Hypertension最新文献

Background: Fixed-dose combination of semaglutide/cagrilintide (CagriSema 2.4 mg/2.4 mg) has demonstrated significant and clinically relevant body weight reductions in adults with overweight or obesity compared with placebo.

Methods: The phase 3a, 68-week REDEFINE 1 trial randomized adults without diabetes with body mass index ≥30 kg/m², or ≥27 kg/m² with ≥1 obesity-related complication, to once-weekly CagriSema 2.4 mg/2.4 mg, semaglutide 2.4 mg, cagrilintide 2.4 mg, or placebo, plus lifestyle intervention. Secondary and post hoc analyses evaluated the antihypertensive effect from REDEFINE 1, focusing on CagriSema and placebo groups, by subgroup/category, including baseline body mass index, the presence of hypertension or resistant hypertension at baseline, and concomitant changes in the use of antihypertensive medications.

Results: Overall, 3417 participants underwent randomization; CagriSema: n=2108, semaglutide: n=302, cagrilintide: n=302, and placebo: n=705. Changes from baseline to week 68 in blood pressure (BP) were greater with CagriSema versus placebo (systolic BP: -10.9 versus -2.8 mm Hg; diastolic BP: -5.4 versus -1.7 mm Hg, respectively). The proportion of participants reaching BP targets at week 68 was 63.0% and 32.0% for CagriSema and placebo, respectively. The proportion of participants with resistant hypertension at baseline (n=167) that reached BP targets at week 68 was 42.0% and 29.3% for CagriSema and placebo, respectively (odds ratio, 1.7 [95% CI, 0.7-4.4]). Among participants who used antihypertensive medication during the study, 39.6% in the CagriSema group decreased or stopped treatment from week 0 to week 68 versus 18.8% with placebo.

Conclusions: CagriSema presents clinically relevant reductions in BP across a wide range of participant subgroups, including those with resistant hypertension.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05567796.

Background: Preeclampsia is associated with increased risk of subsequent maternal cardiovascular diseases (CVD) compared with normotensive pregnancies. We examined whether a longer duration between preeclampsia diagnosis and delivery is associated with a higher CVD risk before age 55.

Methods: Nationwide health registry data from 2 Finnish cohorts were used: FINNPEC (n=1139) and FinnGen (n=3603). Exposure was the duration from preeclampsia diagnosis to delivery in days. Outcome was a composite CVD, including new-onset hypertensive diseases, ischemic heart diseases, cerebral/precerebral arterial diseases, and peripheral artery diseases diagnosed before age 55. Cox proportional hazards models were used to estimate the risk of composite CVD for each day between preeclampsia diagnosis and delivery.

Results: Median follow-up time after delivery was 12.2 years (interquartile range, 11.0-15.5) in FINNPEC and 17.1 years (interquartile range, 12.5-22.2) in FinnGen. A longer preeclampsia duration was associated with elevated CVD risk on a daily basis, with a hazard ratio of 1.02 (95% CI, 1.00-1.04); P=0.020 in FINNPEC and hazard ratio of 1.01 (95% CI, 1.00-1.02); P<0.001 in FinnGen. In FINNPEC, the association between preeclampsia duration and CVD remained significant after adjustment for body mass index, maternal age at delivery, small for gestational age infant, and smoking (adjusted hazard ratio, 1.02 [95% CI, 1.00-1.05]; P=0.022). In FinnGen, the association was observed after adjustment for early-onset preeclampsia, pregestational and gestational diabetes, primiparity, and age at delivery (adjusted hazard ratio, 1.01 [95% CI, 1.00-1.01]; P=0.012).

Conclusions: Long-term CVD risk before age 55 is estimated to increase 1% to 2% per day from preeclampsia diagnosis to delivery. Women with preeclampsia might benefit from early delivery.

Background: As the leading modifiable risk factor for death in the United States, hypertension requires timely and locally detailed surveillance. Current estimates of the high blood pressure (BP) care continuum are lagging national averages from sample surveys with low participation and unknown subnational variation. This study explores the use of self-service health kiosks in retail stores as an alternative source for subnational estimates of prevalence, awareness, and control.

Methods: We analyzed data from adult kiosk users (n=1270 485) across 1892 counties in 49 States (except Massachusetts) and the District of Columbia in a serial cross-sectional analysis from November 2017 to September 2024. High BP was defined as self-reported diagnosed (aware) or elevated BP (systolic ≥140 mm Hg or diastolic ≥90 mm Hg). Among those aware, control was defined as BP <140/90 mm Hg. Small area estimates for counties were calculated using multilevel regression and poststratification based on individual and areal socio-demographic covariates. We compared the prevalence of diagnosed hypertension with the Behavioral Risk Factor Surveillance System 2021.

Results: The analytic sample had a mean age of 42.0 years (SD=15.6). Prevalence of high BP was 51.9% in 2017 to 2018 and 50.4% in 2023 to 2024. In 2023 to 2024, awareness and control were 73.7% and 61.8% and county-level prevalence ranged from 39.5% to 63.1%. Similar hotspots in the Southeast were identified in both the kiosk and Behavioral Risk Factor Surveillance System (Spearman ρ=0.52).

Conclusions: Health kiosk data reveal substantial spatial and socio-demographic variation in high BP. Near real-time subnational surveillance of health kiosk users can provide insights to guide interventions and track progress.

Background: Hypertensive disorders of pregnancy are associated with ongoing postpartum hypertension and increased morbidity. Extravascular water and sodium mobilization are implicated in postpartum blood pressure (BP) elevation; however, trials of postpartum diuretics in hypertensive disorders of pregnancy have had mixed results. Our meta-analysis aimed to analyze the impact of postpartum diuretics on postpartum hypertension following hypertensive disorders of pregnancy.

Methods: A systematic review was performed to identify observational cohort studies and randomized controlled trials studying the efficacy of diuretics in the treatment of postpartum BP. Meta-analysis outcomes included persistent hypertension up to 10 days postpartum, mean postpartum systolic and diastolic BPs, and use of additional antihypertensive medications.

Results: From 10 included randomized controlled trials and 1 prospective cohort study with a moderate level of bias, 1624 subjects were included in the meta-analysis. Postpartum diuretic use was associated with lower systolic BP (SMD, -0.44 [95% CI, -0.66 to -0.21]) without a difference in diastolic BP (SMD, -0.15 [95% CI, -0.47 to 0.16]) compared with controls. There was no difference in rates of persistent hypertension between the postpartum diuretics group versus controls (odds ratio, 0.69 [95% CI, 0.44-1.08]) or in antihypertensive medication use (odds ratio, 0.68 [95% CI, 0.46-1.03]). There was significant heterogeneity in the diuretic effect on outcomes.

Conclusions: Postpartum diuretic use was associated with no difference in persistent hypertension, diastolic BP, or need for hypertensive therapy. A modest reduction in systolic BP was observed, though of uncertain clinical significance. Larger, high-quality studies are needed to clarify whether postpartum diuretic use may be of clinical benefit.