUAlevelsand the prevalence of HTN across different populationsand genders.The review highlights the potential role of uric acid-lowering drugs, like allopurinol, in the prevention and early-stage management of HTN. However, there is scarce research on the efficacy of other uric acid-lowering agents and combination therapies. We believe our review provides compelling evidence of the association between elevated sUAconcentration and new-onset HTN.Identifying and managing hyperuricemia can provide a preventive approach to reducing the burden of HTN and its associated complications.

Arterial Hypertension-clinical trials update 2023.

Arterial hypertension is associated with increased morbidity and mortality and research in the field is highly dynamic. This summary reviews the most important clinical trials published in 2022 and early 2023. Findings on new pharmacological approaches to treat resistant hypertension are presented and new knowledge about the optimal timing of the antihypertensive medication intake is discussed. It is focused on optimal blood pressure treatment targets and the problem of treatment and guideline inertia is acknowledged. Information about pregnancy-related hypertension is presented and blood pressure control following percutaneous thrombectomy after ischemic stroke is discussed. Finally, novel clinical data on device-based approaches to treat hypertension are summarized. The hypertension trials update summarizes the most important clincal trials on hypertension research in 2022 and early 2023. CTD - chlorthalidone, CV - cardiovascular, HCT - hydrochlorothiazide, SBP - systolic blood pressure, RDN - renal denervation *depicts systolic blood pressure only.

RELIABILITY AND RELEVANCE OF 24H AMBULATORY BLOOD PRESSURE MONITORING IN DAY TO DAY TREATMENT OF ARTERIAL HYPERTENSION

Objective: Blood pressure measurements are the basis of diagnosis, treatment and research of arterial hypertension and its sequelae. All decisions hinge on the validity of the measurement method. Here, the ABPM is considered best practice. Evaluation of ABPM, notwithstanding known issues like availability and economy, regarding its validity, accuracy and applicability to clinical practice was investigated. Design and method: We retrospectively consider 450 ABPMs executed using validated devices from Nephrology Center Göttingen (ESH-Excellence-Center). This work evaluates the measurements’ adherence to diagnostic guidelines (ESH) with respect to sources of error, count of valid measurements and cancellation by patient. Criteria for validity are: - Minimum 24 h recording duration.- At least 20 valid day and 7 valid night measurements- Minimum of 70 percent valid measurements in total Cancellation by the patient is assumed if: - Recording duration is below 22h without indication of technical fault or measurement is stopped prior to 7 30 a.m. Results: 23 % (n = 106) of 450 ABPM considered to meet all guideline criteria. Remaining 77 % of measurements failed at least one criterion. In 27 % (n = 120), measurement duration was below 24 h and for 22 % (n = 98) it was below 22 h. In 2.6 % (n = 12) minimum amount of daytime (n = 3) and night-time (n = 9) data points was not met. Requirement for at least 70 % of valid data points was failed by 23.5 % (n = 105). Here the source of error were motion artefacts in about 50 % of cases, pressurisation issues during the day in 17 % (n = 15) and 27 % (n = 11) at night and kinks in tubing in 14 % (n = 12) during daytime. About 20.6 % (n = 93) of ABPM were preliminary cancelled by the patient which amounts to approximately a quarter (25.4 %) of all measurements failing the guideline criteria. Conclusions: Value of ABPM hinges on guideline conforming execution of measurements and should therefore be explicitly discussed with the patient. Quality of data obtained by an ABPM needs to be examined for every case to ensure its validity to justify a course of action.

SERUM PARATHORMONE, VITAMIN D AND CARDIOVASCULAR RISK FACTORS

Objective: The aim of this study is to evaluate the associations of serum 25-OHD and PTH concentrations with blood pressure and hypertension mediated target organ damage including left ventricular hypertrophy (LVH) and carotid intima-media thickness (IMT). Design and method: This observational retrospective study included 98 patients admitted at Hypertension Research Center of Federico II University Hospital in Naples without CKD. We collected serum 25-OHD, PTH, creatinine, BMI, lipid profile, blood glucose and office blood pressure. All patients underwent carotid doppler ultrasound and echocardiography. Results: Mean age of the participants was 53±17 years and 69% were men. Pearson's correlation analysis indicated that PTH levels correlated directly with age, diabetes, dyslipidemia, hypertension, fasting glucose, on statin therapy, left ventricular mass and inversely with the GFR, total cholesterol, LDL and vit D level. Vit. D levels correlated inversely with PTH, diabetes and carotid plaque. Multivariate regression models indicated that PTH was significantly associated with higher fasting glucose and with vit D while Vit D was associated with lower GFR and PTH level. Conclusions: In a population at high cardiovascular risk, Vit. D and PTH are not directly associated with hypertension but might influence association with other cardiovascular risk factors and markers.

Survey and Evaluation of Hypertension Machine Learning Research.

Background Machine learning (ML) is pervasive in all fields of research, from automating tasks to complex decision-making. However, applications in different specialities are variable and generally limited. Like other conditions, the number of studies employing ML in hypertension research is growing rapidly. In this study, we aimed to survey hypertension research using ML, evaluate the reporting quality, and identify barriers to ML's potential to transform hypertension care. Methods and Results The Harmonious Understanding of Machine Learning Analytics Network survey questionnaire was applied to 63 hypertension-related ML research articles published between January 2019 and September 2021. The most common research topics were blood pressure prediction (38%), hypertension (22%), cardiovascular outcomes (6%), blood pressure variability (5%), treatment response (5%), and real-time blood pressure estimation (5%). The reporting quality of the articles was variable. Only 46% of articles described the study population or derivation cohort. Most articles (81%) reported at least 1 performance measure, but only 40% presented any measures of calibration. Compliance with ethics, patient privacy, and data security regulations were mentioned in 30 (48%) of the articles. Only 14% used geographically or temporally distinct validation data sets. Algorithmic bias was not addressed in any of the articles, with only 6 of them acknowledging risk of bias. Conclusions Recent ML research on hypertension is limited to exploratory research and has significant shortcomings in reporting quality, model validation, and algorithmic bias. Our analysis identifies areas for improvement that will help pave the way for the realization of the potential of ML in hypertension and facilitate its adoption.

A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives

BackgroundThere is currently a lack of a precise, concise, and practical clinical prediction model for predicting coronary artery disease (CAD) in patients with essential hypertension (EH). This study aimed to construct a nomogram to predict CAD in patients with EH based on flow-mediated dilation (FMD) of brachial artery and traditional risk factors.MethodsClinical data of 1752 patients with EH were retrospectively collected. High-resolution vascular ultrasound was used to detect FMD in all patients at the Fujian Hypertension Research Institute, China. Patients were divided into two groups, i.e. training group (n = 1204, from August 2000 to December 2013) and validation group (n = 548, from January 2014 to May 2016) according to the time of enrollment. Independent predictors of CAD were analyzed by multivariable logistic regression in the training group, and a nomogram was constructed accordingly. Finally, we evaluated the discrimination, calibration, and clinical applicability of the model using the area under curve (AUC) of receiver operating characteristic analysis, calibration curve combined with Hosmer-Lemeshow test, and decision curve, respectively.ResultsThere were 263 (21.8%) cases of EH combined with CAD in the training group. Multivariate logistic regression showed that FMD, age, duration of EH, waist circumference, and diabetes mellitus were independent influencing factors for CAD in EH patients. Smoking which was close to statistical significance (P = 0.062) was also included in the regression model to increase the accuracy. Ultimately, the nomogram for predicting CAD in EH patients was constructed according to above predictors after proper transformation. The AUC values of the training group and the validation group were 0.799 (95%CI 0.770–0.829) and 0.836 (95%CI 0.787–0.886), respectively. Calibration curve and Hosmer-Lemeshow test showed that the model had good calibration (training group: χ2 = 0.55, P = 0.759; validation group: χ2 = 1.62, P = 0.446). The decision curve also verified the clinical applicability of the nomogram.ConclusionThe nomogram based on FMD and traditional risk factors (age, duration of EH disease, smoking, waist circumference and diabetes mellitus) can predict CAD high-risk group among patients with EH.

Creating Health Equity Through Hypertension Prevention With the AddREssing Social Determinants TO pRevent hypErtension Network: Introduction to an American Journal of Hypertension Compendium.

The RESTORE Network is poised to have a major impact on individuals, communities, and society. The AHA should be applauded for its vision in funding the HERN to prevent hypertension, which has brought together leading hypertension and health equity researchers and community partners, and members to address its strategic goals. In providing the 6 articles on the RESTORE Network, the American Journal of Hypertensionis affirming its commitment to being proactive in supporting the dissemination of research that will contribute to health equity.

Association of APP gene polymorphisms and promoter methylation with essential hypertension in Guizhou: a case–control study

BackgroundSingle-nucleotide polymorphisms (SNPs) and DNA methylation are crucial regulators of essential hypertension (EH). Amyloid precursor protein (APP) mutations are implicated in hypertension development. Nonetheless, studies on the association of APP gene polymorphism and promoter methylation with hypertension are limited. Therefore, this case–control aims to evaluate the genetic association of APP gene polymorphism and promoter methylation with EH in Guizhou populations.Objective and methodsWe conducted a case–control study on 343 EH patients and 335 healthy controls (including Miao, Buyi, and Han populations) in the Guizhou province of China to analyze 11 single-nucleotide polymorphisms (rs2040273, rs63750921, rs2211772, rs2830077, rs467021, rs368196, rs466433, rs364048, rs364051, rs438031, rs463946) in the APP gene via MassARRAY SNP. The MassARRAY EpiTYPER was employed to detect the methylation levels of the promoters.ResultsIn the Han population, the rs2211772 genotype distribution was significantly different between disease and control groups (χ2 = 6.343, P = 0.039). The CC genotype reduced the risk of hypertension compared to the TT or TC genotype (OR 0.105, 95%CI 0.012–0.914, P = 0.041). For rs2040273 in the Miao population, AG or GG genotype reduced the hypertension risk compared with the AA genotype (OR 0.533, 95%CI 0.294–0.965, P = 0.038). Haplotype TCC (rs364051–rs438031–rs463946) increased the risk of EH in Guizhou (OR 1.427, 95%CI 1.020–1.996, P = 0.037). Each 1% increase in CpG_19 (− 613 bp) methylation level was associated with a 4.1% increase in hypertension risk (OR 1.041, 95%CI 1.002–1.081, P = 0.039). Each 1% increase in CpG_1 (− 296 bp) methylation level was associated with an 8% decrease in hypertension risk in women (OR 0.920, 95%CI 0.860–0.984, P = 0.015). CpG_19 significantly correlated with systolic blood pressure (r = 0.2, P = 0.03). The methylation levels of CpG_19 in hypertensive patients with rs466433, rs364048, and rs364051 minor alleles were lower than that with wild-type alleles (P < 0.05). Moreover, rs467021 and rs364051 showed strong synergistic interaction with EH (χ2 = 7.633, P = 0.006). CpG_11, CpG_19, and rs364051 showed weak synergistic interaction with EH (χ2 = 19.874, P < 0.001).ConclusionIn summary, rs2211772 polymorphism and promoter methylation level of APP gene may be linked to EH in Guizhou populations. Our findings will provide novel insights for genetic research of hypertension and Alzheimer's disease.

Remotely Programmable Deep Brain Stimulator Combined with an Invasive Blood Pressure Monitoring System for a Non-Tethered Rat Model in Hypertension Research.

The control circuits of blood pressure have a strong neural regulatory element important in the pathogenesis of essential drug-resistant hypertension. Targeting lower medullary neural control mechanisms of blood pressure by electrical stimulation could be beneficial, and therefore, a novel device is needed. This paper presents a remotely programmable deep brain stimulator with an invasive continuous blood pressure monitoring system in a non-tethered rat model. The device is designed for lower medullary deep brain stimulation research with minimal interference to a daily animal routine. Electrodes were implanted in the caudal ventrolateral medulla. Animal survivability, catheter patency rates, and device data drift were evaluated. Eight out of ten rats survived the surgery and testing period with no or mild temporary neurological compromise. The study revealed that carotid catheters filled with heparinized glycerol ensure better catheter patency rates and blood pressure transduction. There was no significant drift in the device's pressure sensitivity during the experiment. To our knowledge, this is the first experimental study to show considerable animal survival after lower medullary implantation. Combining the ability to measure and monitor invasive blood pressure with a closed-loop brain pulse generator in a single device could be of potential value in future hemodynamic animal research.