Pub Date : 2025-11-14DOI: 10.1038/s41371-025-01093-7
Nicholas Cauwenberghs, Anna Carlén, Thomas Lindow, Viktor Elmberg, Lars Brudin, Magnus Ekström, Kristofer Hedman
During graded exercise, systolic blood pressure (SBP) is expected to increase linearly, but other responses are observed. To date, a framework for algorithmic assessment of the shape of the SBP response is lacking, making its physiological and clinical relevance poorly understood. We aimed to algorithmically identify distinct SBP response shapes and analyze their association with clinical factors and all-cause mortality. We retrospectively analyzed SBP recordings from a cohort of 5633 patients (mean age, 55.1 years; 43% female) undergoing maximal cycle ergometry, who met strict quality criteria, including ≥30 mmHg increase in SBP during exercise. Per patient, test duration and SBP values were rescaled (0-100%) to retrieve the SBP response shape. Group-based trajectory modelling (GBTM) was used to classify SBP shapes by sex. Associations with clinical factors and all-cause mortality were evaluated using multinomial logistic regression and Cox survival analysis. In both sexes, GBTM identified three SBP response shapes: early, linear and late rise in SBP. Late rise was associated with higher resting SBP, lower peak SBP and smaller increases in SBP during exercise (P < 0.05). A late SBP rise related independently to older age, higher body mass index, beta blocker use and lower exercise capacity. A late SBP rise predicted increased all-cause mortality in men (HRadjusted versus early SBP rise: 1.66, 95% CI: 1.10-2.50; P = 0.015) but not in women (1.06, 0.60-1.90; P = 0.84). In conclusion, a late SBP response was linked to a worse risk profile and independently predicted all-cause mortality in men, suggesting clinical relevance for SBP shape assessment during exercise.
在分级运动中，预期收缩压（SBP）线性增加，但观察到其他反应。迄今为止，还缺乏一个评估收缩压反应形状的算法框架，这使得人们对其生理和临床相关性知之甚少。我们的目的是通过算法识别不同的收缩压反应形状，并分析它们与临床因素和全因死亡率的关系。我们回顾性分析了5633例患者的收缩压记录（平均年龄55.1岁，43%为女性），这些患者接受了最大周期测量术，符合严格的质量标准，包括运动时收缩压升高≥30 mmHg。每位患者，测试时间和收缩压值被重新调整（0-100%），以获取收缩压反应形状。采用基于组的轨迹模型（GBTM）对收缩压形状进行性别分类。使用多项logistic回归和Cox生存分析评估与临床因素和全因死亡率的关系。在两性中，GBTM发现了三种收缩压反应形式：早期、线性和晚期收缩压上升。晚起与运动时静息收缩压升高、收缩压峰值降低和收缩压升高较小相关（P校正后与早期收缩压升高：1.66,95% CI: 1.10-2.50; P = 0.015），但与女性无关（1.06,0.60-1.90;P = 0.84）。总之，较晚的收缩压反应与较差的风险状况有关，并独立预测男性的全因死亡率，提示运动期间收缩压形状评估的临床相关性。
{"title":"The shape of the systolic blood pressure response during graded exercise: methodology, correlates and predictive value","authors":"Nicholas Cauwenberghs, Anna Carlén, Thomas Lindow, Viktor Elmberg, Lars Brudin, Magnus Ekström, Kristofer Hedman","doi":"10.1038/s41371-025-01093-7","DOIUrl":"10.1038/s41371-025-01093-7","url":null,"abstract":"During graded exercise, systolic blood pressure (SBP) is expected to increase linearly, but other responses are observed. To date, a framework for algorithmic assessment of the shape of the SBP response is lacking, making its physiological and clinical relevance poorly understood. We aimed to algorithmically identify distinct SBP response shapes and analyze their association with clinical factors and all-cause mortality. We retrospectively analyzed SBP recordings from a cohort of 5633 patients (mean age, 55.1 years; 43% female) undergoing maximal cycle ergometry, who met strict quality criteria, including ≥30 mmHg increase in SBP during exercise. Per patient, test duration and SBP values were rescaled (0-100%) to retrieve the SBP response shape. Group-based trajectory modelling (GBTM) was used to classify SBP shapes by sex. Associations with clinical factors and all-cause mortality were evaluated using multinomial logistic regression and Cox survival analysis. In both sexes, GBTM identified three SBP response shapes: early, linear and late rise in SBP. Late rise was associated with higher resting SBP, lower peak SBP and smaller increases in SBP during exercise (P < 0.05). A late SBP rise related independently to older age, higher body mass index, beta blocker use and lower exercise capacity. A late SBP rise predicted increased all-cause mortality in men (HRadjusted versus early SBP rise: 1.66, 95% CI: 1.10-2.50; P = 0.015) but not in women (1.06, 0.60-1.90; P = 0.84). In conclusion, a late SBP response was linked to a worse risk profile and independently predicted all-cause mortality in men, suggesting clinical relevance for SBP shape assessment during exercise.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"40 1","pages":"37-44"},"PeriodicalIF":3.4,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01093-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523558","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}
While elevated arterial stiffness is recognized as a predictor of atrial fibrillation (AF), the relationship between long-term pulse pressure (PP) and the incidence of AF remains to be fully elucidated. We assessed the influence of time-averaged cumulative PP in midlife on incident AF. The analysis included 9150 adults from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of AF at visit 4. The time-averaged cumulative blood pressure (BP) was calculated as the sum of the averaged BPs from the adjacent consecutive visits (visits 1–4), with the values being indexed to the total exposure time. At visit 4, the mean age of the study population was 62.9 years, with 4045 (44.2%) of the population being male. In 1455 individuals (15.9%) with a median follow-up of 16 years, incident AF was seen. The greatest predictor of incident AF, as indicated by the decline in the −2 Log likelihood statistic, was time-averaged cumulative PP, which was linked to an elevated risk for AF (HR = 1.20 (1.13–1.27)) in adjusted Cox models (per 1-SD increment). The correlation between incident AF and time-averaged cumulative systolic blood pressure (SBP) was 1.14 (1.07–1.22). In contrast, the diastolic relation tended to be opposite (HR = 0.94 (0.88–1.00)). Moreover, among persons aged < 65 years, without hypertension or antihypertensive treatment, these associations were even more remarkable (P < 0.05 for all interactions). Time-averaged cumulative PP in midlife was an important risk factor for incident AF with the strongest predictive effect, especially in persons who were younger, normotensive, or without antihypertensive treatment.
{"title":"Time-averaged cumulative pulse pressure in midlife and incident atrial fibrillation: the atherosclerosis risk in communities study","authors":"Yiquan Huang, Ziwei Zhou, Yifen Lin, Shaozhao Zhang, Zhenyu Xiong, Menghui Liu, Yue Guo, Wenjing Zhang, Xiaodong Zhuang, Xinxue Liao","doi":"10.1038/s41371-025-01050-4","DOIUrl":"10.1038/s41371-025-01050-4","url":null,"abstract":"While elevated arterial stiffness is recognized as a predictor of atrial fibrillation (AF), the relationship between long-term pulse pressure (PP) and the incidence of AF remains to be fully elucidated. We assessed the influence of time-averaged cumulative PP in midlife on incident AF. The analysis included 9150 adults from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of AF at visit 4. The time-averaged cumulative blood pressure (BP) was calculated as the sum of the averaged BPs from the adjacent consecutive visits (visits 1–4), with the values being indexed to the total exposure time. At visit 4, the mean age of the study population was 62.9 years, with 4045 (44.2%) of the population being male. In 1455 individuals (15.9%) with a median follow-up of 16 years, incident AF was seen. The greatest predictor of incident AF, as indicated by the decline in the −2 Log likelihood statistic, was time-averaged cumulative PP, which was linked to an elevated risk for AF (HR = 1.20 (1.13–1.27)) in adjusted Cox models (per 1-SD increment). The correlation between incident AF and time-averaged cumulative systolic blood pressure (SBP) was 1.14 (1.07–1.22). In contrast, the diastolic relation tended to be opposite (HR = 0.94 (0.88–1.00)). Moreover, among persons aged < 65 years, without hypertension or antihypertensive treatment, these associations were even more remarkable (P < 0.05 for all interactions). Time-averaged cumulative PP in midlife was an important risk factor for incident AF with the strongest predictive effect, especially in persons who were younger, normotensive, or without antihypertensive treatment.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"40 1","pages":"23-28"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471148","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 : 2025-11-01DOI: 10.1038/s41371-025-01091-9
Nathália Serafim Paris, Rogério Toshiro Passos Okawa, Wendell Arthur Lopes
{"title":"The need to distinguish office and ambulatory blood pressure in evaluating Pilates efficacy in hypertension","authors":"Nathália Serafim Paris, Rogério Toshiro Passos Okawa, Wendell Arthur Lopes","doi":"10.1038/s41371-025-01091-9","DOIUrl":"10.1038/s41371-025-01091-9","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"903-903"},"PeriodicalIF":3.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426823","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 : 2025-10-23DOI: 10.1038/s41371-025-01088-4
Aida Zaheer, Kimberly H. Peckett, Tania J. Pereira, Stacey M. Acker, Jason S. Au
Although central wave reflections are critical for aortic pressure regulation, the control mechanisms involved in humans are understudied. This study investigated the impact of upper- and lower-limb high-flexion postures on central arterial wave reflections. Twenty-two healthy adults (11 females, aged 25 ± 3 years) underwent three randomized and counter-balanced positions to evaluate the effect on central wave reflection: supine legs and arms in the anatomical position; supine two legs bent and arms straight; and supine two arms bent and legs straight. Characteristic impedance, forward and backward pressure waves, and pulse characteristics were measured via the central pressure-flow relationship in the frequency domain at the end of each posture hold. Central diastolic blood pressure increased during arm flexion only (67 ± 9 mmHg vs. 62 ± 9 mmHg; p < 0.01). Central systolic blood pressure, augmentation index, forward wave amplitude, reflected wave amplitude, central wave reflection magnitude, and characteristic impedance were unaffected by varying limb flexion positions (all p > 0.05). Acutely bending the arms and legs did not influence central wave reflections, likely related to a minimal effect of conduit artery bending, versus microvascular involvement, as suggested in previous studies. These findings underscore the importance of identifying the specific vascular regions responsible for wave reflection generation and support the need to refine central pressure augmentation models to accurately localize the dominant sources of wave reflection in humans.
虽然中央波反射对主动脉压力调节至关重要，但涉及人类的控制机制尚未得到充分研究。本研究探讨了上肢和下肢高屈曲姿势对中央动脉波反射的影响。22名健康成人（女性11名，年龄25±3岁）采用三种随机平衡体位评估对中枢波反射的影响：解剖体位仰卧的腿和手臂；仰卧，两腿弯曲，手臂伸直；仰卧，双臂弯曲，双腿伸直。在每个姿势保持结束时，通过频率域中心压力-流量关系测量特征阻抗、前向和后向压力波以及脉冲特性。仅在手臂屈曲时中央舒张压升高（67±9 mmHg vs 62±9 mmHg; p 0.05）。剧烈弯曲手臂和腿不影响中央波反射，可能与导管动脉弯曲的最小影响有关，而不是微血管受累，正如先前的研究所表明的那样。这些发现强调了识别负责波反射产生的特定血管区域的重要性，并支持完善中心压力增强模型以准确定位人类波反射的主要来源的必要性。
{"title":"The consequences of high-flexion postures on arterial wave reflections","authors":"Aida Zaheer, Kimberly H. Peckett, Tania J. Pereira, Stacey M. Acker, Jason S. Au","doi":"10.1038/s41371-025-01088-4","DOIUrl":"10.1038/s41371-025-01088-4","url":null,"abstract":"Although central wave reflections are critical for aortic pressure regulation, the control mechanisms involved in humans are understudied. This study investigated the impact of upper- and lower-limb high-flexion postures on central arterial wave reflections. Twenty-two healthy adults (11 females, aged 25 ± 3 years) underwent three randomized and counter-balanced positions to evaluate the effect on central wave reflection: supine legs and arms in the anatomical position; supine two legs bent and arms straight; and supine two arms bent and legs straight. Characteristic impedance, forward and backward pressure waves, and pulse characteristics were measured via the central pressure-flow relationship in the frequency domain at the end of each posture hold. Central diastolic blood pressure increased during arm flexion only (67 ± 9 mmHg vs. 62 ± 9 mmHg; p < 0.01). Central systolic blood pressure, augmentation index, forward wave amplitude, reflected wave amplitude, central wave reflection magnitude, and characteristic impedance were unaffected by varying limb flexion positions (all p > 0.05). Acutely bending the arms and legs did not influence central wave reflections, likely related to a minimal effect of conduit artery bending, versus microvascular involvement, as suggested in previous studies. These findings underscore the importance of identifying the specific vascular regions responsible for wave reflection generation and support the need to refine central pressure augmentation models to accurately localize the dominant sources of wave reflection in humans.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"40 1","pages":"18-22"},"PeriodicalIF":3.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355075","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 : 2025-10-22DOI: 10.1038/s41371-025-01086-6
Rafael de Oliveira Alvim, Divanei Zaniqueli, Camila Maciel de Oliveira, Alexandre Costa Pereira, José Geraldo Mill
{"title":"Blood pressure-independent progression of arterial stiffness in older adults","authors":"Rafael de Oliveira Alvim, Divanei Zaniqueli, Camila Maciel de Oliveira, Alexandre Costa Pereira, José Geraldo Mill","doi":"10.1038/s41371-025-01086-6","DOIUrl":"10.1038/s41371-025-01086-6","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"801-803"},"PeriodicalIF":3.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345489","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 : 2025-10-22DOI: 10.1038/s41371-025-01089-3
Kristel Janssens, Stephen J. Foulkes, Paolo D’Ambrosio, Amy M. Mitchell, Stephanie J. Rowe, Youri Bekhuis, Luke Spencer, Evelyn B. Parr, Geoffrey A. Head, Hein Heidbuchel, Guido Claessen, Andre La Gerche
Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24–58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBPmax) using published cut-offs; SBPmax ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBPmax/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden’s Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBPmax was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP > 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBPmax/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBPmax thresholds.
{"title":"Diagnostic accuracy of different exercise blood pressure metrics in identifying hypertension on 24-h ambulatory blood pressure monitoring in athletes","authors":"Kristel Janssens, Stephen J. Foulkes, Paolo D’Ambrosio, Amy M. Mitchell, Stephanie J. Rowe, Youri Bekhuis, Luke Spencer, Evelyn B. Parr, Geoffrey A. Head, Hein Heidbuchel, Guido Claessen, Andre La Gerche","doi":"10.1038/s41371-025-01089-3","DOIUrl":"10.1038/s41371-025-01089-3","url":null,"abstract":"Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24–58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBPmax) using published cut-offs; SBPmax ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBPmax/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden’s Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBPmax was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP > 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBPmax/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBPmax thresholds.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"40 1","pages":"10-17"},"PeriodicalIF":3.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01089-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345542","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 : 2025-10-22DOI: 10.1038/s41371-025-01084-8
H. Oshaju, BS Chori, R. Mshelia-Reng, FO Anumah, AN Odili
There had been no previous study that evaluated the prevalence of masked hypertension (MH), its determinants, and ambulatory blood pressure patterns among patients with type 2 diabetes mellitus (DM) in Nigeria. Among 222 individuals living with type 2 DM with normal clinic blood pressure (SBP < 140 mm Hg and DBP < 90 mm Hg), we obtained 24 h ambulatory blood pressure measurements. Patients were either untreated (77) or treated (145) with antihypertensive medications. The prevalence of MH among the normotensive (untreated) and hypertensive subgroups (treated) was 32.5 and 60% respectively. The prevalence of nocturnal hypertension among all patients was 71.6%, and was significantly higher among patients with masked phenomenon (98.2 vs 46.2%, p < 0.0001) compared to true normotension. The determinants of MH were 5 years or more duration of type 2 DM (odds ratio 2.71, 95% CI 1.21–6.27) and increasing clinic SBP (odds ratio 2.19, 95% CI 1.51–3.36). Masked hypertension is common among patients with type 2 DM. Higher clinic SBP and 5 years or more duration of type 2 DM are the risk factors.
{"title":"Prevalence and determinants of masked hypertension among patients with type 2 diabetes mellitus","authors":"H. Oshaju, BS Chori, R. Mshelia-Reng, FO Anumah, AN Odili","doi":"10.1038/s41371-025-01084-8","DOIUrl":"10.1038/s41371-025-01084-8","url":null,"abstract":"There had been no previous study that evaluated the prevalence of masked hypertension (MH), its determinants, and ambulatory blood pressure patterns among patients with type 2 diabetes mellitus (DM) in Nigeria. Among 222 individuals living with type 2 DM with normal clinic blood pressure (SBP < 140 mm Hg and DBP < 90 mm Hg), we obtained 24 h ambulatory blood pressure measurements. Patients were either untreated (77) or treated (145) with antihypertensive medications. The prevalence of MH among the normotensive (untreated) and hypertensive subgroups (treated) was 32.5 and 60% respectively. The prevalence of nocturnal hypertension among all patients was 71.6%, and was significantly higher among patients with masked phenomenon (98.2 vs 46.2%, p < 0.0001) compared to true normotension. The determinants of MH were 5 years or more duration of type 2 DM (odds ratio 2.71, 95% CI 1.21–6.27) and increasing clinic SBP (odds ratio 2.19, 95% CI 1.51–3.36). Masked hypertension is common among patients with type 2 DM. Higher clinic SBP and 5 years or more duration of type 2 DM are the risk factors.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"867-873"},"PeriodicalIF":3.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345470","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 : 2025-10-18DOI: 10.1038/s41371-025-01082-w
Elias Hellou, Tamer Jamal, Elchanan Zuroff, Parvin Kalhor, Maria Delgado-Lelievre, Matteo Manzato, Lilach O. Lerman, Amir Lerman, Erez Kachel, Ziad Zoghby
Accurate and convenient monitoring of blood pressure (BP) is challenging and relies on cuff-based devices or in the postoperative/intensive care settings, on invasive measurements. The aim of this study was to prospectively evaluate the accuracy of BP measurements obtained from a novel, commercially available cuffless, non-invasive photoplethysmography (PPG)-based chest patch monitor in patients after cardiac surgery. This single center prospective preliminary validation study enrolled adults who underwent cardiac surgery. Data generated by the PPG-based device was compared to those of a standard invasive arterial pressure (IAP). Bland-Altman plots and Pearson’s correlations were used to assess the accuracy of the PPG-based device. Stability and BP changes were not formally evaluated. Ninety-six patients consented for the study. Mean age was 63.2 ± 12.2 years (range 24–84), and 32 (33%) were women. Average monitoring was 25.6 ± 17.2 h. In total, we evaluated 78,659 readings for systolic BP (SBP), 78,818 for diastolic BP (DBP), and 92,544 for heart rate (HR). The correlation coefficients were r = 0.959, 0.973, 0.966, and 0.962 for SBP, DBP, mean arterial pressure (MAP), and (HR), respectively. The bias ± SD was 0.1 ± 4.8 mmHg for SBP; 0.4 ± 2.1 mmHg for DBP; 0.26 ± 2.6 mmHg for MAP, and 0.15 ± 3.6 beats per minutes for HR. 95% of SBP, and 99.9% of DBP measurements were within 10 mmHg of the reference measurement. In conclusion, the tested cuffless device offers acceptable accuracy and is a promising novel noninvasive tool for continuous BP monitoring. Further studies are needed to validate these findings according to the most updated validation protocols for pulseless devices. ClinicalTrials.gov ID NCT04071015.
{"title":"Performance of a cuffless photoplethysmography-based device for continuous monitoring of blood pressure after cardiac surgery: a preliminary validation study","authors":"Elias Hellou, Tamer Jamal, Elchanan Zuroff, Parvin Kalhor, Maria Delgado-Lelievre, Matteo Manzato, Lilach O. Lerman, Amir Lerman, Erez Kachel, Ziad Zoghby","doi":"10.1038/s41371-025-01082-w","DOIUrl":"10.1038/s41371-025-01082-w","url":null,"abstract":"Accurate and convenient monitoring of blood pressure (BP) is challenging and relies on cuff-based devices or in the postoperative/intensive care settings, on invasive measurements. The aim of this study was to prospectively evaluate the accuracy of BP measurements obtained from a novel, commercially available cuffless, non-invasive photoplethysmography (PPG)-based chest patch monitor in patients after cardiac surgery. This single center prospective preliminary validation study enrolled adults who underwent cardiac surgery. Data generated by the PPG-based device was compared to those of a standard invasive arterial pressure (IAP). Bland-Altman plots and Pearson’s correlations were used to assess the accuracy of the PPG-based device. Stability and BP changes were not formally evaluated. Ninety-six patients consented for the study. Mean age was 63.2 ± 12.2 years (range 24–84), and 32 (33%) were women. Average monitoring was 25.6 ± 17.2 h. In total, we evaluated 78,659 readings for systolic BP (SBP), 78,818 for diastolic BP (DBP), and 92,544 for heart rate (HR). The correlation coefficients were r = 0.959, 0.973, 0.966, and 0.962 for SBP, DBP, mean arterial pressure (MAP), and (HR), respectively. The bias ± SD was 0.1 ± 4.8 mmHg for SBP; 0.4 ± 2.1 mmHg for DBP; 0.26 ± 2.6 mmHg for MAP, and 0.15 ± 3.6 beats per minutes for HR. 95% of SBP, and 99.9% of DBP measurements were within 10 mmHg of the reference measurement. In conclusion, the tested cuffless device offers acceptable accuracy and is a promising novel noninvasive tool for continuous BP monitoring. Further studies are needed to validate these findings according to the most updated validation protocols for pulseless devices. ClinicalTrials.gov ID NCT04071015.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"894-902"},"PeriodicalIF":3.4,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318455","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 : 2025-10-18DOI: 10.1038/s41371-025-01087-5
Michael E. Ernst, Kerry M. Sheets, Katherine L. Webb, Michelle A. Fravel, Robyn L. Woods, Lawrence Beilin, Suzanne G. Orchard, Raj C. Shah, Kevan R. Polkinghorne, Christopher M. Reid, Rory Wolfe, Anne Murray, Paul Lacaze, Joanne Ryan
In 19 114 community-dwelling older adults enrolled in the ASPREE trial, high late-life visit-to-visit blood pressure variability (BPV) was associated with increased risks of incident dementia and cognitive decline during the median 4.7 year trial period. Whether sex or apolipoprotein E (ApoE) affect these associations over longer-term follow-up is unknown. We investigated the association between BPV and long term risks of dementia and cognitive decline using data from the ASPREE-eXTension (ASPREE-XT) study (median 8.3 year follow-up for dementia, 7.3 years for cognitive decline, after BPV estimation). Long-term BPV was estimated using standard deviation (SD) of the mean systolic BPs measured at ASPREE baseline, year 1 and 2 visits. Incident dementia was an adjudicated secondary endpoint and cognitive decline was defined as ≥1.5 SD decline in score from baseline sustained on the same of one, or more, standardized cognitive tests administered annually/biennially throughout ASPREE/ASPREE-XT. Analyses were stratified a priori by sex, using sex-specific SD tertiles of systolic BPV. Multivariable Cox proportional hazards regression comparing the highest BPV tertile to the lowest showed increased risk of dementia (HR = 1.33, 1.10–1.61) and cognitive decline (HR = 1.17, 1.06–1.30) in males, and cognitive decline in females (HR = 1.17, 1.07–1.28). In ApoE genotyped participants (81%), females in the highest BPV tertile lacking the ɛ4 allele had increased risk of dementia (HR = 1.39; 1.04–1.84), while risk of cognitive decline was increased in both sexes lacking the ɛ4 allele (males HR = 1.25; 1.09–1.43; females HR = 1.14; 1.01–1.29). These findings suggest both sex and ApoE impact the association of high BPV with long-term cognitive changes.
{"title":"Late-life, visit-to-visit blood pressure variability and its association with sex-specific long-term cognitive outcomes","authors":"Michael E. Ernst, Kerry M. Sheets, Katherine L. Webb, Michelle A. Fravel, Robyn L. Woods, Lawrence Beilin, Suzanne G. Orchard, Raj C. Shah, Kevan R. Polkinghorne, Christopher M. Reid, Rory Wolfe, Anne Murray, Paul Lacaze, Joanne Ryan","doi":"10.1038/s41371-025-01087-5","DOIUrl":"10.1038/s41371-025-01087-5","url":null,"abstract":"In 19 114 community-dwelling older adults enrolled in the ASPREE trial, high late-life visit-to-visit blood pressure variability (BPV) was associated with increased risks of incident dementia and cognitive decline during the median 4.7 year trial period. Whether sex or apolipoprotein E (ApoE) affect these associations over longer-term follow-up is unknown. We investigated the association between BPV and long term risks of dementia and cognitive decline using data from the ASPREE-eXTension (ASPREE-XT) study (median 8.3 year follow-up for dementia, 7.3 years for cognitive decline, after BPV estimation). Long-term BPV was estimated using standard deviation (SD) of the mean systolic BPs measured at ASPREE baseline, year 1 and 2 visits. Incident dementia was an adjudicated secondary endpoint and cognitive decline was defined as ≥1.5 SD decline in score from baseline sustained on the same of one, or more, standardized cognitive tests administered annually/biennially throughout ASPREE/ASPREE-XT. Analyses were stratified a priori by sex, using sex-specific SD tertiles of systolic BPV. Multivariable Cox proportional hazards regression comparing the highest BPV tertile to the lowest showed increased risk of dementia (HR = 1.33, 1.10–1.61) and cognitive decline (HR = 1.17, 1.06–1.30) in males, and cognitive decline in females (HR = 1.17, 1.07–1.28). In ApoE genotyped participants (81%), females in the highest BPV tertile lacking the ɛ4 allele had increased risk of dementia (HR = 1.39; 1.04–1.84), while risk of cognitive decline was increased in both sexes lacking the ɛ4 allele (males HR = 1.25; 1.09–1.43; females HR = 1.14; 1.01–1.29). These findings suggest both sex and ApoE impact the association of high BPV with long-term cognitive changes.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"831-840"},"PeriodicalIF":3.4,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01087-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318445","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 : 2025-10-17DOI: 10.1038/s41371-025-01081-x
Rabeel Khan, Naeem Mubarak, Muhammad Ahsan Waqar
Hypertension, a global health burden affecting over a billion individuals, significantly contributes to cardiovascular diseases and mortality. Despite the availability of effective antihypertensive therapies, medication adherence remains a critical challenge, particularly in low-resource settings. Pharmacist-led interventions have emerged as an effective strategy to enhance adherence and optimize blood pressure (BP) control. Pharmacists’ accessibility enables tailored interventions addressing multifaceted barriers to adherence, such as patient education, complex medication regimens, and communication gaps. Medication therapy management (MTM), implemented internationally, demonstrates significant improvements in adherence and BP control by addressing medication appropriateness and patient-specific challenges. Telemedicine and mobile health technologies allow remote monitoring, ensuring better adherence tracking and timely interventions. Collaborative care models, involving all healthcare professionals, provide integrated care that significantly reduces BP and enhances patient outcomes. Studies across diverse settings highlight the efficacy of these interventions, reporting substantial reductions in systolic and diastolic BP and improved adherence rates. Pharmacist-led interventions represent a paradigm shift in hypertension management, bridging gaps in care and improving health outcomes. By addressing adherence barriers through innovative and patient-centered approaches, pharmacists play a pivotal role in mitigating the global burden of hypertension and advancing public health. This review highlights critical role of pharmacists in improving hypertension management through interventions like MTM, patient counseling, telemedicine, and collaborative care. By addressing barriers such as inadequate understanding, inconsistent medication use, and communication gaps, pharmacists ensure therapeutic appropriateness through medication reconciliation, dosage adjustments, and regular follow-ups. The integration of technology and personalized care enhances adherence, ultimately mitigating hypertension-related morbidity and mortality.
{"title":"A comprehensive global review on pharmacist-led strategies to support medication therapy in hypertensive patients","authors":"Rabeel Khan, Naeem Mubarak, Muhammad Ahsan Waqar","doi":"10.1038/s41371-025-01081-x","DOIUrl":"10.1038/s41371-025-01081-x","url":null,"abstract":"Hypertension, a global health burden affecting over a billion individuals, significantly contributes to cardiovascular diseases and mortality. Despite the availability of effective antihypertensive therapies, medication adherence remains a critical challenge, particularly in low-resource settings. Pharmacist-led interventions have emerged as an effective strategy to enhance adherence and optimize blood pressure (BP) control. Pharmacists’ accessibility enables tailored interventions addressing multifaceted barriers to adherence, such as patient education, complex medication regimens, and communication gaps. Medication therapy management (MTM), implemented internationally, demonstrates significant improvements in adherence and BP control by addressing medication appropriateness and patient-specific challenges. Telemedicine and mobile health technologies allow remote monitoring, ensuring better adherence tracking and timely interventions. Collaborative care models, involving all healthcare professionals, provide integrated care that significantly reduces BP and enhances patient outcomes. Studies across diverse settings highlight the efficacy of these interventions, reporting substantial reductions in systolic and diastolic BP and improved adherence rates. Pharmacist-led interventions represent a paradigm shift in hypertension management, bridging gaps in care and improving health outcomes. By addressing adherence barriers through innovative and patient-centered approaches, pharmacists play a pivotal role in mitigating the global burden of hypertension and advancing public health. This review highlights critical role of pharmacists in improving hypertension management through interventions like MTM, patient counseling, telemedicine, and collaborative care. By addressing barriers such as inadequate understanding, inconsistent medication use, and communication gaps, pharmacists ensure therapeutic appropriateness through medication reconciliation, dosage adjustments, and regular follow-ups. The integration of technology and personalized care enhances adherence, ultimately mitigating hypertension-related morbidity and mortality.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"809-821"},"PeriodicalIF":3.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01081-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313003","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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