American Journal of Hypertension
ISSN / EISSN : 0895-7061 / 1941-7225
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 17,484
Latest articles in this journal
Published: 3 October 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac112
Background: The association of renin with adverse kidney outcomes is largely unknown, and renin measurement strategies vary. We aimed to measure the clinical correlates of different renin measurements and the association between renin and incident chronic kidney disease (CKD), end-stage kidney disease (ESKD), and mortality. Methods: We performed a prospective cohort analysis 9420 participants in the Atherosclerosis Risk in Communities (ARIC) study followed from 1996-1998 through 2019. We estimated longitudinal associations of renin measured using SomaScan modified nucleotide aptamer assay with incident CKD, ESKD, and death using Cox proportional hazards models. Using samples from a subsequent study visit, we compared SomaScan renin with plasma renin activity (PRA) and renin level from Olink, and estimated associations with covariates using univariate and multivariable regression. Results: Higher SomaScan renin levels were associated with higher risk of incident CKD (hazard ratio per two-fold higher [HR], 1.14; 95% confidence interval [CI], 1.09 to 1.20), ESKD (HR, 1.20; 95% CI, 1.03 to 1.41), and mortality (HR, 1.08; 95% CI, 1.04 to 1.13) in analyses adjusted for demographic, clinical, and socioeconomic covariates. SomaScan renin was moderately correlated with PRA (r=0.61) and highly correlated with Olink renin (r=0.94). SomaScan renin and PRA had similar clinical correlates except for divergent associations with age and beta blocker use, both of which correlated positively with SomaScan renin but negatively with PRA. Conclusions: SomaScan aptamer-based renin level was associated with higher risk of CKD, ESKD, and mortality. It was moderately correlated with PRA, sharing generally similar clinical covariate associations.
Published: 1 October 2022
American Journal of Hypertension, Volume 35, pp 902-903; https://doi.org/10.1093/ajh/hpac036
To explore the correlation between obesity phenotypes and high normal blood pressure (BP) among residents residing in Fuzhou communities. A cross-sectional study was conducted and on-site questionnaire survey, physical examinations and laboratory tests were carried out on the residents aged over 18 years in communities of Fuzhou city from 2018 to 2019, in which 900 people with normal BP and 1,006 people with high normal BP were included for analysis. Univariate analysis and multivariate logistic regression model were utilized to analyze the relationship between obesity phenotypes and high normal BP. Receiver operating characteristic (ROC) curve was used to analyze the predictive power of various obesity phenotypes for high normal BP in different genders. The rates of overweight and obesity, abdominal obesity (28.4% vs. 16.0%, P < 0.001), and abnormal waist-to-height ratio (61.6% vs. 41.1%, P < 0.001) were higher in the high normal BP group than those in normal BP group. Multivariate logistic regression analysis showed that high normal BP was positively correlated with body mass index, waist circumference, and waist-to-height ratio. Furthermore, overweight (OR, 95% CI: 1.896, 1.390–2.587), obesity (2.489, 1.427–4.342), abdominal obesity (1.598, 1.152–2.215), and abnormal waist-to-height ratio (2.110, 1.579–2.821) were risk factors of high normal BP among females while abdominal obesity (1.649, 1.021–2.661) and abnormal waist-to-height ratio (1.504, 1.044–2.165) were risk factors of high normal BP among males. The ROC area under the curve was over 0.6 for all obesity types. Overweight, obesity, abdominal obesity, and abnormal waist-to-height ratio are risk factors of high normal BP.
Published: 1 October 2022
American Journal of Hypertension, Volume 35, pp 903-903; https://doi.org/10.1093/ajh/hpac035
To investigate whether fasudil can improve renal microcirculation and protect the kidney in NG-nitro-l-arginine methyl ester (l-NAME)-induced hypertensive rats by inhibiting Rho/Rho associated coiled-coil containing protein kinase (ROCK) signal pathway. The nitric oxide-deficient hypertension was induced by l-NAME (60 mg/l·d) which was provided in drinking water for 8 weeks in Wistar rats. Then they were randomly divided into l-NAME and l-NAME + fasudil groups. Blood, urine, and left kidney samples were collected after fasudil intervention for 6 weeks. Renal artery blood flow, renal function markers in serum and urine, morphological changes of renal interlobular artery, and expression levels of related proteins were detected. Compared with normal control rats, the levels of serum creatinine (SCr) and blood urea nitrogen (BUN) increased while creatinine clearance (CCr) decreased in l-NAME rats. Fasudil treatment significantly decreased SCr and BUN, and increased CCr compared with l-NAME group. Compared with normal controls, the intima of renal interlobular artery increased, the lumen narrowed, the expression of ROCK-1, phosphorylated myosin phosphatase 1/myosin phosphatase 1 (p-MYPT1/MYPT1) increased while endothelial nitric oxide synthase (eNOS) protein levels decreased in l-NAME group (all P < 0.05). Fasudil treatment reduced intimal hyperplasia and lumen stenosis of renal interlobular artery, downregulated ROCK-1 and p-MYPT protein levels and upregulated eNOS expression in l-NAME rats (all P < 0.05). Fasudil treatment improves renal function and structure of renal interlobar artery in nitric oxide-deficient hypertensive rats induced by l-NAME.
Published: 1 October 2022
American Journal of Hypertension, Volume 35, pp 902-902; https://doi.org/10.1093/ajh/hpac034
To investigate the role of plasma metanephrines (MN) and normetanephrines (NMN), in predicting cardiovascular events in essential hypertensive patients. This was a retrospective analysis of 688 hospitalized patients diagnosed with essential hypertension at the Beijing Anzhen hospital from October 2016 to August 2018, with a median (interquartile range) follow-up time of 24 (20–29) months. The primary endpoint was defined as all-cause death and/or readmission for cardiovascular or cerebrovascular events. Patients were divided into event (n = 57) and nonevent (n = 631) groups. High-performance liquid chromatography–tandem mass spectrometry was used to determine plasma MN and NMN levels. According to the cutoff value of plasma NMN from receiver operating characteristic analysis, patients were further divided into NMN ≤125.75 ng/l and NMN >125.75 ng/l groups. The effects of NMN on the prognosis of hypertensive patients were evaluated using Kaplan–Meier curves and multivariate Cox regression analysis. The plasma NMN levels of the event group were higher than those of the nonevent group [110.0 (74.0–135.0) vs. 88.5 (62.0–119.5) ng/l, P = 0.004]. The incidence of the primary endpoint event in NMN ≤125.75 ng/l and NMN >125.75 ng/l groups was 6.0% and 15.8%, respectively. Kaplan–Meier analysis showed that patients with higher baseline NMN levels were more likely to experience adverse events (P < 0.001). Cox regression analysis showed that patients in NMN >125.75 ng/l group had over twofold higher risk of the primary endpoint event than those in NMN ≤125.75 ng/l group (HR = 2.11, 95% CI 1.15–3.84, P = 0.015). Elevated plasma NMN levels are associated with higher risk of cardiovascular and cerebrovascular events in patients with essential hypertension.
Published: 28 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac110
There is evidence that a reduced nocturnal fall in blood pressure (BP) entails an increased risk of hypertensive-mediated organ damage (HMOD) and cardiovascular events. Most studies focusing on left ventricular (LV) systolic function, assessed by conventional LV ejection fraction (LVEF) in non-dippers compared to dippers failed to detect significant differences. To provide a new piece of information on LV systolic dysfunction in the non-dipping setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of LV systolic function. A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until July, 31 st2022. Full articles reporting data on LV GLS and LVEF in non-dippers and dippers were considered suitable. A total of 648 non-dipper and 530 dipper individuals were included in 9 studies. LV GLS was worse in non-dipper than in their dipper counterparts (-18.4±0.30 vs -20.1±0.23%), SMD: 0.73±0.14, CI: 0.46/1.00, p < 0.0001) whereas this was not the case for LVEF (61.4±0.8 and 62.0±0.8%, respectively), SMD: -0.15±0.09, CI: -0.32/0.03, p=1.01). A meta-regression analysis between night-time systolic BP and myocardial GLS showed a significant, relationship between these variables (coefficient 0.085, p < 0.0001). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the non-dipping setting can be unmasked by STE; implementation of STE in current practice may improve the detection of HMOD of adverse prognostic significance in individuals with altered circadian BP rhythm.
Published: 25 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac107
Emerging evidence has linked visit-to-visit, day-to-day and 24-hour ABPM blood pressure variability (BPV) with cognitive impairment. Few studies have, however, considered beat-to-beat BPV. This study, therefore, evaluated the relationship between beat-to-beat BPV and cognitive function among community-dwellers aged 55 years and over. Data was obtained from the Malaysian Elders Longitudinal Research (MELoR) study, which employed random stratified sampling from three parliamentary constituencies within the Klang Valley. Beat-to-beat blood pressure (BP) was recorded using non-invasive BP monitoring (Taskforce TM,CNSystems). Low frequency (LF), high frequency (HF) and low-to-high frequency (LF:HF) ratio for BPV were derived using fast Fourier transformation. Cognition was evaluated using the Montreal Cognitive Assessment (MoCA) test, and categorized into normal aging, mild impairment and moderate-to-severe impairment. Data from 1140 individuals, mean age (SD) 68.48 (7.23) years, were included. Individuals with moderate-to-severe impairment had higher HF-BPV for systolic (SBP) and diastolic (DBP) blood pressure compared to individuals within the normal aging group (OR(95%CI)=2.29(1.62-3.24)) and (OR(95%CI)=1.80(1.32-2.45)), while HF-SBPV (OR(95%CI)=1.41(1.03-1.93)) but not HF-DBPV was significantly higher with mild impairment compared to normal aging after adjustments for potential confounders. Moderate-to-severe impairment was associated with significantly lower LF:HF-SBPV (OR(95%CI)=0.29(0.18-0.47)) and LF:HF-DBPV (OR(95%CI)=0.49(0.34-0.72)), while mild impairment was associated with significantly lower LF:HF-SBPV (OR(95%CI)=0.52(0.34-0.80) but not LF:HF-DBPV (OR(95%CI)=0.81(0.57-1.17), compared to normal aging with similar adjustments. Higher HF-BPV, which indicates parasympathetic activation, and lower LF:HF-BPV, which addresses sympathovagal balance, were observed among individuals with moderate-to-severe cognitive impairment. Future studies should determine whether BPV could be a physiological marker or modifiable risk factor for cognitive decline.
Published: 23 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac108
Elevated blood pressure variability is predictive of increased risk for stroke, cerebrovascular disease, and other vascular brain injuries, independent of traditionally studied average blood pressure levels. However, no studies to date have evaluated whether blood pressure variability is related to diminished cerebrovascular reactivity, which may represent an early marker of cerebrovascular dysfunction presaging vascular brain injury. The present study investigated blood pressure variability and cerebrovascular reactivity in a sample of 41 community-dwelling older adults (mean age 69.6 [SD 8.7] years) without history of dementia or stroke. Short-term blood pressure variability was determined from blood pressure measurements collected continuously during a 5-minute resting period followed by cerebrovascular reactivity during 5-minute hypocapnia and hypercapnia challenge induced by visually guided breathing conditions. Cerebrovascular reactivity was quantified as percent change in cerebral perfusion by pseudo-continuous arterial spin labelling (pCASL)-MRI per unit change in end-tidal CO2. Elevated systolic blood pressure variability was related to lower whole brain cerebrovascular reactivity during hypocapnia (ß = -.43 [95% CI -.73, -.12]; p = .008; adjusted R2 = .11) and hypercapnia (ß = -.42 [95% CI -.77, -.06]; p = .02; adjusted R2 = .19). Findings add to prior work linking blood pressure variability and cerebrovascular disease burden and suggest blood pressure variability may also be related to prodromal markers of cerebrovascular dysfunction and disease, with potential therapeutic implications.
Published: 20 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac106
BACKGROUND: Uncertainty remains over the relationship between blood pressure variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality at 1 year after AIS. METHODS: In a cohort of 862 consecutive patients (age [mean ± SD] 75±15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS: In cumulative cohort, the measured SD and CV of SBP in mmHg were 16±6 and 10±5, respectively. The hazard ratios for the highest vs. lowest quartiles was 1.44 (95% confidence interval 1.04 – 1.81) for SD and 1.29 (95% confidence interval 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV). CONCULSIONS: In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization have no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patientcare rather than a specific focus on BP parameters during hospitalization for AIS.
Published: 12 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac102
Urine biomarkers of kidney tubule health may distinguish aspects of kidney damage that cannot be captured by current glomerular measures. Associations of clinical risk factors with specific kidney tubule biomarkers have not been evaluated in detail. We performed a cross-sectional study in the Systolic Blood Pressure Intervention Trial among 2436 participants with baseline estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m 2. Associations between demographic and clinical characteristics with urine biomarkers of kidney tubule health were evaluated using simultaneous multivariable linear regression of selected variables. Each standard deviation higher age (9 years) was associated with 13% higher levels of chinase-3-like protein-1 (YKL-40), indicating higher levels of tubulointerstitial inflammation and repair. Men had 31% higher levels of alpha-1 microglobulin and 16% higher levels of beta-2 microglobulin, reflecting worse tubule resorptive function. Black race was associated with significantly higher levels of neutrophil gelatinase-associated lipocalin (12%) and lower kidney injury molecule-1 (26%) and uromodulin (22%). Each SD higher SBP (16 mmHg) was associated with 10% higher beta-2 microglobulin and 10% higher alpha-1 microglobulin, reflecting lower tubule resorptive function. Clinical and demographic characteristics, such as race, sex and elevated systolic blood pressure, are associated with unique profiles of tubular damage which could reflect under-recognized patterns of kidney tubule disease among persons with decreased eGFR.
Published: 6 September 2022
American Journal of Hypertension; https://doi.org/10.1093/ajh/hpac104
Hypertension, defined as blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use, affects approximately half of US adults, and appropriately-sized BP cuffs are important for accurate BP measurement and hypertension management. This cross-sectional study analyzed 13,038 US adults (≥18y) in the National Health and Nutrition Examination Survey 2015-March 2020 cycles. Recommended BP cuff sizes were categorized based on mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large adult (>34 to ≤44 cm), and extra-large adult (>44 cm). Analyses were weighted and proportions were extrapolated to the US population. Among US adults (246 million), recommended cuff sizes were: 6% (16 million) small adult, 51% adult (125 million), 40% large adult (98 million), and 3% extra-large adult (8 million). Among adults with hypertension (116 million), large or extra-large cuffs were needed by over half (51%) overall, including 65% of those aged 18-34 and 84% of those with obesity (BMI ≥30 kg/m 2). By race/ethnicity, the proportion needing a large or extra-large cuff was 57% of non-Hispanic Black adults, 54% of Hispanic adults, 51% of non-Hispanic White adults, and 23% of non-Hispanic Asian adults. Approximately 40% of adults with hypertension in Medicare needed a large or extra-large cuff, compared to 54% for private insurance and 53% for Medicaid. Over half of US adults with hypertension need a large or extra-large BP cuff.