The relationship between Plasma Markers and Essential Hypertension in Middle-aged and Elderly Chinese Population: A Community Based Cross-sectional Study

Single nucleotide polymorphism-based biomarker in primary hypertension

Primary hypertension is a multiplex and multifactorial disease influenced by various strong components including genetics. Extensive research such as Genome-wide association studies and candidate gene studies have revealed various single nucleotide polymorphisms (SNPs) related to hypertension, providing insights into the genetic basis of the condition. This review summarizes the current status of SNP research in primary hypertension, including examples of hypertension-related SNPs, their location, function, and frequency in different populations. The potential clinical implications of SNP research for primary hypertension management are also discussed, including disease risk prediction, personalized medicine, mechanistic understanding, and lifestyle modifications. Furthermore, this review highlights emerging technologies and methodologies that have the potential to revolutionize the vast understanding of the basis of genetics in primary hypertension. Gene editing holds the potential to target and correct any kind of genetic mutations that contribute to the development of hypertension or modify genes involved in blood pressure regulation to prevent or treat the condition. Advances in computational biology and machine learning enable researchers to analyze large datasets and identify complex genetic interactions contributing to hypertension risk. In conclusion, SNP research in primary hypertension is rapidly evolving with emerging technologies and methodologies that have the potential to transform the knowledge about genetic basis related to the condition. These advances hold promise for personalized prevention and treatment strategies tailored to an individual's genetic profile ultimately improving patient outcomes and reducing healthcare costs.

Association between elevated homocysteine levels and obstructive sleep apnea hypopnea syndrome: a systematic review and updated meta-analysis

Objective

This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels.

Methods

To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages.

Results

In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 μmol/L, 95% CI: 2.60-5.91, P< 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, P = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels.

Conclusion

Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.

Effect and mechanism of HMG-CoA reductase inhibitor on the improvement of elderly essential hypertension-induced vascular endothelial function impairment based on the JAK/STAT pathway

OBJECTIVE

Our research was designed to figure out the influence and mechanism of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor on the improvement of elderly essential hypertension-induced vascular endothelial function impairment based on the JAK/STAT pathway.

METHODS

Eighty-six elderly patients with essential hypertension were randomized into a control group (oral Amlodipine Besylate Tablets) and an observation group (oral Amlodipine Besylate Tablets + HMG-CoA reductase inhibitor atorvastatin calcium). Patients in both groups were treated with the drug for 12 weeks. Blood pressure, serum levels of inflammatory factors, and vascular endothelial function indicators, and levels of blood lipids were measured. The modeled rats were treated with atorvastatin calcium and a JAK/STAT pathway inhibitor (AG490), and the levels of cardiac function-related indices, left ventricular mass index, lipid levels, serum inflammatory factors and vascular endothelial function-related indices were detected in each group.

RESULTS

HMG-CoA reductase inhibitor improved blood pressure levels, lipid levels, serum inflammatory factor levels and cardiac function in elderly patients with essential hypertension. Both HMG-CoA reductase inhibitor and AG490 improved blood pressure levels, lipid levels, serum inflammatory factor levels and cardiac function in SHR rats. Both HMG-CoA reductase inhibitor and AG490 decreased p-JAK2/JAK2 and p-STAT3/STAT3 expression levels.

CONCLUSION

Our study demonstrates that HMG-CoA reductase inhibitor improves elderly essential hypertension-induced vascular endothelial function impairment by blocking the JAK/STAT pathway.

Clinical Application of Epithelial Sodium Channel (ENaC) as a Biomarker for Arterial Hypertension

Arterial hypertension (HTN) is a global public health concern and an important risk factor for cardiovascular diseases and renal failure. We previously reported overexpression of ENaC on the plasma membrane of human platelets is a hallmark of HTN. In this double-blinded study of an open population (n = 167), we evaluated the sensitivity and specificity of a diagnostic assay based on gold nanoparticles (AuNPs) conjugated to an antibody against epithelial sodium channel (ENaC) expressed on platelets, which is detected using a fluorescent anti-ENaC secondary antibody and spectrofluorometry. Using the cutoff value for the AuNP-anti-ENaC assay, we confirmed the diagnosis for 62.1% of patients with clinical HTN and detected 59.7% of patients had previously undiagnosed HTN. Although some shortcomings in terms of accurately discriminating healthy individuals and patients with HTN still need to be resolved, we propose this AuNP-anti-ENaC assay could be used for initial screening and early diagnosis to critically improve opportune clinical management of HTN.

Investigating the effect of Fenofibrate on biomarkers of vascular inflammation in L-NAME induced hypertensive rats

This study aims to evaluate the impact of fenofibrate on the levels of (IL-6, hsCRP, Lp-PLA2, sCD40L, and cystatin C) in hypertensive rats. Twenty-four rats were divided into two groups each of twelve. The first group served as the normotensive group, while the second group was regarded as the hypertensive group. Each group was further divided into two subgroups (control and treated). The control subgroups only received a placebo and the treated subgroups were given fenofibrate 30 mg/kg daily orally by gastric gavage for 4 weeks. The level of hsCRP, IL6, and Lp-PLA2 significantly increased, but sCD40L and cystatin C levels were not changed in hypertensive rats. Fenofibrate has significantly reduced the levels of hsCRP and Lp-LPA2 in hypertensive rats while IL6 and sCD40s have not been changed in both groups. In conclusion, Fenofibrate has revealed a pleiotropic anti-inflammatory effect by reducing the level of hsCRP and Lp-LPA2 in hypertensive rats.

The association between glycosylated haemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study

BACKGROUND

Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic.

METHODS

We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine.

RESULTS

Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m². One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61).

CONCLUSION

The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.

Associations of the baseline level and change in glycosylated hemoglobin A1c with incident hypertension in non-diabetic individuals: a 3-year cohort study

BACKGROUND

Diabetes mellitus increases the risk of developing hypertension. The relationship between glycosylated hemoglobin A1c (HbA1c) level and incident hypertension remains controversial. This study examined the associations of the baseline level and change in the HbA1c level over 3 years with incident hypertension in non-diabetic individuals.

METHODS

This community-based cohort study was conducted with 2591 individuals aged 40-75 years without hypertension or diabetes at baseline, who participated in a longitudinal (REACTION) study program. Questionnaires were administered during interviews, and anthropometric and laboratory measurements were performed at baseline (2011) and follow-up (2014-2015). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of incident hypertension.

RESULTS

Over a median follow-up period of 3.08 years (interquartile range 3.00, 3.25), 384 (14.82%) subjects developed hypertension. In the fully adjusted linear regression models, change in HbA1c remained significantly associated with changes in systolic blood pressure and diastolic blood pressure [β-coefficient (95% CI), 4.421 (2.811-6.032), 1.681 (0.695-2.667)]. Logistic regression analyses showed that baseline HbA1c level was positively associated with incident hypertension in the unadjusted model; however, the association was no longer significant after further adjustment. Change in HbA1c was positively associated with the development of hypertension, both as a categorical variable stratified by tertiles [adjusted OR (95% CI) in the highest tertile was 1.690 (1.240-2.303) versus the lowest tertile)] and as a continuous variable [adjusted OR (95% CI), 1.242 (1.106-1.394)], independent of age, sex, body mass index, systolic blood pressure, fasting plasma glucose level, lipid profile, the HbA1c level at baseline and 3-year change in body mass index.

CONCLUSIONS

A higher baseline HbA1c level was not an independent risk factor for incident hypertension, whereas the change in HbA1c was independently associated with a greater longitudinal increase in blood pressure and an increased risk of incident hypertension in non-diabetic individuals.

Serum Vitamin D Levels in Relation to Hypertension and Pre-hypertension in Adults: A Systematic Review and Dose–Response Meta-Analysis of Epidemiologic Studies

Background

Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. This meta-analysis of epidemiologic studies assessed the relation of serum vitamin D levels to hypertension (HTN) and pre-hypertension in adults.

Methods

We conducted a systematic search of all published articles up to March 2021, in four electronic databases (MEDLINE (PubMed), Web of Science (ISI), Embase and Scopus), and Google scholar. Seventy epidemiologic studies (10 prospective cohort, one nested case–control, and 59 cross-sectional investigations) that reported relative risks (RRs), odds ratios (ORs), hazard ratios, or prevalence ratios with 95% CIs for HTN or pre-hypertension in relation to serum vitamin D concentrations in adults were included in the analysis.

Results

In prospective studies, a 16% decrease in risk of hypertension was observed in participants with high levels of serum vitamin D compared to low levels (RR: 0.84; 95%CI: 0.73, 0.96; 12 effect sizes). Dose–response analysis in prospective studies revealed that each 25 nmol/L increase in serum vitamin D concentrations resulted in 5% reduced risk of HTN (RR: 0.95; 95% CI: 0.90, 1.00). Also, a significant nonlinear relationship between serum vitamin D levels and HTN was found (P_nonlinearity < 0.001). In cross-sectional investigations, highest vs. lowest level of serum vitamin D was related to reduced odds of HTN (OR: 0.84; 95%CI: 0.79, 0.90; 66 effect sizes) and pre-hypertension (OR: 0.75; 0.95%CI: 0.68, 0.83; 9 effect sizes). Dose–response analysis in these studies showed that each 25 nmol/L increase in serum vitamin D levels was related to a significant 6% reduction in odds of hypertension in all populations (RR: 0.94; 95%CI: 0.90, 0.99) and 3% in studies with representative populations (RR: 0.97; 95%CI: 0.95, 0.99).

Conclusion

This meta-analysis of epidemiologic studies disclosed that serum vitamin D concentrations were inversely related to the risk of HTN in adults, in a dose–response manner in both prospective cohort and cross-sectional studies.

Systematic Review Registration:http://www.crd.york.ac.uk/Prospero, identifier: CRD42021251513.

Precision medicine in secondary prevention of ischemic stroke: how may blood-based biomarkers help in clinical routine? An expert opinion

PURPOSE OF REVIEW

One in eight patients unfortunately suffers a new stroke within 5 years of their first stroke, even today. Research in precision medicine could lead to a more individualized treatment allocation, possibly achieving lower recurrence rates of ischemic stroke. In this narrative review, we aim to discuss potential clinical implementation of several promising candidate blood biomarkers.

RECENT FINDINGS

We discuss specifically some promising blood-based biomarkers, which may improve the identification of underlying causes as well as risk stratification of patients according to their specific cerebrovascular risk factor pattern.

SUMMARY

Multimodal profiling of ischemic stroke patients by means of blood biomarkers, in addition to established clinical and neuroradiological data, may allow in the future a refinement of decision algorithms for treatment allocation in secondary ischemic stroke prevention.

Retinol-binding protein 4 is associated with arterial stiffness in early postmenopausal women

OBJECTIVE

Recent evidence in postmenopausal women suggested lack of association between serum levels of retinol-binding protein 4 (RBP4) and subclinical atherosclerosis; however, associations with arterial stiffness in this population remain unexplored. We evaluated the association among RBP4 and cardiovascular risk factors, including homocysteine, a marker involved in retinoic acid synthesis, and indices of arterial stiffness, in a sample of apparently healthy postmenopausal women.

METHODS

This cross-sectional study included 123 healthy postmenopausal women, not on hormone therapy, antihypertensive, or hypolipidemic treatment and with a menopausal age 10 years or less. We performed biochemical/hormonal assessment and sonographic evaluation, including carotid-femoral pulse wave velocity (PWV) and carotid artery stiffness index (SI).

RESULTS

Univariate analysis showed that RBP4 values correlated with age, low-density lipoprotein-cholesterol and estradiol levels. There was a trend of association of SI and PWV with homocysteine and triglycerides. RBP4 differed according to PWV, using the median PWV value as cut-off (RBP4, PWV ≤8.1 vs >8.1 m/s: 10.09 ± 2.05 vs 10.85 ± 1.91 ng/mL, analysis of covariance P value 0.014 adjusted for age, menopausal age, estradiol, pulse pressure). Linear regression analysis showed that PWV was independently associated with RBP4, age, and pulse pressure, whereas SI was independently associated with RBP4. An increase of one standard deviation in RBP4 levels (2.54 ng/mL) was associated with an increase of 0.577 m/s in PWV.

CONCLUSIONS

RBP4 serum levels are associated with arterial stiffness, in a sample of healthy postmenopausal women. If this association is causative, serum RBP4 levels could serve as a marker of arterial stiffness. Prospective studies are required to investigate the significance of our findings. : Video Summary:http://links.lww.com/MENO/A621.

Familial tendency for hypertension is associated with increased vascular stiffness

OBJECTIVE

Hypertension is the leading cause of cardiovascular disease and premature death. New methods for early detection of hypertension and its consequences can reduce complications arising from uncontrolled hypertension. Pulse-wave velocity (PWV), a measure of arterial stiffness, has been recognized as a valuable tool in assessing risk for cardiovascular complications, although its use in clinical practice is currently limited. Here we examine whether brachial--ankle PWV (baPWV) and femoral--ankle PWV (faPWV) are elevated in nonhypertensive volunteers, with and without a history of familial hypertension.

METHODS

Volunteers were recruited and questioned as to their medical background and family history. Participants were divided into two groups based on history of familial hypertension and were measured for baPWV and faPWV. Carotid--femoral PWV was computed from these measurements.

RESULTS

A total of 82 healthy nonhypertensive volunteers (mean age 31.4 ± 9.6) were recruited. Among the study cohort, 43.7% had a history of familial hypertension. There were no between-group differences in any other clinical or demographic characteristics. Both baPWV and faPWV were significantly elevated in volunteers with a history of familial hypertension (10.86 ± 1.69 vs. 9.68 ± 1.52 m/s, P < 0.004, and 7.01 ± 1.65 vs. 6.28 ± 1.26 m/s, P < 0.028, respectively).

CONCLUSION

Volunteers with a history of familial hypertension present with elevated baPWV and faPWV. This is suggestive of increased central and peripheral arterial stiffness in susceptible individuals before the onset of hypertension. Routine measurement of these parameters may allow for early intervention and risk stratification, especially in persons with a history of familial hypertension.

Elevated glycosylated hemoglobin levels and their interactive effects on hypertension risk in nondiabetic Chinese population: a cross-sectional survey

Background

Abnormal glucose metabolism has been suggested to be involved in the development of hypertension. This study investigated the effect of the association and potential interaction of glycosylated hemoglobin (HbA1c) and other factors on the risk of hypertension among Chinese nondiabetic adults.

Methods

As a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. The HbA1c levels were quantified and grouped by quartiles. Correlations between HbA1c and hypertension, isolated systolic hypertension (ISH), and isolated diastolic hypertension (IDH) risk were investigated by logistic analyses. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively.

Results

In the current study, 1462 nondiabetic subjects were enrolled. In total, the prevalence rates of hypertension, ISH and IDH were 22.4, 9.6 and 4.5%, respectively. When HbA1c levels were grouped by quartile, it was revealed that the prevalence rates of hypertension and ISH were substantially elevated across groups (P_{for trend} < 0.001). In the multivariable logistic regression analyses, in comparison with the first quartile of HbA1c, the normalized OR for hypertension risk was 1.90 (95% CI: 1.28–2.80) for the highest quartile. Also, the risk of ISH was significantly increased with HbA1c level in the highest quartile relative to in the bottom quartile (OR: 2.23,95% CI:1.47–3.71). However, no significant relationship between the HbA1c level and IDH risk was observed (OR: 1.78, 95% CI: 0.82–3.84). Eventually, it was demonstrated from the interactive effect analysis that HbA1c significantly interacted with abdominal obesity (RERI: 1.48, 95% CI: 0.38–2.58; AP: 0.37, 95% CI: 0.14–0.60 and SI: 1.96, 95% CI: 1.06–3.62) and family history of hypertension (AP: 0.37, 95% CI: 0.05–0.70) in influencing the risk of hypertension in nondiabetic participants.

Conclusion

Higher HbA1c levels significantly enhanced the risk of hypertension and ISH, but not IDH among Chinese nondiabetic adults. Moreover, the risk of hypertension was also aggravated by the upregulated HbA1c in a synergistic manner alongside abdominal obesity and family history of hypertension.

Evidence on the causal link between homocysteine and hypertension from a meta-analysis of 40 173 individuals implementing Mendelian randomization

Numerous researchers have investigated the associations among methylenetetrahydrofolate reductase gene (MTHFR) C677T polymorphism, homocysteine (Hcy) concentration, and hypertension. However, the results are controversial. Thus, a meta-analysis implementing Mendelian randomization approach was conducted to examine the hypothesis that elevated Hcy concentration plausibly contributes to increased risk of hypertension. Based on several inclusion and exclusion criteria, eligible studies were selected to explore the correlation between MTHFR C677T and hypertension risk, MTHFR C677T and Hcy concentration in hypertension, and Hcy concentration and hypertension, and they were evaluated by odds ratios (ORs), effect size (ES), and standard mean difference with their corresponding 95% confidence intervals (95% CIs), respectively. Moreover, Mendelian randomization was implemented to evaluate the relationship between Hcy and hypertension. Consequently, 14 378 cases and 25 795 controls were involved in this study and the results showed that MTHFR C677T led to an elevated risk of hypertension (for T vs C: OR = 1.27, 95% CI = 1.17-1.37; for TT vs CC: OR = 1.53, 95% CI = 1.30-1.79). Additionally, in hypertensive subjects, the pooled Hcy concentration in individuals of TT genotype was 7.74 μmol/L (95% CI: 5.25-10.23) greater than that in individuals of CC genotype. Moreover, the pooled Hcy concentration in hypertensive was 0.69 μmol/L (95% CI: 0.50-0.87) greater than that in controls. The estimated causal OR associated with hypertension was 1.32 for 5 μmol/L Hcy increment. Via MTHFR C677T polymorphism, the findings in the present study demonstrated that there exists evidence on causal link between Hcy concentration and the risk of hypertension.