Pub Date : 2025-07-23DOI: 10.1038/s41371-025-01055-z
Luca Faconti, Nayanatara Tantirige, Neil R. Poulter, Jacob George, Vikas Kapil, Ajay Gupta, Pauline A. Swift, Anthony Heagerty, Eduard Shantsila, Sarah Partridge, Ian B. Wilkinson
In this position statement the British and Irish Hypertension Society (BIHS) present a review of the current evidence for blood pressure (BP) treatment thresholds and targets. The BIHS recommend initiating pharmacological antihypertensive therapy, irrespective of cardiovascular disease risk, following a confirmed diagnosis of hypertension (sustained out-of-office BP ≥ 135/85 mmHg despite diet and lifestyle advice). The BIHS recommend an on-treatment BP target < 130/80 mmHg or as low as reasonably achievable without causing unacceptable side-effects, within 6-months of initiating treatment, for all adults. Possible subgroups to whom this may not apply are those who are frail and/or have limited life expectancy where higher targets may be appropriate based on clinical judgement and the individuals’ tolerance to treatment. The BIHS believe that this simple 2-step approach will facilitate practitioners deliver evidence-based best practice, discourage therapeutic inertia around BP lowering and improve heath outcomes for all adults living with high BP.
{"title":"Call to action: British and Irish hypertension society position statement on blood pressure treatment thresholds and targets","authors":"Luca Faconti, Nayanatara Tantirige, Neil R. Poulter, Jacob George, Vikas Kapil, Ajay Gupta, Pauline A. Swift, Anthony Heagerty, Eduard Shantsila, Sarah Partridge, Ian B. Wilkinson","doi":"10.1038/s41371-025-01055-z","DOIUrl":"10.1038/s41371-025-01055-z","url":null,"abstract":"In this position statement the British and Irish Hypertension Society (BIHS) present a review of the current evidence for blood pressure (BP) treatment thresholds and targets. The BIHS recommend initiating pharmacological antihypertensive therapy, irrespective of cardiovascular disease risk, following a confirmed diagnosis of hypertension (sustained out-of-office BP ≥ 135/85 mmHg despite diet and lifestyle advice). The BIHS recommend an on-treatment BP target < 130/80 mmHg or as low as reasonably achievable without causing unacceptable side-effects, within 6-months of initiating treatment, for all adults. Possible subgroups to whom this may not apply are those who are frail and/or have limited life expectancy where higher targets may be appropriate based on clinical judgement and the individuals’ tolerance to treatment. The BIHS believe that this simple 2-step approach will facilitate practitioners deliver evidence-based best practice, discourage therapeutic inertia around BP lowering and improve heath outcomes for all adults living with high BP.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"537-540"},"PeriodicalIF":3.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01055-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698789","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}
Arterial hypertension (AH) and familial hypercholesterolemia (FH) are major risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which the coexistence of AH and FH amplifies the ASCVD risk is not well known. We aimed to explore the effect of AH on the prevalence of ASCVD in patients with FH. This was a cross-sectional analysis from the HELLAS-FH registry. A total of 2367 adults with heterozygous FH were studied. Out of these, 602 (25.4%) patients had AH. Patients with AH were more likely to have additional ASCVD risk factors (diabetes, smoking, obesity, elevated triglycerides and reduced high-density lipoprotein cholesterol levels) compared with patients without AH. Patients with AH had significantly higher prevalence of established coronary artery disease (CAD) (44 vs 14%, p < 0.001), premature CAD (39 vs 13%, p < 0.001), stroke (6 vs 2%, p < 0.001), and peripheral artery disease (6 vs 1%, p < 0.001) compared with those without after adjustment for major ASCVD risk factors. Systolic blood pressure (SBP) was significantly associated with increased odds of established CAD per 1 mmHg [odds ratio (OR) 1.075; 95% CI 1.001–1.153; p = 0.048], stroke (OR 1.023; 95% CI 1.004–1.042; p = 0.019) and PAD (OR 1.022; 95% CI 1.002–1.041; p = 0.028), while diastolic blood pressure showed no significant association with these outcomes. In conclusion, AH is associated with higher ASCVD risk factor burden and increased prevalence of ASCVD in patients with FH.
动脉高血压（AH）和家族性高胆固醇血症（FH）是动脉粥样硬化性心血管疾病（ASCVD）的主要危险因素。AH和FH共存对ASCVD风险的放大程度尚不清楚。我们的目的是探讨AH对FH患者ASCVD患病率的影响。这是来自HELLAS-FH登记处的横断面分析。对2367例成人杂合子FH进行了研究。其中602例（25.4%）患者患有AH。与没有AH的患者相比，AH患者更有可能有额外的ASCVD危险因素（糖尿病、吸烟、肥胖、甘油三酯升高和高密度脂蛋白胆固醇水平降低）。AH患者有较高的冠状动脉疾病（CAD）患病率(44% vs 14%, p
{"title":"Beyond lipid levels: unraveling the hypertensive factor in familial hypercholesterolemia. The HELLAS-FH registry","authors":"Christina Antza, Christos V. Rizos, Vasileios Kotsis, George Liamis, Ioannis Skoumas, Loukianos Rallidis, Anastasia Garoufi, George Sfikas, Genovefa Kolovou, Athanasios Penopoulos, Emmanouil Skalidis, Kimon Stamatelopoulos, Michalis Doumas, Vaia Lambadiari, Panagiotis Anagnostis, Evgenia Mavrokefalou, Amalia Boufidou, Vasiliki Giannakopoulou, Georgia Anastasiou, Ermioni Petkou, Charalambos Vlachopoulos, Ioanna Dima, Georgios Fakas, Konstantinos A. Papathanasiou, Achilleas Attilakos, Charalambos Koumaras, Vana Kolovou, Dimitrios Agapakis, Evangelos Zacharis, Chrysoula Moustou, Niki Katsiki, Aikaterini Kountouri, Eleni Mpellou, Elisavet Prodromiadou, Evangelos Liberopoulos","doi":"10.1038/s41371-025-01052-2","DOIUrl":"10.1038/s41371-025-01052-2","url":null,"abstract":"Arterial hypertension (AH) and familial hypercholesterolemia (FH) are major risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which the coexistence of AH and FH amplifies the ASCVD risk is not well known. We aimed to explore the effect of AH on the prevalence of ASCVD in patients with FH. This was a cross-sectional analysis from the HELLAS-FH registry. A total of 2367 adults with heterozygous FH were studied. Out of these, 602 (25.4%) patients had AH. Patients with AH were more likely to have additional ASCVD risk factors (diabetes, smoking, obesity, elevated triglycerides and reduced high-density lipoprotein cholesterol levels) compared with patients without AH. Patients with AH had significantly higher prevalence of established coronary artery disease (CAD) (44 vs 14%, p < 0.001), premature CAD (39 vs 13%, p < 0.001), stroke (6 vs 2%, p < 0.001), and peripheral artery disease (6 vs 1%, p < 0.001) compared with those without after adjustment for major ASCVD risk factors. Systolic blood pressure (SBP) was significantly associated with increased odds of established CAD per 1 mmHg [odds ratio (OR) 1.075; 95% CI 1.001–1.153; p = 0.048], stroke (OR 1.023; 95% CI 1.004–1.042; p = 0.019) and PAD (OR 1.022; 95% CI 1.002–1.041; p = 0.028), while diastolic blood pressure showed no significant association with these outcomes. In conclusion, AH is associated with higher ASCVD risk factor burden and increased prevalence of ASCVD in patients with FH.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"619-625"},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01052-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682723","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 frequently co-exists with depression, leading to adverse health outcomes. This study aimed to examine the individual and joint effects of hypertension and depression on the risks of new-onset cardiovascular disease (CVD) and all-cause mortality among the middle-aged and older Chinese individuals. Data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011–2020 were used. Participants were divided into four groups for comparison: hypertension alone, depression alone, both conditions, neither condition. Multivariate logistic regression models were established to compare the risks of all-cause mortality and CVD among the four groups. A total of 9178 participants without pre-existing CVD were included and followed for nine years. Compared with individuals with neither condition, the risk of all-cause mortality increased among individuals with hypertension alone (adjusted odds ratio [aOR]: 1.414, 95% confidence interval [CI]: 1.133–1.764), depression alone (aOR: 1.023, 95% CI: 0.795–1.317) and comorbid hypertension and depression (aOR: 1.524, 95% CI: 1.180–1.968). The aORs for CVD events in individuals with both conditions, hypertension alone, and depression only were 2.207 (95% CI: 1.885–2.584), 1.945 (95% CI: 1.702–2.222) and 1.572 (95% CI: 1.365–1.809), respectively. Furthermore, those with severe depressive symptoms were at higher risks of all-cause mortality and CVD, regardless of having hypertension. Hypertension with comorbid depression leads to higher risks of CVD and all-cause mortality than either condition alone. Screening and management of depression among individuals with hypertension are essential for the primary prevention of CVD and premature death.
{"title":"Independent and joint associations of hypertension and depression with cardiovascular diseases and all-cause mortality: a population-based cohort study","authors":"Qiang Tu, Shuanglan Lin, Nashid Hafiz, Karice Hyun, Deborah Manandi, Emma Zhao, Haisheng Wu, Yangxi Huang, Shuzhen Ma, Zhengqiu Zhang, Jiazhen Zheng, Julie Redfern","doi":"10.1038/s41371-025-01045-1","DOIUrl":"10.1038/s41371-025-01045-1","url":null,"abstract":"Hypertension frequently co-exists with depression, leading to adverse health outcomes. This study aimed to examine the individual and joint effects of hypertension and depression on the risks of new-onset cardiovascular disease (CVD) and all-cause mortality among the middle-aged and older Chinese individuals. Data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011–2020 were used. Participants were divided into four groups for comparison: hypertension alone, depression alone, both conditions, neither condition. Multivariate logistic regression models were established to compare the risks of all-cause mortality and CVD among the four groups. A total of 9178 participants without pre-existing CVD were included and followed for nine years. Compared with individuals with neither condition, the risk of all-cause mortality increased among individuals with hypertension alone (adjusted odds ratio [aOR]: 1.414, 95% confidence interval [CI]: 1.133–1.764), depression alone (aOR: 1.023, 95% CI: 0.795–1.317) and comorbid hypertension and depression (aOR: 1.524, 95% CI: 1.180–1.968). The aORs for CVD events in individuals with both conditions, hypertension alone, and depression only were 2.207 (95% CI: 1.885–2.584), 1.945 (95% CI: 1.702–2.222) and 1.572 (95% CI: 1.365–1.809), respectively. Furthermore, those with severe depressive symptoms were at higher risks of all-cause mortality and CVD, regardless of having hypertension. Hypertension with comorbid depression leads to higher risks of CVD and all-cause mortality than either condition alone. Screening and management of depression among individuals with hypertension are essential for the primary prevention of CVD and premature death.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"634-642"},"PeriodicalIF":3.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01045-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659395","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}
Measurements of renin and aldosterone are important for the diagnosis and treatment of different renin sub-types of hypertension as well as endocrine hypertension, particularly primary aldosteronism (PA). However, numerous factors can influence the measurements of renin and aldosterone, including geographical location, ethnicity, body posture, dietary habits, sex, and age, instrumentation, methodology. This study aimed to establish age- and sex-specific reference intervals for renin and aldosterone in Yunnan Province, China. This study was a cross-sectional survey conducted in Yunnan Province, China, using multi-stage stratified random sampling method from four districts/counties and urban and rural settings. Age, gender, medical history, medication history and family history of the individuals were first collected, then height, weight, blood pressure and heart rate were measured and blood specimens were collected to test biochemical parameters, plasma renin concentration (PRC) and plasma aldosterone concentration (PAC). During the selection process, we first excluded individuals with obvious clinical symptoms and diagnosed diseases, and selected 9129 ostensibly healthy as the initial sample. Next, we excluded participants who were in pregnancy, lactating, taking contraceptive, hypertension, hypokalemia, renal insufficiency, obesity, and finally successfully included 5200 individuals. A rigorous statistical analysis was conducted to investigate differences in renin and aldosterone levels by sex and age, facilitating the redefinition of groups, and subsequently, reference intervals for renin and aldosterone were established within the redefined groups. Renin and aldosterone levels differed significantly across sex and age groups. Specifically, PRC was significantly lower in women than men, while PAC was significantly higher in men than women. PRC decreased with age, while PAC levels were lowest in the 18–24 age group and peaked in the 25–64 age group. Our findings underscore the crucial role of sex and age when precisely evaluating renin and aldosterone levels. This study established, for the first time, age- and sex-specific reference intervals for renin and aldosterone in healthy individuals in Yunnan Province, China. These findings may provide some guidance for the diagnosis and treatment of different renin sub-types of hypertension, as well as some help in providing new ideas for further research on PA.
{"title":"Age- and sex-specific reference intervals for renin and aldosterone in healthy individuals in Yunnan Province, China","authors":"CaiYan Zhang, ZiHong Guo, ChunXiu Yi, Han Wang, Wen Zhang, YaJing Zhao","doi":"10.1038/s41371-025-01006-8","DOIUrl":"10.1038/s41371-025-01006-8","url":null,"abstract":"Measurements of renin and aldosterone are important for the diagnosis and treatment of different renin sub-types of hypertension as well as endocrine hypertension, particularly primary aldosteronism (PA). However, numerous factors can influence the measurements of renin and aldosterone, including geographical location, ethnicity, body posture, dietary habits, sex, and age, instrumentation, methodology. This study aimed to establish age- and sex-specific reference intervals for renin and aldosterone in Yunnan Province, China. This study was a cross-sectional survey conducted in Yunnan Province, China, using multi-stage stratified random sampling method from four districts/counties and urban and rural settings. Age, gender, medical history, medication history and family history of the individuals were first collected, then height, weight, blood pressure and heart rate were measured and blood specimens were collected to test biochemical parameters, plasma renin concentration (PRC) and plasma aldosterone concentration (PAC). During the selection process, we first excluded individuals with obvious clinical symptoms and diagnosed diseases, and selected 9129 ostensibly healthy as the initial sample. Next, we excluded participants who were in pregnancy, lactating, taking contraceptive, hypertension, hypokalemia, renal insufficiency, obesity, and finally successfully included 5200 individuals. A rigorous statistical analysis was conducted to investigate differences in renin and aldosterone levels by sex and age, facilitating the redefinition of groups, and subsequently, reference intervals for renin and aldosterone were established within the redefined groups. Renin and aldosterone levels differed significantly across sex and age groups. Specifically, PRC was significantly lower in women than men, while PAC was significantly higher in men than women. PRC decreased with age, while PAC levels were lowest in the 18–24 age group and peaked in the 25–64 age group. Our findings underscore the crucial role of sex and age when precisely evaluating renin and aldosterone levels. This study established, for the first time, age- and sex-specific reference intervals for renin and aldosterone in healthy individuals in Yunnan Province, China. These findings may provide some guidance for the diagnosis and treatment of different renin sub-types of hypertension, as well as some help in providing new ideas for further research on PA.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"652-657"},"PeriodicalIF":3.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01006-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649667","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 : 2025-07-14DOI: 10.1038/s41371-025-01043-3
Jaewon Oh, Wonho Kim, Gee-Hee Kim, Hack-Lyoung Kim, Sang-Don Park, Kyung Wan Min, Dongkeun Hyun, Jun Hwa Hong, Soo Lim, Ji-Hwan Bae, Jinho Shin, the RESOLVE-INT Investigators
This pioneering study investigated the real-life effectiveness of single-pill combination (SPC) antihypertensive therapy in patients with uncontrolled blood pressure (BP) and cardiovascular risk factors. After treatment with olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide for 24 weeks, adults with apparent resistant hypertension had significantly reduced systolic BP and approximately 80% achieved target BP. SPC therapy may improve adherence in patients with pseudo-resistant hypertension and is a potentially effective treatment for resistant hypertension.
{"title":"Effectiveness of single-pill combination olmesartan/amlodipine/hydrochlorothiazide therapy in patients with apparent resistant hypertension","authors":"Jaewon Oh, Wonho Kim, Gee-Hee Kim, Hack-Lyoung Kim, Sang-Don Park, Kyung Wan Min, Dongkeun Hyun, Jun Hwa Hong, Soo Lim, Ji-Hwan Bae, Jinho Shin, the RESOLVE-INT Investigators","doi":"10.1038/s41371-025-01043-3","DOIUrl":"10.1038/s41371-025-01043-3","url":null,"abstract":"This pioneering study investigated the real-life effectiveness of single-pill combination (SPC) antihypertensive therapy in patients with uncontrolled blood pressure (BP) and cardiovascular risk factors. After treatment with olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide for 24 weeks, adults with apparent resistant hypertension had significantly reduced systolic BP and approximately 80% achieved target BP. SPC therapy may improve adherence in patients with pseudo-resistant hypertension and is a potentially effective treatment for resistant hypertension.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"675-678"},"PeriodicalIF":3.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01043-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637188","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 : 2025-07-11DOI: 10.1038/s41371-025-01047-z
Philipp Kasper, Münevver Demir, Hans-Michael Steffen
{"title":"Detection of masked hypertension in patients with metabolic-dysfunction associated steatotic liver disease using a novel clinical risk model","authors":"Philipp Kasper, Münevver Demir, Hans-Michael Steffen","doi":"10.1038/s41371-025-01047-z","DOIUrl":"10.1038/s41371-025-01047-z","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"598-599"},"PeriodicalIF":3.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618607","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 : 2025-07-10DOI: 10.1038/s41371-025-01040-6
Andrew Lowe, Yang Yu, Tanvi Chandel
Accurate blood pressure measurement (BPM) is critical for managing hypertension, a leading global health concern. While international standards like ISO 81060-2 are applied to ensure commercial BPM device safety and effectiveness, gauging compliance earlier in research and development can be challenging. This study proposes an enhanced statistical evaluation framework that calculates a credence of device acceptability, aligned with international standards, which can be used to assess and compare results of device evaluation experiments having various sample sizes, blood pressure ranges, mean, standard deviation and correlations in error. Applied to ten studies featuring diverse BPM methods, the framework demonstrates its capability to provide insights beyond the face-value application of the performance criteria of international standards. This framework advances BPM technology by providing more appropriate tools to assess device accuracy.
{"title":"Credence of device acceptability: a statistical method for comparing blood pressure measurement device accuracy across studies","authors":"Andrew Lowe, Yang Yu, Tanvi Chandel","doi":"10.1038/s41371-025-01040-6","DOIUrl":"10.1038/s41371-025-01040-6","url":null,"abstract":"Accurate blood pressure measurement (BPM) is critical for managing hypertension, a leading global health concern. While international standards like ISO 81060-2 are applied to ensure commercial BPM device safety and effectiveness, gauging compliance earlier in research and development can be challenging. This study proposes an enhanced statistical evaluation framework that calculates a credence of device acceptability, aligned with international standards, which can be used to assess and compare results of device evaluation experiments having various sample sizes, blood pressure ranges, mean, standard deviation and correlations in error. Applied to ten studies featuring diverse BPM methods, the framework demonstrates its capability to provide insights beyond the face-value application of the performance criteria of international standards. This framework advances BPM technology by providing more appropriate tools to assess device accuracy.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"658-665"},"PeriodicalIF":3.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01040-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608486","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}
Preeclampsia increases the risk of morbidity and mortality from cardiovascular diseases. This study aimed to assess the occurrence of hypertension and renal dysfunction within 12 months following pre‐eclampsia and to determine its association with peripartum factors, along with biomarkers at admission or discharge. Using a cohort design, we followed 250 preeclamptic women delivered in a teaching hospital between March 2019 and December 2021. Women with pre-existing hypertension or renal dysfunction or its diagnosis before 20 weeks of gestation were excluded. The primary outcome was the development of hypertension and/or persistent renal dysfunction within 12 months after delivery. The strength of association is expressed as adjusted Odds Ratios(aOR) with a 95% confidence interval (CI). Among 233 who completed follow-up, 109 (48.0%, CI: 41.3–54.7%) had one or both outcomes, i.e. hypertension (n = 84, 37.3%, CI: 31.0–44.0%) or renal dysfunction (n = 39, 17.3%, CI: 12.6–22.9%). Advancing age (aOR=1.08, CI:1.003–1.177) was associated with hypertension, whereas presence of HELLP syndrome (aOR=2.69, CI:1.062–6.803) and higher systolic blood pressure(aOR=1.07, CI:1.022–1.126) were associated with renal dysfunction. Among biomarkers, increasing levels of Troponin-T (aOR=0.97, CI:0.953–0.996) and heparin sulphate (aOR= 0.75, CI: 0.628–0.968) at admission had lower odds of developing hypertension on follow-up. By 12 months of follow-up, half of preeclamptic women had either hypertension or renal dysfunction. Advancing age was associated with hypertension, whereas higher systolic blood pressure and the presence of HELLP syndrome were associated with renal dysfunction. Markers of endo glycocalyx disruption and Troponin T levels had a weak association with hypertension, whereas no biomarkers at discharge were associated with renal dysfunction on follow-up.
{"title":"Role of biomarkers in identifying women at risk of hypertension and renal dysfunction on follow-up after severe preeclampsia","authors":"Anish Keepanasseril, Saranya Ravi, Gowri Dorairajan, Bobby Zachariah, Pankaj Kundra, Sreejith Parameswaran, Ajith Ananthakrishna Pillai, Sitanshu Sekhar Kar, Dilip Kumar Maurya","doi":"10.1038/s41371-024-00981-8","DOIUrl":"10.1038/s41371-024-00981-8","url":null,"abstract":"Preeclampsia increases the risk of morbidity and mortality from cardiovascular diseases. This study aimed to assess the occurrence of hypertension and renal dysfunction within 12 months following pre‐eclampsia and to determine its association with peripartum factors, along with biomarkers at admission or discharge. Using a cohort design, we followed 250 preeclamptic women delivered in a teaching hospital between March 2019 and December 2021. Women with pre-existing hypertension or renal dysfunction or its diagnosis before 20 weeks of gestation were excluded. The primary outcome was the development of hypertension and/or persistent renal dysfunction within 12 months after delivery. The strength of association is expressed as adjusted Odds Ratios(aOR) with a 95% confidence interval (CI). Among 233 who completed follow-up, 109 (48.0%, CI: 41.3–54.7%) had one or both outcomes, i.e. hypertension (n = 84, 37.3%, CI: 31.0–44.0%) or renal dysfunction (n = 39, 17.3%, CI: 12.6–22.9%). Advancing age (aOR=1.08, CI:1.003–1.177) was associated with hypertension, whereas presence of HELLP syndrome (aOR=2.69, CI:1.062–6.803) and higher systolic blood pressure(aOR=1.07, CI:1.022–1.126) were associated with renal dysfunction. Among biomarkers, increasing levels of Troponin-T (aOR=0.97, CI:0.953–0.996) and heparin sulphate (aOR= 0.75, CI: 0.628–0.968) at admission had lower odds of developing hypertension on follow-up. By 12 months of follow-up, half of preeclamptic women had either hypertension or renal dysfunction. Advancing age was associated with hypertension, whereas higher systolic blood pressure and the presence of HELLP syndrome were associated with renal dysfunction. Markers of endo glycocalyx disruption and Troponin T levels had a weak association with hypertension, whereas no biomarkers at discharge were associated with renal dysfunction on follow-up.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"572-579"},"PeriodicalIF":3.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608487","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}
Hypertension, a leading cause of cardiovascular diseases, accounts for 7.5 million deaths annually, affecting over 1.3 billion people globally, with significant burdens in low- and middle-income countries like India. It significantly impacts India’s population, with low rates of awareness, diagnosis, and treatment. This study examines the hypertension care cascade and its key determinants at the national, state, and district levels in India. The analysis was conducted using data from the NFHS-5 survey, involving a total of 743,067 adults aged 18–54 years. From this group, 118,231 individuals with hypertension were identified, and the hypertension care cascade was constructed. A color-coded map was generated to visually depict geographic disparities in prevalence rates across different regions of India. Multivariate logistic regression was employed at the district, state, and national levels, with significance set at p < 0.05. Hypertension awareness varied significantly across districts, with an average rate of 46.0%, ranging from 89.6–6.1%. Treatment rates were 18.7%, with considerable disparity among districts. Blood pressure control was achieved in 32.9% of individuals with hypertension. Older age, female gender, higher socioeconomic status, urban residence, and obesity were associated with better attainment of cascade steps. Conversely, younger age and alcohol consumption were linked to lower attainment, while educated individuals showed lower treatment-seeking behavior despite better awareness. Poor-performing districts were identified in Gujarat, Chhattisgarh, and Madhya Pradesh. These findings highlight the need for targeted, evidence-based interventions to address regional disparities, enhance hypertension care, and reduce the cardiovascular disease burden in India.
{"title":"Variations in the hypertension care cascade across districts and the factors influencing it among Indian adults: findings from the National Family Health Survey -5","authors":"Vaitheeswaran Kulothungan, Kavyashree Seenappa, Rohith Mohan","doi":"10.1038/s41371-025-01039-z","DOIUrl":"10.1038/s41371-025-01039-z","url":null,"abstract":"Hypertension, a leading cause of cardiovascular diseases, accounts for 7.5 million deaths annually, affecting over 1.3 billion people globally, with significant burdens in low- and middle-income countries like India. It significantly impacts India’s population, with low rates of awareness, diagnosis, and treatment. This study examines the hypertension care cascade and its key determinants at the national, state, and district levels in India. The analysis was conducted using data from the NFHS-5 survey, involving a total of 743,067 adults aged 18–54 years. From this group, 118,231 individuals with hypertension were identified, and the hypertension care cascade was constructed. A color-coded map was generated to visually depict geographic disparities in prevalence rates across different regions of India. Multivariate logistic regression was employed at the district, state, and national levels, with significance set at p < 0.05. Hypertension awareness varied significantly across districts, with an average rate of 46.0%, ranging from 89.6–6.1%. Treatment rates were 18.7%, with considerable disparity among districts. Blood pressure control was achieved in 32.9% of individuals with hypertension. Older age, female gender, higher socioeconomic status, urban residence, and obesity were associated with better attainment of cascade steps. Conversely, younger age and alcohol consumption were linked to lower attainment, while educated individuals showed lower treatment-seeking behavior despite better awareness. Poor-performing districts were identified in Gujarat, Chhattisgarh, and Madhya Pradesh. These findings highlight the need for targeted, evidence-based interventions to address regional disparities, enhance hypertension care, and reduce the cardiovascular disease burden in India.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"585-594"},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600699","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 : 2025-07-09DOI: 10.1038/s41371-025-01046-0
Martin R. Salazar, Walter G. Espeche, Julián Minetto, Gustavo Cerri, Soledad Torres, Florencia Grassi, Claudia Santillan, Romina Tizzano, Juan Todoroff, Lautaro Reitovich, Rosario Ramallo, Horacio A. Carbajal
To investigate the relationship between blood pressure (BP) components (daytime vs. nocturnal BP and systolic vs. diastolic BP) and preeclampsia (PE) across gestational stages. We conducted a historical cohort study involving 1363 high-risk pregnant women (mean age, 30 ± 7 years). Ambulatory BP monitoring (ABPM) was performed at 12–19 weeks (n = 389), 20–27 weeks (n = 798), and 28–36 weeks (n = 1176); 59.9, 25.0, and 15.1% of the participants underwent one, two, and three ABPM evaluations, respectively. PE occurred in 15.4, 18.9, and 20.2% of the women evaluated at 12–19, 20–27, and 28–36 weeks, respectively. In the second half of pregnancy, sustained (daytime and nighttime) and isolated nocturnal hypertension were strong predictors of PE. Conversely, before the 20th week of gestation, only sustained hypertension (but not isolated nocturnal hypertension) increased PE risk, with lower odds ratios (ORs). Moreover, the areas under the curve (AUCs) for all ABPM components increased markedly after the 20th week of gestation. In late pregnancy, systolic and diastolic ABPM levels as well as all forms of nocturnal hypertension (isolated systolic, isolated diastolic, and combined systodiastolic) were significantly associated with PE risk, with ORs remaining significant after adjusting for daytime ABPM and maternal covariates. Patients with systodiastolic nocturnal hypertension had the highest risk. Conversely, neither daytime hypertension nor daytime ABPM levels remained statistically significant after adjusting for nocturnal ABPM levels. In conclusion, the association between PE and systolic, diastolic, and systodiastolic nocturnal hypertension emerges in the second half of pregnancy, suggesting a relationship with abnormal placentation.
{"title":"Nocturnal systolic and diastolic blood pressure across gestational periods and the risk of preeclampsia","authors":"Martin R. Salazar, Walter G. Espeche, Julián Minetto, Gustavo Cerri, Soledad Torres, Florencia Grassi, Claudia Santillan, Romina Tizzano, Juan Todoroff, Lautaro Reitovich, Rosario Ramallo, Horacio A. Carbajal","doi":"10.1038/s41371-025-01046-0","DOIUrl":"10.1038/s41371-025-01046-0","url":null,"abstract":"To investigate the relationship between blood pressure (BP) components (daytime vs. nocturnal BP and systolic vs. diastolic BP) and preeclampsia (PE) across gestational stages. We conducted a historical cohort study involving 1363 high-risk pregnant women (mean age, 30 ± 7 years). Ambulatory BP monitoring (ABPM) was performed at 12–19 weeks (n = 389), 20–27 weeks (n = 798), and 28–36 weeks (n = 1176); 59.9, 25.0, and 15.1% of the participants underwent one, two, and three ABPM evaluations, respectively. PE occurred in 15.4, 18.9, and 20.2% of the women evaluated at 12–19, 20–27, and 28–36 weeks, respectively. In the second half of pregnancy, sustained (daytime and nighttime) and isolated nocturnal hypertension were strong predictors of PE. Conversely, before the 20th week of gestation, only sustained hypertension (but not isolated nocturnal hypertension) increased PE risk, with lower odds ratios (ORs). Moreover, the areas under the curve (AUCs) for all ABPM components increased markedly after the 20th week of gestation. In late pregnancy, systolic and diastolic ABPM levels as well as all forms of nocturnal hypertension (isolated systolic, isolated diastolic, and combined systodiastolic) were significantly associated with PE risk, with ORs remaining significant after adjusting for daytime ABPM and maternal covariates. Patients with systodiastolic nocturnal hypertension had the highest risk. Conversely, neither daytime hypertension nor daytime ABPM levels remained statistically significant after adjusting for nocturnal ABPM levels. In conclusion, the association between PE and systolic, diastolic, and systodiastolic nocturnal hypertension emerges in the second half of pregnancy, suggesting a relationship with abnormal placentation.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"541-548"},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01046-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600698","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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