Journal of Human Hypertension最新文献

Cardiovascular events occur 20 years earlier in Sub-Saharan Africa compared to Europe. The risk factors for atherosclerosis differ between population groups and according to age. We compared the main correlates of carotid intima-media thickness (IMT, an index of atherosclerosis) in young and older adults of African ancestry. Hemodynamic (central and peripheral arterial pressures) and metabolic factors (lipids, glucose, glycated haemoglobin), smoking status and carotid IMT were determined in 573 adult Africans. In young (age<35years, n = 181) and middle-aged (35-59years, n = 231) adults, carotid IMT was associated with hemodynamic and metabolic cardiovascular risk factors on bivariate analyses. In older (age≥60years, n = 161) adults only hemodynamic factors were associated with carotid IMT. After adjustments for confounders, lipids were not associated with carotid IMT at any adult age. Carotid IMT was independently associated with backward wave pressure (Pb, p = 0.001) and age (p = 0.006) in young adults; with hemodynamics (central systolic blood pressure, p = 0.003; Pb, p = 0.02), age (p = 0.0002), body mass index (BMI, p = 0.005) and heart rate (p = 0.007) in middle-aged adults; and with Pb (p < 0.0001), male sex (p = 0.03), and HR (p = 0.04) in older adults. Increased carotid IMT was related to Pb in young (odds ratio [OR] = 1.233, p = 0.0003) and older (OR = 1.086, p = 0.0059) adults, and BMI (OR = 1.089, p = 0.0005) in middle-aged adults. Improvements in predictive performance for detecting increased carotid IMT were shown with Pb in young (p = 0.0032) and older (p = 0.0031) adults, and with BMI (p = 0.0004) in middle-aged adults. In conclusion, in African adults in Sub-Saharan Africa, carotid IMT is associated with hemodynamic factors, but not lipids. Moreover, in young adults, carotid IMT is primarily associated with hemodynamic factors.

While non-pharmacological interventions are fundamental to hypertension management, real-world evidence regarding their effectiveness and the specific populations most likely to benefit remains limited in China. This study investigates the demographic and lifestyle factors associated with self-reported blood pressure improvement among untreated middle-aged and elderly hypertensive patients, utilizing longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2015-2020. Among 502 eligible participants not receiving pharmacological treatment, 41.6% reported blood pressure improvement by the 2018 follow-up. Generalized Estimating Equations (GEE) analysis revealed that residential and lifestyle factors were significantly associated with hypertension management outcomes. Specifically, rural residents had significantly lower odds of improvement compared to their urban counterparts (OR = 0.63, 95% CI: 0.40-0.99, p = 0.047). In contrast, lifestyle modifications showed a clear protective effect: never smokers (OR = 1.82, 95% CI: 1.05-3.13, p = 0.032) and non-drinkers (OR = 1.66, 95% CI: 1.09-2.53, p = 0.017) demonstrated significantly higher odds of blood pressure improvement compared to current smokers and heavy drinkers, respectively. While the 2020 follow-up indicated a lower mortality rate in the improved group (1.9%) compared to the ineffective group (4.1%), this difference did not reach statistical significance. These findings highlight that abstaining from smoking and alcohol remains a cornerstone of non-pharmacological blood pressure management. Furthermore, the observed urban-rural disparity suggests a critical need for targeted public health interventions and enhanced resource allocation to support hypertension control in China's rural communities.

The renin-angiotensin-aldosterone system (RAAS) plays a central role in blood pressure (BP) control through its downstream components including angiotensin II and aldosterone. However, recent data show that upstream RAAS components, such angiotensinogen, have a potential as targets for therapeutic interventions, yet remain underexplored. Our study compared BP and pulse pressure (PP) components across quartiles of circulating angiotensinogen in a healthy young population and further examined these associations after stratifying by ethnicity. The study population consisted of 1144 healthy Black and White men and women aged 20-30 years. We derived central systolic BP (SBP), central diastolic BP (DBP), central PP, and measured clinic and 24-hour (24-h) PP and BP. Angiotensinogen levels were determined in serum. Across different BP components, only nighttime PP decreased with increasing angiotensinogen quartiles (P-trend = 0.021). We found higher circulating angiotensinogen levels in White individuals as compared to their Black counterparts. After adjustments for multiple covariates in regression analyses, clinic SBP (β = 0.12, p < 0.001), clinic DBP (β = 0.10, p = 0.011), 24-h DBP (β = 0.11, p = 0.008), daytime DBP (β = 0.11, p = 0.009) and nighttime DBP (β = 0.11, p = 0.014) were positively associated with angiotensinogen only in the White group. Additional adjustment for heart rate (HR) modified these associations. In White individuals, clinic SBP (β = 0.12, p < 0.001) and clinic DBP (β = 0.08, p = 0.046) were positively associated with angiotensinogen, independent of HR, while other associations lost significance. No associations were observed in the Black group. The positive association of clinic BP with angiotensinogen in young, healthy White adults, independent of HR, suggests a probable direct role for angiotensinogen in BP regulation.

This study investigated the relationship between white blood cell counts and pediatric hypertension, addressing the limited evidence on white blood cell counts/subtypes and pediatric hypertension. A prospective cohort study was conducted involving 5971 children aged 6-12 years in Chongqing, China, with baseline data collected in 2014-2015 and 1282 children completed a 5-year follow-up in 2019. White blood cell indicators, including total white blood cell counts (WBC), lymphocyte counts and percentage (LC, LP), monocyte counts and percentage (MC, MP), neutrophil counts and percentage (ANC, NR), and lymphocyte-monocyte ratio (LMR) were measured using Complete Blood Count (CBC) tests. Blood pressure (BP), and anthropometric indices were also measured. Multilevel linear mixed models and logistic regression models, adjusted for confounders were applied to illustrate the relevance of cell counts indicators and blood pressure. Results showed that compared to normal BP (NBP) group, the elevated BP (EBP) group had significant lower MC(OR(95%CIs) = 0.79(0.68,0.90)) and MP(OR(95%CIs) = 0.78(0.68,0.88)) but higher LMR(OR(95%CIs) = 1.31(1.15,1.50)). Multivariate analyses adjusted for confounding factors revealed that MP was negatively correlated with SBP, DBP and MAP, while LMR positively correlated with these blood pressure(P < 0.05). MC and MP were associated with a reduced risk of hypertension, whereas LMR was associated with an increased risk, particularly in boys. No significant mediation effect of WBC indices between BMI and BP was observed. In conclusion, Peripheral MC, MP, and LMR were significantly associated with pediatric hypertension; MC and MP act as protective factors and LMR acts as a risk factor, suggesting that these indices may serve as potential biomarkers for childhood hypertension.

We investigated the association between blood pressure (BP) and renal function decline (RFD) in individuals with preserved kidney function (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m²) and without cardiovascular disease, hypertension, diabetes, dyslipidemia, and smoking. In total, 3455 eligible participants (mean age: 37.8 years; 67.6% women) free of cardiometabolic risk factors were followed until 2021 (median follow-up [interquartile range]: 15.3 [13.4-16.8] years). RFD was defined as an eGFR of <60 mL/min/1.73 m² accompanied by a ≥ 30% decrease from baseline values. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for RFD across BP categories and per 10 mm Hg increase in systolic blood pressure (SBP) and per 5 mm Hg increase in diastolic blood pressure (DBP). After adjustment for a comprehensive set of confounders, each 10 mm Hg increase in SBP and each 5 mm Hg increase in DBP were associated with 1.20 (95% CI: 1.07-1.35) and 1.20 (1.11-1.31) times higher risk of RFD, respectively. However, when both SBP and DBP were included in the models, SBP was no longer significantly associated with RFD (HR: 1.04; 95% CI: 0.90-1.21), whereas DBP remained significantly and linearly associated (1.19; 1.07-1.31). The association between DBP and RFD persisted when restricted to individuals with BP < 120/ < 80 mm Hg, with each 5 mm Hg increase associated with 29% higher risk. In conclusion, higher BP levels, even within the conventionally normal range, are associated with an increased risk of RFD in the absence of traditional cardiometabolic risk factors.

Hypertension is a preventable risk factor for cardiovascular disease and mortality yet is often undiagnosed and uncontrolled. Federally Qualified Health Centers (FQHC) serve vulnerable, understudied populations having characteristics that are associated with greater risk for undiagnosed and uncontrolled hypertension. This study aimed to determine the burden and risk factors associated with undiagnosed and uncontrolled hypertension at a large FQHC, with the co-primary outcomes of yearly rates of undiagnosed and uncontrolled hypertension. The design was a retrospective cross-sectional study of adult patients seen at an FQHC between 2019-2023. Undiagnosed hypertension was defined as an elevated average blood pressure reading ( ≥ 130/80) over at least two encounters within the same year. Hypertension was defined according to the 2025 ACC/AHA guidelines, ≥130/80. Crude and age-adjusted rates for the co-primary outcomes were calculated and adjusted mixed-effects logistic regression identified risk factors. From 2019 to 2023, the yearly percent of age-adjusted undiagnosed hypertension ranged from 28.7-34.7%. From 2019 to 2023, the yearly burden of age-adjusted uncontrolled hypertension ranged from 74.0-79.5%, irrespective of treatment. Factors associated with higher rates of undiagnosed hypertension included older age (OR 1.04, 95% CI [1.04, 1.04]), male sex (2.9, [2.7, 3.2]) and Black race (1.3, [1.1, 1.4]). Factors associated with higher rates of uncontrolled hypertension included male sex (OR 1.2, 95% CI [1.1, 1.2]), Black race (1.5, [1.4, 1.7]), other language preference (1.3, [1.1, 1.4]), and self-pay insurance (1.2, [1.1, 1.4]). There was a substantial burden of undiagnosed and uncontrolled hypertension with intervention needed to reduce cardiovascular disease.

This study evaluated the accuracy of the Hanvon KSY8600 blood pressure monitor in adult populations in accordance with the AAMI/ESH/ISO (ISO 81060-2:2018) and AMD 1:2020 standards. 90 people were recruited as research participants, among which 88 eligible participants were chosen and analyzed according to the research plan. The average age of these participants was 51.3 ± 17.35 years old, with an average arm circumference of 28.1 ± 3.41 cm, and with females accounting for 60.2%. The test results showed that the mean differences (standard deviations) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) displayed on the blood pressure monitor were -0.4 mmHg (2.09 mmHg) and -0.3 mmHg (1.86 mmHg) respectively, meeting the requirements of Criterion 1 (≤ ± 5 mmHg (8 mmHg)). Additionally, the average standard deviations of the participants' SBP and DBP were 0.91 mmHg and 0.90 mmHg respectively. According to Table 1 of Criterion 2, the mean values of SBP and DBP were -0.4 mmHg and -0.3 mmHg respectively, with maximum allowable standard deviations of SBP and DBP of ≤6.93 and ≤6.95 mmHg respectively, meeting the requirements of Criterion 2. It was thus proved that the blood pressure monitor complies with ISO 81060-2:2018 + AMD1:2020, and is recommended for clinical and home blood pressure measurement for adults.