Pub Date : 2024-10-18DOI: 10.1038/s41371-024-00969-4
Eleni Angelaki, Georgios D. Barmparis, Konstantinos Fragkiadakis, Spyros Maragkoudakis, Evangelos Zacharis, Anthi Plevritaki, Emmanouil Kampanieris, Petros Kalomoirakis, Spyros Kassotakis, George Kochiadakis, Giorgos P. Tsironis, Maria E. Marketou
Awareness and early identification of hypertension is crucial in reducing the burden of cardiovascular disease (CVD). Artificial intelligence-based analysis of 12-lead electrocardiograms (ECGs) can already detect arrhythmias and hypertension. We performed an observational two-center study in order to develop a machine learning algorithm to proactively detect arterial hypertension from single-lead ECGs. This could serve as proof of concept with an eye towards todays wearables that record single-lead ECGs. In a prospective observational study, we enrolled 1254 consecutive subjects (539 male, aged 60.22 ± 12.46 years), with and without essential hypertension, and no indications of CVD. A 12-lead ECG of 10 seconds duration in resting position was performed on each subject using a digital electrocardiograph and lead I was isolated for analysis using a calibrated Random Forest (RF). Our RF model classified hypertensive from normotensive subjects on a hold-out test set, with 75% accuracy, ROC/AUC 0.831 (95%CI: 0.781-0.871), sensitivity 72%, and specificity 82% (sensitivity and specificity calculated using a threshold of 0.675). Increasing age, larger values of body mass index, the area under the T wave divided by the QRS complex area, and the area under QRS segment adjusted for BMI, were the four most important features that drove the classification decisions of our model. This study demonstrates the potential to opportunistically detect an undiagnosed hypertension, using a single-lead ECG. While studies with data from wearables are required to translate our findings to actual smartwatch settings, our results could pave the way to innovative technologies for hypertension awareness.
{"title":"Diagnostic performance of single-lead electrocardiograms for arterial hypertension diagnosis: a machine learning approach","authors":"Eleni Angelaki, Georgios D. Barmparis, Konstantinos Fragkiadakis, Spyros Maragkoudakis, Evangelos Zacharis, Anthi Plevritaki, Emmanouil Kampanieris, Petros Kalomoirakis, Spyros Kassotakis, George Kochiadakis, Giorgos P. Tsironis, Maria E. Marketou","doi":"10.1038/s41371-024-00969-4","DOIUrl":"10.1038/s41371-024-00969-4","url":null,"abstract":"Awareness and early identification of hypertension is crucial in reducing the burden of cardiovascular disease (CVD). Artificial intelligence-based analysis of 12-lead electrocardiograms (ECGs) can already detect arrhythmias and hypertension. We performed an observational two-center study in order to develop a machine learning algorithm to proactively detect arterial hypertension from single-lead ECGs. This could serve as proof of concept with an eye towards todays wearables that record single-lead ECGs. In a prospective observational study, we enrolled 1254 consecutive subjects (539 male, aged 60.22 ± 12.46 years), with and without essential hypertension, and no indications of CVD. A 12-lead ECG of 10 seconds duration in resting position was performed on each subject using a digital electrocardiograph and lead I was isolated for analysis using a calibrated Random Forest (RF). Our RF model classified hypertensive from normotensive subjects on a hold-out test set, with 75% accuracy, ROC/AUC 0.831 (95%CI: 0.781-0.871), sensitivity 72%, and specificity 82% (sensitivity and specificity calculated using a threshold of 0.675). Increasing age, larger values of body mass index, the area under the T wave divided by the QRS complex area, and the area under QRS segment adjusted for BMI, were the four most important features that drove the classification decisions of our model. This study demonstrates the potential to opportunistically detect an undiagnosed hypertension, using a single-lead ECG. While studies with data from wearables are required to translate our findings to actual smartwatch settings, our results could pave the way to innovative technologies for hypertension awareness.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 1","pages":"58-65"},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1038/s41371-024-00967-6
Mekayla Forrest, Maria Matossian, Brenda Valdes Sustaita, Helena Papacostas Quintanilla, Bart Spronck, James Sharman, Stella S. Daskalopoulou
Preeclampsia is a leading complication of pregnancy that lacks accurate tools for its early prediction. Improved risk stratification tools early in pregnancy would enable more efficient allocation of limited healthcare resources while ensuring that pregnant women destined to develop preeclampsia receive appropriate care. This brief perspective highlights the current state of first-trimester preeclampsia prediction. We focus on arterial stiffness, an important hemodynamic indicator of vascular health that has shown promising results for improved early prediction of preeclampsia by our and independent research groups. Further, we outline the promise, applicability, and feasibility of integrating arterial stiffness assessments into clinical practice.
{"title":"Arterial stiffness as a novel tool for the early prediction of preeclampsia: a perspective","authors":"Mekayla Forrest, Maria Matossian, Brenda Valdes Sustaita, Helena Papacostas Quintanilla, Bart Spronck, James Sharman, Stella S. Daskalopoulou","doi":"10.1038/s41371-024-00967-6","DOIUrl":"10.1038/s41371-024-00967-6","url":null,"abstract":"Preeclampsia is a leading complication of pregnancy that lacks accurate tools for its early prediction. Improved risk stratification tools early in pregnancy would enable more efficient allocation of limited healthcare resources while ensuring that pregnant women destined to develop preeclampsia receive appropriate care. This brief perspective highlights the current state of first-trimester preeclampsia prediction. We focus on arterial stiffness, an important hemodynamic indicator of vascular health that has shown promising results for improved early prediction of preeclampsia by our and independent research groups. Further, we outline the promise, applicability, and feasibility of integrating arterial stiffness assessments into clinical practice.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 11","pages":"745-749"},"PeriodicalIF":2.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00967-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1038/s41371-024-00966-7
Enos Muisaphanda Rampamba, Johanna Catharina Meyer, Brian Godman, Ntodeni Norah Ndwamato, Stephen Mark Campbell
Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members to rate clarity and appropriateness of 102 hypertension quality indicator statements, grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In Round 2, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate and feasible measurement of the management of hypertension: monitoring (n = 16), review (n = 5), lifestyle advice (n = 9), tests (n = 7), intermediate outcomes (n = 6), referrals (n = 2) and practice/facility structures (n = 1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.
{"title":"Development of quality indicators for hypertension management at the primary health care level in South Africa.","authors":"Enos Muisaphanda Rampamba, Johanna Catharina Meyer, Brian Godman, Ntodeni Norah Ndwamato, Stephen Mark Campbell","doi":"10.1038/s41371-024-00966-7","DOIUrl":"https://doi.org/10.1038/s41371-024-00966-7","url":null,"abstract":"<p><p>Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members to rate clarity and appropriateness of 102 hypertension quality indicator statements, grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In Round 2, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate and feasible measurement of the management of hypertension: monitoring (n = 16), review (n = 5), lifestyle advice (n = 9), tests (n = 7), intermediate outcomes (n = 6), referrals (n = 2) and practice/facility structures (n = 1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.</p>","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1038/s41371-024-00964-9
Uğur Köktürk, Hamdi Püşüroğlu, İlyas Çetin, Mustafa Umut Somuncu, Ahmet Avcı, Mehmet Ertürk
In this study, we investigated the long-term prognostic effects of fibrinogen levels in patients with resistant hypertension. A total of 266 patients with resistant hypertension who had serum fibrinogen measurements and 5 years of follow-up information were retrospectively included in the study. The patients were stratified according to their fibrinogen levels, which were then divided into tertiles. Clinical outcomes for major adverse cardiovascular events (MACE) were assessed at 5 years. MACE was defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke, a new diagnosis of heart failure, or hospitalization for heart failure and peripheral arterial disease. The incidence of MACE at 5 years in patients with resistant hypertension was higher in the highest tertile of fibrinogen. Multivariate analysis identified fibrinogen as an independent predictor of MACE in patients with resistant hypertension (odds ratio = 1.002; 95% CI: 1.001–1.004; p = 0.009). Compared to the lowest tertile, MACE was approximately 2.5 times higher in tertile 2 and approximately 6.9 times higher in the highest tertile. Fibrinogen was able to predict MACE in patients with resistant hypertension (AUC for MACE 0.662 (95% CI 0.596–0.727; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan–Meier curve showing follow-up without MACE (MACE-free) according to the fibrinogen cut-off value, the 5-year incidence of MACE was significantly higher in the high fibrinogen group (p < 0.001). Fibrinogen is a risk marker for MACE in patients with resistant hypertension. Antihypertensive therapy aimed at lowering fibrinogen levels may improve prognosis.
在这项研究中，我们探讨了纤维蛋白原水平对抵抗性高血压患者长期预后的影响。研究回顾性地纳入了266名具有血清纤维蛋白原测量结果和5年随访资料的抵抗性高血压患者。根据患者的纤维蛋白原水平对其进行分层，然后将其分为三等分。在5年后对主要不良心血管事件（MACE）的临床结果进行评估。MACE定义为全因死亡率、心血管死亡率、非致死性心肌梗死（MI）、非致死性中风、心力衰竭新诊断或因心力衰竭和外周动脉疾病住院。抵抗性高血压患者5年后MACE的发生率在纤维蛋白原最高的三分位数中更高。多变量分析发现，纤维蛋白原是耐药高血压患者MACE的独立预测因子（几率比=1.002；95% CI：1.001-1.004；P=0.009）。与最低三分位数相比，第二分位数的 MACE 高出约 2.5 倍，最高三分位数的 MACE 高出约 6.9 倍。纤维蛋白原能够预测抵抗性高血压患者的 MACE（MACE 的 AUC 为 0.662（95% CI 0.596-0.727; p
{"title":"Prognostic impact of fibrinogen in patients with resistant hypertension","authors":"Uğur Köktürk, Hamdi Püşüroğlu, İlyas Çetin, Mustafa Umut Somuncu, Ahmet Avcı, Mehmet Ertürk","doi":"10.1038/s41371-024-00964-9","DOIUrl":"10.1038/s41371-024-00964-9","url":null,"abstract":"In this study, we investigated the long-term prognostic effects of fibrinogen levels in patients with resistant hypertension. A total of 266 patients with resistant hypertension who had serum fibrinogen measurements and 5 years of follow-up information were retrospectively included in the study. The patients were stratified according to their fibrinogen levels, which were then divided into tertiles. Clinical outcomes for major adverse cardiovascular events (MACE) were assessed at 5 years. MACE was defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke, a new diagnosis of heart failure, or hospitalization for heart failure and peripheral arterial disease. The incidence of MACE at 5 years in patients with resistant hypertension was higher in the highest tertile of fibrinogen. Multivariate analysis identified fibrinogen as an independent predictor of MACE in patients with resistant hypertension (odds ratio = 1.002; 95% CI: 1.001–1.004; p = 0.009). Compared to the lowest tertile, MACE was approximately 2.5 times higher in tertile 2 and approximately 6.9 times higher in the highest tertile. Fibrinogen was able to predict MACE in patients with resistant hypertension (AUC for MACE 0.662 (95% CI 0.596–0.727; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan–Meier curve showing follow-up without MACE (MACE-free) according to the fibrinogen cut-off value, the 5-year incidence of MACE was significantly higher in the high fibrinogen group (p < 0.001). Fibrinogen is a risk marker for MACE in patients with resistant hypertension. Antihypertensive therapy aimed at lowering fibrinogen levels may improve prognosis.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"860-866"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1038/s41371-024-00960-z
Anuj Maheshwari, Rajeev Gupta, Narsingh Verma, S. N. Narasingan, Ram B. Singh, Banshi Saboo, C. H. Vasanth Kumar, Arvind Gupta, Manoj K. Srivastava, Amit Gupta, Saurabh Srivastava, Amitesh Aggarwal, Ajoy Tewari, Sajid Ansari, Bijay Patni, Dinesh Agarwal, G. B. Sattur, Lily Rodrigues, K. K. Pareek, Murar Yeolekar, Samar Banerjee, L. Sreenivasamurthy, M. K. Das, Shashank Joshi, Shailendra Vajpeyee, V. V. Muthusamy, A. Muruganathan
The Indian Society of Hypertension (InSH) highlights the urgency for India-specific guidelines on hypertension management. Hypertension affects over one billion people worldwide, with India bearing a significant burden due to its population, diversity, and demographics. In India, hypertension affects 21% of women and 24% of men, while pre-hypertension affects 39% of women and 49% of men. The prevalence of hypertension increases in the population with obesity. Even 7% of school-going children in India have hypertension, especially in urban and overweight children. However, awareness and control of hypertension in India are inadequate. Only 57% of women and 38% of men have been diagnosed with hypertension; among them, only a fraction receive appropriate medication. The overall control of hypertension stands at 15%, with regional variations. Hypertension significantly contributes to cardiovascular and renal diseases, and better detection and treatment could reduce their impact in India. At the total population level, reducing systolic blood pressure (SBP) by 2 mm Hg may significantly affect cardiovascular disease. Considering the unique challenges faced in India, the InSH stresses the importance of a tailored approach to hypertension management. They plan to disseminate guidelines through practitioner training and patient awareness campaigns. These guidelines will cover screening, diagnosis, management, handling hypertension with other conditions, long-term follow-up, and patient education. In conclusion, this position paper calls for immediate action to improve hypertension management in India and alleviate the associated disease burden and mortality.
{"title":"Position statement on hypertension by Indian Society of Hypertension, 2023","authors":"Anuj Maheshwari, Rajeev Gupta, Narsingh Verma, S. N. Narasingan, Ram B. Singh, Banshi Saboo, C. H. Vasanth Kumar, Arvind Gupta, Manoj K. Srivastava, Amit Gupta, Saurabh Srivastava, Amitesh Aggarwal, Ajoy Tewari, Sajid Ansari, Bijay Patni, Dinesh Agarwal, G. B. Sattur, Lily Rodrigues, K. K. Pareek, Murar Yeolekar, Samar Banerjee, L. Sreenivasamurthy, M. K. Das, Shashank Joshi, Shailendra Vajpeyee, V. V. Muthusamy, A. Muruganathan","doi":"10.1038/s41371-024-00960-z","DOIUrl":"10.1038/s41371-024-00960-z","url":null,"abstract":"The Indian Society of Hypertension (InSH) highlights the urgency for India-specific guidelines on hypertension management. Hypertension affects over one billion people worldwide, with India bearing a significant burden due to its population, diversity, and demographics. In India, hypertension affects 21% of women and 24% of men, while pre-hypertension affects 39% of women and 49% of men. The prevalence of hypertension increases in the population with obesity. Even 7% of school-going children in India have hypertension, especially in urban and overweight children. However, awareness and control of hypertension in India are inadequate. Only 57% of women and 38% of men have been diagnosed with hypertension; among them, only a fraction receive appropriate medication. The overall control of hypertension stands at 15%, with regional variations. Hypertension significantly contributes to cardiovascular and renal diseases, and better detection and treatment could reduce their impact in India. At the total population level, reducing systolic blood pressure (SBP) by 2 mm Hg may significantly affect cardiovascular disease. Considering the unique challenges faced in India, the InSH stresses the importance of a tailored approach to hypertension management. They plan to disseminate guidelines through practitioner training and patient awareness campaigns. These guidelines will cover screening, diagnosis, management, handling hypertension with other conditions, long-term follow-up, and patient education. In conclusion, this position paper calls for immediate action to improve hypertension management in India and alleviate the associated disease burden and mortality.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 11","pages":"736-744"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00960-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antihypertensive treatment (AT) is essential for preventing hypertension-related cognitive decline. The goals of this observational study were to compare cognitive performance (CP) between non-hypertensive (NH) volunteers and hypertensive patients and to evaluate the correlation between CP and antihypertensive drugs (AHD). Three groups were constituted: NH (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. To analyze the cognitive domains, a neuropsychological battery was applied and the raw performance values in these tests were transformed into z-scores. The domain was considered impaired if it presented a z-score below −1.5 SD. Compared to group 1, both groups of hypertensive were older (51 [ ± 12] years) and showed a worse CP in episodic memory (p = 0.014), language (p = 0.003) and processing speed (PS) [p = 0.05]. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were the most used AHD (46.3%, p = 0.01 [group 2] and 64.5%, p = 0.005 [group 3]) and showed correlations with PS. Linear regression models revealed a negative association of PS with the use of ACEi (β = −0.230, p = 0.004), but not with the use of ARB (β = 0.208, p = 0.008). The effect of AT on cognition appears to go beyond the search for lower blood pressure targets and also includes the mechanism of action of AHD on the brain, so that additional benefits may possibly be achieved with simple adaptations in the treatment regimen, particularly in patients without clinically manifest cognitive impairment.
{"title":"Angiotensin-converting enzyme inhibitors: a therapeutic option for controlling blood pressure associated with delayed cognitive processing speed","authors":"Michel Ferreira Machado, Henrique Cotchi Simbo Muela, Valeria Aparecida Costa-Hong, Natalia Cristina Moraes, Claudia Maia Memória, Monica Sanches Yassuda, Edson Bor-Seng-Shu, Ricardo Nitrini, Luiz Aparecido Bortolotto, Ricardo de Carvalho Nogueira","doi":"10.1038/s41371-024-00965-8","DOIUrl":"10.1038/s41371-024-00965-8","url":null,"abstract":"Antihypertensive treatment (AT) is essential for preventing hypertension-related cognitive decline. The goals of this observational study were to compare cognitive performance (CP) between non-hypertensive (NH) volunteers and hypertensive patients and to evaluate the correlation between CP and antihypertensive drugs (AHD). Three groups were constituted: NH (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. To analyze the cognitive domains, a neuropsychological battery was applied and the raw performance values in these tests were transformed into z-scores. The domain was considered impaired if it presented a z-score below −1.5 SD. Compared to group 1, both groups of hypertensive were older (51 [ ± 12] years) and showed a worse CP in episodic memory (p = 0.014), language (p = 0.003) and processing speed (PS) [p = 0.05]. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were the most used AHD (46.3%, p = 0.01 [group 2] and 64.5%, p = 0.005 [group 3]) and showed correlations with PS. Linear regression models revealed a negative association of PS with the use of ACEi (β = −0.230, p = 0.004), but not with the use of ARB (β = 0.208, p = 0.008). The effect of AT on cognition appears to go beyond the search for lower blood pressure targets and also includes the mechanism of action of AHD on the brain, so that additional benefits may possibly be achieved with simple adaptations in the treatment regimen, particularly in patients without clinically manifest cognitive impairment.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 1","pages":"15-21"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1038/s41371-024-00963-w
S. E. Sherman, E. Stoutenburg, D. L. Long, S. P. Juraschek, M. Cushman, V. J. Howard, R. P. Tracy, S. E. Judd, D. Kamin Mukaz, N. A. Zakai, T. B. Plante
Leptin is an adipokine associated with obesity and with hypertension in animal models. Whether leptin is associated with hypertension independent of obesity is unclear. Relative to White adults, Black adults have higher circulating leptin concentration. As such, leptin may mediate some of the excess burden of incident hypertension among Black adults. REGARDS enrolled 30,239 adults aged ≥45 years from 48 US states in 2003–07. Baseline leptin was measured in a sex- and race-stratified sample of 4400 participants. Modified Poisson regression estimated relative risk (RR) of incident hypertension (new ≥140/≥90 mmHg threshold or use of antihypertensives) per SD of log-transformed leptin, stratified by obesity (BMI of 30 kg/m2). Inverse odds ratio weighting estimated the % mediation by leptin of the excess hypertension RR among Black relative to White participants. Among the 1821 participants without prevalent hypertension, 35% developed incident hypertension. Obesity modified the relationship between leptin and incident hypertension (P-interaction 0.006) such that higher leptin was associated with greater hypertension risk in the crude model among those with BMI < 30 kg/m2, but not those with BMI ≥ 30 kg/m2. This was fully attenuated when adjusting for anthropometric measures. In the crude model, Black adults had a 52% greater risk of incident hypertension. Leptin did not significantly mediate this disparity. In this national U.S. sample, leptin was associated with incident hypertension among non-obese but not obese adults. Future investigations should focus on the effect of weight modification on incident hypertension among non-obese adults with elevated leptin.
{"title":"The association of leptin and incident hypertension in the reasons for geographic and racial differences in stroke (REGARDS) cohort","authors":"S. E. Sherman, E. Stoutenburg, D. L. Long, S. P. Juraschek, M. Cushman, V. J. Howard, R. P. Tracy, S. E. Judd, D. Kamin Mukaz, N. A. Zakai, T. B. Plante","doi":"10.1038/s41371-024-00963-w","DOIUrl":"10.1038/s41371-024-00963-w","url":null,"abstract":"Leptin is an adipokine associated with obesity and with hypertension in animal models. Whether leptin is associated with hypertension independent of obesity is unclear. Relative to White adults, Black adults have higher circulating leptin concentration. As such, leptin may mediate some of the excess burden of incident hypertension among Black adults. REGARDS enrolled 30,239 adults aged ≥45 years from 48 US states in 2003–07. Baseline leptin was measured in a sex- and race-stratified sample of 4400 participants. Modified Poisson regression estimated relative risk (RR) of incident hypertension (new ≥140/≥90 mmHg threshold or use of antihypertensives) per SD of log-transformed leptin, stratified by obesity (BMI of 30 kg/m2). Inverse odds ratio weighting estimated the % mediation by leptin of the excess hypertension RR among Black relative to White participants. Among the 1821 participants without prevalent hypertension, 35% developed incident hypertension. Obesity modified the relationship between leptin and incident hypertension (P-interaction 0.006) such that higher leptin was associated with greater hypertension risk in the crude model among those with BMI < 30 kg/m2, but not those with BMI ≥ 30 kg/m2. This was fully attenuated when adjusting for anthropometric measures. In the crude model, Black adults had a 52% greater risk of incident hypertension. Leptin did not significantly mediate this disparity. In this national U.S. sample, leptin was associated with incident hypertension among non-obese but not obese adults. Future investigations should focus on the effect of weight modification on incident hypertension among non-obese adults with elevated leptin.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"836-843"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1038/s41371-024-00962-x
Takeshi Fujiwara, Constantinos Koshiaris, Claire L. Schwartz, James P. Sheppard, Naoko Tomitani, Satoshi Hoshide, Kazuomi Kario, Richard J. McManus
This study tested the hypothesis that differences in ethnicity impact the level of agreement between ambulatory blood pressure (ABP) and home BP (HBP) levels. A retrospective analysis of cross-sectional data from the UK and Japan was performed. Participants underwent office BP, daytime ABP, and HBP measurements. The ABP–HBP difference was compared between ethnic groups by multiple linear regression analysis. Diagnostic disagreement was defined as a disparity between the hypertension diagnoses obtained using ABP and HBP, since both measures share common thresholds of 135/85 mmHg for hypertension. Definite diagnostic disagreement was assigned where such a difference exceeded ±5 mmHg for either systolic BP (SBP) or diastolic BP (DBP). A total of 1 408 participants (age 62.1 ± 11.1 years, 48.6% males, 78.9% known hypertensive, White British 18.9%, South Asian 11.2%, African Caribbean 12.0%, Japanese 58.0%) were eligible. More Japanese participants showed higher ABP than HBP compared to White British: SBP + 3.09 mmHg, 95% confidence interval (CI) + 1.14, +5.04 mmHg; DBP + 5.67 mmHg, 95%CI + 4.51, +6.84 mmHg. More Japanese participants than African Caribbean participants exhibited diagnostic disagreement in SBP (33.2% vs. 20.7%, p = 0.006). Furthermore, Japanese participants had a higher percentage of definite diagnostic disagreement in SBP compared to White British (9.3% vs. 4.5%, p = 0.040) and African Caribbean participants (9.3% vs. 3.0%, p = 0.018). In conclusion, Japanese participants showed greater disparity between ABP and HBP compared to White British participants. Complementary use of ABP and HBP monitoring may be more beneficial for assessing cardiovascular disease risk in Japanese participants compared to other ethnic groups.
{"title":"Differences in ambulatory versus home blood pressure levels by ethnicity: data from the United Kingdom and Japan","authors":"Takeshi Fujiwara, Constantinos Koshiaris, Claire L. Schwartz, James P. Sheppard, Naoko Tomitani, Satoshi Hoshide, Kazuomi Kario, Richard J. McManus","doi":"10.1038/s41371-024-00962-x","DOIUrl":"10.1038/s41371-024-00962-x","url":null,"abstract":"This study tested the hypothesis that differences in ethnicity impact the level of agreement between ambulatory blood pressure (ABP) and home BP (HBP) levels. A retrospective analysis of cross-sectional data from the UK and Japan was performed. Participants underwent office BP, daytime ABP, and HBP measurements. The ABP–HBP difference was compared between ethnic groups by multiple linear regression analysis. Diagnostic disagreement was defined as a disparity between the hypertension diagnoses obtained using ABP and HBP, since both measures share common thresholds of 135/85 mmHg for hypertension. Definite diagnostic disagreement was assigned where such a difference exceeded ±5 mmHg for either systolic BP (SBP) or diastolic BP (DBP). A total of 1 408 participants (age 62.1 ± 11.1 years, 48.6% males, 78.9% known hypertensive, White British 18.9%, South Asian 11.2%, African Caribbean 12.0%, Japanese 58.0%) were eligible. More Japanese participants showed higher ABP than HBP compared to White British: SBP + 3.09 mmHg, 95% confidence interval (CI) + 1.14, +5.04 mmHg; DBP + 5.67 mmHg, 95%CI + 4.51, +6.84 mmHg. More Japanese participants than African Caribbean participants exhibited diagnostic disagreement in SBP (33.2% vs. 20.7%, p = 0.006). Furthermore, Japanese participants had a higher percentage of definite diagnostic disagreement in SBP compared to White British (9.3% vs. 4.5%, p = 0.040) and African Caribbean participants (9.3% vs. 3.0%, p = 0.018). In conclusion, Japanese participants showed greater disparity between ABP and HBP compared to White British participants. Complementary use of ABP and HBP monitoring may be more beneficial for assessing cardiovascular disease risk in Japanese participants compared to other ethnic groups.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"828-835"},"PeriodicalIF":2.7,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1038/s41371-024-00961-y
Nikolaos Kakaletsis, Athanase D. Protogerou, Vasilios Kotsis, Konstantinos Vemmos, Eleni Korompoki, Anastasios Kollias, Haralampos Milionis, George Ntaios, Christos Savopoulos
Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.
{"title":"Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis","authors":"Nikolaos Kakaletsis, Athanase D. Protogerou, Vasilios Kotsis, Konstantinos Vemmos, Eleni Korompoki, Anastasios Kollias, Haralampos Milionis, George Ntaios, Christos Savopoulos","doi":"10.1038/s41371-024-00961-y","DOIUrl":"10.1038/s41371-024-00961-y","url":null,"abstract":"Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"676-686"},"PeriodicalIF":2.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00961-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1038/s41371-024-00954-x
Julio Cesar Silva de Sousa, Rafael Yokoyama Fecchio, Laura Oliveira-Silva, Andrea Pio-Abreu, Giovânio Vieira da Silva, Luciano F. Drager, David A. Low, Cláudia Lúcia de Moraes Forjaz
Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON – 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.
{"title":"Effects of dynamic, isometric, and combined resistance training on ambulatory blood pressure in treated men with hypertension: a randomized controlled trial","authors":"Julio Cesar Silva de Sousa, Rafael Yokoyama Fecchio, Laura Oliveira-Silva, Andrea Pio-Abreu, Giovânio Vieira da Silva, Luciano F. Drager, David A. Low, Cláudia Lúcia de Moraes Forjaz","doi":"10.1038/s41371-024-00954-x","DOIUrl":"10.1038/s41371-024-00954-x","url":null,"abstract":"Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON – 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"796-805"},"PeriodicalIF":2.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00954-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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