Current Hypertension Reports[JOURNAL]
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200 papers
Biomarkers for Predicting Blood Pressure Response to Renal Denervation.
Ye Y, Wang J, Peng Y
Curr Hypertens Rep · 2025 Jun · PMID 40555927 · Publisher ↗
PURPOSE OF REVIEW: Since the FDA approved transcatheter renal denervation (RDN) for the treatment of uncontrolled hypertension in 2023, cardiologists have sought to answer a critical question: "Who benefits from RDN?" Th...
PURPOSE OF REVIEW: Since the FDA approved transcatheter renal denervation (RDN) for the treatment of uncontrolled hypertension in 2023, cardiologists have sought to answer a critical question: "Who benefits from RDN?" The blood pressure-lowering effect of RDN varies considerably among individuals, with some showing little to no response. Predicting individual response remains challenging due to the lack of reliable biomarkers. This review summarizes potential biomarkers for predicting the antihypertensive response to RDN, with a focus on their pathophysiological mechanisms. RECENT FINDINGS: Biomarkers reflecting renal efferent nerve activity, rather than afferent nerve activity, may serve as more reliable predictors of RDN response. Additionally, biomarkers linked to renin-angiotensin-aldosterone system (RAAS) activation, such as plasma renin activity and miR-133a, have shown promising predictive value. Further research is needed to validate these findings and identify novel biomarkers to optimize patient selection for RDN.
A Scoping Review of Asymptomatic Hypertension: Definitions, Diagnosis, and Management in the Emergency Department.
Degtyar A, Wilder ME, Richardson LD … +1 more , Souffront KT
Curr Hypertens Rep · 2025 Jun · PMID 40528102 · Publisher ↗
BACKGROUND: This scoping review examines the existing literature to reveal consensus or absence thereof regarding the definition and management strategies for asymptomatic hypertension. METHODS: The review used Joanna Br...
BACKGROUND: This scoping review examines the existing literature to reveal consensus or absence thereof regarding the definition and management strategies for asymptomatic hypertension. METHODS: The review used Joanna Briggs Institute guidelines. We searched the CINAHL (EBSCO), Scopus, Ovid EMBASE, and PubMed (MEDLINE) databases using keywords and index terms to identify adult patients with hypertension in an emergency or outpatient setting. After review and quality assessment, we included 35 texts. RESULTS: The definition of "asymptomatic hypertension" varied widely. There was significant variation in which society or academic guideline served as the reference and what the blood pressure cut offs were; all specified a lack of end-organ damage. End-organ damage was poorly defined- studies instead described the absence of hypertensive emergency. Of the texts which provided recommendations, all recommended a thorough history and physical examination. Only one study recommended additional testing for asymptomatic patients. Treatment recommendations relied predominantly on ACEP clinical policy, with a majority of studies advocating for gradual reduction of blood pressure as well as referral for outpatient management. CONCLUSION: Unified guidelines on the definition and management of asymptomatic hypertension are needed to ensure effective and consistent patient care. There is no consensus for diagnostic testing in patients with a negative history and physical exam, nor whether treatment should be initiated in the emergency department. Addressing this gap would enhance clinical outcomes and streamline healthcare processes across systems. Future research should focus on establishing consensus and developing management strategies that are adaptable to both emergency and primary care environments.
Sex Difference of Alcoholic Hypertension: Mechanism and Targeted Therapy.
Xiao L, Yang S, Song Y … +1 more , Xiao J
Curr Hypertens Rep · 2025 Jun · PMID 40493257 · Publisher ↗
PURPOSE OF REVIEW: This review provides a critical examination of the sex-specific impact of alcohol consumption on the development and progression of hypertension. Specifically, it elucidates the differential roles of a...
PURPOSE OF REVIEW: This review provides a critical examination of the sex-specific impact of alcohol consumption on the development and progression of hypertension. Specifically, it elucidates the differential roles of alcohol metabolism and blood pressure regulatory mechanisms in men and women. Finally, it explores promising sex-specific therapeutic strategies for the management of alcoholic hypertension. RECENT FINDINGS: Emerging evidence indicates significant sex-based disparities in alcohol pharmacokinetics and pharmacodynamics, with women exhibiting heightened susceptibility to alcohol-induced cardiovascular sequelae. Crucially, key mechanistic insights reveal the differential modulation of the renin-angiotensin-aldosterone system (RAAS), oxidative stress pathways, and the intricate interplay of sex hormones, including the protective effects of estrogen and the potential pro-hypertensive effects of testosterone. Consequently, contemporary therapeutic avenues are increasingly focusing on targeting these sex-specific pathophysiological mechanisms. Alcoholic hypertension manifests with distinct sex-related etiologies and underlying mechanisms, necessitating the development of tailored therapeutic interventions. Effective management strategies should prioritize addressing sex-specific differences in oxidative stress, RAAS activation, and the implementation of personalized lifestyle modifications.
Secondary Hypertension in Children-Identifying and Investigating at Risk Children.
Ding FCL, Sandery BJ
Curr Hypertens Rep · 2025 May · PMID 40448860 · Publisher ↗
PURPOSE OF REVIEW: We aim to review the most recent literature on demographic features and diagnostic workup of children with secondary hypertension, in order to provide a framework for health providers to determine whic...
PURPOSE OF REVIEW: We aim to review the most recent literature on demographic features and diagnostic workup of children with secondary hypertension, in order to provide a framework for health providers to determine which hypertensive pediatric patients warrant further investigation for secondary causes. By highlighting the utility of various diagnostic investigations, we aim to minimize unnecessary testing burden. RECENT FINDINGS: A recent meta-analysis revealed that hypertensive children and adolescents with any of the following features were at increased risk of secondary hypertension: < 6 years of age, history of prematurity, family history of secondary hypertension, body mass index (BMI) < 10th percentile. Based on available evidence, we suggest a testing schema that is stratified by both age and BMI. Limited evidence suggest renal ultrasound may be one of the most useful initial investigations for secondary causes in asymptomatic hypertensive children. Lipid profile in overweight/obese children, and echocardiogram for end organ involvement may have high yield of abnormal results. Further studies on the diagnostic utility of tests for secondary hypertension are required, as the current body of evidence is limited.
Remote Blood Pressure Monitoring in Pregnancies at Risk of Developing Preeclampsia.
Rajkumar T, Hennessy A, Makris A
Curr Hypertens Rep · 2025 May · PMID 40434501 · Full text
PURPOSE OF REVIEW: This review examines the literature on remote blood pressure monitoring (RBPM) for pregnant women at high risk of hypertensive disorders of pregnancy (HDP). RECENT FINDINGS: Hypertensive disorders of p...
PURPOSE OF REVIEW: This review examines the literature on remote blood pressure monitoring (RBPM) for pregnant women at high risk of hypertensive disorders of pregnancy (HDP). RECENT FINDINGS: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity. High risk women often require frequent outpatient review for blood pressure monitoring which can be resource-intensive. RBPM is an organised framework which allows patients to monitor their own blood pressure with clinician guidance, improving healthcare utilisation and potentially saving healthcare costs without worsening maternal and fetal outcomes. Following the COVID-19 pandemic and the growing research interest in mobile health, RBPM has been integrated into international guidelines for managing high-risk pregnancies. Yet there is significant heterogeneity across RBPM frameworks described in the literature, and a lack of clear guidance on the development and implementation of this strategy. RBPM offers promising additional surveillance for high-risk pregnant women. However, challenges remain in its safe implementation, including patient selection, technology, costs, and adequate training to ensure accuracy in blood pressure readings.
"Gut Microbiota as a Therapeutic Target for Hypertension: Challenges and Insights for Future Clinical Applications" "Gut Microbiota and Hypertension Therapy".
Mahgoup EM
Curr Hypertens Rep · 2025 Apr · PMID 40261509 · Publisher ↗
PURPOSE OF REVIEW: Systemic hypertension is a major risk factor for cardiovascular disease and remains challenging to manage despite the widespread use of antihypertensive medications and lifestyle modifications. This re...
PURPOSE OF REVIEW: Systemic hypertension is a major risk factor for cardiovascular disease and remains challenging to manage despite the widespread use of antihypertensive medications and lifestyle modifications. This review explores the role of gut microbiota in hypertension development and regulation, highlighting key mechanisms such as inflammation, gut-brain axis modulation, and bioactive metabolite production. We also assess the potential of microbiota-targeted therapies for hypertension management. RECENT FINDINGS: Emerging evidence indicates that microbial dysbiosis, high-salt diets, and gut-derived metabolites such as short-chain fatty acids (SCFAs) and bile acids significantly influence blood pressure regulation. Preclinical and early clinical studies suggest that interventions targeting gut microbiota, including probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and dietary modifications, may help modulate hypertension. However, variability in gut microbiota composition among individuals and limited human trial data pose challenges to translating these findings into clinical practice. While microbiota-based therapies show promise for hypertension management, further research is needed to establish their efficacy and long-term effects. Large-scale, standardized clinical trials are crucial for understanding the therapeutic potential and limitations of gut microbiota interventions. A deeper understanding of the gut-hypertension axis could lead to novel, personalized treatment strategies for hypertension.
Hypertension in Childhood Cancer Survivors: Causes, Screening, and Management.
Wu NL, Hanevold CD
Curr Hypertens Rep · 2025 Mar · PMID 40085293 · Full text
PURPOSE OF REVIEW: Survivors of childhood cancer and hematopoietic cell transplant are at risk for developing chronic health conditions, including hypertension. Studies have identified hypertension as an influential risk...
PURPOSE OF REVIEW: Survivors of childhood cancer and hematopoietic cell transplant are at risk for developing chronic health conditions, including hypertension. Studies have identified hypertension as an influential risk factor for late kidney dysfunction and cardiovascular disease in childhood cancer survivors. The overall risk of hypertension depends on the specific cancer treatment, from chemotherapy to surgery to radiation. In this report, we aim to review the main causes of hypertension in childhood cancer survivors, with a focus on newer therapies, as well as the current recommendations for screening and management of hypertension in this patient population. RECENT FINDINGS: Novel targeted therapies and immunotherapies are being increasingly used in pediatric cancer treatment, with unclear impact on long-term health. Screening guidelines for hypertension in the survivor population have been issued by various childhood cancer cooperative groups based on best available evidence and expert opinion. Newer studies have focused on individual risk prediction, which may help improve the diagnosis and management of hypertension, particularly in higher-risk individuals. Despite the importance of hypertension as one of the few modifiable risk factors for cardiovascular and renal health, studies have yet to define optimal blood pressure targets, screening parameters, or management strategies in childhood cancer survivors. Additionally, further studies are needed to demonstrate improvement in outcomes following interventions for hypertension specifically in this patient population.
Hypertension, Obesity, and Target Organ Injury in Children: An Emerging Health Care Crisis.
Tran AH, Walsh A, Urbina EM
Curr Hypertens Rep · 2025 Feb · PMID 40014185 · Full text
PURPOSE OF REVIEW: To review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood ob...
PURPOSE OF REVIEW: To review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood obesity on target organ damage. RECENT FINDINGS: The prevalence of hypertension and obesity are rising in children despite efforts to address these risk factors. Health disparities play a role in contributing to the rise in prevalence. Hypertension and obesity promote pro-inflammatory cytokines that activate the renin-angiotensin-aldosterone system and sympathetic nervous system which result in adverse effects on blood pressure regulation and renal function. Adverse cardiac, vascular, renal, neurocognitive, and retinal changes can be seen with elevated blood pressure. Recent intervention studies are few, but adequate treatment of hypertension and obesity can result in improvement in target organ damage. Hypertension and obesity have significant impacts upon target organs. Interventions to decrease blood pressure and treat obesity are associated with reductions in left ventricular hypertrophy, improvement in measures of systolic and diastolic function, and improvement in renal outcomes. Appropriate screening and management of these conditions can lessen potential future cardiovascular impact.
Urinary Biomarkers Of Kidney Function As Predictors Of Cardiovascular Health: A Systematic Review.
Degenaar A, Kruger R, Jacobs A … +1 more , Mels CMC
Curr Hypertens Rep · 2025 Feb · PMID 39982568 · Full text
PURPOSE OF REVIEW: The growing burden of cardiovascular diseases has become a significant concern in both adult and youth populations. Urinary biomarkers of kidney function could provide useful insights that may aid in t...
PURPOSE OF REVIEW: The growing burden of cardiovascular diseases has become a significant concern in both adult and youth populations. Urinary biomarkers of kidney function could provide useful insights that may aid in the early identification of individuals at higher risk of adverse cardiovascular outcomes. This systematic review aimed to assess associations between urinary biomarkers of kidney function and different measures of cardiovascular health. RECENT FINDINGS: PubMed, Scopus, and EBSCOhost were searched for articles published between January 2018 and December 2023. Studies exploring associations between urinary kidney biomarkers (alpha-1 microglobulin (uA1M), neutrophil gelatinase-associated lipocalin (uNGAL), uromodulin (uUMOD) and CKD273 classifier) and measures of cardiovascular health (blood pressure and markers of target organ damage) were included. We identified 1186 articles, with 22 studies eligible for inclusion. Among 12 studies reporting associations between uA1M and measures of cardiovascular health, six studies indicated positive associations with office blood pressure and three studies observed associations with different markers of target organ damage. Out of the nine studies that explored the link between uUMOD and cardiovascular health parameters, four found negative associations between uUMOD and blood pressure. With regard to uNGAL, only two out of the seven studies analysed reported varying associations with blood pressure, while neither of the two studies focusing on CKD273 observed any statistically significant results. Biomarkers of kidney tubule function, represented by uA1M and uUMOD, are relevant in the setting of cardiovascular health and should be assessed for utilisation in clinical practice to identify adverse cardiovascular outcomes at an early stage allowing for timely intervention.
Factors associated with preeclampsia and the hypertensive disorders of pregnancy amongst Indigenous women of Canada, Australia, New Zealand, and the United States: A systematic review and meta-analysis.
Stephens J, Grande ED, Roberts T … +5 more , Kerr M, Northcott C, Johnson T, Sleep J, Ryder C
Curr Hypertens Rep · 2025 Feb · PMID 39976766 · Full text
PURPOSE OF THE REVIEW: Preeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing....
PURPOSE OF THE REVIEW: Preeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing. To understand factors associated with increased risk for Indigenous women a systematic review and meta-analysis was conducted. The PRISMA guidelines were adhered to, and the review protocol was registered on PROSPERO (Registration CRD42023381847). EndNote, Covidence and Excel were used to screen and extract data, with studies assessed using JBI critical appraisal tools. RECENT FINDINGS: Seven studies from Canada, Australia, and the United States (none from New Zealand) were included in this review. Meta-analysis showed women classified as overweight (OR 1.32, 95% CI: 1.09-1.60), obese (OR 1.88, 95% CI: 1.57-2.25), or having high mean BMI (MD 3.02 95% CI: 1.72-4.31), high mean systolic blood pressure (MD 15.19 95% CI: 12.83-17.541), or high mean diastolic blood pressure (MD 15.26 95% CI: 13.05-17.47), pre-pregnancy diabetes (OR 3.63, 95% CI: 1.66-17.94), or high microalbuminuria (OR 2.76, 95% CI: 1.40-5.43) were more likely to be diagnosed with preeclampsia. Smoking (OR 0.77, 95% CI: 0.58-1.03), alcohol consumption (OR 1.70, 95% CI: 0.76-3.81), and gestational diabetes (OR 1.74, 95% CI: 0.90-3.37) were not associated with preeclampsia. Understanding factors associated with increased preeclampsia/HDP risk amongst Indigenous women is important to minimising adverse perinatal events and future health complications. This review demonstrates current gaps in the evidence, specifically in relation to social, economic, and environmental factors.
Does Nocturnal Blood Pressure Matter in Retinal Small Vessels? A Systematic Review and Meta-Analysis of the Literature.
Antza C, Palaska S, Anyfanti P … +4 more , Triantis D, Fyntrilakis S, ZiyaSener Y, Kotsis V
Curr Hypertens Rep · 2025 Jan · PMID 39826001 · Full text
PURPOSE OF THE REVIEW: Τhe association between nocturnal blood pressure (BP) and alterations in the retinal microvasculature remains understudied, with few available studies to provide conflicting results. Therefore, we...
PURPOSE OF THE REVIEW: Τhe association between nocturnal blood pressure (BP) and alterations in the retinal microvasculature remains understudied, with few available studies to provide conflicting results. Therefore, we conducted a systematic review and meta-analysis to determine whether an association exists between retinal microvascular alterations and nocturnal BP patterns, determined by 24h ambulatory BP measurement. RECENT FINDINGS: Our search concluded to 1002 patients (6 studies). A total of 3 studies (411 patients) were enrolled in the meta-analysis. Central retinal arteriolar equivalent found to be not different between patients with and without dipping status (mean differences [MD]: -0.01; 95% CI: -0.23 to 0.20; I²=0%; P < 0.610). Regarding central retinal venular equivalent, dippers showed significantly lower values compared to non-dippers (MD: -0.25; 95% CI: -0.47 to -0.03; I²=0%; P < 0.024). For the comparison between nighttime and daytime BP regarding the damage in small retinal vessels, we identified only 5 studies. Due to different evaluated outcomes as well as due to the heterogeneity of outcomes and different grouping of patients based on different BP cut-off values, these results couldn't be analyzed quantitatively. In summary, this is the first effort to summarize evidence on the effects of day-to-night variation of BP on the retinal small vessels. According to the findings of the present systematic review and meta-analysis, non-dipping status may be associated with retinal venular dilatation, and elevated nighttime BP with retinal arteriolar narrowing. Further studies are warranted to elucidate the impact of nocturnal BP patterns in the retinal microvasculature.
Approach to Endocrine Hypertension: A Case-Based Discussion.
Borozan S, Kamrul-Hasan ABM, Shetty S … +1 more , Pappachan JM
Curr Hypertens Rep · 2025 Jan · PMID 39821533 · Full text
PURPOSE OF REVIEW: Hypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managin...
PURPOSE OF REVIEW: Hypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managing the high incidence of cardiovascular disease (CVD) complications and mortality because of elevated blood pressure (BP). However, evaluation and management of endocrine hypertension are not optimal in clinical practice. With three unique clinical case scenarios, we update the evidence base for diagnostic evaluation and management of endocrine hypertension in this review to inform appropriate day-to-day clinical practice decisions. RECENT FINDINGS: Although most individuals with high BP suffer from essential hypertension (≈85%), some patients may have a clear underlying etiology (termed secondary hypertension), and a significant proportion of these patients have endocrine hypertension (≈10%) consequent to hormone excess from dysfunction of one or more endocrine glands. Even if a relatively common disease in the general population, the correct diagnosis and appropriate treatment of endocrine hypertension is often delayed because of poor awareness among clinicians, including primary care providers and physicians in the secondary care settings. An accurate and timely diagnosis of endocrine hypertension is crucial to potentially cure or at least properly manage these patients because the consequences of delays in diagnosis can be catastrophic, with markedly higher end-organ complications such as CVD, chronic kidney disease, and even premature mortality among sufferers.
Guidance for Prescribing Oral Antihypertensive Medications in the Emergency Department.
Roa PA, Hennessy J, Akcasu N … +2 more , Levy PD, Twiner MJ
Curr Hypertens Rep · 2025 Jan · PMID 39812967 · Full text
PURPOSE OF REVIEW: To review the most current recommendations regarding assessment and treatment of asymptomatic hypertension treatment in the emergency department (ED) and to provide guidance for prescribing oral antihy...
PURPOSE OF REVIEW: To review the most current recommendations regarding assessment and treatment of asymptomatic hypertension treatment in the emergency department (ED) and to provide guidance for prescribing oral antihypertensive therapy for ED providers. RECENT FINDINGS: There are varying management strategies for the treatment of asymptomatic hypertension in the ED likely due to a lack of direct guidelines for treatment. There is an increasing body of evidence for the safety of initiating therapy to treat chronic asymptomatic hypertension in the ED. Initiation and optimization of oral antihypertensive therapy in indicated patients can be done by ED providers to enhance and expediate transition of care for patients and can ultimately aid in prevention of cardiovascular disease (CVD). This review provides guidance of when oral antihypertensive therapy can be initiated, medication options depending on the patient's blood pressure and other concurrent medications (if applicable), as well as other factors that may influence choice of therapy are described. Oral antihypertensive therapies can be initiated and optimized in the ED for patients with asymptomatic chronic hypertension.
Sodium-Directed Crosstalk Between Immune Cells and Lymphatic Vessels.
Ahmad T, Crescenzi R, Kon V … +2 more , Kirabo A, Shelton EL
Curr Hypertens Rep · 2025 Jan · PMID 39812718 · Full text
PURPOSE OF REVIEW: The role of the lymphatic system in clearing extravasated fluids, lipid transport, and immune surveillance is well established, and lymphatic vasculature can provide a vital role in facilitating crosst...
PURPOSE OF REVIEW: The role of the lymphatic system in clearing extravasated fluids, lipid transport, and immune surveillance is well established, and lymphatic vasculature can provide a vital role in facilitating crosstalk among various organ systems. Lymphatic vessels rely on intrinsic and local factors to absorb and propel lymph from the interstitium back to the systemic circulation. The biological implications of local influences on lymphatic vessels are underscored by the exquisite sensitivity of these vessels to environmental stimuli. This review is intended to highlight the role of sodium within the local environment in mediating lymphatic and immune cell interactions that contribute to changes in function and disease progression. RECENT FINDINGS: We discuss evidence that accumulation of interstitial sodium modulates lymphatic growth, pumping dynamics, and permeability of renal lymphatics, which involves activation of sodium potassium chloride co-transporter (NKCC1) in lymphatic endothelial cells. These recent findings complement observations that sodium activates immune cells via the epithelial sodium channel (ENaC), leading to the formation and accumulation of lipid oxidation products, isolevuglandins (IsoLGs), in antigen presenting cells, which in turn promotes T cell activation and vasculopathy. In addition, we will underscore the physiologic relevance of altered interplay between immune cells and lymphatics in the sodium avid state that characterizes kidney diseases and consider how sodium accumulation in the interstitial compartment of the kidney modulates the lymphatic network and the interactions between renal lymphatics and activated immune cells. Finally, this article calls attention to persisting knowledge gaps and stresses the need for additional studies to identify salt-sensing mechanisms, including sodium-activated immune cells and lymphatic endothelial cell interactions, for targeted therapeutic interventions in the setting of renal disease.
Small Interfering RNA Therapy for the Management and Prevention of Hypertension.
Ren L, Danser AHJ
Curr Hypertens Rep · 2025 Jan · PMID 39808369 · Full text
PURPOSE OF REVIEW: To review currently existing knowledge on a new type of antihypertensive treatment, small interfering RNA (siRNA) targeting hepatic angiotensinogen. RECENT FINDINGS: Targeting angiotensinogen synthesis...
PURPOSE OF REVIEW: To review currently existing knowledge on a new type of antihypertensive treatment, small interfering RNA (siRNA) targeting hepatic angiotensinogen. RECENT FINDINGS: Targeting angiotensinogen synthesis in the liver with siRNA allows reaching a suppression of renin-angiotensin system (RAS) activity for up to 6 months after 1 injection. This might revolutionize antihypertensive treatment, as it could overcome non-adherence, the major reason for inadequate blood pressure control. Animal data support that its effects on blood pressure and end-organ damage are fully comparable to those of classical RAS blockers, and phase I and II clinical trials confirm its antihypertensive effectiveness and long-term action. Although its side effect profile is placebo-like, its long-term effects also pose a threat in patients who require immediate restoration of RAS activity, like in shock. Here tools are being developed, called REVERSIR, that allow immediate annihilation of the siRNA effect in the liver. One subcutaneous injection of angiotensinogen siRNA lowers blood pressure for 6 months without severe side effects. The decrease in angiotensinogen and blood pressure can be reversed with a drug called REVERSIR if needed.
Diagnosis of Primary Aldosteronism without Discontinuation of Interfering Antihypertensive Medications.
Dong Z, Song X, Jia M … +9 more , Chen J, Zhang Y, Yu H, Ji Y, Shan L, Zhang T, Zheng C, Wen J, Xu X
Curr Hypertens Rep · 2024 Dec · PMID 39680249 · Publisher ↗
PURPOSE OF REVIEW: One of the challenges in the diagnosis and management of primary aldosteronism (PA), the most common type of secondary hypertension with curative potential, is the modification of antihypertensive medi...
PURPOSE OF REVIEW: One of the challenges in the diagnosis and management of primary aldosteronism (PA), the most common type of secondary hypertension with curative potential, is the modification of antihypertensive medications. We seek to explore whether these medications can be continued during the diagnostic process of PA to minimize the duration and risks associated with medication adjustments. RECENT FINDINGS: We searched PubMed for eligible original literature between 1990 and 2024 using the following keywords: (screening) AND (primary aldosteronism); (confirmatory) AND (primary aldosteronism); (adrenal vein sampling) AND primary aldosteronism). Some recent studies support the feasibility of PA-related tests and even adrenal vein sampling (AVS) without the need to discontinue antihypertensive medications in certain cases. In this review, we propose a management approach that considers the specific effects of antihypertensive medications on the RAAS axis and the patient's disease phenotype. Based on this, we suggest a strategy that enables the diagnosis of PA in certain patients without discontinuing their antihypertensive medications.
Invasive Arterial BP Measurements in the Emergency Department-When, if Ever, is it Indicated?
Kaur G, Morton T, Khairy M … +2 more , Foy M, Gardner-Gray J
Curr Hypertens Rep · 2024 Dec · PMID 39656394 · Publisher ↗
PURPOSE OF REVIEW: Extremes of blood pressure (BP) are common among patients that visit emergency departments. In this review article, we discuss the specific indications for invasive blood pressure monitoring in the ED,...
PURPOSE OF REVIEW: Extremes of blood pressure (BP) are common among patients that visit emergency departments. In this review article, we discuss the specific indications for invasive blood pressure monitoring in the ED, particularly in the context of undifferentiated shock and hypertensive emergencies. RECENT FINDINGS: In most cases, non-invasive techniques suffice for blood pressure monitoring, however, in certain patient presentations intermittent automated oscillometry bears significant drawbacks. The most evident drawback is the extended intervals between measurements. Invasive BP (IBP) monitoring offers a pivotal tool for patients with critical illness who require accurate, timely, blood pressure monitoring and indirectly monitors for complications involving vital organ systems. In the management of patients with critical illness or at risk for end organ injury, invasive methods that directly measure BP via arterial cannulation continues to be an established standard. Overall, evaluating patients on an individual basis, with the understanding that patients who present with extreme blood pressure values need closer monitoring, should prompt consideration of invasive methods of blood pressure monitoring.
Targeting the Brain Leptin-Melanocortin Pathway to Treat Heart Failure.
Omoto ACM, do Carmo JM, Mouton AJ … +5 more , Wang Z, Li X, Spitz R, Hall JE, da Silva AA
Curr Hypertens Rep · 2024 Nov · PMID 39612121 · Full text
PURPOSE OF THE REVIEW: The role of leptin in regulating cardiac function is still controversial with conflicting results in clinical and preclinical studies. However, most previous studies have not considered leptin's po...
PURPOSE OF THE REVIEW: The role of leptin in regulating cardiac function is still controversial with conflicting results in clinical and preclinical studies. However, most previous studies have not considered leptin's powerful cardiac effects that are mediated via activation of central nervous system (CNS) leptin receptors (LepRs) which, in turn, elicit major improvements in cardiac metabolism. In this review, we focus mainly on the role of leptin in regulating cardiac function via its CNS LepRs and downstream signaling pathways, such as the brain melanocortin system. RECENT FINDINGS: Studies from our laboratory showed that CNS LepR activation, without raising plasma leptin levels, has remarkable beneficial effects on cardiac metabolism and function that protect the heart during pathological conditions, including heart failure (HF) induced by myocardial infarction (MI). These cardioprotective effects of leptin appear to be mediated by stimulation of CNS proopiomelanocortin neurons and subsequent activation of melanocortin 4 receptors (MC4R) in the brain. Chronic activation of the brain leptin-melanocortin pathway improves cardiac function and metabolism following myocardial infarction. However, the mechanism underlying this brain-heart crosstalk remains unclear and may have important implications for the development of new therapies for MI and HF.
Intradialytic Hypertension in Maintenance Hemodialysis.
Iatridi F, Theodorakopoulou MP, Karagiannidis AG … +1 more , Sarafidis P
Curr Hypertens Rep · 2024 Nov · PMID 39585515 · Publisher ↗
PURPOSE OF REVIEW: To summarize the current evidence regarding epidemiology, clinical pathophysiology, and latest therapeutic approaches for the management of intradialytic hypertension (IDH). RECENT FINDINGS: IDH is a r...
PURPOSE OF REVIEW: To summarize the current evidence regarding epidemiology, clinical pathophysiology, and latest therapeutic approaches for the management of intradialytic hypertension (IDH). RECENT FINDINGS: IDH is a rather common complication of dialysis, affecting 10-15% of the patient population and significantly increasing the cardiovascular risk. Its pathophysiology involves multiple mechanisms, including volume and sodium overload, sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) overactivity, endothelial dysfunction, and arterial stiffness. IDH management requires a combination of nonpharmacological and pharmacological interventions. The first mainly focus on volume control through dry weight optimization and modification of dialysate sodium, as studies show that strict volume control or low dialysate sodium can significantly reduce intradialytic and ambulatory blood pressure (BP). Pharmacological interventions have also been examined in research studies. Beta-blockers, particularly those with vasodilatory properties, can effectively target mechanisms such as SNS overactivity and endothelial dysfunction, and have shown some promising results reducing both intradialytic and ambulatory BP. Other drugs classes have also been explored as potential therapeutic options for IDH management, though further research is needed to clarify the efficacy of these interventions. A tailored approach addressing both the underlying pathophysiological mechanisms and individualized patient is warranted for improving BP control and cardiovascular outcomes in this high-risk population.
Insights into Uromodulin and Blood Pressure.
Zhou M, Mary S, Delles C … +4 more , Padmanabhan S, Graham D, McBride MW, Dominiczak AF
Curr Hypertens Rep · 2024 Dec · PMID 39259220 · Full text
PURPOSE OF REVIEW: We review the role of uromodulin, a protein exclusively expressed in the kidney, in blood pressure regulation and hypertension. RECENT FINDINGS: The last few years have seen a shift of focus from genet...
PURPOSE OF REVIEW: We review the role of uromodulin, a protein exclusively expressed in the kidney, in blood pressure regulation and hypertension. RECENT FINDINGS: The last few years have seen a shift of focus from genetic association to mendelian randomisation and uromodulin-salt interaction studies, thus confirming the causal role of uromodulin in blood pressure regulation and hypertension. This work has been complemented by phenome-wide association studies in a wider range of ethnicities. Important recent molecular work elucidated uromodulin trafficking and secretion and provided more insights into the pathophysiological roles of circulating and urinary uromodulin. Uromodulin has a causal role in blood pressure regulation and hypertensin. Recent studies show utility of the uromodulin as a biomarker and a possible precision medicine application based on genetically determined differential responses to loop diuretics.
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