Yinong Jiang

Sun K, et al. Korean Circ J. 2027 ;57:e25. https://doi.org/10.4070/kcj.2026.0038

This study sought to establish age‐specific optimal cut‐off values for the aldosterone‐to‐renin ratio (ARR) in screening for primary aldosteronism (PA). The analysis included 281 patients with confirmed PA and 1242 with essential hypertension (EH), categorized into four age groups: ≤39, 40–49, 50–59, and ≥60 years. A positive correlation was observed between ARR and age in both patient groups. Receiver operating characteristic analysis determined the optimal ARR cut‐offs to be 2.3, 2.8, 3.1, and 3.6 for the respective age groups, with all demonstrating high diagnostic accuracy. Further evaluation revealed that for patients under 50‐years‐old, a unified ARR cut‐off of 2.4 provided high sensitivity and specificity, while for patients aged 50 or older, a cut‐off of 3.7 was more appropriate. In conclusion, the optimal ARR cut‐off for PA screening increases with age, and we recommend using a value of 2.4 for patients under 50 and 3.7 for those aged 50 or older to achieve superior diagnostic performance.

This study aimed to explore the effects of allisartan in mild‐to‐moderate essential hypertension. This is a randomized, double‐blind, crossover design involving 98 patients with mild‐to‐moderate essential hypertension. Participants were randomized and divided into two groups: Group A (baseline—olmesartan—allisartan) and Group B (baseline—allisartan—olmesartan). Each treatment phase included 12 weeks, and participants were administered allisartan (240 mg) or olmesartan (20 mg) once daily. After treatment, both allisartan and olmesartan led to a significant decrease in systolic blood pressure (SBP) levels from baseline (Δ = 6.50 mmHg, p < 0.001 and Δ = 5.64 mmHg, p = 0.002, respectively), with no significant difference between the two drugs. Notably, allisartan led to a significant decrease in diastolic blood pressure (DBP) levels from baseline (Δ = 3.39 mmHg, p = 0.016), while olmesartan did not (Δ = 2.09 mmHg, p = 0.126), allisartan exhibited a more pronounced reduction in DBP compared to olmesartan (Δ = 3.66 mmHg, p = 0.001). Allisartan significantly dropped serum UA levels (Δ = 26.37 µmol/L, p < 0.001), whereas olmesartan did not achieve a significant reduction compared to allisartan (Δ = −7.26 µmol/L, p = 0.991). In terms of cardiac and artery stiffness, allisartan demonstrated significant reductions in left atrial volume index (LAVI; Δ = 2.86 mL/m², p < 0.001), left ventricular mass index (Δ = 4.82 g/m², p = 0.010) and ankle‐brachial pulse wave velocity (baPWV) (Δ = 154.49 cm/s, p < 0.001), all‐surpassing olmesartan significantly (all p < 0.01). In Conclusion, allisartan 240 mg and olmesartan 20 mg once daily achieve broadly similar reductions in blood pressure, improving left heart structure and function, mitigating arterial stiffness in individuals with mild‐to‐moderate essential hypertension. Compared to olmesartan, allisartan demonstrates significant reductions in serum UA.

Aims: Migraine is a prevalent and incapacitating condition. The association between patent foramen ovale (PFO) and migraine-type headaches has been extensively documented. In clinical practice, patients may observe residual shunting after PFO closure. Nevertheless, the underlying mechanisms affecting residual shunting after PFO closure remain unclear. Recent studies have identified left atrial abnormalities, specifically atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation (AF), left atrial thrombosis, and subsequent stroke. To that end, the present study aims to investigate the relationship between residual shunt occurrence after PFO closure and atrial cardiopathy. Methods: A retrospective analysis comparing postoperative residual shunts in patients with and without atrial cardiopathy was conducted. The study cohort consisted of 174 patients with severe migraine and confirmed right-to-left shunt (RLS) (grades II-IV) who voluntarily opted for PFO closure between April 1, 2021, and December 31, 2022. Enrolled patients were categorized into two groups: PFO with or without atrial cardiopathy. Results: A total of 174 migraineurs who underwent PFO closure (PFO with atrial cardiopathy group, n = 20; PFO without atrial cardiopathy group, n = 154) were included. Compared to patients without atrial cardiopathy, those with atrial cardiopathy were older (54.85 ± 11.86 vs. 43.03 ± 13.78 years, p = 0.0003), had a higher prevalence of hypertension (30.00% vs. 11.69%, p = 0.0255), and a higher prevalence of diabetes mellitus (10.00% vs. 1.30%, p = 0.0146). Following fully adjusted multivariate logistic analysis, atrial cardiopathy (OR = 0.119; P = 0.046), BMI (OR = 0.875; P = 0.025) and atrial septal aneurysm (OR = 5.465; P = 0.028) were identified as independent predictors for residual right-to-left shunt. Conclusions: The presence of atrial cardiopathy in patients with severe migraine and PFO was inversely associated with residual shunting following PFO closure.

Background: Salt substitution (SS) has been found to reduce blood pressure (BP). However, the impact of SS on cardiac structure, as assessed through ultrasonic cardiogram (UCG) and electrocardiograms (ECG), remains poorly understood. This study aims to evaluate the effects of SS on cardiac structure and ECG parameters. Methods: This 12-month prospective, multi-center, randomized, double-blind study involved hypertensive patients aged 50 to 70 years with office systolic BP (SBP) ranging from 140 to 180 mmHg and diastolic BP (DBP) ranging from 90 to 110 mmHg. A total of 352 patients were enrolled and equally randomized to either the normal salt (NS) group or SS group. Office BP measurements (OBPM) were obtained at baseline and at 3, 6, and 12 months, while home BP measurements (HBPM) were recorded at baseline, 3, 6, 9, and 12 months. Fasting blood, UCG, and ECG parameters were obtained at baseline and at the end of the study. Results: Of the 352 enrolled patients, 322 completed the study. In the SS group, the reductions in systolic OBPM, HBPM, and diastolic HBPM were significantly greater than those in the NS group. Notable cardiac parameter changes included a reduction in QT dispersion (QTd) by –5 ms (–10, 5) in the NS group and –5 ms (–15, 0) in the SS group (p = 0.001); the T wave peak-to-end (Tp-e) value was 0 ms (–5, 10) and –5 ms (–10, 0) (p < 0.001), respectively; and Tp-e/QT was 0 (–0.01, 0.02) and –0.02 (–0.04, 0) (p < 0.001), respectively. Additionally, left atrial diameter (LAD) was 0 mm (–1, 1) and –1 mm (–2, 1) (p < 0.001), and the change in left ventricular mass (LVM) was –2 g (–17.75, 11) and –7 g (–18, 6) (p = 0.035), respectively. Conclusions: This study demonstrates that SS not only significantly decreased LAD and LVM, indicating a significant effect on cardiac structure, but also improves UCG parameters, including reductions in QTd, Tp-e, and Tp-e/QT. These findings highlight the potential of SS as a beneficial intervention in managing cardiac risks in hypertensive patients. Clinical Trial Registration: ChiCTR1800019727. (https://www.chictr.org.cn/showproj.html?proj=31036).

Background: Low-sodium (LS) salt substitution is recognized for its potential to reduce blood pressure (BP), but most research relies on office BP measurement (OBPM). There is a lack of data on salt substitution’s effect on target organs, such as the kidney as measured by the urine albumin-to-creatinine ratio (UACR), and its impact on inflammatory cytokines, particularly high-sensitivity C-reactive protein (hs-CRP). To evaluate the effect of LS salt substitution on ambulatory BP measurement (ABPM), kidney function, and inflammation in middle-aged and elderly hypertensive patients. Methods: In this 12-month prospective, multi-center, randomized, double-blind study, 352 hypertensive patients were randomly assigned to the normal salt (NS) group (n = 176) or the LS group (n = 176) at a 1:1 ratio. ABPM, fasting blood, and morning first spot urine samples were obtained at baseline and the endpoint. Results: Of the 352 patients, 322 completed all follow-up surveys, and 301 underwent ABPM. In the LS roup, significant reductions were observed in 24-hr systolic BP (–2.3 mmHg), 24-hr diastolic BP (–1.5 mmHg), daytime systolic BP (–2.6 mmHg), daytime diastolic BP (–1 mmHg), and nighttime systolic BP (–0.1 mmHg) compared to the NS group (all p < 0.05). However, the change in nighttime diastolic BP was not statistically significant (–0.3 vs. 1.1 mmHg, p = 0.063). Additionally, the LS group showed a more substantial decrease in UACR (–2.05 vs. –7.40 µg/mg, p = 0.004) and hs-CRP (–0.06 vs. –0.24 mg/L, p = 0.048) compared to NS. Conclusions: LS salt substitution significantly decreased ABPM, suggesting a notable impact on hypertension. Furthermore, it demonstrated a protective impact on kidney function, as evidenced by changes in UACR. Additionally, LS salt substitution appeared to reduce inflammation, indicated by the decrease in hs-CRP levels. Clinical Trial Registration: The study was registered in the Chinese clinical trial registry (registration number: ChiCTR1800019727).

We aimed to investigate the association between hemoglobin A1c (HbA1c) and left atrial (LA) stiffness in patients with hypertension and to explore the mediating effect of the neutrophil/lymphocyte ratio (NLR) on this association. Essential hypertensive patients (n = 292) aged 18–83 years were enrolled and divided into two groups based on the LA stiffness index (LASI): Group I (LASI ≤ 0.32, n = 146) and Group II (LASI > 0.32, n = 146). The LASI was defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/eʹ) to LA reservoir strain. Multivariate linear regression analysis was performed to determine the independent predictors of the LASI. Age, BMI, SBP, HbA1c, CRP, and NLR were significantly greater in Group II than in Group I (P < 0.05). Additionally, Group II had a greater LA volume index (LAVI), left ventricular mass index (LVMI), and early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/eʹ) and lower LA reservoir, conduit, and booster pump strains than Group I (P < 0.001). Univariate and multivariate linear regression models revealed that age, SBP, HbA1c, and the NLR were independently associated with the LASI. Further mediation analysis was performed to determine the mediating effect of the NLR on the association between HbA1c and the LASI and revealed that the NLR had a mediating role only in overweight hypertensive patients, and the proportion of the mediating effect was 21.9%. The NLR was independently correlated with the LASI and played a mediating role in the relationship between HbA1c and the LASI in overweight hypertensive patients.

Background: To explore the diagnostic accuracy and the optimal cutoff value between the saline infusion test (SIT) and captopril challenge test (CCT) [including the value and suppression of plasma aldosterone concentration (PAC)] for primary aldosteronism (PA) diagnosing.Methods: A total of 318 patients with hypertension were consecutively enrolled, including 126 patients with PA and 192 patients with essential hypertension (EH), in this observational study. The characteristics of patients and laboratory examinations were collected and compared. The comparison between SIT and CCT was carried by drawing the receiver operator characteristic curve (ROC) and calculating the area under the curve (AUC) to explore the diagnostic accuracy and the optimal cutoff value.Results: The average age was 51.59 ± 10.43 in the PA group and 45.72 ± 12.44 in the EH group (p<0.05). The optimal cutoff value was 10.7 ng/dL for post-CCT PAC, 6.8 ng/dL for post-SIT PAC, and 26.9% for suppression of post-CCT PAC. The diagnostic value of post-CCT PAC was the highest with 0.831 for the AUC and 0.552 for the Youden index. The optimal cutoff value for patients who were <50 years old was 11.5 ng/dL for post-CCT PAC and 8.4 ng/dL for post-SIT PAC. The suppression of post-CCT PAC turned to 18.2% for those of age 50 or older.Conclusion: Compared with SIT, CCT had a higher diagnostic value when post-CCT PAC was used as the diagnostic criterion in Chinese people, while the selection of diagnostic thresholds depended on patient age.