INTRODUCTION: Fludrocortisone and midodrine are frequently used to raise blood pressure (BP) in patients with vasovagal syncope (VVS)/low BP phenotype and orthostatic hypotension (OH), despite limited supporting evidence...INTRODUCTION: Fludrocortisone and midodrine are frequently used to raise blood pressure (BP) in patients with vasovagal syncope (VVS)/low BP phenotype and orthostatic hypotension (OH), despite limited supporting evidence. This study assesses changes in Ambulatory Blood Pressure Monitor (ABPM) biomarkers and symptoms of syncope after commencing/increasing fludrocortisone or midodrine. METHODS: Patients attending a tertiary-referral falls & syncope unit and prescribed fludrocortisone/midodrine were included. ABPM at index visit and follow-up (after commencing/increasing fludrocortisone/midodrine) were analysed, with specific focus on biomarkers of syncope risk: overall systolic BP (sBP), minimum sBP, and 'dips' in sBP <100 mmHg. Symptoms of presyncope and syncope were assessed at follow-up. These variables were compared pre and post medication changes using paired t-tests. RESULTS: 110 patient reviews (median age 57.0 (95%CI 46.4-63.8) years, 77% female) were followed for median 4.0 (IQR 2.0-8.0) months. Of these, 52% (57/110) commenced/increased fludrocortisone, and 48% (53/110) commenced/increased midodrine. Fludrocortisone use was associated with significant increases in overall sBP, minimum sBP and reduction in sBP dips <100mmHg. Symptoms of presyncope improved in 73.7% participants commencing/increasing fludrocortisone. Only 9/27 outcomes reached statistical significance in participants commencing/increasing midodrine: overall sBP increase commencing midodrine, overall sBP increase increasing midodrine (including subgroup ≥65 years), overall sBP increase commencing/increasing midodrine (including subgroup ≥65 years), minimum sBP increase commencing midodrine (including subgroup <65 years), decrease in sBP dips <100mmHg in subgroup aged ≥65 years increasing midodrine, and decrease in sBP dips <100mmHg in subgroup ≥65 years commencing/increasing midodrine. Symptoms of presyncope improved in 64.2% participants commencing/increasing midodrine. CONCLUSION: This study provides clinical data on the effectiveness of fludrocortisone and midodrine in patients with VVS/low BP phenotype and OH. Both fludrocortisone and midodrine significantly improved markers of future syncope risk, with fludrocortisone use showing a relatively greater effect.
OBJECTIVE: In this study, we aimed to determine the prevalence and spectrum of secondary hypertension among patients with apparently resistant arterial hypertension (aRH) and to compare the rate of decline in estimated g...OBJECTIVE: In this study, we aimed to determine the prevalence and spectrum of secondary hypertension among patients with apparently resistant arterial hypertension (aRH) and to compare the rate of decline in estimated glomerular filtration rate (eGFR) between those with primary aldosteronism (PA) and true resistant arterial hypertension (RAH). METHODS: This retrospective cohort study involved 790 patients with aRH referred to a hypertension excellence centre. All patients fulfilled pharmacological criteria for aRH and underwent a screening protocol to evaluate secondary hypertension. We compared clinical and laboratory markers of patients with PA to those with RAH, with a median follow-up of 7 years. RESULTS: Secondary hypertension was identified in 213 patients (27%), with PA being the most common cause (17%), followed by renovascular hypertension (4.1%) and renal parenchymal disease (3.7%). Compared to RAH patients, those with PA had significantly fewer cardiovascular comorbidities. Patients with RAH exhibited a faster decline in renal function, specifically an additional 0.7 mL/min/1.73 m reduction per year (95% confidence interval: 0.05-1.35, = .03), despite similar baseline eGFR and blood pressure (BP) control. In RAH, a continuous association between higher average 24-h systolic BP and a faster decline in renal function was observed. CONCLUSION: Systematic screening in aRH reveals a high prevalence of secondary hypertension, particularly PA. Patients with RAH showed significantly worse renal outcomes compared to those with PA, with faster renal decline associated with higher BP within the RAH group, underscoring the need for early diagnosis and strict BP management.
BACKGROUND: Maintaining intraoperative mean arterial pressure (MAP) is crucial for surgical safety in elderly hypertensive patients, but the optimal target remains unclear. This study evaluated the association between di...BACKGROUND: Maintaining intraoperative mean arterial pressure (MAP) is crucial for surgical safety in elderly hypertensive patients, but the optimal target remains unclear. This study evaluated the association between different intraoperative MAP ranges and postoperative stress responses and organ function. METHODS: We conducted a single-center retrospective cohort study of 368 elderly hypertensive patients undergoing surgery under general anaesthesia. Patients were categorised into three groups based on actual intraoperative MAP: 65-75 mmHg, 75-85 mmHg, and 85-95 mmHg. Postoperative stress markers (cortisol, C-reactive protein [CRP]) and organ function markers (cardiac, renal, neurologic) were analysed using routine perioperative data. RESULTS: Patients in the low MAP group (65-75 mmHg) showed the highest postoperative cortisol and CRP levels, indicating stronger stress responses, and were more likely to experience myocardial and renal impairment. The high MAP group (85-95 mmHg) had a slightly increased cardiac load. The moderate MAP group (75-85 mmHg) demonstrated a balanced profile, with lower stress levels and better preservation of cardiac and renal function. Neurologic injury markers (NSE, S100β) and the incidence of postoperative delirium showed no statistically significant differences among groups, though trends towards higher values were observed in the low MAP group. CONCLUSION: Maintaining intraoperative MAP within 75-85 mmHg appears to reduce postoperative stress and preserve cardiac and renal function in elderly hypertensive patients. Neurologic outcomes did not differ significantly, but avoiding excessively low MAP may help minimise potential neurological risk.
BACKGROUND: Blood Pressure Variability (BPV) is an independent risk factor for cardiovascular events. Short-term indices of BPV, such as standard deviation (SD), coefficient of variation (CV), average real variability (A...BACKGROUND: Blood Pressure Variability (BPV) is an independent risk factor for cardiovascular events. Short-term indices of BPV, such as standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and Time Rate Index (TRI) are calculated using blood pressure (BP) measurements from 24-hour ambulatory blood pressure monitoring (ABPM). Although these indices have distinct units and amplitudes, their relationships have not been thoroughly investigated. This study aims to explore the correlation between the SD, CV, ARV, and TRI indices of short-term BPV. METHODS: Data were collected during the baseline evaluation of hypertensive participants with obstructive sleep apnoea in a randomised controlled trial. Systolic BPV indices were measured using 24-hour systolic ABPM. Pearson correlation () and intraclass correlation (ICC) for consistency were calculated among the BPV indices. RESULTS: Sixty-five participants aged ≥40 years were evaluated. SD, CV, and ARV showed high linear correlations, and their ICCs indicated moderate consistency between SD and CV, and between CV and ARV. In contrast, TRI exhibited weak correlations and no ICC consistency with the other indices. CONCLUSIONS: The strong linear correlations and moderate-to-high ICC consistency among SD, CV, and ARV suggest these indices may be used interchangeably in studies of short-term BPV and cardio-vascular outcomes. TRI, however, reflects a distinct construct and should be evaluated separately when assessing its prognostic value.
PURPOSE: It is not clear whether white-coat hypertension (WCH) is related to the development of left ventricular geometry changes in children. MATERIALS AND METHODS: This retrospective, single-centre study categorised pa...PURPOSE: It is not clear whether white-coat hypertension (WCH) is related to the development of left ventricular geometry changes in children. MATERIALS AND METHODS: This retrospective, single-centre study categorised patients into obese and normal-weight groups. The obese cohort comprised 72 with hypertension (48 male, 12.3 ± 3.2 years), 40 with white-coat hypertension (WCH; 29 male, 12.9 ± 2.8 years) and 31 normotensive controls (18 male, 11.9 ± 2.2 years). The normal-weight cohort included 62 with hypertension (40 male, 12.9 ± 3.9 years), 32 with WCH (21 male, 12.5 ± 3.3 years) and 89 normotensive controls (60 male, 13.0 ± 2.1 years). Echocardiography and ambulatory blood pressure monitoring were performed for all participants with WCH or hypertension. Abnormal left ventricular geometry was defined as the presence of concentric remodelling, concentric left ventricular hypertrophy (LVH), or eccentric LVH. RESULTS: The prevalence of abnormal left ventricular geometry demonstrated a significant, stepwise increase from the control group to the WCH and hypertension groups among normal-weight children (1%, 9.4% and 25.8%, respectively; < .001). This graded trend was absent in children with obesity, where the prevalence was elevated across all groups but did not increase progressively with the severity of the blood pressure phenotype (19.3%, 15% and 45.8%, respectively; = .002). CONCLUSION: These findings suggest that WCH may signify an intermediate cardiovascular risk state even in the absence of obesity. From a preventive medicine perspective, the identification of WCH in normal-weight children warrants periodic blood pressure monitoring. While our study clearly establishes the presence of this association in normal-weight youth, the specific nature of the interaction between WCH and obesity - whether additive or synergistic - warrants further investigation in larger, longitudinal cohorts.
OBJECTIVE: This study aimed to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and its circadian rhythm in patients with essential hypertension (EH). METHODS: A systematic search was conducte...OBJECTIVE: This study aimed to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and its circadian rhythm in patients with essential hypertension (EH). METHODS: A systematic search was conducted across five English databases (PubMed, the Cochrane Library, Embase, Web of Science, and The National Library of Medicine) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and VIP Chinese Science and Technology Journal Full-Text Database). The search period for each database was from inception to 31 May 2025. A meta-analysis was performed using RevMan 5.4.1 software. RESULTS: A total of 13 randomised controlled trials, involving 1,080 patients with EH, were included. The meta-analysis results showed that compared with the control group, the experimental (acupuncture) group demonstrated significantly lower values in the following parameters: 24-hour average systolic BP (SBP) (MD = -3.57, 95% confidence interval [CI]: -5.04 to -2.10, < 0.001), 24-hour average diastolic BP (DBP) (MD = -3.61, 95% CI: -5.12 to -2.10, < 0.001), 24-hour SBP variability (MD = -1.15, 95% CI: -1.57 to -0.73, < 0.001), 24-hour DBP variability (MD = -0.96, 95% CI: -1.27 to -0.65, < 0.001), 24-hour SBP load (MD = -3.47, 95% CI: -5.76 to -1.17, = 0.003) and 24-hour DBP load (MD = -2.20, 95% CI: -4.08 to -0.31, = 0.02). CONCLUSION: Compared with Western medication alone, acupuncture combined with Western medication shows significant advantages in improving ambulatory BP parameters, including 24-hour average BP, 24-hour BP variability, 24-hour BP load, and the BP circadian rhythm.
Belančić A, Antza C, Sinigoj P
… +5 more, Casper J, Motiejunaite J, Ferrao D, Young Investigators Group of the European Society of Hypertension:, Young Investigators Group of the European Society of Hypertension
PURPOSE: The Portuguese Society of Hypertension is responsible for the Mission 70/26 Project, a movement that aims to achieve 70% control of hypertensive patients aged 18-65 years old, under Primary Healthcare by 2026. T...PURPOSE: The Portuguese Society of Hypertension is responsible for the Mission 70/26 Project, a movement that aims to achieve 70% control of hypertensive patients aged 18-65 years old, under Primary Healthcare by 2026. To reach the general population, different activities were done, in this article we will describe one in particular, the campaign called 'Pela Saúde de Portugal'. MATERIALS AND METHODS: From December 2023 to July 2024, there were nine screenings for hypertension done in eight cities in Portugal. Volunteers were asked about medical history, their weight and blood pressure were assessed and they were informed about Hypertension (HTN) and target organ damage. RESULTS: 479 screenings were performed. Of the participants, 243 (51%) were female. History of hypertension was reported in 34,7% of them and 32,4% of these were taking medication. There was a significant blood pressure (BP) reduction from the first to the third measurement and both systolic and diastolic BP (mean of the second and third measurements) were higher in hypertensive patients. There were significant BP differences between the cities. CONCLUSION: 'Pela Saúde de Portugal' was not a study of the prevalence of hypertension but merely an awareness campaign with HTN screening done all around the country. This type of campaign is important to draw attention to HTN and other risk factors, improving health literacy in this field. The analysis of the volunteer's characteristics is important to design future interventions.
PURPOSE: Pulse wave velocity (PWV) is a measure of arterial stiffness that reflects vascular ageing and predicts risk for cardiovascular disease. We developed a PWV measurement method that uses dual-impedance cardiograph...PURPOSE: Pulse wave velocity (PWV) is a measure of arterial stiffness that reflects vascular ageing and predicts risk for cardiovascular disease. We developed a PWV measurement method that uses dual-impedance cardiography (d-ICG) to address limitations of other common methods (e.g. ultrasound, tonometry, etc.), as well as to enable PWV assessments across a broader range of populations. This pre-registered, cross-sectional study tested for the first time the extent to which d-ICG PWV associates with cardiometabolic risk factors (i.e. blood pressure and other metabolic syndrome components) and vascular markers of preclinical atherosclerosis (i.e. carotid-artery intima-media thickness [C-IMT] and plaque). METHODS: Participants were 366 healthy adults (aged 28-57; 63.4% female). In a subsample ( = 179), estimates of d-ICG PWV were compared for the first time against carotid-femoral PWV (cfPWV) measured by a Complior device. RESULTS: d-ICG PWV and cfPWV measures were comparably associated with age and blood pressure ('s ≥ .28, 's ≤ .001), and they exhibited moderate consistency (ICCs = 0.51 to 0.55, 's < .001). Across all cardiometabolic risk factors and markers of preclinical atherosclerosis, there were no clinically meaningful differences in the average composite (Fisher's Z-score) correlations with arterial stiffness measured by d-ICG and cfPWV based on Cohen's values ('s = 0.042 to 0.097). CONCLUSION: d-ICG PWV may be a low-cost, reliable, and alternative method for obtaining estimates of arterial stiffness that track with cardiometabolic risk factors and preclinical atherosclerosis.
Cortez-Gómez CA, Flores-Barrada MA, González-Garrido JA
… +6 more, Castillo-Avila RG, López-Victorio CJ, Arias-Vázquez PI, Tejas-Juárez JG, De la Cruz-Cano E, Díaz-Gandarilla JA
PURPOSE: Poor adherence to antihypertensive treatment is one of the leading causes of life-threatening complications in individuals with hypertension. Therefore, investigating the factors involved is essential. This stud...PURPOSE: Poor adherence to antihypertensive treatment is one of the leading causes of life-threatening complications in individuals with hypertension. Therefore, investigating the factors involved is essential. This study aimed to identify sociodemographic factors, comorbidities, and biochemical parameters associated with poor adherence to antihypertensive treatment among university employees in southeastern Mexico. METHODS: A total of 259 hypertensive employees were included and grouped according to their level of adherence-high, moderate, or poor-using the MMAS-8 Scale. For group comparisons, the Kruskal-Wallis and χ tests were used for continuous and categorical variables, respectively. To quantify the strength of these associations, a univariate binary logistic regression was performed, considering those variables that were significant in the preliminary comparative analyses. Additionally, to reinforce these observations, receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative ability of biochemical parameters significantly associated with treatment adherence. RESULTS: A higher prevalence of hypertensive employees with low educational and occupational status was observed in the poor-adherence group, with obesity and dyslipidaemia being the most frequent comorbidities among them. Elevated blood glucose, uric acid, and lipid levels were also significantly associated with poor adherence ( < 0.001). CONCLUSIONS: Educational institutions and healthcare systems should pay special attention to this working population, including, among other measures, medical follow-up, periodic monitoring of biochemical parameters, and the implementation of lifestyle changes.
BACKGROUND: Ambient fine particulate matter (PM2.5) is a major environmental risk factor for hypertension, yet the renal sodium-handling mechanisms remain incompletely understood. This study investigates the role of G pr...BACKGROUND: Ambient fine particulate matter (PM2.5) is a major environmental risk factor for hypertension, yet the renal sodium-handling mechanisms remain incompletely understood. This study investigates the role of G protein-coupled receptor kinase 4 (GRK4) and its downstream signalling axis in PM2.5-induced hypertensive pathogenesis. METHODS: Male Sprague-Dawley rats were exposed to PM2.5 (10 or 40 mg/kg) intratracheal instillation for 12 weeks. Hemodynamic parameters, renal function, and molecular alterations were analysed using immunohistochemistry, Western blot, qPCR, and co-immunoprecipitation. GRK4 expression was manipulated lentiviral vectors to validate its role in blood pressure regulation. RESULTS: PM2.5 exposure induced dose-dependent hypertension, renal dysfunction, and sodium retention. Mechanistically, PM2.5 upregulated renal GRK4 expression through promoter hypomethylation, enhancing its interaction with Nedd4L (a ubiquitin ligase). Phosphorylated Nedd4L (p-Nedd4L) reduced epithelial sodium channel (ENaC) ubiquitination, leading to ENaC accumulation and sodium reabsorption. GRK4 overexpression exacerbated hypertension and sodium retention, whereas GRK4 knockdown attenuated these effects. CONCLUSION: This study identifies a novel signalling axis-GRK4/Nedd4L/ENaC-in PM2.5-induced hypertension, highlighting epigenetic and post-translational regulatory mechanisms. These findings provide mechanistic insights into environmentally mediated hypertensive pathogenesis and suggest potential therapeutic targets for PM2.5-related cardiovascular diseases.
BACKGROUND: Hypertension is the UK's most common treatable cause of mortality and morbidity, including cardiovascular disease (CVD), renal disease and dementia. OBJECTIVE: This systematic review has explored the efficacy...BACKGROUND: Hypertension is the UK's most common treatable cause of mortality and morbidity, including cardiovascular disease (CVD), renal disease and dementia. OBJECTIVE: This systematic review has explored the efficacy and safety of commencing full-dose antihypertensive treatment in individuals with essential hypertension. METHOD: Method16 randomised controlled trials (RCTs) were eligible for inclusion, with some RCTs assessing more than one treatment. The review assessed commonly used antihypertensive drugs (perindopril 8 mg, ramipril 10 mg, amlodipine 10 mg, losartan 100 mg, irbesartan 300 mg, candesartan 16 mg and candesartan 32 mg) compared to low starting doses or placebo RCTs. Eligible studies included 12 RCTs that compared full vs low doses and 19 RCTs that compared full starting doses vs placebo. The primary outcome was the difference in blood pressure reduction compared to controls (reported or calculated). ResultsUsing full doses compared to low doses led to better BP reduction (overall, 3.9/2.2 mmHg lower achieved BP) without an increase in adverse effects. This notion is supported by the changes achieved with full-dose treatment initiation compared to placebo (average over all studies: 11.4 [4.4]/6.5 [2.9] mmHg). CONCLUSIONS: This review indicates that initiating full-dose antihypertensives for essential hypertension may be beneficial and safe. The available data are limited, and further RCTs are required to assess this in specific patient groups to assess safety and efficac.
AIM: This systematic review study aimed to discuss about the possibility role of epigenetic in HTN of children and adolescent. MATERIAL AND METHODS: This evidence-based research is implemented within the scope of the Pre...AIM: This systematic review study aimed to discuss about the possibility role of epigenetic in HTN of children and adolescent. MATERIAL AND METHODS: This evidence-based research is implemented within the scope of the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) 2020. The data were analyzed qualitatively to assess the risk of bias, with the New Ottawa Scale (NOS) and Agency for Health Research and Quality (AHRQ) criteria as the thresholds. Our research highlights in particular showed that there is a role for epigenetics in HTN in children and adolescents. CONCLUSION: Fourteen journals were included to be qualitatively assessed. Eleven journals (78.5%) stated that there was a correlation between epigenetic and BP in children and adolescents, however each study examined different genes or loci. In summary, epigenetic modifications of various single nucleotide polymorphisms (SNPs) and other genes were associated with higher systolic and diastolic BP in children and adolescents.
PURPOSE: Primary aldosteronism (PA) is recognised as the most prevalent form of secondary hypertension. This study aims to provide a concise summary of one year's data from Czech registries concerning newly diagnosed cas...PURPOSE: Primary aldosteronism (PA) is recognised as the most prevalent form of secondary hypertension. This study aims to provide a concise summary of one year's data from Czech registries concerning newly diagnosed cases of PA, accompanied by a brief clinical characterisation of these patients. MATERIALS AND METHODS: Newly diagnosed patients with primary aldosteronism were included from five separate centres across the Czech Republic during the first year of the PA registry's existence. Additionally, data on PA diagnoses were obtained from the National Health Information and Statistics Institute of the Ministry of Health of the Czech Republic. The diagnosis of PA in the centres was established in a hospital setting in accordance with international guidelines. RESULTS: In the first year of the registry, 84 new cases of primary aldosteronism were identified (mean age 50.0 years; range 18-76), including 29 women (35%). Notable differences were observed among the five hypertensive centres. All patients with PA presented with hypertension, and positive adrenal imaging was found in 54% of cases. Adrenal venous sampling was performed in 85% of the patients. According to data from the Institute of Health Information and Statistics, newly diagnosed hypertension was recorded in 157,000 subjects, and PA was registered in 666 cases nationwide during the same year, with the first diagnosis of PA recorded in 153 patients. Measurements of aldosterone and renin were performed in 9,579 and 17,152 cases, respectively, throughout the Czech Republic during this period. CONCLUSIONS: Data from Czech registries indicate a relatively low number of newly detected PA cases within one year. This finding contrasts with the current notion and may be partially attributed to infrequent laboratory screening among hypertensive patients.
PURPOSE: There is currently no specific treatment for nocturnal hypertension (HT). By improving sleep quality and drug-specific mechanisms, hypnotics have been suggested as a potential treatment for nocturnal HT, but thi...PURPOSE: There is currently no specific treatment for nocturnal hypertension (HT). By improving sleep quality and drug-specific mechanisms, hypnotics have been suggested as a potential treatment for nocturnal HT, but this has never been investigated by a systematic review and meta-analysis. MATERIALS AND METHODS: Multiple databases were searched since inception till 19 November 2024. Only randomised controlled trials (RCTs) comparing oral hypnotics administration for ≥1 week versus placebo and reporting nocturnal systolic blood pressure (SBP) or diastolic blood pressure (DBP) were included. Study selection, data extraction and quality assessment (by the Cochrane risk-of-bias tool) were conducted by two independent reviewers. Pairwise meta-analysis using a random effect model pooled weighted mean BP difference. RESULTS: Eight studies including 414 participants were included. Hypnotics did not significantly impact on nocturnal SBP (-3.24 mmHg; 95% confidence interval [CI]: -8.55, 2.06; : 89.4%), nocturnal DBP (-0.97 mmHg; 95% CI: -2.79, 0.85; : 74.6%) and daytime/24-h/office SBP/DBP except for nonbenzodiazepine benzodiazepine receptor agonists (NBZRAs), which may reduce 24-h SBP. Benzodiazepines increase 24-h/daytime/nighttime heart rate. Seven included studies had unclear to high risk of bias. Strength of evidence was ranked very low to low. This is the first meta-analysis to investigate the effects of hypnotics on nocturnal BP, highlighting the lack of adequately powered and low-risk-of-bias studies, especially in patients with HT and insomnia, who may experience preferential nocturnal BP reduction with hypnotics, but this hypothesis is currently supported only by two RCTs involving NBZRAs. CONCLUSIONS: Despite limited data, hypnotics appear to have neutral effects on BP, including nocturnal SBP and DBP, and currently have no role in clinical practice for the treatment of HT (PROSPERO no.: CRD42023490914).