Pub Date : 2024-03-06DOI: 10.1038/s41371-024-00904-7
Stephen D. Persell, Lauren Anthony, Yaw A. Peprah, Ji Young Lee, Jim Li, Hironori Sato, Lucia C. Petito
This pragmatic matched cohort study using EHR data extended the follow up to 18 months for BP outcomes comparing individuals prescribed remote patient monitoring (n = 288) and temporally-matched controls (n = 1152) from six primary care practices. After 18 months, the RPM-prescribed cohort had greater BP control < 140/90 mm Hg (RPM cohort: 71.5%, control cohort: 51.9%, p < 0.001) and lower systolic BP (131.6 versus 136.0 mm Hg, p = 0.004) using office and home measurements. BP control at 18 months assessed by office measurements only was also higher in the RPM group (62.2% versus 51.9%, p = 0.004).
{"title":"Blood pressure outcomes at 18 months in primary care patients prescribed remote physiological monitoring for hypertension: a prospective cohort study","authors":"Stephen D. Persell, Lauren Anthony, Yaw A. Peprah, Ji Young Lee, Jim Li, Hironori Sato, Lucia C. Petito","doi":"10.1038/s41371-024-00904-7","DOIUrl":"10.1038/s41371-024-00904-7","url":null,"abstract":"This pragmatic matched cohort study using EHR data extended the follow up to 18 months for BP outcomes comparing individuals prescribed remote patient monitoring (n = 288) and temporally-matched controls (n = 1152) from six primary care practices. After 18 months, the RPM-prescribed cohort had greater BP control < 140/90 mm Hg (RPM cohort: 71.5%, control cohort: 51.9%, p < 0.001) and lower systolic BP (131.6 versus 136.0 mm Hg, p = 0.004) using office and home measurements. BP control at 18 months assessed by office measurements only was also higher in the RPM group (62.2% versus 51.9%, p = 0.004).","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"286-288"},"PeriodicalIF":2.7,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00904-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049673","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 : 2024-03-04DOI: 10.1038/s41371-024-00906-5
Alexander S. MACDONALD, Alex MCCONNACHIE, David Alexander DICKIE, Philip M. BATH, Kirsten FORBES, Terence QUINN, Niall M. BROOMFIELD, Krishna DANI, Alex DONEY, Keith W. MUIR, Allan STRUTHERS, Matthew WALTERS, Mark BARBER, Ajay BHALLA, Alan CAMERON, Paul GUYLER, Ahamad HASSAN, Mark KEARNEY, Breffni KEEGAN, Sekaran LAKSHMANAN, Mary Joan MACLEOD, Marc RANDALL, Louise SHAW, Ganesh SUBRAMANIAN, David WERRING, Jesse DAWSON
Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18–2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31–2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.
{"title":"Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack: a secondary analysis of XILO-FIST","authors":"Alexander S. MACDONALD, Alex MCCONNACHIE, David Alexander DICKIE, Philip M. BATH, Kirsten FORBES, Terence QUINN, Niall M. BROOMFIELD, Krishna DANI, Alex DONEY, Keith W. MUIR, Allan STRUTHERS, Matthew WALTERS, Mark BARBER, Ajay BHALLA, Alan CAMERON, Paul GUYLER, Ahamad HASSAN, Mark KEARNEY, Breffni KEEGAN, Sekaran LAKSHMANAN, Mary Joan MACLEOD, Marc RANDALL, Louise SHAW, Ganesh SUBRAMANIAN, David WERRING, Jesse DAWSON","doi":"10.1038/s41371-024-00906-5","DOIUrl":"10.1038/s41371-024-00906-5","url":null,"abstract":"Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18–2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31–2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"307-313"},"PeriodicalIF":2.7,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00906-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028222","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 : 2024-02-29DOI: 10.1038/s41371-024-00903-8
Paul Olowoyo, Anastase Dzudie, Akinkunmi Paul Okekunle, Reginald Obiako, Ana Mocumbi, Hind Beheiry, Gianfranco Parati, Daniel T. Lackland, Fred S. Sarfo, Augustine Odili, Abiodun M. Adeoye, Kolawole Wahab, Charles Agyemang, Norman Campbell, Andre Pascal Kengne, Paul K. Whelton, Pierpaolo Pellicori, Ad Adams Ebenezer, Oladimeji Adebayo, Oladotun Olalusi, Ayodele Jegede, Ezinne Uvere, Olayinka Adebajo, Baffour Awuah, Andrew Moran, Bryan Williams, Tomasz J. Guzik, Collins Kokuro, Fred Bukachi, Okechukwu S. Ogah, Christian Delles, Pasquale Maffia, Rufus Akinyemi, Prebo Barango, Dike Ojji, Mayowa Owolabi
The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.
{"title":"ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa","authors":"Paul Olowoyo, Anastase Dzudie, Akinkunmi Paul Okekunle, Reginald Obiako, Ana Mocumbi, Hind Beheiry, Gianfranco Parati, Daniel T. Lackland, Fred S. Sarfo, Augustine Odili, Abiodun M. Adeoye, Kolawole Wahab, Charles Agyemang, Norman Campbell, Andre Pascal Kengne, Paul K. Whelton, Pierpaolo Pellicori, Ad Adams Ebenezer, Oladimeji Adebayo, Oladotun Olalusi, Ayodele Jegede, Ezinne Uvere, Olayinka Adebajo, Baffour Awuah, Andrew Moran, Bryan Williams, Tomasz J. Guzik, Collins Kokuro, Fred Bukachi, Okechukwu S. Ogah, Christian Delles, Pasquale Maffia, Rufus Akinyemi, Prebo Barango, Dike Ojji, Mayowa Owolabi","doi":"10.1038/s41371-024-00903-8","DOIUrl":"10.1038/s41371-024-00903-8","url":null,"abstract":"The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"193-199"},"PeriodicalIF":2.7,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00903-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996509","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 : 2024-02-27DOI: 10.1038/s41371-024-00902-9
Yingting Zuo, Shuohua Chen, Xue Tian, Shouling Wu, Anxin Wang
It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35–0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94–0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.
在以社区为基础的人群研究中，改善动脉僵化（AS）是否能降低临床结果风险尚未得到充分研究。在这项前瞻性研究中，开滦研究共纳入了 5247 名 AS 异常（基线时）且在 2018 年前重复测量过肱-踝脉搏波速度（baPWV）的个体。根据第二次baPWV测量结果，我们将参与者分为两组，即强直性脊柱炎改善组（定义为强直性脊柱炎升高状态转为正常）和强直性脊柱炎持续组（定义为强直性脊柱炎升高状态维持不变）。结果是中风、心肌梗死和全因死亡的综合事件。我们使用 Cox 比例危险回归法来检验随访时的 AS 状态与后续结果之间的关联。在中位 5.2 年的随访期间，我们观察到 413 例终点事件。在对潜在的混杂因素进行调整后，与持续性强直性脊柱炎组相比，强直性脊柱炎好转组的患者发生主要复合事件的风险降低了 43%（危险比 [HR]，0.57；95% 置信区间 [CI]，0.35-0.94）。我们还发现，baPWV 下降 1 m/s 与主要复合事件风险降低 3% 相关（HR，0.97；95% 置信区间 [CI]，0.94-0.99）。我们进一步证实，年龄小于 60 岁、不吸烟、无高血压、无糖尿病与改善 AS 状态有关。总之，改善强直性脊柱炎状况可降低发生临床事件的风险。今后，应开展更多的研究来探索改善 AS 状态的目标。
{"title":"Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population","authors":"Yingting Zuo, Shuohua Chen, Xue Tian, Shouling Wu, Anxin Wang","doi":"10.1038/s41371-024-00902-9","DOIUrl":"10.1038/s41371-024-00902-9","url":null,"abstract":"It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35–0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94–0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"460-466"},"PeriodicalIF":2.7,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139981346","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 : 2024-02-26DOI: 10.1038/s41371-024-00905-6
Andrew O. Agbaje
This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40–<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = −0.057; [95% CI −0.101 to −0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007–0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014–0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.
{"title":"Mediating effect of fat mass, lean mass, blood pressure and insulin resistance on the associations of accelerometer-based sedentary time and physical activity with arterial stiffness, carotid IMT and carotid elasticity in 1574 adolescents","authors":"Andrew O. Agbaje","doi":"10.1038/s41371-024-00905-6","DOIUrl":"10.1038/s41371-024-00905-6","url":null,"abstract":"This study examined the mediating effect of total body fat mass, lean mass, blood pressure (BP) and insulin resistance on the associations of sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous PA (MVPA) with carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT) and carotid elasticity in 1574 adolescents from the Avon Longitudinal Study of Parents and Children birth cohort, UK. ST, LPA and MVPA were assessed with ActiGraph accelerometer. ST and LPA were sex-categorised in tertiles as low (reference), moderate and high, while MVPA was categorised as <40 min/day (reference), 40–<60 min/day and ≥60 min/day. cfPWV, cIMT and carotid elasticity were measured with Vicorder and ultrasound. Fat mass and lean mass were assessed with dual-energy X-ray absorptiometry and homeostatic model assessment of insulin resistance (HOMA-IR) was computed. Mediation analyses structural equation models and linear mixed-effect models adjusted for cardiometabolic and lifestyle factors were conducted. Among 1574 adolescents [56.2% female; mean (SD) age 15.4 (0.24) years], 41% males and 17% females accumulated ≥60 min/day of MVPA. Higher ST was associated with lower cIMT partly mediated by lean mass. Higher LPA (standardized β = −0.057; [95% CI −0.101 to −0.013; p = 0.014]) and the highest LPA tertile were associated with lower cfPWV. BP had no significant mediating effect movement behaviour relations with vascular indices. Lean mass partially mediated associations of higher MVPA with higher cIMT (0.012; [0.007–0.002; p = 0.001], 25.5% mediation) and higher carotid elasticity (0.025; [0.014–0.039; p = 0.001], 28.1% mediation). HOMA-IR mediated the associations of higher MVPA with higher carotid elasticity (7.7% mediation). Engaging in ≥60 min/day of MVPA was associated with higher carotid elasticity. In conclusion, higher LPA was associated with lower arterial stiffness, but higher MVPA was associated with thicker carotid wall explained by higher lean mass.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 5","pages":"393-403"},"PeriodicalIF":2.7,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00905-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972155","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 : 2024-02-21DOI: 10.1038/s41371-024-00896-4
Liping Huang, Qiang Li, Jason HY Wu, Maoyi Tian, Xuejun Yin, Jie Yu, Yishu Liu, Xinyi Zhang, Yangfeng Wu, Ellie Paige, Kathy Trieu, Matti Marklund, Anthony Rodgers, Bruce Neal
The Salt Substitute and Stroke Study (SSaSS) demonstrated significant reductions in systolic blood pressure (SBP), and the risk of stroke, major cardiovascular events and total mortality with the use of potassium-enriched salt. The contribution of sodium reduction versus potassium increase to these effects is unknown. We identified four different data sources describing the association between sodium reduction, potassium supplementation and change in SBP. We then fitted a series of models to estimate the SBP reductions expected for the differences in sodium and potassium intake in SSaSS, derived from 24-h urine collections. The proportions of the SBP reduction separately attributable to sodium reduction and potassium supplementation were calculated. The observed SBP reduction in SSaSS was −3.3 mmHg with a corresponding mean 15.2 mmol reduction in 24-h sodium excretion and a mean 20.6 mmol increase in 24-h potassium excretion. Assuming 90% of dietary sodium intake and 70% of dietary potassium intake were excreted through urine, the models projected falls in SBP of between −1.67 (95% confidence interval: −4.06 to +0.73) mmHg and −5.33 (95% confidence interval: −8.58 to −2.08) mmHg. The estimated proportional contribution of sodium reduction to the SBP fall ranged between 12 and 39% for the different models fitted. Sensitivity analyses assuming different proportional urinary excretion of dietary sodium and potassium intake showed similar results. In every model, the majority of the SBP lowering effect in SSaSS was estimated to be attributable to the increase in dietary potassium rather than the fall in dietary sodium.
{"title":"The contribution of sodium reduction and potassium increase to the blood pressure lowering observed in the Salt Substitute and Stroke Study","authors":"Liping Huang, Qiang Li, Jason HY Wu, Maoyi Tian, Xuejun Yin, Jie Yu, Yishu Liu, Xinyi Zhang, Yangfeng Wu, Ellie Paige, Kathy Trieu, Matti Marklund, Anthony Rodgers, Bruce Neal","doi":"10.1038/s41371-024-00896-4","DOIUrl":"10.1038/s41371-024-00896-4","url":null,"abstract":"The Salt Substitute and Stroke Study (SSaSS) demonstrated significant reductions in systolic blood pressure (SBP), and the risk of stroke, major cardiovascular events and total mortality with the use of potassium-enriched salt. The contribution of sodium reduction versus potassium increase to these effects is unknown. We identified four different data sources describing the association between sodium reduction, potassium supplementation and change in SBP. We then fitted a series of models to estimate the SBP reductions expected for the differences in sodium and potassium intake in SSaSS, derived from 24-h urine collections. The proportions of the SBP reduction separately attributable to sodium reduction and potassium supplementation were calculated. The observed SBP reduction in SSaSS was −3.3 mmHg with a corresponding mean 15.2 mmol reduction in 24-h sodium excretion and a mean 20.6 mmol increase in 24-h potassium excretion. Assuming 90% of dietary sodium intake and 70% of dietary potassium intake were excreted through urine, the models projected falls in SBP of between −1.67 (95% confidence interval: −4.06 to +0.73) mmHg and −5.33 (95% confidence interval: −8.58 to −2.08) mmHg. The estimated proportional contribution of sodium reduction to the SBP fall ranged between 12 and 39% for the different models fitted. Sensitivity analyses assuming different proportional urinary excretion of dietary sodium and potassium intake showed similar results. In every model, the majority of the SBP lowering effect in SSaSS was estimated to be attributable to the increase in dietary potassium rather than the fall in dietary sodium.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"298-306"},"PeriodicalIF":2.7,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00896-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912769","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 : 2024-02-20DOI: 10.1038/s41371-024-00898-2
Rebecca Hanna
{"title":"Hypertension is a genetic condition—a quantum dilemma","authors":"Rebecca Hanna","doi":"10.1038/s41371-024-00898-2","DOIUrl":"10.1038/s41371-024-00898-2","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"289-292"},"PeriodicalIF":2.7,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00898-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912816","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 : 2024-02-20DOI: 10.1038/s41371-024-00900-x
Susanna M. Kuneinen, Hannu Kautiainen, Mikael O. Ekblad, Päivi E. Korhonen
The aim of this study was to investigate if mortality during a 13-year follow-up varied between normotensive subjects, screen-detected hypertensive subjects, and subjects with antihypertensive medication at baseline. A population-based screening and intervention program identified 2659 apparently healthy, middle-aged cardiovascular-risk persons in southwestern Finland. Screen-detected hypertension was verified by home blood pressure measurements. Lifestyle counseling was provided for all participants and preventive medications were started or intensified if needed. All-cause and cardiovascular mortality were obtained from the official statistics. Screen-detected hypertension was diagnosed in 17% of the participants, 51% were normotensive and 32% had antihypertensive medication at baseline. The screen-detected hypertensives had higher mean blood pressure and cholesterol levels than the two other groups. Altogether 289 subjects died during the follow-up, 83 (29%) from cardiovascular disease. Those with screen-detected hypertension had decreased cardiovascular mortality risk compared to the medicated hypertensives [sHR 0.40 (95% CI: 0.19 to 0.88, p = 0.023)], and comparable with that of the normotensives [sHR 0.53 (95% CI: 0.24 to 1.15)]. Newly diagnosed diabetes at baseline was a powerful predictor of cardiovascular mortality [sHR 2.71 (95% CI: 1.57 to 4.69)]. Early detection of hypertension and timely multifactorial intervention seem to be important in preventing hypertension-related mortality.
这项研究的目的是调查在长达 13 年的随访过程中，正常血压者、筛查出的高血压者和基线服用降压药者之间的死亡率是否存在差异。一项基于人群的筛查和干预计划在芬兰西南部发现了2659名表面上健康的中年心血管高危人群。筛查出的高血压通过家庭血压测量进行验证。为所有参与者提供了生活方式咨询，并在必要时开始或加强预防性药物治疗。全因死亡率和心血管死亡率均来自官方统计数据。17%的参与者被诊断为筛查出的高血压，51%的参与者血压正常，32%的参与者在基线时服用了降压药。筛查出的高血压患者的平均血压和胆固醇水平高于其他两组。共有 289 人在随访期间死亡，其中 83 人（29%）死于心血管疾病。与药物治疗的高血压患者相比，通过筛查发现的高血压患者的心血管死亡风险降低[sHR 0.40 (95% CI: 0.19 to 0.88, p = 0.023)]，与正常血压患者的风险相当[sHR 0.53 (95% CI: 0.24 to 1.15)]。基线时新诊断的糖尿病是心血管死亡率的有力预测因素[sHR 2.71 (95% CI: 1.57 to 4.69)]。早期发现高血压并及时采取多因素干预措施似乎对预防高血压相关死亡率非常重要。
{"title":"Multifactorial prevention program for cardiovascular disease in primary care: hypertension status and effect on mortality","authors":"Susanna M. Kuneinen, Hannu Kautiainen, Mikael O. Ekblad, Päivi E. Korhonen","doi":"10.1038/s41371-024-00900-x","DOIUrl":"10.1038/s41371-024-00900-x","url":null,"abstract":"The aim of this study was to investigate if mortality during a 13-year follow-up varied between normotensive subjects, screen-detected hypertensive subjects, and subjects with antihypertensive medication at baseline. A population-based screening and intervention program identified 2659 apparently healthy, middle-aged cardiovascular-risk persons in southwestern Finland. Screen-detected hypertension was verified by home blood pressure measurements. Lifestyle counseling was provided for all participants and preventive medications were started or intensified if needed. All-cause and cardiovascular mortality were obtained from the official statistics. Screen-detected hypertension was diagnosed in 17% of the participants, 51% were normotensive and 32% had antihypertensive medication at baseline. The screen-detected hypertensives had higher mean blood pressure and cholesterol levels than the two other groups. Altogether 289 subjects died during the follow-up, 83 (29%) from cardiovascular disease. Those with screen-detected hypertension had decreased cardiovascular mortality risk compared to the medicated hypertensives [sHR 0.40 (95% CI: 0.19 to 0.88, p = 0.023)], and comparable with that of the normotensives [sHR 0.53 (95% CI: 0.24 to 1.15)]. Newly diagnosed diabetes at baseline was a powerful predictor of cardiovascular mortality [sHR 2.71 (95% CI: 1.57 to 4.69)]. Early detection of hypertension and timely multifactorial intervention seem to be important in preventing hypertension-related mortality.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"322-328"},"PeriodicalIF":2.7,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00900-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912768","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 : 2024-02-15DOI: 10.1038/s41371-024-00901-w
Ge Tian, Rong Zhou, Xingzhi Guo, Rui Li
Observational studies have indicated that high blood pressure (BP) may be a risk factor to frailty. However, the causal association between BP and frailty remains not well determined. The purpose of this bi-directional two-sample Mendelian randomization (MR) study was to investigate the causal relationship between BP and frailty. Independent single nucleotide polymorphisms (SNPs) strongly (P < 5E-08) associated with systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were selected as instrumental variables. Two different published genome-wide association studies (GWAS) on BP from the CHARGE (n = 810,865) and ICBP (n = 757,601) consortia were included. Summary-level data on frailty index (FI) were obtained from the latest GWAS based on UK Biobank and Swedish TwinGene cohorts (n = 175,226). Inverse variance weighted (IVW) approach with other sensitivity analyses were used to calculate the causal estimate. Using the CHARGE dataset, genetic predisposition to increased SBP (β = 0.135, 95% CI = 0.093 to 0.176, P = 1.73E-10), DBP (β = 0.145, 95% CI = 0.104 to 0.186, P = 3.14E-12), and PP (β = 0.114, 95% CI = 0.070 to 0.157, p = 2.87E-07) contributed to a higher FI, which was validated in the ICBP dataset. There was no significant causal effect of FI on SBP, DBP, and PP. Similar results were obtained from different MR methods, indicating good stability. There was potential heterogeneity detected by Cochran’s Q test, but no horizontal pleiotropy was observed in MR-Egger intercept test (P > 0.05). These findings evinced that higher BP and PP were causally associated with an increased risk of frailty, suggesting that controlling hypertension could reduce the risk of frailty.
{"title":"Causal effects of blood pressure and the risk of frailty: a bi-directional two-sample Mendelian randomization study","authors":"Ge Tian, Rong Zhou, Xingzhi Guo, Rui Li","doi":"10.1038/s41371-024-00901-w","DOIUrl":"10.1038/s41371-024-00901-w","url":null,"abstract":"Observational studies have indicated that high blood pressure (BP) may be a risk factor to frailty. However, the causal association between BP and frailty remains not well determined. The purpose of this bi-directional two-sample Mendelian randomization (MR) study was to investigate the causal relationship between BP and frailty. Independent single nucleotide polymorphisms (SNPs) strongly (P < 5E-08) associated with systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were selected as instrumental variables. Two different published genome-wide association studies (GWAS) on BP from the CHARGE (n = 810,865) and ICBP (n = 757,601) consortia were included. Summary-level data on frailty index (FI) were obtained from the latest GWAS based on UK Biobank and Swedish TwinGene cohorts (n = 175,226). Inverse variance weighted (IVW) approach with other sensitivity analyses were used to calculate the causal estimate. Using the CHARGE dataset, genetic predisposition to increased SBP (β = 0.135, 95% CI = 0.093 to 0.176, P = 1.73E-10), DBP (β = 0.145, 95% CI = 0.104 to 0.186, P = 3.14E-12), and PP (β = 0.114, 95% CI = 0.070 to 0.157, p = 2.87E-07) contributed to a higher FI, which was validated in the ICBP dataset. There was no significant causal effect of FI on SBP, DBP, and PP. Similar results were obtained from different MR methods, indicating good stability. There was potential heterogeneity detected by Cochran’s Q test, but no horizontal pleiotropy was observed in MR-Egger intercept test (P > 0.05). These findings evinced that higher BP and PP were causally associated with an increased risk of frailty, suggesting that controlling hypertension could reduce the risk of frailty.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 4","pages":"329-335"},"PeriodicalIF":2.7,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741208","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 : 2024-02-15DOI: 10.1038/s41371-024-00899-1
Daniel González-Devesa, Silvia Varela, Jose C. Diz-Gómez, Carlos Ayán-Pérez
This study aimed to systematically review the available evidence on the effects of Pilates training programs on blood pressure in hypertensive patients. Randomized clinical trials and comparative studies were searched in four electronic databases until September 2023 (updated December 2023). The methodological quality of included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales. A total of 4 randomized clinical trials and 7 comparative studies were included, showing a low (n = 1), hight (n = 6), and good (n = 4) methodological quality. Data synthesis indicated that participants who performed Pilates program obtained significantly reduces on systolic blood pressure and diastolic blood pressure, of −4.76 mmHg (95% CI: −6.55 to −2.97, p < 0.001) and −3.43 mmHg (95% CI: −4.37 to −2.49, p < 0.001), respectively, in comparison with those included in the comparison groups. When the analysis was performed by comparing hypertensive, and normotensive patients, the results remained non-significant for blood pressure (systolic blood pressure: 0.96 mmHg (95% CI: −2.85 to 4.77, P = 0.49); diastolic blood pressure: 1.18 mmHg (95% CI: −1.23 to 3.58, P = 0.34); mean blood pressure: 1.73 mmHg (95% CI: −1.96 to 5.42, P = 0.36). Evidence suggests Pilates is safe for hypertensive patients and can be part of their rehabilitation, but it may not necessarily offer superior results or improve exercise adherence compared to other modalities.
{"title":"The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis","authors":"Daniel González-Devesa, Silvia Varela, Jose C. Diz-Gómez, Carlos Ayán-Pérez","doi":"10.1038/s41371-024-00899-1","DOIUrl":"10.1038/s41371-024-00899-1","url":null,"abstract":"This study aimed to systematically review the available evidence on the effects of Pilates training programs on blood pressure in hypertensive patients. Randomized clinical trials and comparative studies were searched in four electronic databases until September 2023 (updated December 2023). The methodological quality of included studies was assessed using the Physiotherapy Evidence Database and Methodological Index for Non-Randomized Studies scales. A total of 4 randomized clinical trials and 7 comparative studies were included, showing a low (n = 1), hight (n = 6), and good (n = 4) methodological quality. Data synthesis indicated that participants who performed Pilates program obtained significantly reduces on systolic blood pressure and diastolic blood pressure, of −4.76 mmHg (95% CI: −6.55 to −2.97, p < 0.001) and −3.43 mmHg (95% CI: −4.37 to −2.49, p < 0.001), respectively, in comparison with those included in the comparison groups. When the analysis was performed by comparing hypertensive, and normotensive patients, the results remained non-significant for blood pressure (systolic blood pressure: 0.96 mmHg (95% CI: −2.85 to 4.77, P = 0.49); diastolic blood pressure: 1.18 mmHg (95% CI: −1.23 to 3.58, P = 0.34); mean blood pressure: 1.73 mmHg (95% CI: −1.96 to 5.42, P = 0.36). Evidence suggests Pilates is safe for hypertensive patients and can be part of their rehabilitation, but it may not necessarily offer superior results or improve exercise adherence compared to other modalities.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 3","pages":"200-211"},"PeriodicalIF":2.7,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00899-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741209","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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