Clinical Hypertension最新文献

Background: There is limited evidence regarding the incidence and prognosis of apparent resistant hypertension (aRHT) in hypertensive patients. This study aimed to estimate the incidence of aRHT and assess the risk of cardiovascular and kidney complications in patients with aRHT compared to those without aRHT, using a multi-state analysis.

Methods: This retrospective cohort study utilized real-world data from hypertensive patients treated at Ramathibodi Hospital, Bangkok, Thailand, between January 2010 and June 2024. aRHT was defined as having uncontrolled blood pressure (BP), while using ≥ 3 antihypertensive medications or having controlled BP with using ≥ 4 antihypertensive medications. The outcomes of interest were cardiovascular and kidney complications including coronary artery disease (CAD), stroke, heart failure (HF), and chronic kidney disease (CKD), and all-cause mortality. A multi-state analysis was applied to estimate the risk of disease progression from hypertension without complications to aRHT, CAD, stroke, HF, CKD, and all-cause death. Kaplan-Meier estimates with a clock-reset approach were used to calculate transition probabilities for each progression. Multivariate Cox regression analysis was applied to assess the risk factors of aRHT and assess the prognosis of aRHT.

Results: Among 114,364 hypertensive patients, the incidence of aRHT was 2.61 per 100 person-years (95% confidence interval [CI], 2.56-2.65). Results from multivariate Cox regression analysis found that the independent risk factors of aRHT were increasing age, males, obesity, type 2 diabetes mellitus, dyslipidemia, and having cardiovascular and kidney complications including CAD, stroke, CKD, and HF. Regarding the prognosis of aRHT, compared to non-aRHT patients, those with aRHT had significant higher risk of CAD, CKD, HF, and all-cause mortality with hazard ratios (95% CI) of 1.80 (1.56-2.08), 1.93 (1.79-2.08), 4.24 (3.54-5.08), and 2.84 (1.89-4.27), respectively.

Conclusions: The risk of aRHT was higher in hypertensive patients with cardiovascular and kidney complications compared to those without. Patients with aRHT had a worse prognosis than hypertensive patients without aRHT, as evidenced by higher risks of CAD, CKD, HF, and all-cause death.

Background: High blood pressure (BP) in children and adolescents is a major public health concern globally, including in India. It is typically defined by BP > 95th percentile of normative BP distribution, with the American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG 2017) being most widely used. However, Indian-specific reference derived from healthy children set higher BP cut-offs than AAP-CPG 2017, leading to debate about their suitability. This study compares high BP prevalence using both references and examines how each classification by the 2 reference standards relates to cardiometabolic risk factors.

Methods: A secondary analysis of cross-sectional data from the Comprehensive National Nutrition Survey (2016-2018) was conducted to compare the prevalence of high BP in Indian adolescents aged 10-16 years using Indian and AAP-CPG 2017 references. The association between cardio-metabolic risk markers and high BP classified by these references was examined by survey weighted multiple log-binomial regression to examine the validity of each reference standard.

Results: In young adolescents aged 10-12 years, the prevalence of high BP was 16% (95% confidence interval [CI], 13.6-19%) and 33.6% (95% CI, 30.4-37%) by Indian and AAP-CPG reference respectively. Similarly, in older adolescents aged 13-16 years, the prevalence of high BP was lower with Indian reference. The adjusted risk ratios (ARRs) for high triglycerides, total cholesterol, and low-density lipoprotein were significantly elevated in young adolescents with high BP by AAP-CPG 2017 reference but not with Indian reference.

Conclusions: The prevalence of high BP among Indian adolescents differed significantly based on the BP reference standard used. Clustering of cardiometabolic risk markers with high BP was observed when using the AAP-CPG reference but not with Indian reference. However, these findings should be interpreted cautiously given the cross-sectional study design with single visit BP measurement and limited generalizability of the Indian BP reference standard. Larger, nationally representative studies using standardized BP measurement methods are essential to establish validated BP norms for Indian adolescents.

Background: Uncontrolled hypertension is a major modifiable risk factor for cardiovascular diseases. This study evaluated the effectiveness of the Uncontrolled Hypertension Treatment Intervention in Nursing Model (UHTINuM), a nurse-led, integrative, multimodal intervention combining yoga, adherence education, and home blood pressure (BP) monitoring.

Methods: In this single-blind, randomized controlled trial, 48 adults aged 50-65 years with uncontrolled hypertension were randomized 1:1 to receive either the 12-week UHTINuM program or usual care. The intervention included structured group yoga sessions, individualized adherence education, and home BP self-monitoring with telefeedback. Primary outcomes were systolic and diastolic BP, perceived stress, and medication adherence. Secondary outcomes were body mass index (BMI) and physical activity level. Analyses were conducted using the intention-to-treat principle.

Results: Compared with controls, the intervention group achieved significantly greater reductions in systolic BP (mean difference = -21.8 mmHg; 95% confidence interval [CI], -25.9 to -17.6) and diastolic BP (-11.4 mmHg; 95% CI, -14.9 to -7.9). Perceived stress decreased by -4.2 points (95% CI, -6.3 to -2.1), and adherence improved by -3.1 points (95% CI, -4.8 to -1.3). Secondary outcomes also favored the intervention group, with a modest reduction in BMI (-0.7 kg/m²; 95% CI, -1.1 to -0.3) and a shift from inactive to minimally active physical activity levels in 58% of participants.

Conclusions: The multimodal, nurse-led UHTINuM intervention integrating yoga, education and self-monitoring significantly improved BP control, reduced stress and enhanced medication adherence in middle-aged adults with uncontrolled hypertension. Implementing similar integrative strategies could bolster community hypertension management.

Trial registration: ClinicalTrials.gov Identifier: NCT04809519.

This scoping review conducted from April 1, 2025, to May 31, 2025, aims to use palliative care as a valuable opportunity to reduce polypharmacy and enhance patient-centered care in the final days of life. To conduct this scoping review with systematic components, a database search was conducted on PubMed and EBSCO to identify studies focused on deprescribing cardiovascular medications in patients subject to polypharmacy in nursing homes. Eligible studies were inclusive of human patients aged 65 and older, patients receiving palliative care or with a limited life expectancy and focused on examining the effects of deprescribing practices and other outcomes affected. Study quality was assessed using the Cochrane Risk of Bias assessment tools RoB-2 and ROBINS-I. The quality assessment was performed by two reviewers, and discretion was discussed until consensus was achieved. In total, 31 studies met the inclusion criteria and were included in the discussion of the review, and 11 of those were included in the quantitative data analysis. There was a notable variation in both baseline medication uses and rates of discontinuation seen across the studies. Rates of deprescribing for antihypertensives varied widely, reported as low as 16.6% in large retrospective cohort studies and as high as 87.8% in structured intervention trials using specified guideline tools such as STOPPFrail. Deprescribing should be routine in palliative assessments, guided by frameworks that consider prognosis, symptoms, and patient values. Limitations of this scoping review include heterogeneity of the studies, which limits direct comparability between them and difficulty in generalizing the findings to a broader palliative care population and assessing the quality of life (QoL) as only a few studies used a validated instrument or patient outcome, but not all were able to assess them in the same manner. Due to the need for properly structured deprescribing guidelines, physicians lack the time and tools to utilize shared decision making to their advantage in many places. The findings from this review suggest that a tailored deprescribing strategy could effectively complement traditional pharmacological treatments by decreasing potential adverse effects and medication burden in vulnerable populations, especially those diagnosed with cardiovascular disease.

[This retracts the article 3 in vol. 22, PMID: 26973794.].

Background: The optimal treatment for individuals with high-normal blood pressure (BP, systolic BP 130-139 mmHg and diastolic BP < 90 mmHg) is debated. This study evaluates whether pharmacologically reducing systolic BP to below 130 mmHg could prevent major adverse cardiovascular events (MACE) in high-normal BP cases with no comorbidities and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5%.

Methods: In this randomized, controlled, parallel, unicentric trial, participants were assigned to either an intervention group (pharmacotherapy plus diet control) or a control group (diet control only). The study aimed for 1,600 participants but was terminated after the first phase due to limited resources and recruitment challenges. Fixed-dose combinations of valsartan and amlodipine were administered as BP-lowering agents. Follow-up visits every 3 months adjusted pharmacotherapy to maintain systolic BP < 130 mmHg in the intervention group and < 140 mmHg in the control group. MACE was the primary endpoint, with its components (cardiovascular death, myocardial infarction, stroke, and heart failure) as secondary endpoints. Multivariable Cox regression analysis was utilized to compare the group endpoints.

Results: Of 14,562 screened individuals, 231 in the intervention and 235 in the control group were included in the final intention-to-treat analysis. At baseline, the control group had a slightly higher mean age than the intervention group (67.7 vs. 66.1 years; P = 0.013). Females comprised a minority in both groups (19.5% in intervention vs. 16.2% in control; P = 0.397). The mean 10-year ASCVD risk was slightly higher in the control group (17.4% vs. 15.9%; P = 0.013). The MACE occurred in 9 participants (1.57 per 100 person-year) in the intensive treatment group vs. 24 (4.16 per 100 person-year) in the control group (adjusted hazard ratio [aHR], 0.26; 95% confidence interval [CI], 0.11-0.62; P = 0.003). The incidence of serious adverse events (hypotension, syncope, injurious falls, electrolyte imbalances, or acute kidney injury) was similar between the groups (aHR, 1.47; 95% CI, 0.82-2.62; P = 0.195).

Conclusions: PRINT-TAHA9 findings suggest that pharmacological BP reduction may benefit healthy asymptomatic individuals with high-normal BP and ASCVD risk ≥ 7.5%.

Trial registration: Iranian Registry of Clinical Trials Identifier: IRCT20191002044961N1.

Background: Hypertension is a leading risk factor for cardiovascular disease and mortality. It is often treated as a uniform entity despite evidence highlighting distinct outcomes associated with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic-diastolic hypertension (SDH). ISH predominates in older adults and is linked to adverse outcomes through arterial stiffness and increased pulse pressure, whereas IDH is more common in younger populations, with unclear long-term mortality implications. In this study we aim to explore differences in mortality between ISH, IDH and SDH in the general population and in patients with coronary artery disease (CAD).

Methods: We conducted a longitudinal analysis using National Health and Nutrition Examination Survey data (1999-2020), examining 47,582 adults aged 20 to 84. Participants were categorized by hypertension subtypes: ISH, IDH, SDH, or normotensive. Mortality data (1999-2018) were obtained via the National Death Index. Primary outcomes included demographic and clinical differences across groups; secondary outcomes assessed all-cause mortality using weighted logistic regression and Kaplan-Meier survival analysis. Analyses were stratified by CAD status and adjusted for key sociodemographics and comorbidities.

Results: ISH patients were older (mean age 65.9) with higher Medicare coverage and lower education levels; IDH patients were younger, predominantly male, and more likely to be uninsured. Age-adjusted mortality was highest in ISH (adjusted odds ratio [aOR], 1.32, 95% confidence interval [CI], 1.24-1.41), followed by SDH (aOR, 1.60, 95% CI, 1.39-1.84). IDH showed no significant mortality risk at blood pressure (BP) ≥ 130/80 but demonstrated increased risk at diastolic BP ≥ 90 mmHg (aOR, 1.45, 95% CI, 1.12-1.89). ISH remained a significant mortality predictor after adjusting for age. IDH showed a shift from apparent protection in unadjusted models to risk after adjustment, suggesting heterogeneity based on age and severity.

Conclusions: This study sheds focus on systolic and diastolic components of hypertension. ISH is associated with increased mortality, independent of age, and should prompt prioritizing systolic control. IDH-more prevalent in younger adults-warrants age-specific management strategies. Findings support differential treatment thresholds for hypertension subtypes and underscore the need for longitudinal studies to better define IDH's long-term risk.

Background: Pulmonary arterial hypertension (PAH) leads to heart failure, with limited treatment options to prevent adverse remodeling and metabolic dysfunctions. Exercise and bioactive compounds like blueberry extract show potential, but their combined effects are unclear. We tested if combining resistance exercise training (RT) and blueberry extract could protect against cardiac and skeletal muscle remodeling and metabolic disruptions in monocrotaline (MCT)-induced PAH.

Methods: Male rats received MCT (60 mg/kg), blueberry extract (100 mg/kg/day), and RT (ladder climbing; 15 climbs at 55-65% max load, 5 times/week). Exercise tolerance, blood lactate levels, and echocardiography were assessed. After euthanasia, heart and biceps brachii were analyzed. RT and blueberry attenuated mortality, weight loss, and exercise intolerance in hypertensive rats.

Results: Both interventions reduced pulmonary artery resistance and partially prevented right ventricular (RV) pressure overload and dysfunction, while their combination fully preserved left ventricular function. Hypertension-induced cardiac myocyte remodeling was mitigated by both interventions, with RT improving contractile function, whereas blueberry had no effect. Both treatments reduced oxidative stress and improved metabolic biomarkers in the RV. Blueberry preserved hypertrophy signaling pathways, while RT increased phospho (p)-Akt expression. Both interventions partially prevented reductions in p-mTOR, p-4E-BP1, and eIF4E, with their combination fully preserving these markers.

Conclusions: RT program and blueberry extract employed, either alone or in combination, demonstrated protective effects against the progression of cardiac and skeletal muscle remodeling and metabolism disruptions in the MCT-induced PAH model.

Background: Isometric resistance exercise has been shown to reduce blood pressure (BP), particularly when involving large muscle groups. Isometric plank exercise (IPE), which elicits extensive muscle activation, may offer similar benefits; however, its acute effects on ambulatory blood pressure monitoring (ABPM) and variability remain unclear. This study aimed to examine the acute effects of IPE on ABPM, blood pressure variability (BPV) and ambulatory arterial stiffness index (AASI) in young adults with prehypertension.

Methods: Twelve young adults (mean age, 26.4 ± 5.4 years) with prehypertension (systolic BP [SBP] 120-139 mmHg or diastolic BP [DBP] 80-89 mmHg) participated in a randomized cross-over trial. Each participant completed 2 sessions in random order: 1) 4 × 2-minute IPE session with 1-minute rest, and 2) a non-exercise control session. Office BP was measured at baseline, 30 minutes, and 90 minutes post-trial. ABPM, BPV and AASI were recorded over the following 24 hours.

Results: A significant interaction effect was observed for systolic office BP (P = 0.009), with post-hoc analysis revealing a significant reduction at 90 minutes post-IPE session (P = 0.048). Twenty-four-hour average systolic and DBP were significantly lower in the IPE session compared to control session (P = 0.004, P = 0.031, respectively). In addition, both daytime SBP (P = 0.020) and nighttime DBP (P = 0.014) significantly decreased after the IPE session. Nighttime systolic BPV was also significantly decreased after the IPE session (P = 0.040). No significant changes were observed in other BPV index and AASI.

Conclusions: IPE significantly reduced 24-hour SBP and DBP and improved nighttime BP variability in young adults with prehypertension. These findings provide preliminary evidence that IPE may serve as a potential nonpharmacologic strategy for early BP management. Large-scale interventional studies are warranted to confirm and extend on these effects.

Background: Indirect estimates of pulse wave velocity (PWV) have been proposed as a feasible alternative for PWV assessment in clinical practice; however, their validity and clinical applicability remain uncertain. This study aimed to evaluate the relationships between indirect measures of arterial stiffness and directly measured PWV to determine their potential utility in clinical settings.

Methods: In this multicentre, international study, data from 4,206 individuals from Brazil, Greece, Korea, and Australia were analysed. The relationships between estimated PWV (ePWV), 24-hour (24h)-pulse pressure (PP), Early Vascular Aging Ambulatory Score (EVAAS), and carotid-femoral (cf-PWV) and/or brachial-ankle (ba-PWV) PWV were assessed through correlation and multivariate linear regression analyses. Subgroup-specific associations were also examined.

Results: The study population had a mean age of 57.6 ± 14.3 years, with 42.5% being male and 82.1% having pre-existing hypertension. After adjusting for multiple factors related to arterial stiffness, ePWV demonstrated a strong association with cf-PWV (β = 0.599, P < 0.001) and ba-PWV (β = 1.342, P < 0.001). 24h-PP and EVAAS showed moderate associations with both cf-PWV and ba-PWV. Subgroup analyses indicated that ePWV correlated more strongly with both cf-PWV and ba-PWV in individuals without traditional cardiovascular risk factors.

Conclusions: ePWV may be used as a surrogate marker for arterial stiffness, particularly in individuals without major cardiometabolic comorbidities. Although 24h-PP and EVAAS are also associated with PWV, their clinical utility varies across subgroups. Future research should explore their role in improving cardiovascular risk prediction and guiding personalized treatment strategies for vascular aging.

Trial registration: PROSPERO Identifier: CRD420250618863.