The pathogenesis of high blood pressure

1. Pathogenesis and risk factors

The Tobago Health Study conducted a prospective Longitudinal study among men of African descent, using CT to measure the attenuation of fat tissue and skeletal muscle between the legs of participants. After adjusting for baseline body mass index (BMI) and 6-year changes in BMI, it was found that changes in skeletal muscle fat content can predict the occurrence and development of subsequent hypertension. Rocha Penha et al. investigated Myeloperoxidase in pregnancy induced hypertension and its effect on nitric oxide injury induced by vasodilator. The results showed that preeclampsia and pregnancy induced hypertension patients without antihypertensive treatment showed higher levels and activities of Myeloperoxidase, respectively.

In addition, inhibition of Myeloperoxidase activity can improve the bioavailability of nitric oxide in vitro. This study shows that hypertensive pregnant women have a high cardiovascular risk, and activated Myeloperoxidase may play a role in endothelial dysfunction by inhibiting nitric oxide activity. In addition, the use of antihypertensive drugs seems to reduce the level of Myeloperoxidase, indicating that these drugs have new protective effects.

Zeiler et al. conducted a meta-analysis of the whole genome expression profile of Monocyte based on two populations, including 2549 subjects, in order to identify Transcriptome components related to blood pressure. Two independent whole blood Transcriptome data containing 1990 subjects were repeated. For the identified candidate genes, the direct association between long-term blood pressure changes and gene expression and treatment for blood pressure reduction was evaluated. To analyze the predictive value of protein level encoded by candidate genes for subsequent cardiovascular diseases.

The results showed that eight Transcriptome components (CRIP1, MYADM, TIPARP, TSC22D3, CEBPA, F12, IMNA and TPPP3) Co-determination blood pressure variability up to 13%. Among the eight Transcriptome components, the changes of CRIP1, MYADM, TIPARP, LMNA, TSC22D3, CEBPA and TPPP3 are related to the changes of blood pressure. In addition, the expression of CRIP1 gene is related to myocardial hypertrophy.

This study conducted a comprehensive analysis of the whole gene expression, identified eight new Transcriptome significantly related to blood pressure, and provided a link between gene expression and blood pressure. The ESCAPE study selected a total of 41072 subjects from Norway, Sweden, Denmark, Germany, and the Fourth Class to investigate the effects of exposure to European air pollution on human health

Period impact. The research results suggest that among adults, the risk of developing hypertension is significantly higher for every 100 people in the same age group living in the most polluted urban areas than for those living in less polluted areas. Another concave study included 32 related observational epidemiological studies, covering nearly 265000 subjects. The meta-analysis suggests that noise exposure may be a risk factor for hypertension, and the higher the noise, the higher the risk of hypertension. Summary analysis shows that living or working in a noisy environment increases the risk of hypertension by 62% compared to the general population; There is a dose-response relationship between the level of noise and the risk of hypertension. For every 10 decibels increase in noise, the risk of hypertension increases by 6%. The research results suggest that noise or hypertension are risk factors.

A study on rural China included 10265 adults aged ≥ 18 who underwent physical examinations from 2007 to 2008. The study subjects were divided into the following groups based on gender and waist circumference increase ratio:<2.5%, 2.5%, 2.6-5%, and>5%. After an average of 6 years of follow-up, the research results indicate that waist circumference has increased among rural populations in China

It is significantly associated with an increased risk of hypertension. Yankey et al. combined the use of cannabis with the mortality data of the International Health Statistics Center in 2011 to assess the relationship between the use of cannabis and the duration and the death of hypertension, heart disease and Cerebrovascular disease, control cigarette use and Demography variables.

Hypertension death includes many causes, such as primary hypertension and Hypertensive kidney disease. The results show that marijuana users have a higher risk of death from hypertension. Compared to not smoking marijuana, marijuana users have a 3.42-fold higher risk of hypertension death, with an annual increase of 1.04 in risk. The management of hypertension in the elderly has a prevalence rate of 49%, significantly higher than that of the middle-aged and young population; The prevalence rate of elderly hypertensive patients is over 90%. In addition, elderly hypertensive patients have the characteristics of multiple comorbidities, low control rate, and poor prognosis, and their blood pressure control cannot be ignored.

From the perspective of Pathophysiology, elderly hypertensive patients are often accompanied by Arteriosclerosis and decreased elasticity, left ventricular hypertrophy and diastolic function, decreased baroreceptor sensitivity, decreased renal function/impaired water salt metabolism, insulin resistance/abnormal glucose metabolism, and decreased endocrine function. Therefore, antihypertensive treatment for elderly patients with hypertension should balance benefits and risks, ensuring that antihypertensive treatment can bring benefits such as reducing cardiovascular events, stroke risk, and prolonging lifespan to patients.

A study conducted a cohort analysis of elderly hypertensive patients (aged ≥ 80 years) who received antihypertensive drug treatment without baseline dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure. According to the systolic blood pressure of the subjects, they were grouped at intervals of 10 mm Hg from<125 mmHg (1mm Hg=0.133 kPa) to ≥ 185 mm Hg, with 145 to 154 mm Hg as a reference. The research results show that for elderly hypertensive patients aged ≥ 80 years without comorbidities, systolic blood pressure<135 mm Hg is associated with higher mortality rates

Sex. Bakris and Briasoulis were selected from 10857 elderly hypertensive patients and randomly divided into an enhanced blood pressure control group (5437 cases) and a standard blood pressure control group (5420 cases). They were followed up for an average of 3.1 years and their beneficial outcomes (major adverse cardiovascular events, cardiovascular death, stroke, myocardial infarction, heart failure, and severe non hypertension) were evaluated

Analysis of good events and renal failure. The results indicate that for elderly patients, strengthening blood pressure control benefits the cardiovascular system while potentially increasing the risk of adverse events.

Weiss et al. systematically reviewed the impact of intensive and general blood pressure control on prognosis in elderly hypertensive patients. This study was selected into 21 Randomized controlled trial, of which 9 studies provided strong clinical evidence: controlling blood pressure below 150/90 mm Hg can reduce all-cause mortality by 10%, cardiovascular events by 23% and stroke by 26%. Six trials have provided general clinical evidence: controlling blood pressure at<140/85 mm Hg can reduce cardiovascular mortality by 18%, stroke by 2l%, and non-specific mortality by 14%. Low to moderate evidence shows that Hypotension goals do not increase falls and cognitive impairment. This study suggests that at least currently, setting blood pressure<150/90 mm Hg can improve the prognosis of elderly hypertensive patients.

The American College of Physicians and the American College of Family Physicians have jointly issued an evidence-based clinical guideline that recommends the use of moderate systolic blood pressure target values for hypertensive patients aged ≥ 60 years old. The American College of Physicians and the American College of Family Physicians have developed three recommendations for patients aged ≥ 60: (1) Elderly patients with systolic blood pressure ≥ 150 mm Hg need to initiate antihypertensive treatment to reduce mortality, stroke, and heart events (high-quality evidence); (2) Elderly patients with a history of stroke or Transient ischemic attack should consider starting or strengthening drug treatment to reduce systolic blood pressure to<140

Mm Hg to reduce the risk of stroke recurrence (medium quality evidence); (3) High risk cardiovascular patients are considering initiating or intensifying medication therapy to reduce systolic blood pressure to<140mm Hg to reduce the risk of stroke and cardiac events (low-quality evidence). At the same time, it is pointed out that the evidence shows that the additional benefits of actively controlling blood pressure are minimal, and the outcomes of patients after intensive antihypertensive treatment are not entirely consistent. The target value<150 mm Hg can benefit most elderly patients, regardless of whether they have diabetes or not.

Wu et al. followed up 7492 subjects aged ≥ 65 years for 6 years, and 1/4 of the subjects died. After adjusting for confounding factors, among elderly individuals with weaker grip strength, those with increased systolic and diastolic blood pressure had a 6% and 16% lower risk of death, respectively. The study also suggests that frail elderly people often have poor reactions to antihypertensive drugs, and lowering blood pressure to lower levels does not benefit them. In addition, this result is consistent with the individualized treatment concept, and elderly patients should not only consider their age, but also their physical functional status.

The VALISH study recruited elderly individuals with systolic blood pressure ≥ 160 mm Hg and diastolic blood pressure<90 mm Hg (3035 cases; average age 76 years old). According to the target blood pressure achieved by the patient's treatment, they were divided into three groups: the systolic blood pressure<130 mm Hg group (317 cases), the 130-145 mm Hg group (2025 cases), or the>145 mm Hg group (693 cases). The results showed that among the elderly patients with isolated systolic hypertension in Japan, the patients with systolic blood pressure between 130 and 145 mm Hg had the least adverse prognosis, and cardiovascular disease and all-cause mortality also decreased.

Ho and Nation evaluated the memory protection effect of Angiotensin II receptor antagonist on the elderly. 1626 elderly non manic subjects were selected in this study and divided into Angiotensin II receptor antagonist group, other antihypertensive drugs group and normal blood pressure control group. The results showed that Angiotensin II receptor antagonists could protect the memory of elderly hypertensive patients through the Blood–brain barrier. Corrao et al. evaluated whether adherence to antihypertensive drugs in patients aged 85 or older reduces the risk of cardiovascular events. The results showed that the compliance of taking antihypertensive drugs was good, which could reduce the risk of cardiovascular disease in patients aged ≥ 85 years.