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Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated., (© 2023 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Adverse pregnancy outcomes (APOs) are at increased future cardiovascular risk and require effective risk mitigation. However, data regarding appropriate postpartum screening for young women with APOs are lacking. We aimed to investigate the association between APOs and vascular aging by the determination of high pulse wave velocity (PWV) in young women. Women who gave birth from 1990 to 2020 and underwent brachial-ankle pulse wave velocity (baPWV) assessments in the postpartum period were recruited. We excluded women with age ≥50 years at the baPWV assessment or missing postpartum health examinations. The history of APOs including hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and low birth weight were assessed by medical records. High PWV was defined as baPWV above the 90th percentile for different age group. Multivariable Logistic regression was used to evaluate the association of APOs and high PWV. 3193 participants were included in the analysis, including 912 (28.6%) individuals with APOs. The prevalence of high PWV in the non-APO group and the APOs group were 7.19% (164) and 13.9% (127), respectively (P < 0.05). Compared with non-APO group, the OR (95% CI) of APOs group was 1.67 (1.29-2.16). The risks in the 20-29, 30-39, and 40-49 age groups were 2.51 (1.13-5.59), 1.83 (1.30-2.59), and 1.35 (0.82-2.21) (P for trend <0.05). We conclude that APOs are risk factors of vascular aging for young women and the risk decreased with increasing age. BaPWV should be an important indicator for preventive cardiovascular risk management in young women with APOs. Clinical trial registration: Registration number ChiCTR-TNRC-11001489, http://www.chictr.org.cn/showproj.aspx?proj=8050 ., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: To study the development of microalbuminuria (MAU) in essential hypertension (EHT), we investigated the association of MAU with central blood pressure (CBP), direct renin concentration (DRC), plasma aldosterone (PA), and uric acid (UA)., Method: We determined 24 h-urinary albumin excretion (24 h-UAE) in patients with EHT who were hospitalized at TEDA International Cardiovascular Hospital from June 2020 to May 2022. We defined MAU as 24 h-UAE in the range of 30 mg/24 h to 300 mg/24 h. Univariate and multivariate analyses were conducted to determine the associations of MAU with CBP, DRC, PA, and UA in EHT, considering demographic and clinical information. We also plotted receiver operating characteristic curves (ROCs) for predicting MAU using these results., Results: More than a quarter of patients (26.5%, 107/404, 95% CI: 22.2-31.1%) were diagnosed with MAU in EHT. A higher body mass index (BMI), longer duration of hypertension, and higher severity were associated with MAU. Also, nearly 10% more creatinine levels were recorded in the MAU group than in the control group (69.5 ± 18.7 µmol/L vs. 64.8 ± 12.5 µmol/L, P = 0.004). The increase was also observed for PA (15.5, 9.7-20.6 ng/dL vs. 12.3, 9.0-17.3 ng/dL, P = 0.024) and UA (419.8 ± 105.6 µmol/L vs. 375.1 ± 89.5 µmol/L, P < 0.001) in the MAU group compared to that in the control group. Several variables were associated with MAU, including central diastolic blood pressure (CDBP) (OR = 1.017, 95% CI: 1.002-1.032, P = 0.027), PA (OR = 1.043, 95% CI: 1.009-1.078, P = 0.012) and UA (OR = 1.005, 95% CI: 1.002-1.008, P < 0.001). For MAU prediction, the area under the curve (AUC) was 0.709 (95% CI: 0.662-0.753; P < 0.001) when CDBP, PA, and UA were used in combination, and the optimal probability of the cut-off value was 0.337., Conclusion: We found that CDBP, PA, and UA, used for MAU prediction, might be associated with its development during EHT., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: To estimate the relationship among uric acid (UA), 24-h microalbumin (24 h-MAU) and estimated glomerular filtration rate (eGFR) in hypertensive patients., Method: The study enrolled adult patients hospitalized in TEDA International Cardiovascular Hospital. The study was used to explore the correlation among UA, 24 h-MAU and eGFR. Univariate analysis was used to compare continuous or categorical data groups according to data type. Multivariate analysis was used to explore the correlation among UA, Log 24 h-MAU and eGFR by linear regression, and the relationship among UA, 24 h-MAU ≥ 30 mg/24 h (increased 24 h-MAU) and eGFR < 90 ml·min -1 ·1.73 m -2 (mildly decreased eGFR) by logistic regression. Mediation effect analysis was used to explore the mediating effect of increased 24 h-MAU between UA and mildly decreased eGFR. Subgroup analysis was used to investigate the correlation among UA, 24 h-MAU and eGFR in different gender., Result: Seven hundred and thirty-three inpatients were enrolled in the study, including 257 patients with hyperuricemia. The level of UA was 377.8 ± 99.9 μmol/L in all patients enrolled, and it was about 50.1% higher in hyperuricemia group (482.3 ± 58.8 μmol/L vs. 321.4 ± 63.5 μmol/L, P < 0.001). The prevalence of hyperuricemia was 35.1% (95%CI 31.6-38.5%). The univariate regression analysis showed that UA was significant related to Log 24 h-MAU, increased 24 h-MAU, eGFR and mildly decreased eGFR. After adjusted confounding factors, UA was significant related to Log 24 h-MAU (β = 0.163, P < 0.001), eGFR (β = - 0.196, P < 0.001), increased 24 h-MAU (quantitative analysis: OR = 1.045, 95%CI 1.020-1.071, P < 0.001; qualitative analysis: OR = 2.245, 95%CI 1.410-3.572, P = 0.001), but had no significant relationship with mildly decreased eGFR. Mediating effect analysis showed that increased 24 h-MAU partially mediated the relationship between UA and mildly decreased eGFR (relative indirect effect: 25.0% and 20.3% in quantitative analysis and qualitative analysis respectively). In the subgroup analysis, the results were stable and similar to the analysis for entry patients., Conclusion: The prevalence of hyperuricemia was higher in hypertensive inpatients. UA was strongly associated with Log 24 h-MAU, eGFR and increased 24 h-MAU, while the correlation with mildly decreased eGFR was affected by multiple factors. And increased 24 h-MAU might be the intermediate factor between UA and mildly decreased eGFR., (© 2023. The Author(s).)

Background: This study aims to analyze the association of obstructive sleep apnea (OSA) with endothelial function and heart structure in patients with hypertension and lay a clinical foundation for preventing and treating endothelial dysfunction and heart remodeling in patients with hypertension., Methods: A cross-sectional study design was adopted in this study. From April 2020 to April 2021, 143 patients with hypertension were included and classified into two groups according to the severity of OSA: 81 patients with hypertension without OSA [apnea-hypopnea index (AHI) < 5 events/hour] serving as the control group; 62 patients with hypertension with moderate-severe OSA (AHI ≥ 15 events/hour) serving as the OSA group. The endothelial function and heart structure were assessed by flow-mediated vasodilation (FMD) and transthoracic echocardiography. Logistic regression analyses were conducted to identify factors associated with endothelial dysfunction and heart remodeling., Results: Compared with the control group, patients with OSA had significantly greater interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) (P < 0.05), and FMD exhibited a significant decrease (P < 0.05). Logistic regression analyses demonstrated that gender and AHI were associated with FMD (P < 0.05), and FMD was associated with LVMI (P < 0.05)., Conclusions: OSA was associated with endothelial dysfunction and heart remodeling in patients with hypertension. Endothelial dysfunction may be crucial for the development of heart remodeling in patients with hypertension with OSA., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Background: The causal association between educational attainment (EA) and stroke remains unclear. Hence, a novel multivariable Mendelian randomization (MVMR) approach was applied to solve this issue., Methods: The single nucleotide polymorphisms (SNPs) from a recent genome-wide association study (GWAS) on years of schooling served as instruments. Univariable mendelian randomization (MR) and MVMR analyses were performed to detect the relationship between genetically predicted EA and the stroke risk. In the MVMR, cigarette consumption, alcohol consumption, body mass index (BMI), intelligence, and hypertension were adjusted. The summary statistics for stroke from the MEGASTROKE consortium included 446,696 participants (40,585 cases of stroke and 34,217 cases of ischemic stroke), most of whom were of European descent., Results: In the univariable MR, genetically predicated EA could decrease the risks of total stroke (OR = 0.66, 95% CI 0.61-0.72, P = 2.70 × 10 -23 ), ischemic stroke (OR = 0.67, 95% CI 0.61-0.73, P = 2.58 × 10 -18 ), large artery atherosclerosis (OR = 0.51, 95% CI 0.40-0.64, P = 1.80 × 10 -8 ), small vessel stroke (OR = 0.60, 95% CI 0.49-0.73, P = 5.59 × 10 -7 ), and cardioembolic stroke (OR = 0.81, 95% CI 0.68-0.96, P = 1.46 × 10 -2 ) using the inverse-variance weighted (IVW) estimator. Higher EA might be negatively correlated with the odds of total stroke (OR = 0.62, 95% CI 0.50-0.77, P = 1.44 × 10 -5 ), ischemic stroke (OR = 0.63, 95% CI 0.50-0.80, P = 1.41 × 10 -4 ), and cardioembolic stroke (OR = 0.59, 95% CI 0.39-0.90, P = 0.01), but was not significant in large artery atherosclerosis (OR = 0.65, 95% CI 0.37-1.15, P = 0.14) and small vessel stroke (OR = 0.68, 95% CI 0.41-1.13, P = 0.14) after controlling other exposures., Conclusions: We found that genetically predicated higher EA decreased the risks of total stroke, ischemic stroke, and cardioembolic stroke, independent of smoking, alcohol consumption, BMI, intelligence, and hypertension., (© 2022. The Author(s).)

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain., Methods: We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020)., Results: Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 ( P <0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic., Conclusions: Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03015311.

The optimal systolic blood pressure (SBP) treatment target in elderly people is full of challenge, and non-adherence is one major cause of uncontrolled BP. The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial is a multi-center, randomized controlled trial that aims to examine whether an intensive treatment (110 ≤ SBP < 130 mmHg) will provide more benefits in lowering cardiovascular events than a mild treatment (130 ≤ SBP < 150 mmHg) among people aged 60-80 years. From January 10, 2017 to December 31, 2017, 8511 patients with primary hypertension were recruited at 42 clinical centers throughout China and randomly assigned to the intensive or standard treatment in 1:1 ratio, in which clinical sites are considered as a stratification factor in randomization. Participants will be followed for an average of four years. All participants used the same validated home BP device and all centers used the same validated office BP device which can automatically upload the readings to a data center. The hospitals were randomly classified as the smartphone-based App center or usual care center in 1:1 ratio for the secondary purpose to study the effect of App management on BP control. In this trial, mean age of participants was 66.2 ± 4.8 years, 24.1% were in the range of 70-80 years, and 65% were at high-risk with the 10-year Framingham risk score ≥ 15%. In conclusion, STEP will provide evidence not only to address appropriate target of BP control among hypertensive patients aged 60-80 years, but also to assess an effective model of App management for hypertension. Trial Registration number: ClinicalTrials. gov. Unique identifier: NCT03015311., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

The occurrence of hypertension is influenced by combined actions of genetic and environmental factors. Among environmental factors, high salt intake is considered as one of the most important and critical dietary factors. High salt intake is closely related to the incidence and mortality of cardiac and cerebrovascular events, as well as ventricular hypertrophy, renal damage, and other target organ damages. The existing data show that the daily sodium salt intake of Chinese population is significantly higher than that of European and American populations, and it generally exceeds the standard. Therefore, sodium and potassium intake in patients with hypertension should be actively assessed to carry out targeted treatment, which is an important strategy in blood pressure management. According to the characteristics of high prevalence of hypertension, high sodium salt intake, and low blood pressure control rate in China, Chinese Medical Association Hypertension Professional Committee believes that it is necessary to promote salt restriction and formulate the assessment of salt intake and clinical process of blood pressure management according to the current status of sodium intake., (©2019 Wiley Periodicals, Inc.)

Background: Excessive gestational weight gain (GWG) is a potential risk factor for hypertensive disorders of pregnancy (HDP)., Methods: We systematically reviewed three electronic databases for relevant articles published in English: PubMed, EMBASE and Web of Science. The Newcastle-Ottawa Scale was used to assess study quality. Random-effects meta-analyses were performed to supply a pooled estimation of the OR comparing the risk of HDP among healthy pregnant women with and without excessive GWG., Results: The pooled estimation for the association between excessive GWG and the risk of HDPs yielded an odds ratio (OR) of 1.79 (95% CI: 1.61-1.99). A subgroup analysis showed that women who had excessive GWG were more likely to have an HDP (OR 1.82; 95% CI 1.53-2.17), preeclampsia (OR 1.92; 95% CI 1.36-2.72), or gestational hypertension (OR 1.67; 95% CI 1.43-1.95). The pooled estimation for the association between excessive GWG and the risk of HDPs among pregestational normal weight women yielded an OR of 1.57 (95% CI 1.26-1.96). A subgroup analysis showed that women who had excessive GWG were more likely to have HDP (OR 1.45; 95% CI 1.09-1.92) or gestational hypertension (OR 1.51; 95% CI 1.22-1.86). The summary ORs of pre-gestational underweight women and pre-gestational overweight and obese women were 2.17 (95% CI 1.56-3.02) and 1.32 (95% CI 1.08-1.63), respectively., Conclusions: The findings of this study suggest that excessive GWG in accordance with the IOM recommendations influences the rate of HDP.

Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-cardiology Group, College of Cardiovascular Physicians of Chinese Medical Doctor Association, and Hypertension Group of the Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of two parts. The sections of Part A include (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis. The sections of Part B contain (IV) Treatment recommendations, and (V) Prospects. This article presents Part B of the consensus. [ABSTRACT FROM AUTHOR]

Objective: Emerging evidence shows that high blood pressure (BP) level even below 140/90 mmHg during pregnancy is associated with increased risk for maternal and infant complications. The meta-analysis evaluated the associations between prehypertension (BP 120-139/80-89 mmHg) during pregnancy and the risk of small for gestational age (SGA), as well as the impact of prehypertension on birth weight (BW).Methods: Databases (PubMed, Embase, and Cochrane Library) were searched for cohort studies with data on prehypertension in pregnancy and adverse obstetrical outcomes, including SGA and/or BW. The relative risks (RRs) of SGA and weighted mean differences (WMD) in BW were calculated and reported with 95% confidence intervals (95% CIs). We calculated pooled RRs using fixed- and random-effects models.Results: A total of 143,835 participants from five cohort studies were included. Prehypertension in pregnancy increased the risk of SGA (RR 1.59, 95%CI 1.44 to 1.76, p < .00001) and lowered BW (WMD -13.71, 95% CI -83.28 to 55.87, p = .70) compared with optimal BP (<120/80 mmHg). In subgroup analyses, for prehypertension in late pregnancy, the risk of SGA was significantly higher than for optimal BP (RR 1.60, 95% CI 1.44 to 1.78).Conclusion: BP within the range of 120-139/80-89 mmHg during pregnancy, as previously defined as prehypertension, particularly in late pregnancy, was associated with a 59% increase in the risk of having an SGA birth. [ABSTRACT FROM AUTHOR]

Preeclampsia is a pregnancy-specific disease characterized by hypertension as well as proteinuria after the 20th week of pregnancy. Animal models are effective tools for studying the pathogenesis, diagnostic criteria and treatment methods of preeclampsia. The present study sought to establish and evaluate a preeclampsia-like Sprague Dawley (SD) rat model using N-nitro-L-arginine methyl ester (L-NAME). Rats were randomly assigned to 7 groups (n=10 in each): Control rats and rats treated with low-dose L-NAME (40 mg/kg body weight/day) starting from gestational day (GD) 9, medium-L-NAME (75 mg/kg body weight/day) starting from GD 9 (9D ML group), high-dose L-NAME (125 mg/kg body weight/day) starting from GD 9, low-dose L-NAME starting from GD 10, medium-dose L-NAME starting from GD 10 and high-dose L-NAME starting from GD 10. Blood pressure (BP), 24-h proteinuria, fetal intrauterine growth, histopathological changes, the plasma soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PLGF) ratio and cytokine levels were evaluated. Elevated BP, increased urinary albumin excretion, severe endotheliosis, mesangial expansion and increased sFlt-1/PLGF ratios were observed in the experimental groups compared with the control group (P<0.05), particularly in the 9D ML group. The results of the present study may optimize the conditions of the previously established L-NAME-induced preeclampsia SD rat model and aid further study into the pathogenesis of preeclampsia. [ABSTRACT FROM AUTHOR]