Pub Date : 2025-09-19DOI: 10.1038/s41371-025-01069-7
Tuomas P. Saarinen, Lauri J. Suojanen, Manoj Kumar Choudhary, Jukka Mustonen, Pasi I. Nevalainen, Jenni K. Koskela, Ilkka Pörsti
Elevated blood pressure is traditionally classified into systolic-diastolic hypertension, isolated systolic hypertension, and isolated diastolic hypertension. In this cross-sectional study, participants not using antihypertensive medications (n = 654) were divided into normotensive subjects (n = 421), and predominantly systolic (n = 130) versus predominantly diastolic hypertension (n = 103) based on the percentage elevation of aortic blood pressure above 125 mmHg systolic or 85 mmHg diastolic. Non-invasive hemodynamics were recorded using radial applanation tonometry and whole-body impedance cardiography during passive head-up tilt. Mean aortic blood pressures in the groups were 108/73, 141/89, and 131/94 mmHg, respectively. Mean age and BMI (43.6, 47.3 and 52.6 years; 25.9, 28.7 and 28.7 kg/m2, respectively) were lower in the normotensive than in hypertensive participants (p < 0.05). Predominantly systolic hypertension was characterized by higher forward wave amplitude, central pulse pressure, and systemic vascular resistance (p < 0.003 for all) than predominantly diastolic hypertension. Predominantly diastolic hypertension was characterized by higher heart rate and cardiac index (p < 0.004 for both), but lower stroke volume (p < 0.002), than predominantly systolic hypertension. Both hypertensive groups had increased systemic vascular resistance, but highest values were observed in predominantly systolic hypertension (p < 0.001). Pulse wave velocity was equally elevated by ~1 m/s in both hypertensive groups (p < 0.001). In response to head-up tilt, the increase in systemic vascular resistance, and the decrease in cardiac output, were more pronounced in predominantly systolic versus diastolic hypertension. To conclude, predominantly diastolic hypertension featured hyperdynamic circulation, while increased pulse pressure in predominantly systolic hypertension was related to higher stroke volume and systemic vascular resistance than in predominantly diastolic hypertension.
{"title":"Hyperdynamic circulation distinguishes predominantly diastolic hypertension from predominantly systolic hypertension","authors":"Tuomas P. Saarinen, Lauri J. Suojanen, Manoj Kumar Choudhary, Jukka Mustonen, Pasi I. Nevalainen, Jenni K. Koskela, Ilkka Pörsti","doi":"10.1038/s41371-025-01069-7","DOIUrl":"10.1038/s41371-025-01069-7","url":null,"abstract":"Elevated blood pressure is traditionally classified into systolic-diastolic hypertension, isolated systolic hypertension, and isolated diastolic hypertension. In this cross-sectional study, participants not using antihypertensive medications (n = 654) were divided into normotensive subjects (n = 421), and predominantly systolic (n = 130) versus predominantly diastolic hypertension (n = 103) based on the percentage elevation of aortic blood pressure above 125 mmHg systolic or 85 mmHg diastolic. Non-invasive hemodynamics were recorded using radial applanation tonometry and whole-body impedance cardiography during passive head-up tilt. Mean aortic blood pressures in the groups were 108/73, 141/89, and 131/94 mmHg, respectively. Mean age and BMI (43.6, 47.3 and 52.6 years; 25.9, 28.7 and 28.7 kg/m2, respectively) were lower in the normotensive than in hypertensive participants (p < 0.05). Predominantly systolic hypertension was characterized by higher forward wave amplitude, central pulse pressure, and systemic vascular resistance (p < 0.003 for all) than predominantly diastolic hypertension. Predominantly diastolic hypertension was characterized by higher heart rate and cardiac index (p < 0.004 for both), but lower stroke volume (p < 0.002), than predominantly systolic hypertension. Both hypertensive groups had increased systemic vascular resistance, but highest values were observed in predominantly systolic hypertension (p < 0.001). Pulse wave velocity was equally elevated by ~1 m/s in both hypertensive groups (p < 0.001). In response to head-up tilt, the increase in systemic vascular resistance, and the decrease in cardiac output, were more pronounced in predominantly systolic versus diastolic hypertension. To conclude, predominantly diastolic hypertension featured hyperdynamic circulation, while increased pulse pressure in predominantly systolic hypertension was related to higher stroke volume and systemic vascular resistance than in predominantly diastolic hypertension.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"784-791"},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01069-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091923","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 : 2025-09-16DOI: 10.1038/s41371-025-01067-9
Michael T. Saban, Samie Tootooni, Talar W. Markossian, Amy Wozniak, Grant T. Hiura, Beatrice Probst, Katherine Habicht, Holly J. Kramer
Neighborhood characteristics may influence patient and clinician management of blood pressure (BP) control. This study examined the association of the Area Deprivation Index (ADI) with uncontrolled BP ( ≥ 140/90 mmHg) at primary care visits and therapeutic inertia (TI) during visits with uncontrolled BP. Data included 52 750 visits among 8 434 patients aged ≥65 years across nine outpatient clinics in Chicago suburbs between January 1, 2017, and March 10, 2020. ADI represents national percentiles of census block group deprivation (0 = least, 100 = most deprived). TI was defined as no initiation or escalation of BP-lowering medication during visits with uncontrolled BP. Adjusted prevalence ratios (PRs) of uncontrolled BP and TI by ADI quartiles were estimated using generalized estimating equations. Mean age was 74.3 years (SD 7.8), 42.3% were male, 69.1% Non-Hispanic (NH) White, 15.9% NH Black, and 8.2% Hispanic. Uncontrolled BP occurred in 33.8% of visits. Of those, 73.4% experienced TI. There was no significant association between ADI and uncontrolled BP in adjusted models. Adjusted PRs of TI were higher in ADI Q2 (PR 1.03, 95% CI: 1.00-1.06) and Q3 (PR 1.04 (95% CI: 1.01-1.07), but not Q4 compared to Q1. ADI modeled continuously with splines showed modest increases in adjusted predicted prevalence of both outcomes, although confidence intervals widened at the extremes. Neighborhood deprivation may contribute to disparities in hypertension management but more studies with larger number of patient visits at the extremes of ADI distribution are needed.
{"title":"The association of area deprivation index and blood pressure control and therapeutic inertia among older adults with hypertension","authors":"Michael T. Saban, Samie Tootooni, Talar W. Markossian, Amy Wozniak, Grant T. Hiura, Beatrice Probst, Katherine Habicht, Holly J. Kramer","doi":"10.1038/s41371-025-01067-9","DOIUrl":"10.1038/s41371-025-01067-9","url":null,"abstract":"Neighborhood characteristics may influence patient and clinician management of blood pressure (BP) control. This study examined the association of the Area Deprivation Index (ADI) with uncontrolled BP ( ≥ 140/90 mmHg) at primary care visits and therapeutic inertia (TI) during visits with uncontrolled BP. Data included 52 750 visits among 8 434 patients aged ≥65 years across nine outpatient clinics in Chicago suburbs between January 1, 2017, and March 10, 2020. ADI represents national percentiles of census block group deprivation (0 = least, 100 = most deprived). TI was defined as no initiation or escalation of BP-lowering medication during visits with uncontrolled BP. Adjusted prevalence ratios (PRs) of uncontrolled BP and TI by ADI quartiles were estimated using generalized estimating equations. Mean age was 74.3 years (SD 7.8), 42.3% were male, 69.1% Non-Hispanic (NH) White, 15.9% NH Black, and 8.2% Hispanic. Uncontrolled BP occurred in 33.8% of visits. Of those, 73.4% experienced TI. There was no significant association between ADI and uncontrolled BP in adjusted models. Adjusted PRs of TI were higher in ADI Q2 (PR 1.03, 95% CI: 1.00-1.06) and Q3 (PR 1.04 (95% CI: 1.01-1.07), but not Q4 compared to Q1. ADI modeled continuously with splines showed modest increases in adjusted predicted prevalence of both outcomes, although confidence intervals widened at the extremes. Neighborhood deprivation may contribute to disparities in hypertension management but more studies with larger number of patient visits at the extremes of ADI distribution are needed.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"748-754"},"PeriodicalIF":3.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075470","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 : 2025-09-10DOI: 10.1038/s41371-025-01066-w
Victoria D. Dahmen
The Stanley Peart Essay Competition is an annual event run by the British and Irish Hypertension Society to encourage Early Career Researchers to continue the ethos of Sir Stanley Peart. Sir Stanley Peart was a clinician and clinical researcher who made a major contribution to our understanding of blood pressure regulation. He was the first to demonstrate the release of noradrenaline in response to sympathetic nerve stimulation. He was also the first to purify, and determine the structure of, angiotensin and he later isolated the enzyme, renin, and carried out many important investigations of the factors controlling its release in the body. This year, the essay topic was “Is Essential Hypertension really Primary or Essential?”. In her prize-winning essay, Victoria Dahmen questions the continued use of the term “essential hypertension” suggesting that it may obscure the complex and often modifiable factors contributing to elevated blood pressure. By exploring the roles of salt sensitivity, obesity, and their physiological interplay, her essay calls for a more nuanced, mechanism-based classification of hypertension. Such a shift, she argues, will facilitate clinicians to deliver personalised medicine by aligning medical language with modern scientific understanding.
{"title":"The Linguistics of Hypertension: Is “Essential” Really Primary, or Just Plain Complex?","authors":"Victoria D. Dahmen","doi":"10.1038/s41371-025-01066-w","DOIUrl":"10.1038/s41371-025-01066-w","url":null,"abstract":"The Stanley Peart Essay Competition is an annual event run by the British and Irish Hypertension Society to encourage Early Career Researchers to continue the ethos of Sir Stanley Peart. Sir Stanley Peart was a clinician and clinical researcher who made a major contribution to our understanding of blood pressure regulation. He was the first to demonstrate the release of noradrenaline in response to sympathetic nerve stimulation. He was also the first to purify, and determine the structure of, angiotensin and he later isolated the enzyme, renin, and carried out many important investigations of the factors controlling its release in the body. This year, the essay topic was “Is Essential Hypertension really Primary or Essential?”. In her prize-winning essay, Victoria Dahmen questions the continued use of the term “essential hypertension” suggesting that it may obscure the complex and often modifiable factors contributing to elevated blood pressure. By exploring the roles of salt sensitivity, obesity, and their physiological interplay, her essay calls for a more nuanced, mechanism-based classification of hypertension. Such a shift, she argues, will facilitate clinicians to deliver personalised medicine by aligning medical language with modern scientific understanding.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"679-682"},"PeriodicalIF":3.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01066-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033429","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 : 2025-09-03DOI: 10.1038/s41371-025-01062-0
Andrew R. Heckel, Alaina C. Glasgow, Wonhee Cho, Joon Young Kim
Vascular dysfunction has been shown to negatively impact physical function, with arterial stiffening being linked to worsening balance function. Estimated pulse wave velocity (ePWV), derived from age and blood pressure (BP), is an emerging method of assessing vascular function that can be widely used in large, observational studies. Whether ePWV is associated with balance function in US adults remains unknown. A total of 3276 adult men and women from the 2021–2023 National Health and Nutrition Examination Survey who completed BP and balance function measures were included in this study. Balance function was assessed using the Modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (MRT). ePWV was used to assess vascular function and derived from a regression equation using age and mean blood pressure. A general linear model was then used to determine whether ePWV is significantly associated with the number of MRT conditions passed. The model showed that, after covarying for age, systolic BP, diastolic BP, gender, race/ethnicity, educational attainment, socioeconomic status, alcohol, smoking, body mass index, and physical activity levels, ePWV was significantly and inversely related to the number of MRT conditions passed (β = −0.398, p < 0.001). Higher ePWV is associated with worsened balance control in a nationally representative sample of US adults. As ePWV only requires age and BP, measures that are taken routinely at physical examinations, future studies should longitudinally examine associations between ePWV and balance function in a clinical setting.
血管功能障碍已被证明会对身体机能产生负面影响，动脉硬化与平衡功能恶化有关。估计脉搏波速度（ePWV）是一种评估血管功能的新兴方法，可广泛用于大型观察性研究。ePWV是否与美国成年人的平衡功能有关尚不清楚。本研究共纳入了来自2021-2023年全国健康与营养调查的3276名成年男性和女性，他们完成了血压和平衡功能测量。平衡功能评估使用修正Romberg测试站立平衡在坚固和柔顺的支持表面（MRT）。ePWV用于评估血管功能，并由年龄和平均血压的回归方程得出。然后使用一般线性模型来确定ePWV是否与通过MRT条件的数量显着相关。该模型显示，在协变年龄、收缩压、舒张压、性别、种族/民族、受教育程度、社会经济地位、酒精、吸烟、体重指数和体育活动水平后，ePWV与通过MRT条件的次数呈显著负相关(β = -0.398, p
{"title":"The association between estimated pulse wave velocity and balance function in U.S. adults","authors":"Andrew R. Heckel, Alaina C. Glasgow, Wonhee Cho, Joon Young Kim","doi":"10.1038/s41371-025-01062-0","DOIUrl":"10.1038/s41371-025-01062-0","url":null,"abstract":"Vascular dysfunction has been shown to negatively impact physical function, with arterial stiffening being linked to worsening balance function. Estimated pulse wave velocity (ePWV), derived from age and blood pressure (BP), is an emerging method of assessing vascular function that can be widely used in large, observational studies. Whether ePWV is associated with balance function in US adults remains unknown. A total of 3276 adult men and women from the 2021–2023 National Health and Nutrition Examination Survey who completed BP and balance function measures were included in this study. Balance function was assessed using the Modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (MRT). ePWV was used to assess vascular function and derived from a regression equation using age and mean blood pressure. A general linear model was then used to determine whether ePWV is significantly associated with the number of MRT conditions passed. The model showed that, after covarying for age, systolic BP, diastolic BP, gender, race/ethnicity, educational attainment, socioeconomic status, alcohol, smoking, body mass index, and physical activity levels, ePWV was significantly and inversely related to the number of MRT conditions passed (β = −0.398, p < 0.001). Higher ePWV is associated with worsened balance control in a nationally representative sample of US adults. As ePWV only requires age and BP, measures that are taken routinely at physical examinations, future studies should longitudinally examine associations between ePWV and balance function in a clinical setting.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"764-769"},"PeriodicalIF":3.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01062-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992665","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}
Hypertension remains a public health problem worldwide, particularly in Africa, where the burden is disproportionately high. However, little is known about the burden and factors associated with hypertension among populations living in slums, particularly in Sub-Saharan African countries like Nigeria, where a significant proportion of the population in Africa lives. This study assessed the hypertension burden and risk factors among individuals residing in the slums compared to the overall sample and those from the non-slum areas in Ibadan, Nigeria. In this study, 3635 participants from the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases study provided information on sociodemographic and lifestyle factors. Blood pressure and anthropometric measurements were carried out using standard procedures. Hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, self-reported diagnosis of hypertension by a certified health professional, and current use of anti-hypertensive or blood pressure-lowering medications. Overall, 903 (24.8%) were hypertensive in the entire sample, but 29.4% (170 of 579) of the participants from the slums and 23.9% (733 of 3056) of those living in non-slum areas presented with hypertension. Generally, the odds of hypertension (using “no formal education” as reference) decreased with increasing education in the overall population and those from non-slum areas, with generally suggestive lower odds among those from the slum areas; OR: 0.45; 95% CI: 0.16, 1.25). Lifestyle modification interventions targeting older people who are married and less educated should lessen the burden of hypertension in these slums.
{"title":"Hypertension burden and associated risk factors among people from the slums in a developing country: evidence from the COMBAT-CVD study","authors":"Olumide Ebenezer Olufayo, Osahon Jeffery Asowata, Akinkunmi Paul Okekunle, Onoja Mattthew Akpa","doi":"10.1038/s41371-025-01057-x","DOIUrl":"10.1038/s41371-025-01057-x","url":null,"abstract":"Hypertension remains a public health problem worldwide, particularly in Africa, where the burden is disproportionately high. However, little is known about the burden and factors associated with hypertension among populations living in slums, particularly in Sub-Saharan African countries like Nigeria, where a significant proportion of the population in Africa lives. This study assessed the hypertension burden and risk factors among individuals residing in the slums compared to the overall sample and those from the non-slum areas in Ibadan, Nigeria. In this study, 3635 participants from the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases study provided information on sociodemographic and lifestyle factors. Blood pressure and anthropometric measurements were carried out using standard procedures. Hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, self-reported diagnosis of hypertension by a certified health professional, and current use of anti-hypertensive or blood pressure-lowering medications. Overall, 903 (24.8%) were hypertensive in the entire sample, but 29.4% (170 of 579) of the participants from the slums and 23.9% (733 of 3056) of those living in non-slum areas presented with hypertension. Generally, the odds of hypertension (using “no formal education” as reference) decreased with increasing education in the overall population and those from non-slum areas, with generally suggestive lower odds among those from the slum areas; OR: 0.45; 95% CI: 0.16, 1.25). Lifestyle modification interventions targeting older people who are married and less educated should lessen the burden of hypertension in these slums.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"755-763"},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01057-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956827","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 : 2025-08-26DOI: 10.1038/s41371-025-01064-y
Jin Li, Peizhen Zhang, Yuting Yang
Arteriosclerosis is one of the most common diseases that progresses to cardiovascular disease in ageing postmenopausal women. Early changes away from the poor lifestyle choices and the active management of risk factors can improve the survival of postmenopausal women. A network meta-analysis was performed to compare the effects of different exercise modes on the risk factors for arteriosclerosis in postmenopausal women. The primary outcomes were systolic and diastolic blood pressure, whereas the secondary outcomes included flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), and total cholesterol/high-density lipoprotein. Randomised controlled trials on the effects of exercise on arteriosclerosis in postmenopausal women were identified in 10 databases (PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, SinoMed, VIP, Wanfang Data, and Wanfang Med Online). Sixty-four studies (2460 particpants) were eventually included. Among postmenopausal women with hypertension, continuous aerobic exercise (CAE) was most effective in reducing systolic and diastolic blood pressure. Among those without hypertension, high-intensity interval training was the most effective in lowering blood pressure and increasing FMD, whereas CAE combined with resistance training was most beneficial in reducing baPWV. Exercise prescriptions for postmenopausal women should be tailored according to their blood pressure status to ensure the selection of the most suitable exercise modality and to maximize the effectiveness of the intervention. Trial registration: PROSPERO, registration number: CRD42022337536.
动脉硬化是绝经后老年妇女发展为心血管疾病的最常见疾病之一。早期改变不良的生活方式选择和积极管理风险因素可以提高绝经后妇女的生存率。一项网络荟萃分析比较了不同运动模式对绝经后妇女动脉硬化危险因素的影响。主要终点是收缩压和舒张压，而次要终点包括血流介导的舒张（FMD）、肱-踝脉波速度（baPWV）和总胆固醇/高密度脂蛋白。在10个数据库（PubMed、Cochrane Library、Embase、Web of Science、EBSCO、CNKI、SinoMed、VIP、万方数据和万方医学在线）中检索了运动对绝经后妇女动脉硬化影响的随机对照试验。最终纳入64项研究（2460名参与者）。在绝经后高血压妇女中，持续有氧运动（CAE）在降低收缩压和舒张压方面最有效。在没有高血压的患者中，高强度间歇训练在降低血压和增加FMD方面最有效，而CAE联合阻力训练在降低baPWV方面最有益。绝经后妇女的运动处方应根据自己的血压状况量身定制，确保选择最适合自己的运动方式，使干预效果最大化。试验注册号：PROSPERO，注册号：CRD42022337536。
{"title":"Effects of different exercise modes on the risk factors of arteriosclerosis in postmenopausal women: A systematic review and network meta-analysis","authors":"Jin Li, Peizhen Zhang, Yuting Yang","doi":"10.1038/s41371-025-01064-y","DOIUrl":"10.1038/s41371-025-01064-y","url":null,"abstract":"Arteriosclerosis is one of the most common diseases that progresses to cardiovascular disease in ageing postmenopausal women. Early changes away from the poor lifestyle choices and the active management of risk factors can improve the survival of postmenopausal women. A network meta-analysis was performed to compare the effects of different exercise modes on the risk factors for arteriosclerosis in postmenopausal women. The primary outcomes were systolic and diastolic blood pressure, whereas the secondary outcomes included flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), and total cholesterol/high-density lipoprotein. Randomised controlled trials on the effects of exercise on arteriosclerosis in postmenopausal women were identified in 10 databases (PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, SinoMed, VIP, Wanfang Data, and Wanfang Med Online). Sixty-four studies (2460 particpants) were eventually included. Among postmenopausal women with hypertension, continuous aerobic exercise (CAE) was most effective in reducing systolic and diastolic blood pressure. Among those without hypertension, high-intensity interval training was the most effective in lowering blood pressure and increasing FMD, whereas CAE combined with resistance training was most beneficial in reducing baPWV. Exercise prescriptions for postmenopausal women should be tailored according to their blood pressure status to ensure the selection of the most suitable exercise modality and to maximize the effectiveness of the intervention. Trial registration: PROSPERO, registration number: CRD42022337536.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"601-618"},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957117","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 : 2025-08-22DOI: 10.1038/s41371-025-01061-1
Yusuff Adebayo Adebisi, Najim Z. Alshahrani, Isaac Olushola Ogunkola, Don Eliseo Lucero-Prisno III
Hypertension remains a leading cause of morbidity and mortality worldwide, yet its relationship with physical disability has been underexplored in population-based longitudinal studies. We conducted a prospective cohort analysis using data from the UK Household Longitudinal Study. Individuals aged 16 and older without baseline hypertension (N = 19,319) were followed from Wave 10 (2018–19) to Wave 14 (2022–23). Physical disability was defined as self-reported difficulty, lasting or expected to last at least 12 months, in any of eight domains of physical and sensory functioning. Modified Poisson regression with robust standard errors was used to estimate adjusted relative risks (RRs) for incident hypertension, controlling for age group, sex, residential location (urban/rural), educational attainment, ethnicity, smoking status, and baseline health conditions. Over a four-year follow-up, 610 of 19,319 participants (3.2%) developed hypertension. In fully adjusted model, individuals with any physical disability had a significantly elevated risk of hypertension (RR = 1.65; 95% CI:1.39–1.97; p < 0.001) compared to those without disability. Compared to individuals with no disability, those with one physical disability had an RR of 1.29 (95% CI:1.01–1.64; p = 0.043), while those with two or more disabilities had an RR of 2.10 (95% CI:1.69–2.59; p < 0.001). A linear trend was observed across increasing number of disabilities (RR per additional domain = 1.43; 95% CI:1.29–1.59; p < 0.001). By type, the highest risks were observed for coordination or balance impairment (RR = 2.12; 95% CI:1.58–2.84), mobility impairment (RR = 2.03; 95% CI:1.66–2.48), and sight impairment (RR = 1.80; 95% CI:1.27–2.56), all p < 0.001. Physical disability was a significant independent predictor of incident hypertension in this population-based cohort.
高血压仍然是世界范围内发病率和死亡率的主要原因，但其与身体残疾的关系在基于人群的纵向研究中尚未得到充分探讨。我们使用来自英国家庭纵向研究的数据进行了前瞻性队列分析。16岁及以上无基线高血压的个体（N = 19,319）从第10波（2018-19）到第14波（2022-23）进行随访。身体残疾被定义为自我报告的困难，持续或预计持续至少12个月，在身体和感觉功能的八个领域中的任何一个。在控制了年龄、性别、居住地点（城市/农村）、受教育程度、种族、吸烟状况和基线健康状况等因素后，采用修正泊松回归稳健标准误差来估计高血压事件的校正相对风险（rr）。在四年的随访中，19319名参与者中有610人（3.2%）患上了高血压。在完全调整模型中，任何身体残疾的个体患高血压的风险都显著升高（RR = 1.65; 95% CI:1.39-1.97; p . 1）
{"title":"Physical disability and risk of incident hypertension: a prospective cohort analysis","authors":"Yusuff Adebayo Adebisi, Najim Z. Alshahrani, Isaac Olushola Ogunkola, Don Eliseo Lucero-Prisno III","doi":"10.1038/s41371-025-01061-1","DOIUrl":"10.1038/s41371-025-01061-1","url":null,"abstract":"Hypertension remains a leading cause of morbidity and mortality worldwide, yet its relationship with physical disability has been underexplored in population-based longitudinal studies. We conducted a prospective cohort analysis using data from the UK Household Longitudinal Study. Individuals aged 16 and older without baseline hypertension (N = 19,319) were followed from Wave 10 (2018–19) to Wave 14 (2022–23). Physical disability was defined as self-reported difficulty, lasting or expected to last at least 12 months, in any of eight domains of physical and sensory functioning. Modified Poisson regression with robust standard errors was used to estimate adjusted relative risks (RRs) for incident hypertension, controlling for age group, sex, residential location (urban/rural), educational attainment, ethnicity, smoking status, and baseline health conditions. Over a four-year follow-up, 610 of 19,319 participants (3.2%) developed hypertension. In fully adjusted model, individuals with any physical disability had a significantly elevated risk of hypertension (RR = 1.65; 95% CI:1.39–1.97; p < 0.001) compared to those without disability. Compared to individuals with no disability, those with one physical disability had an RR of 1.29 (95% CI:1.01–1.64; p = 0.043), while those with two or more disabilities had an RR of 2.10 (95% CI:1.69–2.59; p < 0.001). A linear trend was observed across increasing number of disabilities (RR per additional domain = 1.43; 95% CI:1.29–1.59; p < 0.001). By type, the highest risks were observed for coordination or balance impairment (RR = 2.12; 95% CI:1.58–2.84), mobility impairment (RR = 2.03; 95% CI:1.66–2.48), and sight impairment (RR = 1.80; 95% CI:1.27–2.56), all p < 0.001. Physical disability was a significant independent predictor of incident hypertension in this population-based cohort.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"709-715"},"PeriodicalIF":3.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01061-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956852","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 : 2025-08-20DOI: 10.1038/s41371-025-01063-z
Jesse E. Passman, Amanda Bader, Nadim Mahmud, Kristoffel R. Dumon, Heather Wachtel, Feibi Zheng, Jordana B. Cohen
Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m2 and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000–2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m2 and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9–5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5–2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23–1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78–0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.
代谢和减肥手术（MBS）是治疗肥胖和代谢综合征的有效方法。关于MBS对高血压预后影响的证据受到短期随访的限制。因此，本回顾性队列研究旨在比较接受和不接受MBS治疗的患者之间的血压（BP）控制、抗高血压药物（AHMs）数量、明显难治性高血压（ATRH）的发展以及高血压缓解情况。纳入了2000-2019年在退伍军人健康管理系统内接受治疗的BMI≥35 kg/m2和新诊断为高血压的成年人。使用广义估计方程和时间更新的Cox模型与逆概率处理权重来处理时间更新的混淆。在中位5.1年的随访中，183702例BMI≥35 kg/m2的高血压患者接受了医学治疗，3965例接受了手术治疗。基线时，接受MBS的患者中女性多于男性（22%对10%）。随着时间的推移，手术治疗的患者表现出明显更好的血压控制，平均收缩压降低5.4 mm Hg (95% CI 4.9-5.9)，舒张压降低1.8 mm Hg （95% CI 1.5-2.1）。与接受药物治疗的患者相比，接受MBS的患者完全停止AHM的可能性高出32% （95% CI 1.23-1.42）。接受MBS治疗的患者发生ATRH的可能性降低14% （95% CI 0.78-0.95）。总体而言，在肥胖和高血压患者中，与医疗管理相比，MBS治疗与持续改善的血压控制相关，包括更低的收缩压和舒张压，更高的AHM终止率和更低的ATRH率。
{"title":"The Effect of Bariatric Surgery on Hypertension Outcomes: A Retrospective Cohort Study","authors":"Jesse E. Passman, Amanda Bader, Nadim Mahmud, Kristoffel R. Dumon, Heather Wachtel, Feibi Zheng, Jordana B. Cohen","doi":"10.1038/s41371-025-01063-z","DOIUrl":"10.1038/s41371-025-01063-z","url":null,"abstract":"Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m2 and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000–2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m2 and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9–5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5–2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23–1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78–0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"683-689"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01063-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957177","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 : 2025-08-19DOI: 10.1038/s41371-025-01048-y
Yongho Jee, Wes Spiller, Eleanor Sanderson, Kate Tilling, Tom Palmer, Eunhee Ha, YoungJu Kim
This study explores the causal role of multiple correlated risk factors in coronary heart disease (CHD) and ischemic stroke, using Mendelian randomization (MR) analyses with GWAS summary data from both prevalent and incident stroke cases. Thirteen candidate risk factors were considered, including age at menarche, adiposity, lipid fractions, blood pressure, and smoking. Univariable MR identified seven exposures significantly associated with CHD risk, including BMI, blood pressure, LDL, triglycerides, type-II diabetes, and smoking. Notably, HDL showed a protective effect (OR = 0.77, 95% CI: 0.72–0.83), while type-II diabetes was positively associated with CHD (OR = 1.10, 95% CI: 1.05–1.16). For ischemic stroke subtypes, diastolic and systolic blood pressure showed consistent effects across both small vessel and large artery stroke (e.g., DBP OR = 2.27, 95% CI: 1.77–2.89 for small vessel stroke), and HDL again demonstrated protective effects. Multivariable MR (MVMR) further confirmed these associations, though estimates were attenuated. In summary, both univariable and MVMR analyses identified robust associations of lipid fractions and blood pressure with cardiovascular outcomes, highlighting their importance in CHD and ischemic stroke risk across multiple stroke subtypes.
{"title":"Elucidating the causal role of age of menarche, adiposity, lipid fractions, and blood pressure upon cardiovascular disease: a multivariable Mendelian randomization study","authors":"Yongho Jee, Wes Spiller, Eleanor Sanderson, Kate Tilling, Tom Palmer, Eunhee Ha, YoungJu Kim","doi":"10.1038/s41371-025-01048-y","DOIUrl":"10.1038/s41371-025-01048-y","url":null,"abstract":"This study explores the causal role of multiple correlated risk factors in coronary heart disease (CHD) and ischemic stroke, using Mendelian randomization (MR) analyses with GWAS summary data from both prevalent and incident stroke cases. Thirteen candidate risk factors were considered, including age at menarche, adiposity, lipid fractions, blood pressure, and smoking. Univariable MR identified seven exposures significantly associated with CHD risk, including BMI, blood pressure, LDL, triglycerides, type-II diabetes, and smoking. Notably, HDL showed a protective effect (OR = 0.77, 95% CI: 0.72–0.83), while type-II diabetes was positively associated with CHD (OR = 1.10, 95% CI: 1.05–1.16). For ischemic stroke subtypes, diastolic and systolic blood pressure showed consistent effects across both small vessel and large artery stroke (e.g., DBP OR = 2.27, 95% CI: 1.77–2.89 for small vessel stroke), and HDL again demonstrated protective effects. Multivariable MR (MVMR) further confirmed these associations, though estimates were attenuated. In summary, both univariable and MVMR analyses identified robust associations of lipid fractions and blood pressure with cardiovascular outcomes, highlighting their importance in CHD and ischemic stroke risk across multiple stroke subtypes.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"723-734"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01048-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882917","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 : 2025-08-11DOI: 10.1038/s41371-025-01060-2
Muhammad Yousaf, Ali Hassan
{"title":"Critical appraisal of machine learning-based hypertension detection via single-lead electrocardiograms","authors":"Muhammad Yousaf, Ali Hassan","doi":"10.1038/s41371-025-01060-2","DOIUrl":"10.1038/s41371-025-01060-2","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"735-736"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821560","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}
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