Journal of Human Hypertension最新文献

People living with resistant hypertension (RH) are at high risk of adverse cardiovascular events. The British and Irish Hypertension Society has identified suspected RH as a condition for which specialist guidance may improve rates of blood pressure control and help clinicians identify those individuals who may benefit from specialist review. In this position statement we provide a practical approach for the investigation and management of adults with RH. We highlight gaps in the current evidence and identify important future research questions. Our aim is to support the delivery of high-quality and consistent care to people living with RH across the UK and Ireland.

Blood pressure (BP) measurement is a common procedure conducted in various disciplines and is widely available on clinical reports. The diagnosis and management of hypertension require reliable measurement of BP in outpatient clinics. Published studies suggest the standardised method for BP measurement is difficult to apply in routine clinical practice. This study aimed to assess the current practice of BP measurement in outpatient clinics in relevant secondary care clinical specialties across the 15 separate hospital sites of the NHS Greater Glasgow and Clyde region (population 1.2 million) compared to the recommended standardised method. An online questionnaire was developed and disseminated to the supervising clinician of each of 268 regular outpatient clinics. The questionnaire focused on the standardised BP method (patient preparation, environment, and BP measurement technique). The questionnaire was returned for 110 clinics. 73 (66.4%) of the participating clinics measure BP routinely and these formed the basis for further analysis. 3 clinics (4.1%) apply all components of the standardised BP method. 5 (6.9%) clinics deliver advice to patients prior to clinic attendance on how to prepare for BP measurement. 61 (83.6%) of participating clinics have a dedicated quiet environment for BP measurement. 50 (68.5%) clinics always place the cuff on bare upper arm and 63.0% use a cuff size appropriate to upper arm circumference. In a wide range of secondary care out-patient clinic settings, we found that BP measurement rarely adheres to the recommended standards. This has important implications for the quality of treatment decisions that are based on BP measurement.

The conventional assessment of the relationship between arterial hypertension (AH) and cardiovascular damage has predominantly relied on office measurements. However, the diagnostic significance of ambulatory and home measurements has gained prominence, particularly in identifying distinct AH phenotypes like masked hypertension (MH), characterized by normal office values but elevated readings outside the clinical setting, carrying comparable risks to sustained AH. Current guidelines advocate for Ambulatory Blood Pressure Monitoring (ABPM) in individuals with office values exceeding 130/85 mmHg. This study aims to develop a clinical prediction model to identify masked hypertension in individuals with normal office blood pressure and to create a clinical score.A cross-sectional study was conducted in a secondary level hospital, including patients aged 18-85 years with average office blood pressure <140/90 mmHg who underwent a valid ABPM on the same day. Pregnant and postpartum women were excluded. A multivariable logistic regression model with calibration, discrimination, and stability parameters was applied to predict masked hypertension. 506 individuals with valid ABPM were analysed. The prevalence of masked hypertension was 30.8%. The selected variables were: diastolic blood pressure, pulse pressure, waist diameter and sex. The model calibrated adequately (Hosmer-Lemeshow test p = 0.35), with an AUC of 0.72 (95% CI, 0.67-0.77). Significant differences existed between the traditional and the new models (p < 0.001). A user-friendly clinical model was developed, with a clinical score achieving 90% specificity using an estimated probability of 0.4 with a 10-point score.A novel model, performed with easily collectable clinical variables, showed robust calibration, stability, and discrimination. It outperforms sole reliance on office blood pressure, exhibiting high specificity (~90%) for masked hypertension detection. Its internal validity suggests a potential for enhanced masked hypertension identification.

Low blood pressure (BP) is suggested to be associated with all-cause mortality in older adults. The aim of this study is to validate the relationship in older adults and to examine the possible involvement of clinical characteristics, namely functional disability, comorbidities, antihypertensive treatment, and reverse causation, in the relationship using insurance claims data including annual health checkup data. The study participants were 337,975 individuals aged ≥65 years. The earliest day of participation in the annual health checkup from 2012 to 2020 was determined at baseline. Data on comorbidities, functional disability levels, prescribed antihypertensive medications, and incidence of stroke, myocardial infarction and all-cause mortality were obtained from the insurance claims. During a mean follow-up period of 5.3 years, there were 27,495 cases of all-cause mortality, 9000 cases of stroke and 1640 cases of myocardial infarction. A U-shaped association was observed between systolic BP and all-cause mortality in participants aged ≥75 years and the hazard ratio calculated systolic BP 120-129 mmHg as reference was 1.14 for <110 mmHg and 1.16 for ≥150 mmHg (all P < 0.001). The U-shaped association remained significant in the sub-analyses of individuals without severe comorbidities, antihypertensive treatment, or functional disability. Similar results were observed in the analysis excluding early-mortality cases. In contrast, the risk of stroke and myocardial infarction increased linearly with increasing BP. Low BP was associated with all-cause mortality in older adults. The U-shaped association may not be solely attributed to the previously suggested factors, including antihypertensive treatment, potential comorbidities, and functional disability.

The importance of accurate blood pressure (BP) measurement is well-established. However, there is little quantitative comparative data on the influence of different measurement conditions on BP or the stability of the oscillometric pulse waveform from which BP is calculated. This study investigates the effect of six different measurement conditions (Quiet, Reading, Speaking, Deep Breathing, Moving, and Tapping) on BP readings in 30 healthy normotensive subjects. We hypothesize that non-standard conditions will result in significant deviations in BP measurements compared to the Quiet condition. Additionally, the quality and stability of the oscillometric waveform were assessed by evaluating the smoothness of the oscillometric pulse waveform characteristics during cuff deflation. Compared with the Quiet condition, all others resulted in significantly higher blood pressures, except for the respiratory condition, which resulted in significantly lower BPs. Average subject systolic BP (SBP) rose from 117.4 ± 6.0 mmHg for the Quiet condition to 129.7 ± 7.2 mmHg for the light finger tapping condition, P < 0.00001. Overall, changes for diastolic BP (DBP) were not significant. For the quality Noise indicator, all conditions in comparison with the Quiet condition were significantly noisier, increasing from 0.144 ± 0.024 to 1.055 ± 0.308 mmHg, P < 0.00001. Changes in SBP were significantly correlated to changes in quality Noise (r = 0.965, P < 0.001). This study confirms the importance of following international BP measurement guidelines, providing quantitative data showing significant changes in BP when guidelines are not followed. A method for assessing the quality of the measurement is also demonstrated, and shows that BP changes are significantly related to changes in the quality indicator.

Hypertension is the most preventable cause of morbidity and mortality, but many individuals are underdiagnosed and lack treatment control. High blood pressure (BP) in the emergency department (ED) is commonly observed, but mostly used for short-term evaluation. We aimed to study the usefulness of high BP in the ED as a screening tool for undiagnosed hypertension. We used the electronic medical record system to identify all patients that had attended the ED at a university hospital from 2018-01-01 to 2018-03-31 and from 2018-07-01 to 2018-09-30 with an obtained systolic BP ≥ 160 and/or diastolic BP ≥ 100 mmHg measured at the ED. We excluded patients with previously diagnosed hypertension and patients on BP-lowering medication. All patients identified where contacted two years after attending the ED, with a letter of consent and a questionnaire regarding diagnosis of hypertension and current medication. 5424 patients attended the ED during the 6-months-period. 271 patients met the inclusion criteria and were asked to participate. 167 individuals (62%) agreed to participate and responded to the questionnaire. Mean age of participants were 63.1 years and 51% were women. 134 patients (80%) had measured their BP after the ED-visit, and 48 (36%) of those had been diagnosed with hypertension. 96% of patients diagnosed with hypertension were on BP-lowering medication. To follow-up BP ≥ 160/100 mmHg after an ED visit can reveal undiagnosed hypertension in one third of the patients. Given the amount of undiagnosed hypertension, an ED-measured BP might provide an important tool to detect and start treatment of hypertension.

Hypertension is still a common chronic disease worldwide and seriously affects human health. Aim of this study was to investigate the association between tricarboxylic acid (TCA) cycle-related metabolites and hypertension in older adults. A total of 1127 community-dwelling older adults were included in this cross-sectional analysis, of whom 609 were assigned to the hypertension group and 518 to the no-hypertension group. Plasma concentrations of 8 TCA cycle-related metabolites (citrate, cis-aconitate, isocitrate, 2-oxoglutarate, succinate, maleate, fumarate, and malate) were determined by gas chromatography-triple quadrupole mass spectrometry. Multivariate logistic regression was used to assess the association between these metabolites and hypertension risk. After adjustment for covariates, we found that the increased plasma concentrations of 2-oxoglutarate and malate were significantly associated with hypertension. These two associations remained unchanged after using the false discovery rate (FDR)-adjustment method (both FDR-adjusted P-trend <0.05). In stratified analysis, these two associations were not modified by overweight, physical activity, and current drinking (all P-interaction >0.05). In the multivariate diagnostic model, the inclusion of these two metabolites modestly and significantly improved the diagnosis of hypertension (AUC = 0.64, 95% CI: 0.60-0.67). These results indicated that plasma 2-oxoglutarate and malate might be the candidate metabolic markers of hypertension among older adults. However, further longitudinal and experimental studies are necessary to confirm this finding.

Hypertension is a major risk factor for cardiovascular events worldwide, and little is known about its association with sleep quality (SQ) among Africans. We evaluated the association of SQ with hypertension among adults in Ibadan, Nigeria. In Ibadan and its suburbs, we identified 3635 participants in the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases (COMBAT-CVDs) study. SQ was self-reported, and SQ scores were classified by the tertile distribution in this sample as good (<9), moderate (10-18), and poor (≥19), and hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or prior diagnosis by a certified health professional or current use of blood pressure-lowering drugs. Using good SQ as a reference, logistic regression models were used to estimate the multivariable-adjusted odds ratio and 95% confidence interval (CI) for odds of hypertension by tertiles of SQ scores in a two-sided test at p < 0.05. In all, 1182 (32.5%) had poor SQ, 903 (24.8%) had hypertension, and the mean(±SD) age was 35.3 ± 15.2 years in this sample. The multivariable-adjusted odds of hypertension by tertiles of SQ scores (using good SQ as reference) were OR: 1.13 (95% CI: 0.92, 1.38) for moderate SQ, and OR: 1.29 (95% CI: 1.05, 1.59) for poor SQ; P for trend = 0.06 after adjusting for relevant covariates. Poor SQ is associated with higher odds of hypertension in this sample. The imperative of culturally sensitive interventions to improve SQ would be promising in managing poor sleep-associated hypertension burden in this population.

Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management. We conducted a retrospective analysis of brain MRI data from MHT patients admitted to Bordeaux University Hospital between 2008 and 2022. Eligible patients had at least one follow-up MRI. Analysis blinded to clinical data was performed to identify markers of posterior reversible encephalopathy syndrome (PRES), acute stroke, cerebral hemorrhage, and microangiopathy. Out of 149 patients, 47 had follow-up MRIs. Most were male (72.3%) with a mean age of 48.2 ± 10.8 years. The median interval between initial and follow-up MRI was 228 days. Follow-up MRIs revealed new strokes in 10.6% of patients, cerebral hemorrhages in 4.3%, and no cases of PRES. Additionally, more patients exhibited chronic lacunar infarcts and/or microbleeds, with overall Fazekas scores remaining stable in 66.0%, improving in 31.9%, and worsening in 2.1%. Subgroup analyses based on blood pressure control or follow-up duration showed no significant differences in MRI markers. This study sheds light on the risk of new cerebrovascular events and the dynamic changes in brain MRI markers following acute MHT crisis management. Understanding these changes could lead to improved diagnosis, personalized treatment strategies, and proactive patient care for individuals with MHT.

Although there have been reports on the association between smoking and increased level of inflammatory markers in hypertensive this has not been assessed prospectively in a large, modern cohort using data mining approaches. We conducted a cross-sectional analysis of the Mashad trial which was a prospective. 2085 smokers aged 35 to 65 years was studied. Inflammatory indices measured included: Hemoglobin-Platelet Ratio (HPR), Uric acid-high Density Lipoprotein (HDL) Ratio (UHR), Neutrophil-Lymphocyte Ratio (NLR), Systemic Immune Inflammation (SII) index, WBC, Platelet-Lymphocyte Ratio (PLR), and RBC Distribution Width (RDW). The association between these parameters and smoking in hypertensive individuals was examined. Over the course of the 6-year monitoring period, 585 peoples had HTN of whom the majority was female (59%). As per the LR analysis, there was a significant association between hypertension and age, WBC, SII, PLR in female smokers, as well as age and PLR in male smokers. (p-value < 0.05). PLR (OR = 0.993, CI 95% (0.987, 0.999)) and age (1.080 (1.058, 1.102)) for male and WBC (1.340 (1.139, 1.577)) and age (1.091 (1.070, 1.113)) for female exhibits the most appropriate estimate. Using the DT model for male individuals, those with, age ≥ 64 years, and SII < 336 had the correlated with hypertension prevalence (76%). For females, those with age ≥ 62 years, WBC ≥ 6.1, and SII < 445.634 had the highest risk of HTN. Age and SII for smoker males and age and WBC for smoker females showed the strongest correlation with hypertension. Age and WBC were the most significant indicators for predicting HTN.