AIM: To investigate age-related differences in the pharmacokinetics (PK) and pharmacodynamics (PD) of perindopril. METHODS: We compared the PK/PD of perindopril between younger (<50 years) and older (>70 years) participa...AIM: To investigate age-related differences in the pharmacokinetics (PK) and pharmacodynamics (PD) of perindopril. METHODS: We compared the PK/PD of perindopril between younger (<50 years) and older (>70 years) participants in a prospective study. The primary outcome was the difference in area under the concentration-time curve (AUC), both dose uncorrected (AUC, in µg/L/24h) and dose corrected (AUC, in µg/L/24h/mg). We calculated the AUCs of both perindopril and its metabolite perindoprilat. Secondary outcomes included the difference in blood pressure (BP) drop between the two groups, using ΔBP between blank (pre-perindopril) and nonblank (post-perindopril). RESULTS: We included 26 participants, of whom 15 (58%) were aged <50 years. The median age in the younger group was 34 years (interquartile range [IQR] = 27 - 41) and 74 in the older group (IQR = 71 - 77). For both the perindopril AUC and AUC we did not find statistically significant differences between the younger and older group. For perindoprilat AUC, there was a statistically significant difference in the median between the younger [45.8, IQR = 32.0 - 57.4] and the older group [77.0, 62.5 - 96.5; = 0.008], as well as for perindoprilat AUC [15.2, 12.2 - 20.0 and 23.1, 18.5 - 23.5; = 0.027], respectively. We found a higher but statistically nonsignificant median Systolic BP drop between the blank and nonblank measurements in the older versus younger group (-9 mmHg vs -5 mmHg; > 0.05). CONCLUSION: Older adults exhibited higher perindoprilat exposure than younger adults, alongside an exploratory, nonsignificant trend toward greater systolic BP reduction. Given the limited sample size, no causal inference can be drawn from our data; nevertheless, these findings support consideration of age-related factors and individualized dosing in hypertension management.
PURPOSE: Hypertension-induced vascular injury involves endothelial dysfunction, inflammation, oxidative stress, and mitochondrial damage. While remote ischaemic postconditioning (RIPost) and Enalapril independently offer...PURPOSE: Hypertension-induced vascular injury involves endothelial dysfunction, inflammation, oxidative stress, and mitochondrial damage. While remote ischaemic postconditioning (RIPost) and Enalapril independently offer vascular protection, their synergistic effects remain unclear. This study investigates the combined impact of RIPost and Enalapril on endothelial and mitochondrial function in spontaneously hypertensive rats (SHRs). METHODS: Male SHRs were divided into five groups: untreated SHR, RIPost-treated, Enalapril-treated, combination-treated (RIPost + Enalapril), and MitoQ-treated. Endothelial function was evaluated through histology and vascular relaxation assays. Inflammatory cytokines, oxidative stress indicators, and mitochondrial parameters were assessed ELISA, Western blotting, and fluorescence-based assays. RESULTS: SHRs showed elevated blood pressure, endothelial damage, increased inflammatory cytokines (TNF-α, IL-6, IL-1β, MCP-1), oxidative stress (ROS, MDA), and mitochondrial dysfunction (reduced ATP, mtDNA, JC-1; altered MFN2, OPA1, FIS1, DRP1). Both RIPost and Enalapril individually ameliorated these effects, but the combined treatment produced significantly greater improvements. RIPost + Enalapril synergistically reduced blood pressure, restored endothelial integrity, suppressed inflammation and oxidative stress, and normalised mitochondrial dynamics more effectively than either intervention alone. CONCLUSION: RIPost combined with Enalapril synergistically attenuates hypertension-induced vascular injury by reducing inflammation and oxidative stress while preserving mitochondrial function. These findings support the combined therapeutic strategy as a promising approach for comprehensive management of hypertensive vascular complications.
INTRODUCTION: Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of...INTRODUCTION: Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of RF RDN treatment in the Dutch healthcare setting. METHODS: A previously published decision-analytic model was utilised to project outcomes over a lifetime horizon for RF RDN vs. standard of care (SoC). Data from the SPYRAL HTN-ON MED study informed the cohort characteristics and base case treatment effect modelled (-4.9 mmHg office-based systolic blood pressure (oSBP) reduction vs. sham), while alternate assumptions were explored in sensitivity analyses. Cost-effectiveness was evaluated against a burden of disease-determined threshold of €20,000 per quality-adjusted life year gained, according to Dutch guidelines. RESULTS: In the base case, ten-year clinical event risk reductions were 0.80 for stroke, 0.88 for myocardial infarction, 0.89 for angina pectoris and coronary heart disease, 0.72 for heart failure, 0.96 for end-stage renal disease, and 0.93 for all-cause death. Over lifetime and under the base case effect size, RF RDN resulted in increased costs of €4,137 (€46,769 (RF RDN) vs. €42,632 (SoC)) and quality-adjusted life years (QALY) of 0.61 (17.49 RF RDN vs. 16.88 SoC), with an incremental cost-effectiveness ratio (ICER) of €6,784 per QALY gained. RF RDN was highly cost-effective or dominant across the range of scenario and sensitivity analyses performed. CONCLUSION: Over lifetime, RF RDN was found cost-effective in the Dutch healthcare system, with an ICER substantially below the applicable willingness-to-pay threshold, while providing meaningful reductions in clinical events for uncontrolled including resistant hypertension patients.
PURPOSE: This study aimed to investigate the effects of public health nursing combined with dietary intervention on metabolic control, self-management abilities, and quality of life in patients with both diabetes mellitu...PURPOSE: This study aimed to investigate the effects of public health nursing combined with dietary intervention on metabolic control, self-management abilities, and quality of life in patients with both diabetes mellitus (DM) and hypertension (HTN). MATERIALS AND METHODS: A total of 120 patients with DM and HTN were randomly classified into a control group or an intervention group. Baseline data, SBP, DPB, FPG, 2hPG, and HbA1c were compared between the two groups before and after the intervention. Disease knowledge was assessed using the Diabetes Knowledge Questionnaire (DKQ). Dietary behaviour management was evaluated using a 5-point Likert scale and management norms for DM and HTN. Quality of life was assessed utilising the GQOLI-74. Self-management ability was recorded as the proportion of patients meeting the established criteria. Patient satisfaction was compared using a hospital-developed satisfaction questionnaire. RESULTS: Following the intervention, the intervention group demonstrated notably lower levels of SBP, DPB, FPG, 2 hPG, and HbA1c ( < 0.01). The intervention group exhibited significant improvements in DKQ scores, dietary behaviour, and GQOLI-74 scores, as well as significantly higher compliance rates across all dimensions of self-management ability ( < 0.01). Moreover, overall patient satisfaction was significantly higher in the intervention group ( < 0.01). CONCLUSION: Public health nursing combined with dietary interventions can effectively improve blood pressure, glycemic control (FPG, 2hPG, HbA1c), disease knowledge, dietary behaviour, and self-management ability, while also enhancing quality of life and patient satisfaction in patients with DM and HTN.
OBJECTIVES: This study investigates the effects of whole-body vibration (WBV) training on arterial stiffness (AS) in adults. METHODS: We primarily evaluated pulse wave velocity (PWV) as the main outcome, while augmentati...OBJECTIVES: This study investigates the effects of whole-body vibration (WBV) training on arterial stiffness (AS) in adults. METHODS: We primarily evaluated pulse wave velocity (PWV) as the main outcome, while augmentation index (AIx), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were secondary measures. Data analysis was conducted using RevMan 5.4.1 software, employing a random effects model for pooled effect sizes, reported as weighted mean differences (WMD) with 95% confidence intervals (95% CI). RESULTS: Seven randomised controlled trials (RCTs) involving 174 subjects were included. WBV training significantly reduced PWV (-0.68 m/s [95% CI: -0.81 to -0.54], < 0.00001), AIx (-5.81% [95% CI: -7.51 to -4.11], < 0.00001), SBP (-4.82 mmHg [95% CI: -7.71 to -1.94], = 0.001), and DBP (-1.90 mmHg [95% CI: -3.71 to -0.09], = 0.04). CONCLUSIONS: Long-term WBV training significantly improves arterial health by reducing PWV, AIx, SBP, and DBP in adults. These findings support WBV training as a beneficial intervention for cardiovascular health management.
INTRODUCTION: Catheterisation of the right adrenal vein during adrenal venous sampling (AVS) is technically challenging and may fail. PURPOSE: We hypothesised that, in selected patients with primary aldosteronism who hav...INTRODUCTION: Catheterisation of the right adrenal vein during adrenal venous sampling (AVS) is technically challenging and may fail. PURPOSE: We hypothesised that, in selected patients with primary aldosteronism who have a right adrenal gland adenoma on imaging, left-sided suppression on AVS could be sufficient to qualify the patient for successful surgical treatment. METHODS: We identified 77 patients referred to the Hypertension Inpatients Clinic at the Medical University of Gdańsk between 2015 and 2023 with suspected primary aldosteronism, subsequently confirmed by an intravenous saline suppression test. All patients underwent AVS, and management (surgical or pharmacological) was guided by the results. The effectiveness of surgical treatment was assessed by improvements in blood pressure control and reductions in serum aldosterone concentration. RESULTS: Of the 77 patients with confirmed primary aldosteronism, 13 (mean age 59.5 ± 10.1 years; 2 women) had a focal lesion in the right adrenal gland. In this subgroup, catheterisation of the right adrenal vein was unsuccessful in 4 patients (mean age 64.8 ± 6.5 years; 1 woman) due to anatomical factors; therefore, only the contralateral suppression index was calculated (mean 0.31). In view of their clinical histories and the right adrenal lesion on CT, all 4 patients were referred for adrenalectomy, and histology confirmed an aldosterone-producing adenoma. Following surgery, a significant decrease in serum aldosterone concentration (mean reduction 36.5 ± 18 ng/dL) and improved blood pressure control were observed. CONCLUSION: In selected patients with primary aldosteronism - those with a typical right adrenal adenoma on CT and left-sided suppression on AVS- the suppression index may be considered a sufficient criterion for proceeding to adrenalectomy.
BACKGROUND: The interrelationships between physical activity (PA), sleep disorders, and hypertension remain incompletely characterised, particularly regarding potential interactions between PA and sleep disorders on hype...BACKGROUND: The interrelationships between physical activity (PA), sleep disorders, and hypertension remain incompletely characterised, particularly regarding potential interactions between PA and sleep disorders on hypertension risk. This study aimed to investigate these associations using complementary epidemiological approaches. METHODS: We conducted a population-based observational analysis of 18,052 adults aged ≥18 years using data from the National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey (2005-2018). Weighted multivariate logistic regression models were used to examine the associations between PA, sleep disorders, and hypertension, as well as the interaction effect of PA and sleep disorders on hypertension. Additionally, we performed a two-sample Mendelian randomisation (MR) analysis was conducted to assess the causal relationship between PA, sleep disorders, and hypertension. RESULTS: The analysis of observational data shows that sleep disorders are significantly associated with a higher risk of hypertension, with an odds ratio (OR) of 1.61 (95% CI: 1.10-2.35, = 0.015). Restricted Cubic Spline (RCS) analysis revealed an S-shaped dose-response relationship between PA and hypertension (P-non-linear < 0.001). The MR analysis results were consistent with these findings. CONCLUSIONS: Convergent evidence from observational and genetic analyses identified sleep disorders as an independent risk factor for hypertension. The non-monotonic S-shaped association between PA and hypertension underscored the importance of personalised activity prescriptions for cardiovascular risk optimisation. Notably, no significant interaction was observed between PA and sleep disorders, suggesting that their effects on hypertension are likely independent.
BACKGROUND: Blood pressure (BP) monitoring is crucial for the management of hypertensive disorders of pregnancy. Cuffless, continuous BP-monitoring devices have been developed, but have yet to be validated during pregnan...BACKGROUND: Blood pressure (BP) monitoring is crucial for the management of hypertensive disorders of pregnancy. Cuffless, continuous BP-monitoring devices have been developed, but have yet to be validated during pregnancy. OBJECTIVES: To describe the case of a 37-year-old patient presenting primary hyperaldosteronism, who suffered from severe preeclampsia during her first pregnancy. She chose to wear a cuffless BP monitoring device (AKTIIA) during her second pregnancy while undergoing three 24-h ABPM sessions. She developed preeclampsia, leading to hospitalisation and premature birth at 32 weeks of pregnancy. We aimed to compare the results obtained with these two methods for BP monitoring. METHODS: We described the pregnancy and medication evolution. We compared results obtained during the same 24-hour period with the AKTIIA device and ABPM device, on two occasions during pregnancy and at 6 months postpartum. Mean daytime, nighttime and 24-hour blood pressure values were calculated during these three sessions, and the difference in paired BP values illustrated with a Bland and Altmann plot. Individual BP readings aquired by both devices within the same 5-minute intervals were also compared. RESULTS AND CONCLUSIONS: For three 24-h ABPM sessions, daytime mean BP values were comparable between the ABPM cuff and the AKTIIA device, but we noted noted significant differences between the ABPM and AKTIIA's measurements during nighttime. The AKTIIA device helped to ensure closer monitoring of her blood pressure. Our results highlight the need for formal validation of such devices during pregnancy.
BACKGROUND: The weight-adjusted waist index (WWI) is a novel obesity measure standardizing waist circumference by body weight. While linked to cardiometabolic disorders, its association with hypertension (HTN) and the me...BACKGROUND: The weight-adjusted waist index (WWI) is a novel obesity measure standardizing waist circumference by body weight. While linked to cardiometabolic disorders, its association with hypertension (HTN) and the mediating role of systemic inflammation remain unclear. This study investigated the WWI-HTN relationship and the mediating effects of C-reactive protein-albumin-lymphocyte ratio (CALLY), C-reactive protein-albumin ratio (CAR), and lymphocyte-C-reactive protein ratio (LCR). METHODS: We analyzed data from 10,869 adults (≥20 years) in NHANES 1999-2010. Associations of WWI with HTN and inflammatory markers were examined using multivariable regression, restricted cubic splines (RCS), and generalized additive models (GAM). Mediation was evaluated through bootstrap analysis. RESULTS: Higher WWI was strongly associated with HTN risk (OR = 1.79; 95% CI: 1.66-1.93; < 0.001). Participants in the highest quartile had nearly fourfold greater risk than those in the lowest (OR = 3.79; 95% CI: 3.04-4.72). The relationship remained robust after adjusting for inflammatory markers (OR = 1.62; 95% CI: 1.49-1.75). Elevated log-CALLY and log-LCR were protective, whereas higher log-CAR increased HTN risk. Mediation analyses showed CALLY, LCR, and CAR explained 12.81%, 12.54%, and 15.89% of the association, respectively, with a combined effect of 13.91%. Subgroup analyses confirmed WWI as a consistent risk factor, and RCS/GAM demonstrated a nonlinear positive association with a threshold at WWI = 11.70. CONCLUSION: WWI is independently and nonlinearly associated with hypertension risk, particularly when WWI ≤11.70. Systemic inflammation partially mediates this association, underscoring its role in obesity-related hypertension.
BACKGROUND: Transportation noise seems to be inherent in modern urban living. However, many studies indicate that it can unfavorably affect human health, especially by influencing the cardiovascular outcome. The large nu...BACKGROUND: Transportation noise seems to be inherent in modern urban living. However, many studies indicate that it can unfavorably affect human health, especially by influencing the cardiovascular outcome. The large number of people exposed to noise in the European Union becomes relevant to public health. This requires the creation and implementation of laws that aim to reduce the burden of adverse environmental factors, such as noise, air pollution, and light pollution. Road noise, aircraft, and railway noise have been shown to increase the incidence of hypertension, myocardial infarction, and mortality. AIM AND METHOD: This narrative review presents possible mechanisms of adverse effects of noise on the body that lead to increased cardiovascular risk, its potential reversibility, and methods of mitigating noise influence. CONCLUSIONS: Comprehensive multidisciplinary efforts are needed to reduce the impact of noise on Europeans and thereby reduce cardiovascular risk. Authorities, institutions, and healthcare providers play an important role in mitigating noise impact and promoting awareness, emphasizing the importance of continuous monitoring and preventive screening for especially vulnerable people in areas of high exposure..
BACKGROUND: Weight loss after gastric bypass is associated with blood pressure (BP) reduction. However, the precise role of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) in this red...BACKGROUND: Weight loss after gastric bypass is associated with blood pressure (BP) reduction. However, the precise role of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) in this reduction remains unclear. We investigated the effect of RYGB-induced weight loss on the hemodynamic, hormonal and renal responses to an orthostatic stress induced by lower body negative pressure (LBNP). METHODS: We conducted a monocentric study comparing response to LBNP (-30 mbar) in two groups of obese participants the first group underwent RYGB surgery (RYGB group) and the second group received lifestyle counselling (control group). We studied urinary sodium excretion, hemodynamic and hormonal responses before, during and 1 h after orthostatic stress induced by LBNP at three timelines: one month before planned RYGB (intervention group), and 3 and 12 months after the intervention. RESULTS: Thirty-seven adult participants were enrolled: 25 patients (72% women, age: 42.1 ± 10.5 years old, BMI 43.0 ± 5.1 kg/m) in the RYGB group and 12 in control group (58% women, age: 44.8 ± 13.6 years old, BMI 43.3 ± 5.3 kg/m). At 12 months, mean weight decreased from 126.3 ± 23.2 kg to 116 ± 20.7 kg in the control group and from 120.9 ± 19.4 kg to 78.6 ± 14.0 kg in the RYGB group ( value < 0.01 between groups). During LBNP, the reduction in urinary sodium excretion (-1.98 mmol/h; CI95%: -3.72 to -0.30, value = 0.02) and the increase in plasma aldosterone concentration (PAC; +9.94 pg/ml, CI 95%: 0.317-19.569, value = 0.043) were more pronounced in the RYGB group. CONCLUSIONS: Our study suggests that weight loss induced by RYGB increases aldosterone responsiveness to orthostatic stress and enhances the sodium tubular response during orthostatic stress. CLINICALTRIALS.GOV ID: NCT02218112.
OBJECTIVES: To study the prevalence and severity of right ventricular hypertrophy (RVH) in relation to left ventricular hypertrophy (LVH) among individuals with hypertension during their lifetime using post-mortem examin...OBJECTIVES: To study the prevalence and severity of right ventricular hypertrophy (RVH) in relation to left ventricular hypertrophy (LVH) among individuals with hypertension during their lifetime using post-mortem examination records. METHODS: In total, 647 autopsy protocols for individuals with systematic hypertension during their lifetime were investigated at forensic laboratories in Semey (Kazakhstan). Associations between right ventricular wall thickness (RVWT) and left ventricular wall thickness (LVWT) adjusted for age, sex, and ethnic background were studied using multiple quantile regression. LVH and RVH as categorical variables were analysed using chi-square tests and multivariable Poisson regression. Prevalence ratios (PR) were calculated using 95% confidence intervals (CI) with robust standard errors. RESULTS: The right ventricle hypertrophy during systemic hypertension has been less extensively studied, particularly using post-mortem examination data. The prevalence of LVH and RVH were 100% and 87.2%, respectively. A positive correlation was observed between RVWT and LVWT ( = 0.66, < 0.001). LVWT was the strongest predictor of RVH (PR = 1.27, 95% CI: 1.19- 1.36). Moreover, male sex (PR = 1.08, 95% CI: 1.01- 1.15) and Russian ethnicity (PR = 1.11, 95% CI: 1.03- 1.20) but not age were associated with RVH in the multivariable model. LVWT was the only significant predictor of RVWT as a continuous dependent variable. CONCLUSIONS: Right ventricular hypertrophy is common in hypertension and is more frequent and pronounced among men and ethnic Russians in Eastern Kazakhstan. Our findings corroborate the existing evidence suggesting that remodelling of the left and right ventricles occurs concurrently.
AIMS: We investigated on-treatment systolic BP (SBP) <130, 130-139 and ≥140 mmHg related to nephroprotection in 3065 patients with proteinuria and 10,738 patients without proteinuria in the VALUE Trial. METHOD AND RESULT...AIMS: We investigated on-treatment systolic BP (SBP) <130, 130-139 and ≥140 mmHg related to nephroprotection in 3065 patients with proteinuria and 10,738 patients without proteinuria in the VALUE Trial. METHOD AND RESULTS: Worsened kidney function (WKF) was ≥50% increase in serum creatinine, and end-stage kidney disease (ESKD) was dialysis/transplantation. Cox proportional hazards models were adjusted for covariates in the on-treatment SBP groups. Lower SBP was significantly related to less WKF ( < .001) in patients , both at <130 mmHg ( = 14/529, 2.6%) and 130-139 mmHg ( = 46/1176, 3.9%) compared to ≥140 mmHg ( = 145/1358, 10.7%). None of the 532 patients with proteinuria had ESKD at <130 mmHg, and only 11/1194 (0.9%) at 130-139 mmHg ( = .098) compared to 39/1339 (2.9%) at SBP ≥ 140 mmHg. In patients the relation between lower SBP and WKF was not significant ( = .23) at <130 mmHg ( = 24/1927, 1.2%) but significant ( = .04) at 130-139 mmHg ( = 74/4611, 1.6%) compared to SBP ≥ 140 mmHg ( = 117/4199, 2.8%). ESKD was 0.2%, 0.2% and 0.4% in the SBP groups, respectively. WKF fell from 12.1% in Q1 (highest SBP quartile) to 6.1% in Q2 ( = .023), 4.2% in Q3 ( = .006) and 2.8% in Q4 ( < .001) in patients and ESKD from 3.5% (Q1) to 1.6% (Q2) ( = .13), 0.7% (Q3) ( = .027) and 0.1% in Q4 ( = .009). In the patients , neither WKF nor ESKD showed statistically significant changes between SBP quartiles. CONCLUSIONS: Our data suggest that, compared to SBP ≥ 140 mmHg, on-treatment SBP <130 and 130-139 mmHg were strongly related to nephroprotection in hypertensive patients with proteinuria.
AIMS: Explore the association between short sleep and hypertension risk in the Chinese population. METHODS: Data from the 2020 Chinese Psychological and Behavioural Study of the Population were utilised. Restricted cubic...AIMS: Explore the association between short sleep and hypertension risk in the Chinese population. METHODS: Data from the 2020 Chinese Psychological and Behavioural Study of the Population were utilised. Restricted cubic spline models assessed dose-response relationships between sleep duration and hypertension risk. A binary logistic regression model, incorporating propensity score matching, explored the true association between short sleep duration and hypertension risk in the Chinese population. In addition, using binary logistic regression models examined the association between >5 h of sleep and hypertension risks and the impact of health behaviours on hypertension risk among short sleepers. RESULTS: Sleep duration and hypertension risk exhibited a non-linear U-shaped pattern. ≤5-hour sleepers had a 32% reduced hypertension risk per additional hour of sleep post-matching. >5-hour sleep didn't affect hypertension risk. Among ≤5-hour sleepers, smoking and prolonged fixed position work increased hypertension risk by 128 and 103.4%, respectively, while engaging in physical activity for over six months reduced it by 63.7%. CONCLUSION: The 5-hour sleep threshold represents a significant turning point for hypertension risk in the Chinese population studied and could serve as a criterion for defining short sleep. Lifestyle modifications such as quitting smoking, adjusting posture during work, and maintaining regular exercise routines can mitigate hypertension risk among individuals with short sleep duration.