There has been steady progress in documenting the psychosocial risk factors of hypertension. However, most of the extant evidence is based on population from the developed countries. Using nationally representative data from India, this cross-sectional study explores whether spousal age gap is associated with risk of hypertension in married women aged 20 to 49 years. Based on the age difference with their husbands, women were grouped into four categories: husband was – i) of similar age, ii) 3–5 years older, iii) 6–9 years older, and iv) 10+ years older. Compared to women whose husbands were of similar age, the odds of having hypertension for the other categories were assessed by estimating multivariable logistic regression models. While the hypertension prevalence in our sample was 18.9%, it was 2.2%-points lower among women whose husbands were of similar age, and 3.3%-points higher among women whose husbands were 10+ years older. The adjusted odds of having hypertension for women with 10+ years of spousal age difference were 1.18 (95% CI: 1.13–1.24) times that of their counterparts who were of similar age to their husbands. These results were persistent in both younger (age 20–34) and older (age 35–49) women and robust across age at marriage, years in marriage, and various socioeconomic sub-groups including women’s educational attainment, husband’s educational level, household wealth, urban/rural residence, and geographic regions. The relationship also persisted after adjusting for husband’s hypertension status. Our findings thus highlight spousal age difference as a biopsychosocial factor influencing the risk of hypertension in women.
{"title":"Spousal age difference and risk of hypertension in women: evidence from India","authors":"Biplab Kumar Datta, Ashwini Tiwari, Murshed Jahan, Natalia Torres, Sara Attari","doi":"10.1038/s41371-024-00959-6","DOIUrl":"10.1038/s41371-024-00959-6","url":null,"abstract":"There has been steady progress in documenting the psychosocial risk factors of hypertension. However, most of the extant evidence is based on population from the developed countries. Using nationally representative data from India, this cross-sectional study explores whether spousal age gap is associated with risk of hypertension in married women aged 20 to 49 years. Based on the age difference with their husbands, women were grouped into four categories: husband was – i) of similar age, ii) 3–5 years older, iii) 6–9 years older, and iv) 10+ years older. Compared to women whose husbands were of similar age, the odds of having hypertension for the other categories were assessed by estimating multivariable logistic regression models. While the hypertension prevalence in our sample was 18.9%, it was 2.2%-points lower among women whose husbands were of similar age, and 3.3%-points higher among women whose husbands were 10+ years older. The adjusted odds of having hypertension for women with 10+ years of spousal age difference were 1.18 (95% CI: 1.13–1.24) times that of their counterparts who were of similar age to their husbands. These results were persistent in both younger (age 20–34) and older (age 35–49) women and robust across age at marriage, years in marriage, and various socioeconomic sub-groups including women’s educational attainment, husband’s educational level, household wealth, urban/rural residence, and geographic regions. The relationship also persisted after adjusting for husband’s hypertension status. Our findings thus highlight spousal age difference as a biopsychosocial factor influencing the risk of hypertension in women.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"851-859"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289276","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 : 2024-09-17DOI: 10.1038/s41371-024-00958-7
Vinicius Crahim, Valéria Verri, Andrea De Lorenzo, Eduardo Tibirica
Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences. The study was registered at ClinicalTrials.gov ( https://register.clinicaltrials.gov ) under protocol # NCT05464849, initial release 12/07/2022.
耐药性高血压（RH）可能与微量白蛋白尿（MAU）有关，后者是心血管风险和靶器官损伤的标志物，两者都可能与微血管损伤有关。激光斑点对比成像（LSCI）是一种无创评估全身微血管内皮功能的创新方法，对伴有或不伴有MAU的RH非常有用。微量白蛋白尿的定义是尿白蛋白与肌酐的比率在 30 至 300 毫克/克之间。使用 LSCI 对微血管反应性进行评估，以对皮肤微血管灌注变化进行无创测量。药理（乙酰胆碱[ACh]或硝普钠[SNP]）和生理（闭塞后反应性充血[PORH]）刺激用于评估血管扩张反应。对 32 名患有 RH 且尿白蛋白与肌酐比值正常的患者（RH 组）和 32 名患有 RH 且有微量白蛋白尿的患者（RH + MAU）进行了评估。与无微量白蛋白尿的患者相比，RH + MAU 患者的内皮依赖性全身微血管反应性降低，表现为 PORH 诱导的微血管扩张减弱。另一方面，ACh 诱导的血管舒张在各组之间没有差异。研究结果还显示，与非 MAU 患者相比，患有 MAU 的高血压患者的内皮依赖性（SNP 诱导的）微血管反应性降低。在这项研究中，有证据表明，RH + MAU 患者的内皮功能障碍与微血管平滑肌功能受损有关。这可能表明，RH 患者需要更强化的治疗策略来控制血压，以避免进一步的血管损伤和由此导致的后果。该研究已在临床试验网（https://register.clinicaltrials.gov）注册，协议号为 NCT05464849，初始发布日期为 2022 年 7 月 12 日。
{"title":"Reduced systemic microvascular function in patients with resistant hypertension and microalbuminuria: an observational study","authors":"Vinicius Crahim, Valéria Verri, Andrea De Lorenzo, Eduardo Tibirica","doi":"10.1038/s41371-024-00958-7","DOIUrl":"10.1038/s41371-024-00958-7","url":null,"abstract":"Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences. The study was registered at ClinicalTrials.gov ( https://register.clinicaltrials.gov ) under protocol # NCT05464849, initial release 12/07/2022.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"806-813"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00958-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258819","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 : 2024-09-13DOI: 10.1038/s41371-024-00956-9
Jonathan P. Glenning, Kieran Sandhu, Hilary A. Harrington, Lucas Eastaugh, Geoffrey K. Lane, Joseph J. Smolich, Jonathan P. Mynard
High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4–16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10–18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4 mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21–23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.
{"title":"Accuracy of the WatchBP Office Central as a Type 2 device for non-invasive estimation of central aortic blood pressure in children and adolescents","authors":"Jonathan P. Glenning, Kieran Sandhu, Hilary A. Harrington, Lucas Eastaugh, Geoffrey K. Lane, Joseph J. Smolich, Jonathan P. Mynard","doi":"10.1038/s41371-024-00956-9","DOIUrl":"10.1038/s41371-024-00956-9","url":null,"abstract":"High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4–16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10–18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4 mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21–23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"814-820"},"PeriodicalIF":2.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00956-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217708","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 : 2024-09-12DOI: 10.1038/s41371-024-00951-0
Johanna Seiffert, Niklas Ortelbach, Anja Hummel, Grace O’Malley, Thomas Stamm, Karl Haller
Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline’s recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients’ perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients’ views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.
{"title":"How do the guideline recommendations work for you? Patients’ perceived effectiveness of therapeutic approaches in arterial hypertension","authors":"Johanna Seiffert, Niklas Ortelbach, Anja Hummel, Grace O’Malley, Thomas Stamm, Karl Haller","doi":"10.1038/s41371-024-00951-0","DOIUrl":"10.1038/s41371-024-00951-0","url":null,"abstract":"Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline’s recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients’ perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients’ views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"821-827"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217703","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 : 2024-09-12DOI: 10.1038/s41371-024-00955-w
Xiaohua Liang, Daochao Huang, Yang Bi, Yun He, Taoyu Mao, Qin Liu, Guomin Hu, Jishuang Tong, Lan Chen, Yuwei Wang, Xizou An, Xiaoping Jiang, Muhammad Fahad Tahir
To explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated BP in children and adolescents. Both a nested case control and a cohort study were designed to explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated blood pressure (BP). All the included participants were from primary school. A total of 326 subjects (116:210) in nested case control were from an established cohort. And 270 participants without hypertension at baseline and followed in 2019 in cohort. FA and VB12 levels were lower in the elevated BP group than in the control group, and homocysteine level was higher than that in the control group. In the elevated BP group, overweight/obese children had lower FA than overweight/obese children in the normal BP group. FA was positively correlated with high-density lipoprotein (HDL) and Apo lipoprotein A (APOA), but negatively correlated with triglyceride (TG). FA was significantly correlated with elevated BP in children and adolescents (β = –0.353, P = 0.032), after adjusting VB12, and homocysteine (HCY), and the interaction effect of FA*HCY was significant. Both systolic and diastolic BP levels were statistically lower in the FA high exposure group than in the FA low exposure group in the cohort study. This study found that FA and vitamin B12 deficiency in childhood was correlated with elevated BP levels, which may affect BP by regulating lipid levels, and confirmed the importance of maintaining high levels of FA and vitamin B12 in childhood either by diet or supplementation.
探讨儿童和青少年血清叶酸（FA）或维生素 B12（VB12）与血压升高之间的关系。为了探讨血清叶酸（FA）或维生素 B12（VB12）与血压（BP）升高之间的关系，我们设计了一项巢式病例对照和一项队列研究。所有研究对象均来自小学。在嵌套病例对照中，共有 326 名受试者（116:210）来自已建立的队列。队列中有 270 人基线时没有高血压，但在 2019 年接受了跟踪调查。血压升高组的 FA 和 VB12 水平低于对照组，同型半胱氨酸水平高于对照组。在血压升高组中，超重/肥胖儿童的 FA 值低于血压正常组中的超重/肥胖儿童。FA与高密度脂蛋白（HDL）和载脂蛋白A（APOA）呈正相关，但与甘油三酯（TG）呈负相关。在调整 VB12 和同型半胱氨酸（HCY）后，FA 与儿童和青少年的血压升高明显相关（β = -0.353，P = 0.032），FA*HCY 的交互效应也很明显。据统计，在队列研究中，高 FA 暴露组的收缩压和舒张压水平均低于低 FA 暴露组。这项研究发现，儿童期缺乏足量脂肪酸和维生素 B12 与血压升高有关，这可能会通过调节血脂水平来影响血压，并证实了在儿童期通过饮食或补充剂维持高水平足量脂肪酸和维生素 B12 的重要性。
{"title":"The impact of folic acid/VB12 deficiency on essential hypertension in children and adolescents: from a nested case-control and a cohort study","authors":"Xiaohua Liang, Daochao Huang, Yang Bi, Yun He, Taoyu Mao, Qin Liu, Guomin Hu, Jishuang Tong, Lan Chen, Yuwei Wang, Xizou An, Xiaoping Jiang, Muhammad Fahad Tahir","doi":"10.1038/s41371-024-00955-w","DOIUrl":"10.1038/s41371-024-00955-w","url":null,"abstract":"To explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated BP in children and adolescents. Both a nested case control and a cohort study were designed to explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated blood pressure (BP). All the included participants were from primary school. A total of 326 subjects (116:210) in nested case control were from an established cohort. And 270 participants without hypertension at baseline and followed in 2019 in cohort. FA and VB12 levels were lower in the elevated BP group than in the control group, and homocysteine level was higher than that in the control group. In the elevated BP group, overweight/obese children had lower FA than overweight/obese children in the normal BP group. FA was positively correlated with high-density lipoprotein (HDL) and Apo lipoprotein A (APOA), but negatively correlated with triglyceride (TG). FA was significantly correlated with elevated BP in children and adolescents (β = –0.353, P = 0.032), after adjusting VB12, and homocysteine (HCY), and the interaction effect of FA*HCY was significant. Both systolic and diastolic BP levels were statistically lower in the FA high exposure group than in the FA low exposure group in the cohort study. This study found that FA and vitamin B12 deficiency in childhood was correlated with elevated BP levels, which may affect BP by regulating lipid levels, and confirmed the importance of maintaining high levels of FA and vitamin B12 in childhood either by diet or supplementation.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"844-850"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217704","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 : 2024-09-09DOI: 10.1038/s41371-024-00953-y
Nazar Mohd Azahar, Mohamad Rodi Isa, Mizuki Ohashi, Yuichiro Yano
{"title":"Navigating the waves: understanding blood pressure amplitude and rhythm changes from childhood to adulthood","authors":"Nazar Mohd Azahar, Mohamad Rodi Isa, Mizuki Ohashi, Yuichiro Yano","doi":"10.1038/s41371-024-00953-y","DOIUrl":"10.1038/s41371-024-00953-y","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"673-675"},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217707","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 : 2024-09-02DOI: 10.1038/s41371-024-00952-z
Fotini Iatridi, Marieta P. Theodorakopoulou, Areti Georgiou, Artemios G. Karagiannidis, Nasra Haddad, Nikolaos Devrikis, Christopher C. Mayer, Vasileios Kamperidis, Vasileios Anastasiou, Antonios Karpetas, Pantelis Sarafidis
Male patients with pre-dialysis chronic kidney disease (CKD) have worse ambulatory blood pressure (BP) control than females; this is associated with higher mortality. Male hemodialysis patients have higher ambulatory BP levels than females. This analysis aimed to investigate the association of sex differences in ambulatory BP with cardiovascular events and mortality in hemodialysis individuals. 129 male and 91 female hemodialysis patients with valid 48-h BP monitoring were followed for 53.4 ± 31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, heart failure-hospitalization, coronary or peripheral revascularization. Cumulative freedom from the primary endpoint was lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between-groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher in women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined endpoint was not different between the two groups (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for major risk factors (age, diabetes, dialysis vintage, coronary disease and hemoglobin) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.295 (95% CI [0.808, 2.078]), secondary: HR = 0.763 (95% CI [0.521, 1.118])). After additional adjustment for 44-h systolic BP the above relationships did not alter (primary: HR = 1.329 (95% CI [0.826, 2.137]), secondary: HR = 0.808 (95% CI [0.551, 1.184])). In conclusion, female hemodialysis patients have higher crude but similar adjusted cardiovascular mortality rates compared to male counterparts. In contrast to pre-dialysis CKD, the neutral relationship between gender and adverse cardiovascular outcomes in hemodialysis is not further affected by ambulatory BP.
透析前慢性肾病（CKD）男性患者的动态血压（BP）控制比女性患者差；这与死亡率较高有关。男性血液透析患者的动态血压水平高于女性。这项分析旨在研究血液透析患者流动血压的性别差异与心血管事件和死亡率的关系。对 129 名男性和 91 名女性血液透析患者进行了为期 53.4 ± 31.1 个月的有效 48 小时血压监测。主要终点是心血管死亡率；次要终点是心血管死亡、非致死性心肌梗死、非致死性中风、心脏骤停后复苏、心力衰竭住院、冠状动脉或外周血管再通术的复合终点。女性的主要终点累积自由度较低（logrank-p = 0.032），而次要终点累积自由度在组间无显著差异（logrank-p = 0.644）。女性的心血管死亡粗风险明显更高（HR = 1.613，95% CI [1.037，2.509]）。综合终点的粗风险在两组之间没有差异（HR = 0.918，95% CI [0.638，1.320]）。在对主要风险因素（年龄、糖尿病、透析年限、冠心病和血红蛋白）进行调整后，未观察到女性和男性在一级和二级终点风险方面存在显著差异（一级：HR = 1.295 (95% CI [0.808, 2.078])，二级：HR = 0.763 (95% CI [0.521, 1.118])）。在对 44 h 收缩压进行额外调整后，上述关系没有改变（一级：HR = 1.329 (95% CI [0.826, 2.137])，二级：HR = 0.808 (95% CI [0.551, 1.184])）。总之，女性血液透析患者的粗略心血管死亡率高于男性患者，但调整后的心血管死亡率与男性患者相似。与透析前慢性肾脏病相比，血液透析患者的性别与不良心血管预后之间的中性关系不会受到流动血压的进一步影响。
{"title":"The association of sex differences in ambulatory blood pressure with cardiovascular events and mortality in dialysis patients","authors":"Fotini Iatridi, Marieta P. Theodorakopoulou, Areti Georgiou, Artemios G. Karagiannidis, Nasra Haddad, Nikolaos Devrikis, Christopher C. Mayer, Vasileios Kamperidis, Vasileios Anastasiou, Antonios Karpetas, Pantelis Sarafidis","doi":"10.1038/s41371-024-00952-z","DOIUrl":"10.1038/s41371-024-00952-z","url":null,"abstract":"Male patients with pre-dialysis chronic kidney disease (CKD) have worse ambulatory blood pressure (BP) control than females; this is associated with higher mortality. Male hemodialysis patients have higher ambulatory BP levels than females. This analysis aimed to investigate the association of sex differences in ambulatory BP with cardiovascular events and mortality in hemodialysis individuals. 129 male and 91 female hemodialysis patients with valid 48-h BP monitoring were followed for 53.4 ± 31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, heart failure-hospitalization, coronary or peripheral revascularization. Cumulative freedom from the primary endpoint was lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between-groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher in women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined endpoint was not different between the two groups (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for major risk factors (age, diabetes, dialysis vintage, coronary disease and hemoglobin) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.295 (95% CI [0.808, 2.078]), secondary: HR = 0.763 (95% CI [0.521, 1.118])). After additional adjustment for 44-h systolic BP the above relationships did not alter (primary: HR = 1.329 (95% CI [0.826, 2.137]), secondary: HR = 0.808 (95% CI [0.551, 1.184])). In conclusion, female hemodialysis patients have higher crude but similar adjusted cardiovascular mortality rates compared to male counterparts. In contrast to pre-dialysis CKD, the neutral relationship between gender and adverse cardiovascular outcomes in hemodialysis is not further affected by ambulatory BP.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"789-795"},"PeriodicalIF":2.7,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00952-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217706","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 : 2024-08-28DOI: 10.1038/s41371-024-00949-8
Ayşe Soylu, Ömer Tanrıverdi
The WHO reported that 46% of adults with HT in the global statistics were unaware of the disease.The aim of this study was to examine the moderating role of self-efficacy in risk awareness and treatment compliance of hypertensive patients. Data for this descriptive and correlational study were collected between 22.08.2023 and 22.02.2024. A personal information form was used for data collection together with a risk awareness scale, self-efficacy scale, and antihypertensive treatment compliance scale. The data were collected from 169 patients in face-to-face intterviews. Multiple linear regression and PROCESS macro-Model vn.3.5 were used in the analyses. The STROBE control list was followed in the study. A moderate level of risk awareness (40.03 ± 7.98) and self-awareness (56.11 ± 10.18) of the study participants was determined, and there was seen to be treatment compliance (6.53 ± 2.34). Risk awareness was seen to be positively correlated with both treatment compliance and self-efficacy (p < 0.05). The moderating effect of the treatment points between risk awareness and self-efficacy was analyzed and the model formed was found to be statistically significant (F = 1.942, p = 0.006). Independent variables in the model explained 28% of the change in the dependent variable. Self-efficacy points were not found to have a moderating effect on the effect of cardiovascular risk awareness on antihypertensive treatment compliance (p = 0.144). Treatment compliance can increase with an increase in the self-efficacy and risk awareness of an individual. Increased self-efficacy may affect the moderating role.
{"title":"The moderating effect of self-efficacy in the risk awareness and treatment compliance of hypertensive patients","authors":"Ayşe Soylu, Ömer Tanrıverdi","doi":"10.1038/s41371-024-00949-8","DOIUrl":"10.1038/s41371-024-00949-8","url":null,"abstract":"The WHO reported that 46% of adults with HT in the global statistics were unaware of the disease.The aim of this study was to examine the moderating role of self-efficacy in risk awareness and treatment compliance of hypertensive patients. Data for this descriptive and correlational study were collected between 22.08.2023 and 22.02.2024. A personal information form was used for data collection together with a risk awareness scale, self-efficacy scale, and antihypertensive treatment compliance scale. The data were collected from 169 patients in face-to-face intterviews. Multiple linear regression and PROCESS macro-Model vn.3.5 were used in the analyses. The STROBE control list was followed in the study. A moderate level of risk awareness (40.03 ± 7.98) and self-awareness (56.11 ± 10.18) of the study participants was determined, and there was seen to be treatment compliance (6.53 ± 2.34). Risk awareness was seen to be positively correlated with both treatment compliance and self-efficacy (p < 0.05). The moderating effect of the treatment points between risk awareness and self-efficacy was analyzed and the model formed was found to be statistically significant (F = 1.942, p = 0.006). Independent variables in the model explained 28% of the change in the dependent variable. Self-efficacy points were not found to have a moderating effect on the effect of cardiovascular risk awareness on antihypertensive treatment compliance (p = 0.144). Treatment compliance can increase with an increase in the self-efficacy and risk awareness of an individual. Increased self-efficacy may affect the moderating role.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 11","pages":"772-778"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093513","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 : 2024-08-27DOI: 10.1038/s41371-024-00950-1
Artemios G. Karagiannidis, Fotini Iatridi, Pantelis A. Sarafidis
{"title":"Feel the rhythm of the beat: rhythmic components in ambulatory blood pressure monitoring for predicting cardiovascular risk in CKD patients","authors":"Artemios G. Karagiannidis, Fotini Iatridi, Pantelis A. Sarafidis","doi":"10.1038/s41371-024-00950-1","DOIUrl":"10.1038/s41371-024-00950-1","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 9","pages":"629-630"},"PeriodicalIF":2.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00950-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080571","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}
Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibit an increased cardiovascular risk compared to hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. In a randomized cross-over manner, 29 IDH patients underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice versa. 48 h ambulatory BP measurement was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48 h, 24 h, day-time and night-time periods were calculated. Mean 48 h BP was 5.3/2.6 mmHg lower with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007 respectively). All 48 h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg, p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392; SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some comparisons with a trend for lower BPV during day-time 2 and higher BVP during night-time 2 with low dialysate sodium. In conclusion, low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should explore alternative interventions to reduce BP and BPV in this high-risk population.
{"title":"Dialysate sodium and short-term blood pressure variability in patients with intradialytic hypertension: a randomized crossover study","authors":"Fotini Iatridi, Robert Ekart, Efstathios Xagas, Eleni Karkamani, Antonios Karpetas, Marieta P. Theodorakopoulou, Nikolaos Devrikis, Ioanna Revela, Aikaterini Papagianni, Pantelis Sarafidis","doi":"10.1038/s41371-024-00947-w","DOIUrl":"10.1038/s41371-024-00947-w","url":null,"abstract":"Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic hypertension (IDH) also exhibit an increased cardiovascular risk compared to hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH. In a randomized cross-over manner, 29 IDH patients underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice versa. 48 h ambulatory BP measurement was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48 h, 24 h, day-time and night-time periods were calculated. Mean 48 h BP was 5.3/2.6 mmHg lower with low compared to standard dialysate sodium concentration, (p = 0.005/p = 0.007 respectively). All 48 h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99 ± 5.39 vs. 16.98 ± 4.33 mmHg, p = 0.982; SBP-wSD: 15.93 ± 5.02 vs. 16.12 ± 4.16 mmHg, p = 0.769; SBP-ARV: 11.99 ± 3.67 vs. 11.45 ± 3.35 mmHg, p = 0.392; SBP-CV: 12.36 ± 3.65 vs. 11.92 ± 3.18%, p = 0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some comparisons with a trend for lower BPV during day-time 2 and higher BVP during night-time 2 with low dialysate sodium. In conclusion, low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should explore alternative interventions to reduce BP and BPV in this high-risk population.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 11","pages":"750-757"},"PeriodicalIF":2.7,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00947-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055799","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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