Hypertension Research最新文献

It remains unclear whether poor cardiovascular outcomes are associated with the longitudinal changes in inter-arm blood pressure (BP) difference. We aimed to investigate the role of repeated BP measurement in bilateral arms in predicting all-cause mortality. A total of 27,147 hypertensive participants aged ≥18 years (56.6% women; mean age, 67.1 years) were selected from the basic public health system of Samming city and underwent repeated bilateral BP measurement at two health checkups in 2013 and 2018. Multivariable-adjusted Cox regression was used to relate future mortality with change in inter-arm BP difference. The absolute inter-arm difference ≥10 mmHg increased from 12.6 to 13.3% for systolic and 8.18 to 8.27% for diastolic BP over 5 years apart. When assessed using the dichotomous cutoff of 10 mmHg for inter-arm systolic/diastolic BP difference at two examinations, 76.1%/84.4% remained persistently low and 2.00%/0.87% persistently high, and 11.3%/7.40% of the participants changed from low to high and 10.6%/7.31% from high to low. During a median follow-up of 5.43 years, 1703 (6.27%) deaths occurred. Participants who had persistently elevated absolute values of inter-arm BP difference over 5 years were at higher risk for all-cause mortality with adjusted hazard ratios amounting to 1.47 (95% CI: 1.10-1.98; P = 0.010) for systolic BP and 1.68 (95% CI: 1.10-2.56; P = 0.016) for diastolic BP. Repeated bilateral BP measurement indicated that persistently increased absolute levels of inter-arm BP difference over time were associated with future mortality, highlighting that repeated bilateral BP measurements may provide additional risk information for hypertension management.

Whether chronological age affects the ability of vascular aging indicators to predict cardiovascular events risk remains unknown. This study sought to examine whether the predictability of vascular aging indicators is better in middle-aged participants than older participants. This prospective cohort study included 8163 participants from a community-based atherosclerosis cohort in Beijing, China. Vascular age (VA) was defined as the predicted age in a multivariable regression model including cardiovascular risk factors and pulse wave velocity. Residuals by regressing VA on chronological age were defined as ∆-age, reflecting vascular aging. We used Cox proportional hazard regression model to examine the association between ∆-age and the risk of cardiovascular events in different chronological age groups. Of all participants, 5691 (69.7%) were between 40 and 60 years old, and 2472 (30.3%) were over 60 years old. During a median 9.9-year follow-up period, 818 (10%) endpoints were observed. After adjusting for confounders, ∆-age was positively associated with the risk of cardiovascular events in middle-aged participants (HR: 1.13, 95% CI: 1.07-1.21; p < 0.001), whereas no significant association was observed in older participants (HR: 1.03, 95% CI: 0.99-1.06; p = 0.148). Interaction analysis in total participants showed that chronological age significantly modified the relationship between ∆-age and the risk of cardiovascular events (p = 0.017). Our findings indicate that the predictive ability of residuals between VA and chronological age for the risk of cardiovascular events is better in middle-aged people than that in older people. The VA assessment may be more valuable to the middle-aged population. The modifying effect of chronological age showed that vascular aging categories in middle-aged participants have stronger predictive ability for the risk of cardiovascular events than that in older participants. MACE, a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular mortality; normal VA, normal vascular aging; EVA, early vascular aging; SUPERNOVA, supernormal vascular aging.

Background: Non-adherence to antihypertensive regimens undermines both hypertension therapy and the validity of clinical trials. However, existing adherence measures do not effectively reflect bidirectional medication-taking behavior. This secondary SPRINT analysis investigated at how dynamic, bidirectional adherence to medication patterns associated with cardiovascular outcomes.

Methods: We analyzed self-reported medication information for 9343 participants. Adherence was divided into four categorized based on discrepancies between prescribed and taken medication over the first 12 months: full adherence, over-adherence, under-adherence, and fluctuating adherence. The primary outcomes were composite cardiovascular events and all-cause mortality; the secondary outcomes were 12-month systolic blood pressure (SBP) control, SBP variability from visit to visit (coefficient of variance), and serious adverse events (SAEs).

Results: Over a median follow-up of 3.26 years, 53.6% displayed full adherence, while 16.2%, 22.7%, and 7.5% showed over-, under-, and fluctuating adherence. Compared to full adherence, fluctuating adherence was independently associated with significantly elevated risks of composite cardiovascular events (HR: 1.737, 95% CI: 1.250-2.414, P﹤0.001) and all-cause mortality (HR: 1.487, 95% CI: 1.030-2.147, P = 0.029). This pattern was also associated with decreased SBP control (OR: 0.825, 95% CI: 0.700-0.972, P = 0.022), increased SBP variability, and the highest incidence of SAEs in non-adherence groups. There were no significant changes in outcomes between over- or under-adherence and full adherence. Importantly, the detrimental association for fluctuating adherence persisted among a subgroup of patients classified as "fully adherent" by the self-reported Visual Analog Scale.

Conclusions: Fluctuating antihypertensive adherence, characterized by unstable use of medications, was independently linked with poor SBP control increased cardiovascular risk and mortality. Hypertension studies and clinical practice ought to prioritize identifying and managing dynamic adherence patterns to enhance trial validity and optimize the therapeutic benefits. Registration ClinicalTrials.gov (NCT01206062).

Functional foods are increasingly used by patients with chronic diseases, including hypertension, yet whether their therapeutic use is associated with medication adherence remains unclear. We conducted a cross-sectional study of adults with self-reported hypertension who were receiving antihypertensive medication, using data from the Japan COVID-19 and Society Internet Survey (JACSIS 2024; December 2024-January 2025). Respondents were classified as functional food users if they reported using functional foods specifically to treat hypertension; non-users served as comparators. Medication adherence was measured with the Japanese 8-item Morisky Medication Adherence Scale (MMAS-8); low adherence was defined as MMAS-8 <6. Among 4063 treated hypertensive adults (586 users; 3477 non-users), functional food use was associated with a higher risk of low adherence after adjusting for demographic, socioeconomic, and health-related factors: risk ratio 1.24 (95% CI 1.04-1.48). These findings suggest that therapeutic use of functional foods may be linked to suboptimal adherence to prescribed antihypertensive therapy, warranting further investigation. However, causal relationships cannot be inferred due to the cross-sectional design, and the self-reported nature of both exposures and outcomes may introduce measurement error.

This real-world, non-interventional, retrospective cohort study evaluated the achievement rate of guideline-recommended target blood pressure (BP) and representative safety profile of the treatment incorporating sacubitril/valsartan (Sac/Val) in Japanese patients with essential hypertension. Data were collected from electronic health records from ~4700 clinics across Japan, covering ~11.4% of the nationwide population. Of the 1405 eligible patients, 1247 were included in the effectiveness analysis. The primary endpoint investigated the proportion of patients achieving the Japanese Society of Hypertension 2019-recommended antihypertensive goals within 8 weeks of initial Sac/Val administration (index date). Secondary endpoints included description of baseline characteristics and their relative contribution to BP goal attainment, description of prescription patterns, and safety. A total of 29.8% of patients achieved individual estimated BP goals, with significant mean reductions in systolic and diastolic BPs (-15.6 mmHg and -6.1 mmHg, respectively, p < 0.0001). Patients aged ≥75 years, those with cerebrovascular disease, and those classified as Grade I hypertension were more likely to meet BP goals. Among patients with BP reduction of ≥10 mmHg, the most common prescription pattern at index date was a combination of calcium channel blocker (CCB) and Sac/Val, and a majority switched from CCB and angiotensin receptor blocker combination or were on CCB monotherapy. The most common signs of adverse events were hypotension and diuresis-related events, particularly during summer. The discontinuation rates following these signs were 1.0% and 0.8%. This real-world study demonstrated the clinical utility and representative safety profile of treatments involving Sac/Val in Japanese patients with essential hypertension.

Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those with proteinuric CKD. Effectiveness of RASi in treating non-proteinuric CKD is still unknown, yet. In order to evaluate the impact of RASi on cardiovascular morbidity and mortality in patients with non-proteinuric CKD, we performed a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study. A urine protein-to-creatinine ratio less than 0.15 g/g or negative/trace protein on urinalysis was considered as non-proteinuric CKD. Those who have undergone dialysis, kidney transplant recipients, and patients who refused to give their consent were excluded. A composite of cardiovascular events, initiation of renal replacement therapy, and all-cause mortality was studied as the primary outcome. Of 2379 patients with CKD, 630 met the criteria for non-proteinuric CKD. Among them, 490 used RASi, and 140 did not. Although the RASi group was considerably younger and had a higher prevalence of hypertension and calcium channel blocker use, baseline characteristics were comparable. 12.1% of the control group and 16.7% of the RASi group experienced the primary outcome during follow-up, with no significant difference (adjusted HR: 1.37; 95% CI: 0.81-2.31). Secondary outcomes and analyses of RASi use for the whole observation period did not show any significant differences (adjusted HR: 0.81; 95% CI: 0.43-1.56). These results imply that RASi was not linked to a decreased risk of mortality or long-term events in those with nonproteinuric CKD.

Elevated blood pressure (BP) has been linked to brain structure changes and cognitive decline. However, few studies have accounted for long-term cumulative BP exposure. We investigated the association between cumulative BP exposure, brain volume, cerebral blood flow (CBF), and cognitive decline. Furthermore, we explored whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. We included 1012 adult participants from the Kailuan study. Cumulative BP exposure was calculated from 2006 to 2020. Brain MRI scans and the Montreal Cognitive Assessment (MoCA) were performed in 2020. Generalized linear regression models were used to investigate the associations between cumulative BP, brain volume, CBF, and cognitive function. Mediation analysis was performed to examine whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. Compared with the lowest tertiles, the highest tertiles of cumulative SBP were associated with lower volumes in total brain (-9.11 [-16.25, -1.97]), total GM (-5.53 [-10.02, -1.04]), frontal lobe (-2.46 [-4.15, -0.78]), temporal lobe (-1.37 [-2.51, -0.23]) and hippocampus (-0.15 [-0.26, -0.03]), and the highest tertiles of cumulative DBP were associated with lower volume in frontal lobe (-2.33 [-3.98, -0.68]) and temporal lobe (-1.15 [-2.27, -0.04]). Higher cumulative SBP and DBP were associated with lower total and regional CBF and MoCA scores (all P < 0.05). The associations between cumulative DBP and cognitive decline were mediated by the volumes in total GM, frontal lobe and temporal lobe. Early intervention in cumulative BP may help preserve brain structure and function.

Whether high remnant cholesterol (RC) is associated with an increased risk of incident hypertension, independent of its well-known risk factors, in the general population remains unclear. We followed 5264 participants (3312 women; mean age 39.1 years) from Tehran Lipid and Glucose Study. RC was calculated as total cholesterol minus the sum of the high- and low-density lipoprotein-cholesterol. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, or diastolic blood pressure (DBP) ≥ 90 mmHg, or using anti-hypertensive medications. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In a random-effects meta-analysis we combined our results with six previous studies. In our cohort study, during a median follow-up of 12.4 years, 2189 events of hypertension occurred. Accordingly, in multivariable analyses, the association between RC and hypertension reached non-significant after adjusting for baseline SBP and DBP as covariates in both continuous (per 1-SD increase: 1.00 (0.91-1.10)) and categorical analyses (Q4 vs. Q1: 1.02 (0.85-1.22) (P for trend = 0.343)). However, in the meta-analysis, elevated RC was significantly associated with hypertension (pooled 11 effect-sizes, 1.30 (1.14-1.48); I² = 99.80; N = 7 studies (6 studies used calculated RC); 2,559,478 participants). In subgroup analyses of meta-analysis, this association was generally more pronounced among individuals with lower baseline risk. In conclusion, in our cohort study, elevated RC was not significantly associated with higher risk of incident hypertension in the presence of large set of confounders, including baseline SBP and DBP levels. We investigated the association between remnant cholesterol and risk of hypertension through a prospective study and meta-analysis. In our cohort study, the association between RC and hypertension was not independent of baseline SBP and DBP levels among Iranian adults. However, the meta-analysis revealed a significant association, albeit with substantial heterogeneity.