Long-term Hypertension Research Articles

Association between albumin-corrected anion gap and kidney function in individuals with hypertension – NHANES 2009–2016 cycle

Objectives Long-term uncontrolled hypertension increases the risk of kidney decompensation. This study aimed to explore the connection between albumin-corrected anion gap (ACAG) and kidney function in hypertensive patients. Methods This study utilized data from 1988 participants diagnosed with hypertension sourced from the NHANES database. Binary logistic regression analysis and subgroup analysis were utilized to investigate the relationship between ACAG and kidney function. The study employed restricted cubic spline (RCS) to assess the non-linear associations between ACAG and eGFR, as well as ACAG and ACR. Furthermore, mediation and moderation effect analyses were carried out, with blood pressure serving as the mediator and moderator, ACAG as the independent variable, and eGFR and ACR as the dependent variables. Finally, the study developed ACAG-based models for predicting kidney function decline. Results Higher ACAG is identified as an independent risk factor for eGFR < 60 mL/minute/1.73 m2 and ACR ≥ 30 mg/g. Results from RCS indicate a non-linear relationship between ACAG and eGFR, as well as between ACAG and ACR. The mediation effect analysis revealed that DBP mediated the relationship between ACAG and eGFR. Analysis on moderation effect demonstrated that SBP played a significant role in moderating the interaction between ACAG and ACR. Moreover, the models based on ACAG showed strong performance. Conclusions The levels of ACAG are found to be independently associated with both eGFR and ACR. Additionally, ACAG shows promise as a new and dependable biomarker for predicting the decline in kidney function in hypertensive patients.

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.

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry.

To evaluate the impact of aldosterone excess on renal function in individuals with primary aldosteronism and to compare its evolution after surgery or mineralocorticoid receptor antagonist (MRA) treatment. A multicentre, retrospective cohort study of primary aldosteronism patients in follow-up in 36 Spanish tertiary hospitals, who underwent specific treatment for primary aldosteronism (MRA or adrenalectomy). A total of 789 patients with primary aldosteronism were included, with a median age of 57.5 years and 41.8% being women. At primary aldosteronism diagnosis, the prevalence of chronic kidney disease (CKD) was 10.7% ( n = 84), with 75% of cases classified as state 3a ( n = 63). Primary aldosteronism patients with CKD had a longer duration of hypertension, a higher prevalence of type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. Unilateral adrenalectomy was performed in 41.8% of cases ( n = 330), and 459 patients were treated with MRA. After a median follow-up of 30.7 months (range 13.3-68.4), there was a significant decline in the estimated glomerular filtration rate (eGFR) in operated patients and those receiving MRA. During follow-up, 24.4% of patients with CKD at the time of primary aldosteronism diagnosis had normalized renal function, and 39% of those with albuminuria had albuminuria remission. There were no differences in renal function or albuminuria regression between the two therapy groups. However, development of albuminuria was less common in operated than in medically treated patients (0 vs. 6.0%, P = 0.009). CKD affects around 10% of the patients with primary aldosteronism, with a higher risk in individuals with long-term hypertension, type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. At short-term, both MRA and surgical treatment lead to a reduction of renal function, but adrenalectomy led to higher renal protection.

O101 THE ANGIOTENSIN II TYPE 1 RECEPTOR-BIASED AGONIST REDUCES BLOOD PRESSURE IN SPONTANEOUSLY HYPERTENSIVE RATS AND RESTORES VENTRICULAR HYPERTROPHY BY AFFECTING THE CONNEXIN 43 PATHWAY

Purpose: Hypertension is one of the common causes of cardiovascular diseases. Long-term hypertension can lead to structural and functional impairment of the heart. Therefore, active treatment of hypertension is highly significant in preventing target organ damage. Angiotensin II (AngII) plays a crucial role in hypertension-induced cardiac hypertrophy. Reportedly, TRV027, an AngII type 1 receptor (AT1R) biased agonist, can competitively bind to AT1R and inhibit the AngII-induced damage. Whether TRV027 could lower blood pressure and treat hypertensive cardiac hypertrophy remains unknown. Methods: Spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats were selected, and some of the SHRs were administered with TRV027. H9C2 cells were utilized for in vitro study to explore the underlying mechanism of TRV027. A multidisciplinary approach combining pathology and molecular techniques was used to explore the role and mechanism of TRV027 in reducing blood pressure and restoring ventricular hypertrophy. Results: Our studies revealed that TRV027 reduced blood pressure and restored hypertension-induced ventricular hypertrophy in SHRs. Moreover, the modulated expression of Connexin43 (Cx43) and phosphorylation of the MAPK/ERK pathway were normalized by TRV027. After the inhibition of Cx43 expression, cardiomyocytes recovered from hypertrophy and damage, followed by the modulation of phosphorylation of the MAPK/ERK pathway. Conclusion: TRV027 demonstrates a potential to lower the blood pressure in SHRs and ameliorate hypertension-induced cardiac hypertrophy. While AngII stimulated cardiomyocyte injury by decreasing Cx43 expression and increasing the phosphorylation of the MAPK/ERK pathway, TRV027 repaired the hypertrophy by restoring the expression of the Cx43/MAPK/ERK pathway.

O72 ASSOCIATION BETWEEN CUMULATIVE BLOOD PRESSURE AND RISK OF GASTEROINTESTINAL CANCER

Objective: We aimed to examine the association between cumulative blood pressure (cumBP) and risk of gastrointestinal cancer. Methods: The Kailuan study is a prospective cohort study based on community. CumBP (mmHg year) was calculated as follows: cumBP = [(BP1 + BP2)/2 time1-2] + [(BP2 + BP3)/2 time2-3]. All participants were into four groups according to the quartiles of cumBP. The association between quartiles of cumBP or duration of hypertension and gastrointestinal cancer was assessed by the Cox proportional hazards models (hazard ratios [HRs], 95%confidence intervals [CI]). Results: During the median follow-up time of 11 years, a total of 624 (0.95%) participants gastrointestinal cancer occurred among 65,734 participants. The Kaplan-Meier curves showed that higher quartiles on cumulative systolic blood pressure (cumSBP), cumulative diastolic blood pressure (cumDBP) and cumulative pulse pressure (cumPP) or duration of hypertension are strongly associated with an increased risk of gastrointestinal cancer. After adjusting for covariables, compared with the lowest quartile of cumSBP, cumDBP and cumPP, the HRs (95%CI) of gastrointestinal cancer in highest quartiles were 1.96 (1.44-2.67), 1.29 (0.98-1.71), and 2.18 (1.62-2.92), respectively. Furthermore, compared to those with hypertension unexposed, participants with a 6 years exposure duration of hypertension had 1.37-fold higher risk of gastrointestinal cancer. Conclusions: The higher exposure of cumSBP, cumPP and duration of hypertension are associated with an increased risk of gastrointestinal cancer. Striving to control long-term SBP, PP and hypertension across the life course, and avoiding to develop hypertension by keeping good pathways such as health lifestyles could be of enormous benefit for gastrointestinal cancer risk reduction.

P139 THE GUT MICROBIOME AS A PREDICTOR OF INCIDENT HYPERTENSION: DATA FROM A POPULATION SAMPLE OF 3055 INDIVIDUALS WITH A FOLLOW-UP OF 20 YEARS

Background and Objective: Our goal was to examine the previously unknown long-term association between gut microbiome composition and incident hypertension in a representative population cohort. Methods: We collected fecal samples from a population sample of 3,055 non-hypertensive Finns (mean age 43.1 years; 60.8% women) in 2002. These individuals were followed up for incident hypertension until 31 December 2021 using nationwide register data. The samples were sequenced using shotgun metagenomics. We examined associations between gut microbiome composition and incident hypertension using Cox regression (alpha diversity and microbial taxa), permutational multivariate ANOVA (beta diversity) and Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC; microbial taxa) models adjusted for conventional hypertension risk factors. Results: Altogether, 587 cases of incident diabetes occurred over the median follow-up of 19.8 years. Gut microbiome alpha diversity (Shannon index; p=0.98) and beta diversity (R2=0.49%; p=0.99) were not associated with incident hypertension. Furthermore, the associations between microbial taxa and incident hypertension were non-significant. In Cox regression models (Figure), two species reached an FDR-corrected P-value &lt;0.1: Eubacterium G Ventriosum (hazard ratio per 1-SD increase 0.89; 95% CI 0.83-0.96; P=0.07) and Hespellia Stercorisuis (hazard ratio 1.16; 95% CI 1.05-1.27; P=0.098). In ANCOM-BC models, three species reached an FDR corrected P-value of &lt;0.1: Merdousia sp000438015 (log2 fold change 0.32±0.09; P=0.06), Mitsuokella multacida (log2 fold change -0.32±0.09; P=0.06), and Scybalousia sp900543675 (log2 fold change -0.28±0.09; P=0.07). Conclusions: In this first-ever analysis on the association between the gut microbiome and long-term hypertension incidence, we observed that the associations between overall gut taxonomic composition and incident hypertension are weak. In addition, only a few microbial taxa reached a borderline level of significance with inconsistent results between two statistical methods. These findings suggest that the gut microbiome is not a strong predictor of future hypertension.

Long-term exposure to low-level ozone and the risk of hypertension: A prospective cohort study conducted in a low-pollution region of southwestern China

BackgroundThe current evidence regarding the association between long-term exposure to ozone (O3) and hypertension incidence is limited and inconclusive, particularly at low O3 concentrations. Therefore, our research aims to investigate the potential link between long-term O3 exposure and hypertension in a region with low pollution levels. MethodsFrom 2010 to 2012, we conducted a cohort prospective study by recruiting nearly 10,000 attendees through multistage cluster random sampling in Guizhou Province, China. These individuals were followed up from 2016 to 2020, and 5563 cases were finally included in the analysis. We employed a high-resolution model with both temporal and spatial accuracy to estimate the maximum daily 8-h average O3 and utilized annual average O3 concentrations for three exposure periods (2009_10, 2007_10, 2005_10) as the exposure indicator. Time-dependent covariates Cox regression model was exerted to estimate the hazard ratios (HRs) of hypertension incidence. Generalized linear model was employed to assess the association between O3 and systolic, diastolic, pulse, and mean arterial pressure. The dose-response curve was explored using a restricted cubic spline function. Results1213 hypertension incidents occurred during 39,001.80 person-years, with an incidence density of 31.10/1000 Person Years (PYs). The average O3 concentrations during the three exposure periods were 66.76 μg/m3, 67.85 μg/m3, and 67.21 μg/m3, respectively. Per 1 μg/m3 increase in O3 exposure was associated with 11 % increase in the incidence of hypertension in the single-pollution model, and the association was more pronounced in Han, urban, and higher altitude areas. SBP, PP, and MAP were increased by 0.619 (95 % CI, 0.361–0.877) mm Hg, 0.477 (95 % CI, 0.275–0.679) mm Hg, 0.301 (95 % CI, 0.127–0.475) mm Hg, respectively. Furthermore, we observed a nonlinear exposure-response relationship between O3 and hypertension incidence. ConclusionsLong-term exposure to low-level O3 exposure is associated with an increased risk of hypertension.

Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study.

Posterior urethral valves represent the most common cause of lower urinary tract obstruction in male infants (∼1/4000 live births). Long-term kidney outcomes of posterior urethral valves remain uncertain. We aimed to determine the time-varying risk of major adverse kidney events (MAKE) following children with posterior urethral valves into adulthood. A population-based retrospective cohort study of all males (<2 years) diagnosed with posterior urethral valves between 1991-2021 in Ontario, Canada. Comparator cohorts were: 1) male general population and 2) male pyeloplasty patients (both <2 years). The primary outcome was MAKE (death, long-term kidney replacement therapy [dialysis or kidney transplant], or chronic kidney disease). Time-to-MAKE was analyzed using multivariable-adjusted Cox proportional hazards models. We censored for provincial emigration, or administrative censoring (March 31, 2022). We included 727 children with posterior urethral valves, 855 pyeloplasty comparators, and 1,013,052 general population comparators. Median follow-up time was 16.6 years (Q1-3 8.6-24.5) overall. Throughout follow-up, 32% of children with posterior urethral valves developed MAKE vs. 1% of the general population and 6% of pyeloplasty comparators. Their adjusted hazard ratio for MAKE was 36.6 (95%CI 31.6-42.4) vs. the general population. The risk of developing MAKE declined over the first 5 years after posterior urethral valves diagnosis but remained elevated for >30-year follow-up. Children with posterior urethral valves were also at higher risk of death, chronic kidney disease, long-term kidney replacement therapy, hypertension, and acute kidney injury than general population or pyeloplasty comparators. Children with posterior urethral valves are at higher risk of adverse long-term kidney outcomes well into adulthood.

Bevacizumab for Retinopathy of Prematurity Is Not Associated With Systemic Hypertension.

To evaluate for an association between systemic hypertension and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) treatment, due to a 2020 case report of a neonate with ROP developing systemic hypertension and posterior reversible encephalopathy syndrome (PRES) after IVB and limited data on long-term safety of IVB. A retrospective cohort study was conducted using vital signs for 90 days, comparing IVB to laser treatment. The primary outcome was short-term hypertension, recorded for at least 3 consecutive days following treatment. As a secondary outcome, infants treated with IVB were also compared to infants with severe ROP who experienced spontaneous regression without treatment. Rates of long-term hypertension, based on chart diagnoses at discharge, were also reviewed. Neuroimaging was re-reviewed to evaluate for vasogenic edema consistent with PRES. Overall, 137 infants with severe ROP were included, of whom 94 required treatment. There were no baseline differences in neonatal comorbidities comparing laser to IVB. There was no difference on unadjusted or adjusted logistic regression comparing odds of short-term hypertension after IVB to laser (adjusted odds ratio: 0.69, 095% CI: 0.25, 1.87). There was no significant difference in the rate of long-term hypertension diagnoses by treatment group. The lack of association between IVB and short-term systemic hypertension is reassuring. Further studies are warranted to confirm this. [J Pediatr Ophthalmol Strabismus. 2024;61(6):434-441.].

Long-Term Kidney Outcomes after Pediatric Acute Kidney Injury.

Acute kidney injury (AKI) is common in hospitalized children. Pediatric AKI receiving acute kidney replacement therapy (KRT) is associated with long-term chronic kidney disease (CKD), hypertension, and death. We aim to determine the outcomes after AKI in children who did not receive acute KRT, since these remain uncertain. Retrospective cohort study of all hospitalized children (0-18 years) surviving AKI without acute KRT between 1996-2020 in Ontario, Canada, identified by validated diagnostic codes in provincial administrative health databases. Children with prior KRT, CKD, or AKI were excluded. Cases were matched with up to four hospitalized comparators without AKI by age, neonatal status, sex, intensive care unit admission, cardiac surgery, malignancy, hypertension, hospitalization era, and a propensity score for AKI. Patients were followed until death, provincial emigration, or censoring in March 2021. The primary outcome was long-term major adverse kidney events (MAKE-LT; a composite of all-cause mortality, long-term KRT, or incident CKD). We matched 4,173 pediatric AKI survivors with 16,337 hospitalized comparators. Baseline covariates were well-balanced following propensity score matching. During median 9.7-year follow-up, 18% of AKI survivors developed MAKE-LT vs. 5% of hospitalized comparators (hazard ratio [HR] 4.0, 95% confidence interval [CI] 3.6-4.4). AKI survivors had higher rates of long-term KRT (2% vs. <1%; HR 11.7, 95%CI 7.5-18.4), incident CKD (16% vs. 2%; HR 7.9, 95%CI 6.9-9.1), incident hypertension (17% vs. 8%; HR 2.3, 95%CI 2.1-2.6), and AKI during subsequent hospitalization (6% vs. 2%; HR 3.7, 95%CI 3.1-4.5), but no difference in all-cause mortality (3% vs. 3%; HR 0.9, 95%CI 0.7-1.1). Children surviving AKI without acute KRT were at higher long-term risk of CKD, long-term KRT, hypertension, and subsequent AKI vs. hospitalized comparators.

Coffee consumption and cardiometabolic health: a comprehensive review of the evidence.

This review provides a comprehensive synthesis of longitudinal observational and interventional studies on the cardiometabolic effects of coffee consumption. It explores biological mechanisms, and clinical and policy implications, and highlights gaps in the evidence while suggesting future research directions. It also reviews evidence on the causal relationships between coffee consumption and cardiometabolic outcomes from Mendelian randomization (MR) studies. Findings indicate that while coffee may cause short-term increases in blood pressure, it does not contribute to long-term hypertension risk. There is limited evidence indicating that coffee intake might reduce the risk of metabolic syndrome and non-alcoholic fatty liver disease. Furthermore, coffee consumption is consistently linked with reduced risks of type 2 diabetes (T2D) and chronic kidney disease (CKD), showing dose-response relationships. The relationship between coffee and cardiovascular disease is complex, showing potential stroke prevention benefits but ambiguous effects on coronary heart disease. Moderate coffee consumption, typically ranging from 1 to 5 cups per day, is linked to a reduced risk of heart failure, while its impact on atrial fibrillation remains inconclusive. Furthermore, coffee consumption is associated with a lower risk of all-cause mortality, following a U-shaped pattern, with the largest risk reduction observed at moderate consumption levels. Except for T2D and CKD, MR studies do not robustly support a causal link between coffee consumption and adverse cardiometabolic outcomes. The potential beneficial effects of coffee on cardiometabolic health are consistent across age, sex, geographical regions, and coffee subtypes and are multi-dimensional, involving antioxidative, anti-inflammatory, lipid-modulating, insulin-sensitizing, and thermogenic effects. Based on its beneficial effects on cardiometabolic health and fundamental biological processes involved in aging, moderate coffee consumption has the potential to contribute to extending the healthspan and increasing longevity. The findings underscore the need for future research to understand the underlying mechanisms and refine health recommendations regarding coffee consumption.

Renal denervation in secondary arterial hypertension therapy: clinical case

Introduction. Renovascular hypertension is one of the most severe types of hypertension in terms of the choice of treatment strategy. Recent studies have not provided a clear answer to the question of which treatment approach (conservative or surgical) is most appropriate for these patients.Brief description. The presented case describes a female patient with a longterm uncontrolled hypertension, whose examination revealed bilateral renal artery stenosis. Considering the debatable clinical effectiveness of revascularization of renal artery stenosis, the patient underwent distal renal artery denervation using multielectrode catheters. A decrease in blood pressure was shown. Follow-up of the patient demonstrated stable antihypertensive effect of the procedure, as well as its safety in case of impaired renal function.Discussion. This clinical demonstrates the third way in the treatment of patients with renal arteries stenosis and resistant hypertension — renal sympathetic denervation. This method requires a separate controlled study with individuals with renal dysfunction, including renovascular origin.

Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies.

Intracerebral hemorrhage (ICH) is attributable to cerebral small vessel disease (cSVD), which includes cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD). HTN-cSVD includes patients with strictly deep ICH/microbleeds and mixed location ICH/microbleeds, the latter representing a more severe form of HTN-cSVD. We test the hypothesis that more severe forms of HTN-cSVD are related to worse hypertension control in long-term follow-up after ICH. From consecutive non-traumatic ICH patients admitted to a tertiary care center, we classified the ICH as CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds. CSVD burden was quantified using a validated MRI-based score (range: 0-6 points). We created a multivariable (linear mixed effects) model adjusting for age, sex, race, year of inclusion, hypertension, and antihypertensive medication usage to investigate the association of average systolic blood pressure (SBP) during follow-up with cSVD etiology/severity. 796 ICH survivors were followed for a median of 48.8months (IQR 41.5-60.4). CAA-related ICH survivors (n = 373) displayed a lower median SBP (138mmHg, IQR 133-142mmHg) compared to those of strictly deep ICH (n = 222, 141mmHg, IQR 136-143mmHg, p = 0.04), and mixed location ICH/microbleeds (n = 201, 142mmHg, IQR 135-144mmHg, p = 0.02). In the multivariable analysis, mixed location ICH/microbleeds (effect: + 3.8mmHg, SE: 1.3mmHg, p = 0.01) and increasing cSVD severity (+ 1.8mmHg per score point, SE: 0.8mmHg, p = 0.03) were associated with higher SBP in follow-up. CSVD severity and subtype predicts long-term hypertension control in ICH patients.

NON-INVASIVE CENTRAL BLOOD PRESSURE AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS

Objective: Hypertension (HT) remains as the leading cause of death around the globe and brain diseases, such as cognitive decline. The association between HT and cerebrovascular diseases is strong, mainly with stroke and cognitive impairment, but the mechanistic bases remain to be established. The objective of this study is to observe central blood pressure, arterial stiffness and intracranial pressure in long-term chronic hypertensive patients. Design and method: Patients above 18 years were assessed from November 2022 to August 2023 with non-invasive central blood pressure and intracranial pressure waveform measurements in a cross-sectional analysis. Peripheral and central blood pressure parameters were obtained using a validated oscillometric device (Mobil-O-Graph). Non-invasive intracranial pressure measurement was performed with the validated Brain4Care (B4C) sensor. Using the B4C non-invasive evaluation, the cut-off point identified to define ICHT by the P2/P1 ratio was &gt; 1.2, and the cut-off for time to peak (TTP) was &gt; 0.25 seconds. To compare P2/P1 and TTP values between the categories of quantitative variables, the chi-square test was used; the Mann Whitney or ANOVA tests were used for bivariate analyses; and for correlations, the Spearman test was used. It was adopted as significant at p &lt; 0,05. Results: Non-invasive central blood pressure, arterial stiffness, and intracranial pressure waveform assessment were performed in 145 patients with essential long-term hypertension over a period of ten months. The median age was 69.0 (61.8 – 75.7) years, 77.9% were female, and the median BMI was 29.0 (25.4 – 33.1) kg/m2. The average time since the hypertension diagnosis was 20.0 years. The median value of P2/P1 ratio for all cohort was 1.4 (1.2 – 1.5) and TTP 0.24 (0.21 – 0.29) seconds. A bivariate analysis was performed considering ICHT or not and the parameters of central BP and PWV assessments, with findings of higher central SBP, central DBP, and peripheral DBP among patients with ICHT by the parameter of P2/P1. Conclusions: Central systolic blood pressure levels are more linked to intracranial hypertension, while diastolic blood pressure values are similar, raising questions about the most suitable blood pressure assessment method for brain disorders.

Uncontrolled hypertension and hypertensive urgency: One-year single-center emergency department experience.

The prevalence of uncontrolled hypertension remains a significant concern in public healthcare systems, including daily practices of emergency departments (ED). We aimed to characterize patients admitted to an ED for elevated blood pressure (BP) and to identify factors leading to hospitalization. This retrospective analysis included all patients admitted to an ED in a tertiary hospital in 2022 due to an acute BP rise without hypertensive emergencies. The studied group (n = 570) constituted 1.5% of all ED admissions in 2022. The median age was 67 years (Q1-Q3) (52-75), 68.9% were females. Systolic BP (200 mm Hg [180-212]) and diastolic BP (105 mm Hg [100-115]) at home were higher than during triage (173 mm Hg [160-190] and 95 mm Hg [84-103], respectively [P <0.0001]). Thirty-nine percent of the studied population had taken BP-lowering agents before ED admission (captopril in 91.8% of cases). In the ED, nitrendipine (54.2%), captopril (38.1%), furosemide (16.3%), urapidil (10.0%), and nitroglycerine (1.9%) were administered. Eventually, a median of 140/82 mm Hg BP was reached in the median time of 288 minutes (202-400). Hospitalization was necessary in 5.4% of patients. The need for furosemide or urapidil administration in the ED doubled the risk of hospitalization (OR, 2.0; P <0.01). Before ED admission, only 17.0% of patients received guidelines-recommended single-pill combination therapy, and 17.6% had already visited ED for uncontrolled hypertension (median of 388 days earlier). Elevated BP is a common reason for admission to the ED. Crucially, improvements in long-term hypertension treatment and education are needed to reduce the number of patients seeking ED care for elevated BP.

Macrophage Polarization in Left Ventricular Structural Remodeling Induced by Hypertension.

Following long-term hypertension, mechanical stretching and neuroendocrine stimulation, cause multiple heterogeneous cells of the heart to interact, and result in myocardial remodeling with myocardial hypertrophy and fibrosis. The immune system, specifically macrophages, plays a vital role in this process. Macrophages are heterogeneous and plastic. Regulated by factors such as microenvironment and cytokines, polarization can be divided into two main forms: M1/M2, with different polarizations playing different roles in left ventricular structural remodeling associated with hypertension. However, descriptions of macrophage phenotypes in hypertension-induced myocardial hypertrophy models are not completely consistent. This article summarizes the phenotypes of macrophages in several models, aiming to assist researchers in studying macrophage phenotypes in hypertension-induced left ventricular structural remodeling models.

Transcriptome and proteome analyses reveal that upregulation of GSTM2 by allisartan improves cardiac remodeling and dysfunction in hypertensive rats.

Long-term hypertension can lead to hypertensive heart disease, which ultimately progresses to heart failure. As an angiotensin receptor blocker antihypertensive drug, allisartan can control blood pressure, and improve cardiac remodeling and cardiac dysfunction caused by hypertension. The aim of the present study was to investigate the protective effects of allisartan on the heart of spontaneously hypertensive rats (SHRs) and the underlying mechanisms. SHRs were used as an animal model of hypertensive heart disease and were treated with allisartan orally at a dose of 25 mg/kg/day. The blood pressure levels of the rats were continuously monitored, their body and heart weights were measured, and their cardiac structure and function were evaluated using echocardiography. Wheat germ agglutinin staining and Masson trichrome staining were employed to assess the morphology of the myocardial tissue. In addition, transcriptome and proteome analyses were performed using the Solexa/Illumina sequencing platform and tandem mass tag technology, respectively. Immunofluorescence co-localization was conducted to analyze Nrf2 nuclear translocation, and TUNEL was performed to detect the levels of cell apoptosis. The protein expression levels of pro-collagen I, collagen III, phosphorylated (p)-AKT, AKT, p-PI3K and PI3K, and the mRNA expression levels of Col1a1 and Col3a1 were determined by western blotting and reverse transcription-quantitative PCR, respectively. Allisartan lowered blood pressure, attenuated cardiac remodeling and improved cardiac function in SHRs. In addition, allisartan alleviated cardiomyocyte hypertrophy and cardiac fibrosis. Allisartan also significantly affected the 'pentose phosphate pathway', 'fatty acid elongation', 'valine, leucine and isoleucine degradation', 'glutathione metabolism', and 'amino sugar and nucleotide sugar metabolism' pathways in the hearts of SHRs, and upregulated the expression levels of GSTM2. Furthermore, allisartan activated the PI3K-AKT-Nrf2 signaling pathway and inhibited cardiomyocyte apoptosis. In conclusion, the present study demonstrated that allisartan can effectively control blood pressure in SHRs, and improves cardiac remodeling and cardiac dysfunction. Allisartan may also upregulate the expression levels of GSTM2 in the hearts of SHRs and significantly affect glutathione metabolism, as determined by transcriptome and proteome analyses. The cardioprotective effect of allisartan may be mediated through activation of the PI3K-AKT-Nrf2 signaling pathway, upregulation of GSTM2 expression and reduction of cardiomyocyte apoptosis in SHRs.

Long-term PM1 exposure and hypertension hospitalization: A causal inference study on a large community-based cohort in South China

Limited evidence exists on the effect of submicronic particulate matter (PM1) on hypertension hospitalization. Evidence based on causal inference and large cohorts is even more scarce. In 2015, 36,271 participants were enrolled in South China and followed up through 2020. Each participant was assigned single-year, lag0–1, and lag0–2 moving average concentration of PM1 and fine inhalable particulate matter (PM2.5) simulated based on satellite data at a 1-km resolution. We used an inverse probability weighting approach to balance confounders and utilized a marginal structural Cox model to evaluate the underlying causal links between PM1 exposure and hypertension hospitalization, with PM2.5-hypertension association for comparison. Several sensitivity studies and the analyses of effect modification were also conducted. We found that a higher hospitalization risk from both overall (HR: 1.13, 95% CI: 1.05–1.22) and essential hypertension (HR: 1.15, 95% CI: 1.06–1.25) was linked to each 1 µg/m3 increase in the yearly average PM1 concentration. At lag0–1 and lag0–2, we observed a 17%–21% higher risk of hypertension associated with PM1. The effect of PM1 was 6%–11% higher compared with PM2.5. Linear concentration-exposure associations between PM1 exposure and hypertension were identified, without safety thresholds. Women and participants that engaged in physical exercise exhibited higher susceptibility, with 4%–22% greater risk than their counterparts. This large cohort study identified a detrimental relationship between chronic PM1 exposure and hypertension hospitalization, which was more pronounced compared with PM2.5 and among certain groups.

Association of Alpha-Crystallin with Human Cortical and Nuclear Lens Lipid Membrane Increases with the Grade of Cortical and Nuclear Cataract.

Eye lens α-crystallin has been shown to become increasingly membrane-bound with age and cataract formation; however, to our knowledge, no studies have investigated the membrane interactions of α-crystallin throughout the development of cataracts in separated cortical membrane (CM) and nuclear membrane (NM) from single human lenses. In this study, four pairs of human lenses from age-matched male and female donors and one pair of male lenses ranging in age from 64 to 73 years old (yo) were obtained to investigate the interactions of α-crystallin with the NM and CM throughout the progression of cortical cataract (CC) and nuclear cataract (NC) using the electron paramagnetic resonance spin-labeling method. Donor health history information (diabetes, smoker, hypertension, radiation treatment), sex, and race were included in the data analysis. The right eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 1, NC: 2), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Similarly, left eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 2, NC: 3), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Analysis of α-crystallin binding to male and female eye lens CM and NM revealed that the percentage of membrane surface occupied (MSO) by α-crystallin increases with increasing grade of CC and NC. The binding of α-crystallin resulted in decreased mobility, increased order, and increased hydrophobicity on the membrane surface in male and female eye lens CM and NM. CM mobility decreased with an increase in cataracts for both males and females, whereas the male lens NM mobility showed no significant change, while female lens NM showed increased mobility with an increase in cataract grade. Our data shows that a 68 yo female donor (long-term smoker, pre-diabetic, and hypertension; grade 3 CC) showed the largest MSO by α-crystallin in CM from both the left and right lens and had the most pronounced mobility changes relative to all other analyzed samples. The variation in cholesterol (Chol) content, size and amount of cholesterol bilayer domains (CBDs), and lipid composition in the CM and NM with age and cataract might result in a variation of membrane surface mobility, membrane surface hydrophobicity, and the interactions of α-crystallin at the surface of each CM and NM. These findings provide insight into the effect of decreased Chol content and the reduced size and amount of CBDs in the cataractous CM and NM with an increased binding of α-crystallin with increased CC and NC grade, which suggests that Chol and CBDs might be a key component in maintaining lens transparency.

Catheter-directed therapies for high and intermediate-high risk patients with acute pulmonary embolism: Results from a multiparametric follow-up protocol

Introduction: Intermediate-high- and high-risk pulmonary embolism (PE) patients treated with anticoagulation alone are associated with a considerable risk of circulatory collapse, death, or long-term pulmonary hypertension. Pulmonary Embolism Response Teams (PERT) have been created to deliver PE patients a better care. Catheter-Directed Therapies (CDT), with mechanical thrombolysis and/or local fibrinolysis allow faster reperfusion and hemodynamic improvement without the systemic bleeding risk of systemic fibrinolysis. However, clinical evidence of its safety and benefits are lacking. Objectives: This analysis aims to describe the hemodynamics, morphological and perfusion improvement over time in intermediate-high- and high-risk acute PE patients submitted to CDT. Methods: Prospective registry of consecutive intermediate-high- and high-risk PE patients submitted to CDT (mechanical thrombolysis with Penumbra aspiration system and/or intrapulmonary local fibrinolysis with alteplase) in a single tertiary center. A multiparametric follow-up protocol was designed to evaluate echocardiographic, CT-scan, pulmonary angiogram, and right heart catheterization data at admission and at 3 months after CDT.