Clinical Hypertension最新文献

Background: Childhood hypertension is strongly associated with the development of cardiovascular diseases in adulthood. Understanding the epidemiological patterns of disease burden is crucial for developing effective prevention strategies.

Methods: This cross-sectional study utilized data from the Global Burden of Disease Study (GBD) 2021, including 204 countries and territories. The analysis estimated deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to high systolic blood pressure (sBP) among individuals under the age of 20 within the GBD comparative risk assessment (CRA) framework, covering the period from 1990 to 2021. Trends and regional disparities in disease burden were examined, emphasizing correlations between DALY rates and socio-demographic indices (SDI).

Results: In 2021, the global DALY rate was 2.39 (95% uncertainty interval [UI], 1.75 to 2.88) per 100,000 population, representing a 20.11% decrease (95% UI, -35.02 to 10.21) compared to 1990. The YLL rate showed a decrease of 21.06% (95% UI, -36.21 to 9.95), contributing to the decline in the DALY rate, whereas the YLD rate showed an increase of 22.33% (95% UI, 4.16 to 40.74). The DALY rates were negatively correlated with Socio-demographic Index. Among the 21 GBD regions in 2021, Middle East and North Africa (MENA) showed the highest disease burden across all metrics. Western Sub-Saharan Africa (SSA) demonstrated a pronounced gender disparity. High-income North America experienced the largest increase in disease burden.

Conclusions: Global DALYs and deaths attributable to high sBP among children and adolescents suggested a declining trend from 1990 to 2021, although the 95% UIs were compatible with no clear change. DALYs showed a negative correlation with SDI, with highest burden in MENA and notable gender disparities in Western SSA. High-income North America showed the largest increase since 1990.

Background: Patients with repaired coarctation of the aorta (CoAo) remain at risk for left ventricular hypertrophy (LVH) even in the absence of hypertension. Alterations in wave reflection and the timing of reflected pressure waves may contribute to ventricular remodeling beyond pressure load alone.

Methods: We performed a cross-sectional analysis of patients with repaired CoAo. Office and ambulatory blood pressure (ABPM), non-invasive central hemodynamics, and echocardiographic indices of left ventricular structure were assessed. Linear and multivariable regression models evaluated associations with posterior wall thickness in diastole (PWTd) and interventricular septal thickness in diastole. Computational simulations were conducted to examine the impact of heart rate on ventricular remodeling.

Results: Fifty-seven patients (median post-repair follow-up 11 years) were included. LVH prevalence was 15.2% (95% confidence interval [CI], 4.8, 25.6). Although 42% met criteria for hypertension based on ABPM, no patients exhibited elevated central blood pressure and LVH. Heart rate-adjusted augmentation index (AIX@75) was inversely associated with PWTd and remained independently associated after multivariable adjustment (R² = 0.40, P < 0.01). Replacing AIX@75 by heart rate improved model performance (R² = 0.44), with lower heart rate independently associated with greater PWTd. Simulation modeling showed that a 10% increase in heart rate reduced mean PWTd and decreased posterior wall hypertrophy prevalence from 30.9% to 2.4% (odds ratio, 0.10; 95% CI, 0.01, 0.44).

Conclusions: Ventricular remodeling occurs despite normal central blood pressure in CoAo. A lower heart rate associates with increased ventricular mass. Heart rate-mediated modulation of wave reflection timing represents a potential mechanistic and therapeutic target.

The recently released 2026 Korean Society of Hypertension (KSH) guidelines incorporate contemporary advances in the diagnosis and management of hypertension. This highlight summarizes the most important updates, focusing on the underlying evidence and key changes, particularly the newly introduced and revised recommendations. The major additions include the incorporation of isolated diastolic hypertension into blood pressure (BP) classification, the first integration of cuffless BP devices into clinical practice, and the incorporation of a new therapy with a BP-lowering effect (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors). A dose-based classification of single-pill combination therapies has been introduced to enhance treatment adherence. In addition, obesity, hypertension in young adults, hypertensive emergencies, and patient-centered care have been incorporated and emphasized. Major updates include expanded screening for primary aldosteronism, adoption of more intensive BP targets, and risk-based initiation of pharmacological therapy in individuals with prehypertension. Lifestyle recommendations have been broadened to include e-smoking cessation and mind-body practices. Furthermore, the definition and management of uncontrolled (or resistant) hypertension have been updated, and BP targets in older adults are now individualized according to frailty status and overall cardiovascular risk; intensive BP lowering to 130/80 mmHg is recommended in selected high-risk older individuals. Finally, BP management during pregnancy has also been refined to emphasize active BP control at < 140/90 mmHg and the use of out-of-office BP measurements for more accurate diagnosis. Overall, the new KSH guidelines provide a more evidence-based framework for hypertension management, with the goal of improving BP control and reducing cardiovascular morbidity and mortality.

Background: The role of social isolation in the connections between the hypertension care cascade, cognitive function, and cardiovascular disease (CVD) remains unclear. This study aims to investigate the relationships between the hypertension care cascade, cognitive performance, and CVD among middle-aged and older adults with varying levels of social isolation.

Methods: Eight thousand two hundred eighty-seven participants aged 45 years and older from the China Health and Retirement Longitudinal Study were included in the analysis. Participants were categorized based on their social isolation status, either as socially isolated or not. Both multivariable linear regression and logistic regression models were employed. All analyses were weighted to account for the multistage, probability-proportional-to-size sampling design of the study. Hypertension was defined according to European, Chinese, and American guidelines.

Results: The weighted rates of hypertension awareness, treatment, and control were 55.0%, 44.5%, and 25.4%, respectively, with a more favorable performance in the hypertension care cascade observed among individuals without social isolation. When applying American guidelines to define hypertension, the rates of awareness, treatment, and control significantly declined, irrespective of social isolation status. Compared to non-hypertensive individuals, participants with treated and controlled blood pressure (BP) exhibited similar cognitive function and odds of CVD. In contrast, individuals with treated but uncontrolled BP and those who were unaware of hypertension demonstrated poorer cognitive performance and a heightened risk of CVD. Social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD risk. Isolated individuals who are unaware of hypertension faced a more higher risk of worsen prognosis than that of the non-isolated individuals (P for interaction < 0.05).

Conclusions: Individuals experiencing social isolation exhibited poor performance in the hypertension care cascade. Furthermore, social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD. Our study emphasizes that addressing social isolation could be a significant factor for improving the hypertension care cascade and health outcomes among middle-aged and older adults in China.

Background: Although catheter-based renal denervation (RDN) has emerged as a potential treatment for resistant hypertension, it has limitations, including incomplete denervation and anatomical constraints. To address these challenges, we introduce the HyperQure™ RDN System, a novel extravascular RDN procedure targeting the renal artery adventitia, where renal sympathetic nerves are primarily distributed, for a more complete denervation.

Methods: This pilot, single-arm, multicenter, first-in-human trial will evaluate the efficacy and safety of an extravascular RDN system in patients with hypertension. Ten patients aged 19-79 years with uncontrolled hypertension despite using three or more antihypertensive medications will undergo extravascular RDN. The procedure involves a retroperitoneal laparoscopic approach to achieve circumferential ablation of the sympathetic nerves surrounding the renal artery. A repeat procedure can be performed at different locations on the artery or by targeting branch vessels and accessory arteries. The primary efficacy outcome is the change in 24-hour ambulatory systolic blood pressure at 3 months post-procedure. Safety endpoints include the incidence of overall, major, acute/procedural, and chronic adverse events.

Conclusions: Extravascular RDN has the potential to overcome the limitations of catheter-based techniques by enabling more complete sympathetic denervation that targets a broader range of renal sympathetic nerve fibers. This trial will generate critical first-in-human data to guide future clinical applications of extravascular RDN.

Trial registration: Clinical Research Information Service Identifier: KCT0009209.

Background: Whether higher volumes of physical activity (PA) and a greater proportion of vigorous-intensity physical activity (VPA) within total PA volume are associated with lower risks of major adverse cardiovascular events (MACE) and mortality remains unclear. This study aimed to examine the associations of total PA volume and the proportion of VPA within total PA volume with all-cause mortality and MACE among adults with hypertension.

Methods: This nationwide cohort study included 124,370 adults with hypertension from the Korean National Health Insurance Service database (2009-2012), with follow-up through 2019. MACE was defined as a composite of cardiovascular disease (CVD) mortality, myocardial infarction (MI), and ischemic stroke. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality and MACE.

Results: During a median follow-up of 9.1 years, 11,063 deaths occurred. Higher PA volumes were associated with stepwise reductions in all-cause and CVD mortality. In contrast, risk reductions for ischemic stroke plateaued at higher volumes, whereas reductions in MI risk were evident primarily at the highest volumes. Among 91,113 participants who engaged in any PA, a higher proportion of VPA was associated with lower risks of all-cause mortality (HR, 0.92; 95% confidence interval [CI], 0.87-0.98 for < 50% VPA and HR, 0.85; 95% CI, 0.78-0.93 for ≥ 50% VPA), MI (HR, 0.77; 95% CI, 0.67-0.89 and HR, 0.71; 95% CI, 0.58-0.86, respectively), and ischemic stroke (HR, 0.84; 95% CI, 0.76-0.92 for ≥ 50% VPA) after adjusting for total PA volume. No significant associations were observed between the proportion of VPA and CVD mortality.

Conclusions: Among adults with hypertension, a higher PA volume was associated with lower risks of all-cause and CVD mortality. Additionally, a greater proportion of VPA, after accounting for total PA volume, was associated with lower risks of MI and ischemic stroke. These findings suggest that both PA volume and intensity composition may be relevant for cardiovascular risk reduction in individuals with hypertension.

Background: Postprandial hypotension (PPH), which is associated with adverse cardiovascular outcomes, is a prevalent but often overlooked in individuals with type 2 diabetes mellitus (T2DM). In addition, its relationship with comprehensive 24-hour hemodynamic profiles remains poorly defined. We aimed to assess the prevalence and characteristics of PPH in patients with T2DM and to determine its association with systolic blood pressure (SBP) variability and circadian blood pressure (BP) patterns.

Methods: We prospectively enrolled T2DM patients with stable glycemic control. PPH was defined as a post-meal SBP fall of ≥ 20 mmHg or a drop to < 90 mmHg within 2 hours after a meal. Hemodynamic patterns, including SBP variability (standard deviation) and circadian rhythms, were analyzed via 24-hour ambulatory BP monitoring.

Results: We analyzed 67 T2DM patients (59.2 ± 11.9 years, 33 females). PPH was observed in 28 patients (41.8%). PPH occurred most frequently after dinner (64.3%), and less frequently after breakfast (25.9%). While average 24-hour BP levels were similar between groups, the PPH group exhibited significantly higher 24-hour SBP variability (21.4 ± 5.7 vs. 16.2 ± 4.3, P < 0.001) and a higher prevalence of morning surge (53.6% vs. 25.6%, P = 0.024). Multivariate logistic regression revealed that 24-hour SBP variability was the sole independent predictor of PPH (odds ratio, 1.211; 95% confidence interval, 1.043-1.406; P = 0.012).

Conclusions: In our cohort, PPH was found in 41.8% of patients with T2DM and was independently associated with increased SBP variability. These results suggest that BP variability could be a valuable marker for identifying individuals at higher risk for postprandial hemodynamic instability.

Background: Fundoscopy is of pivotal importance in patients with suspected hypertensive emergency in order to detect hypertensive retinopathy and determine the need for prompt intravenous antihypertensive treatment. However, direct fundoscopy by an ophthalmologist is time-consuming and delays treatment. In this pilot study in the emergency department (ED), we evaluated whether smartphone ophthalmoscopy is a feasible and faster alternative.

Methods: We evaluated duration of ED-treatment in patients who underwent smartphone ophthalmoscopy for suspected hypertensive emergency. Smartphone ophthalmoscopy included 30-second retinal video recordings captured by the attending physicians, which were remotely evaluated by an ophthalmologist. Patients in the smartphone-group were matched in a 1:2-ratio to a historical cohort who underwent direct fundoscopy by an ophthalmologist. We evaluated total ED-length-of-stay (total ED-LOS; defined as the interval between ED-admission and ED-discharge) and 'treatment time' (defined as total ED-LOS minus time in waiting room).

Results: In the present analysis, we included 54 patients in the smartphone-group and matched them with 108 historical controls. On average, total ED-LOS was 29 minutes shorter in the smartphone-group as compared to controls (217 ± 73 minutes vs. 246 ± 73 minutes; P = 0.016). Treatment time was 40 minutes shorter in the smartphone-group (193 ± 68 minutes vs. 233 ± 71 minutes; P = 0.002). Stratified analyses suggested that the reduction in treatment time was most pronounced outside office hours. Smartphone ophthalmoscopy was feasible in 87% of the patients, the other 13% (n = 10) required additional direct fundoscopy by an ophthalmologist.

Conclusions: Smartphone ophthalmoscopy in suspected hypertensive emergency was feasible and faster as compared to direct fundoscopy by an ophthalmologist, which may allow earlier treatment and reduce ED-crowding.

Background: Air pollution, particularly nitrogen dioxide (NO₂), adversely affects cardiovascular health by inducing systemic inflammation. Evidence remains limited regarding short-term exposure to traffic-related air pollution, including NO₂, and whether statin use modifies susceptibility to pollution-related acute cardiovascular events. This study evaluated whether the short-term effects of NO₂ exposure and ischemic heart disease (IHD) hospitalization differ by statin-use status, focusing on patients with hypertension.

Methods: A time-stratified case-crossover analysis was conducted using data from National Health Insurance Service for patients hospitalized with IHD in Seoul from 2018 to 2020. The included patients had a prior diagnosis of hypertension and had used antihypertensive medication within the previous 3 years. This group was further stratified as prescription-based statin users and non-users based on whether they had received a statin prescription within 1 year before their IHD admission. The daily average NO₂ concentrations in Seoul were retrieved from Air Korea for the admission day and the preceding 7 days. Weighted conditional logistic regression models were applied separately for each subgroup after adjusting for meteorological conditions and national holidays. The risk of IHD hospitalization was presented as odds ratios (ORs) per 0.01 ppm increase in NO₂, with 95% confidence intervals (CIs). Differences in risk between statin users and non-users were tested (P for interaction).

Results: Of the 72,753 IHD cases analyzed, 24% were statin non-users and 76% were statin users. A 0.01 ppm increase in NO₂ at lag0 was associated with higher odds of IHD-related hospitalization (OR, 1.012; 95% CI, 1.003-1.020), with similar results for lag0-lag5 and cumulative windows (lag01, lag02). A significant interaction between NO₂ exposure and statin use was identified (P for interaction < 0.05). The associations differed by statin-use status, with generally lower, non-significant estimates among statin users. Among non-users, significant positive associations were observed at lag1, lag2, and lag01 (ORs > 1). In contrast, estimates among statin users were lower and non-significant.

Conclusions: Short-term NO₂ exposure was associated with an increased risk of hospitalization for IHD among patients with hypertension. However, this association differed by statin-use status, with lower estimates observed among statin users than non-users.

Background: Blood-pressure variability (BPV) has been associated with adverse outcomes after stroke, but its relevance to post-stroke cognitive impairment (PSCI) remains unclear, particularly in cardioembolic stroke. We investigated the association between acute-phase systolic and diastolic BPV and PSCI in patients with atrial fibrillation-related ischemic stroke.

Methods: We conducted a retrospective analysis of a prospective stroke registry including consecutive patients with cardioembolic stroke who underwent standardized neuropsychological assessment at 3 months post-stroke. PSCI was defined as any domain z-score < -2 after adjustment for age, sex, and education. BPV metrics were derived from all systolic and diastolic measurements obtained during the first 7 days of hospitalization. Multivariable logistic regression models adjusted for demographic factors, vascular risk factors, initial National Institutes of Health Stroke Scale (NIHSS) score, and neuroimaging characteristics.

Results: Among 143 patients (mean age 70 years; 60.1% male; median NIHSS 5), PSCI occurred in 67 (46.9%). Higher short-term variability in both systolic and diastolic blood pressure (SBP and DBP) was independently associated with PSCI. Each 1-standard deviation (SD) increase in SBP SD conferred an adjusted odds ratio (aOR) of 1.09 (95% confidence interval [CI], 1.01-1.17), and each 1-SD increase in diastolic BP SD an aOR of 1.14 (95% CI, 1.01-1.29). Mean SBP and DBP were also independently associated with PSCI.

Conclusions: In patients with cardioembolic stroke, short-term variability in both SBP and DBP during the acute phase was independently associated with PSCI. Acute BPV may represent a modifiable hemodynamic marker of early cognitive vulnerability, warranting further investigation in larger and mechanistic studies.