Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper

Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper Parati, G., Bilo, G., Kollias, A., Pengo, M., Ochoa, J.E., Castiglioni, P., Stergiou, G.S., Mancia, G., Asayama, K., Asmar, R., Avolio, A., Caiani, E.G., De La Sierra, A., Dolan, E., Grillo, A., Guzik, P., Hoshide, S., Head, G.A., Imai, Y., Juhanoja, E., Kahan, T., Kario, K., Kotsis, V., Kreutz, R., Kyriakoulis, K.G., Li, Y., Manios, E., Mihailidou, A.S., Modesti, P.A., Omboni, S., Palatini, P., Persu, A., Protogerou, A.D., Saladini, F., Salvi, P., Sarafidis, P., Torlasco, C., Veglio, F., Vlachopoulos, C., & Zhang, Y. (2023). Journal of Hypertension, 41(4), 527-544. DOI: 10.1097/HJH.0000000000003363

This paper is a European Society of Hypertension position paper that summarizes the available evidence on blood pressure variability (BPV) assessment methodology and clinical applications, and provides practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. The aim of the paper is to provide better standardization of future studies on BPV, and to provide clinicians with some indications on how BPV can be managed based on currently available data. The paper discusses the interaction between environmental and behavioural factors and intrinsic cardiovascular regulatory mechanisms that result in continuous fluctuations of blood pressure. The authors argue that increased BPV may indicate an impaired cardiovascular regulation and is a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, endstage renal disease, and dementia incidence. The paper provides clinical and methodological recommendations supported by available evidence, reports pending issues, and suggests areas for future research.

A Meta-Analysis of the Haemodynamics of Primary Hypertension in Children and Adults

Li, Y., Haseler, E., McNally, R., Sinha, M. D., & Chowienczyk, P. J. (2023). Journal of Hypertension, 41(2), 212-219. DOI: 10.1097/HJH.0000000000003326

Li et al. conducted a systematic review and meta-analysis to investigate the haemodynamics of primary hypertension in children and adults. The study included 27 studies on 11,765 hypertensive and normotensive children and adults in whom cardiac output was measured. The results showed that cardiac output but not systemic vascular resistance was elevated in hypertensive compared to normotensive children and young adults. In older hypertensive adults, both cardiac output and systemic vascular resistance were elevated compared to normotensive individuals. The main haemodynamic alteration in primary hypertension in both children and young to middle-aged adults is an elevation of cardiac output. With longer duration and greater severity of hypertension, there may be progression from a ‘cardiac’ to a ‘vascular’ phenotype with increased systemic vascular resistance.

Assessing the Association Between Smoking and Hypertension: Smoking Status, Type of Tobacco Products, and Interaction with Alcohol Consumption

Gao, N., Liu, T., Wang, Y., Chen, M., Yu, L., Fu, C., & Xu, K. (2023). Frontiers in Cardiovascular Medicine, 10, 1027988. DOI: 10.3389/fcvm.2023.1027988

This study aimed to investigate the relationship between tobacco smoking and future hypertension risk, while taking into consideration the role of tobacco type and dosage response. The study included 5,625 participants from the Guizhou Population Health Cohort in southwest China. The results showed that heavy smokers of machine-rolled cigarettes had an elevated hypertension risk compared with non-smokers, while no significant association was found between overall tobacco use status and the risk of hypertension. The interaction effects of heavy smoking-heavy drinking patterns increased the future hypertension risk. A J-shape association was found between the average daily consumption of machine-rolled cigarettes and the risk of hypertension. The study suggests that tobacco and alcohol consumption jointly increase the long-term hypertension risk, and that heavy machine-rolled cigarette smokers may be at a statistically significant increased risk of developing hypertension.

Association of Lp(a) and Hypertension in Primary Prevention of Cardiovascular Disease:The MESA

Rikhi, R., Bhatia, H.S., Schaich, C.L., Ashburn, N., Tsai, M.Y., Michos, E.D., Chevli, P.A., Herrington, D.M., Tsimikas, S., & Shapiro, M.D. (2023). Association of Lp(a) (Lipoprotein[a]) and hypertension in primary prevention of cardiovascular disease: The MESA. Hypertension, 80(2), 352-360. DOI: 10.1161/HYPERTENSIONAHA.122.20189

This study explored the longitudinal relationship of Lp(a) and hypertension to cardiovascular outcomes in a large multiethnic cohort free of baseline cardiovascular disease. Individuals were grouped based on their Lp(a) and hypertension status, and the relationship of Lp(a) and hypertension with time to cardiovascular disease events was assessed using KaplanMeier curves and multivariable Cox proportional hazard models. The results showed that the major contribution to cardiovascular risk was hypertension, but elevated Lp(a) significantly modified the association of hypertension with cardiovascular disease. The study suggests that more research is needed to understand the mechanistic links among Lp(a), hypertension, and cardiovascular disease.

Decoding the Mechanism of Hypertension through Multiomics Profiling

Adua, E. (2023). Decoding the mechanism of hypertension through multiomics profiling.
Journal of Human Hypertension, 37(4), 253-264. DOI: 10.1038/s41371-022-00769-8

Hypertension, characterized by a constant high blood pressure, is a primary risk factor for multiple cardiovascular events and a major cause of death in adults. The review by Adua highlights the multi-omics approaches for hypertension prediction and diagnosis. Innovations in high-throughput technologies have enabled the global exploration of the whole genome (genomics), revealing dysregulated genes that are linked to hypertension.
Moreover, post-genomic biomarkers, from the emerging fields of transcriptomics, proteomics, glycomics, and lipidomics, have provided new insights into the molecular underpinnings of hypertension. The paper reviews the pathophysiology of hypertension and the multi-omics approaches for hypertension prediction and diagnosis. The review suggests that multi-omics profiling can provide new insights into the molecular mechanisms of
hypertension and improve hypertension prediction and diagnosis.

Cardiovascular Disease Risk in Patients with Type 2 Diabetes and Hypertension

Kawada, T. (2023). Cardiovascular disease risk in patients with type 2 diabetes and
hypertension. Journal of Hypertension, 41(2), 365. DOI: 10.1097/HJH.0000000000003313

Kawada's article discusses the increased risk of cardiovascular disease in patients with both type 2 diabetes and hypertension. The study aimed to determine the extent to which these two conditions interact to increase cardiovascular disease risk. The results showed that the risk of cardiovascular disease is significantly higher in patients with both type 2 diabetes and hypertension compared to those with only one of these conditions. The study emphasizes the importance of monitoring and treating both type 2 diabetes and hypertension in order to reduce the risk of cardiovascular disease.

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De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital

Parker, S. E., Ajayi, A., & Yarrington, C. D. (2023). De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital. Hypertension, 80(2), 279-287. DOI: 10.1161/HYPERTENSIONAHA.122.19275

This study aimed to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. The study included a retrospective cohort of 3925 deliveries from 2016 to 2018. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN. The study found that patients with all of the risk factors of being ≥35 years, delivered via cesarean, or being current or former smokers had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. The study suggests that monitoring and managing patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular-related maternal morbidity.

De Novo Postpartum Hypertension: Is Pregnancy a Stress Test or Risk Factor?

Sanusi, A.A. & Sinkey, R.G. (2023). De Novo Postpartum Hypertension: Is Pregnancy a Stress
Test or Risk Factor?. Hypertension, 80(2), 288-290. DOI: 10.1161/HYPERTENSIONAHA.122.20155

Sanusi and Sinkey's article discusses the relationship between pregnancy and postpartum hypertension. The authors suggest that pregnancy may serve as a "stress test" for identifying women who are at risk for hypertension later in life. They propose that the physiological changes that occur during pregnancy, such as increased blood volume and cardiac output, may unmask preexisting hypertension or contribute to the development of hypertension in women who are predisposed to the condition. The article also discusses the potential role of genetics, lifestyle factors, and other environmental factors in the development of postpartum hypertension. The authors conclude that further research is needed to better understand the relationship between pregnancy and postpartum hypertension, and to develop strategies for preventing and managing hypertension in this population.

Postpartum Medical Management of Hypertension and Risk of Readmission for Hypertensive Complications

Lovgren, T., Connealy, B., Yao, R., & Dahlke, J. D. (2023). Postpartum medical management of hypertension and risk of readmission for hypertensive complications. Journal of Hypertension, 41(2), 351-355. DOI: 10.1097/HJH.0000000000003340 This retrospective study aimed to compare the risk of readmission for hypertensive complications in patients with peripartum hypertension who were prescribed no treatment, labetalol, nifedipine, or both at hospital discharge after delivery. The study included 19,425

Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension

Freeman, M. W., Halvorsen, Y-D., Marshall, W., Pater, M., Isaacsohn, J., Pearce, C., Murphy, B., Alp, N., Srivastava, A., Bhatt, D. L., & Brown, M. J. (2023). Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension. New England Journal of Medicine, 388(5), 395-405. DOI: 10.1056/NEJMoa2213169

The phase 2 trial investigated the efficacy and safety of baxdrostat, an aldosterone synthase inhibitor, in treating treatment-resistant hypertension. The randomized, multicenter,placebo-controlled trial included 248 patients with treatment-resistant hypertension who received stable doses of at least three antihypertensive agents, including a diuretic. Patients were randomly assigned to receive baxdrostat once daily for 12 weeks or placebo. The primary endpoint was the change in systolic blood pressure from baseline to week 12 in each baxdrostat group as compared with the placebo group. The results showed that baxdrostat had dose-dependent reductions in systolic blood pressure. The difference in the change in systolic blood pressure between the 2-mg group and the placebo group was -11.0 mm Hg, and the difference in this change between the 1-mg group and the placebo group was -8.1 mm Hg. No deaths occurred during the trial, and no serious adverse events were attributed to baxdrostat. The study suggests that baxdrostat may be a promising treatment option for patients with treatment-resistant hypertension.