Pub Date : 2025-07-09DOI: 10.1038/s41371-025-01044-2
Jaehoon Chung, Hack-Lyoung Kim, Hyun Sung Joh, Woo-Hyun Lim, Jae-Bin Seo, Sang-Hyun Kim, Joo-Hee Zo, Myung-A Kim
The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether total arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1 610 consecutive subjects (mean age 56.3 ± 9.8 years, 59.4% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 938 days (interquartile range, 125–2 252 days), there were 61 cases of MACE (3.8%). The elevated baPWV (≥1 526 cm/s) (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.64–5.46, P < 0.001) and positive ETT result (HR 4.18, 95% CI 2.48–7.06, P < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects’ risk (low baPWV and negative ETT result vs high baPWV and positive ETT result; HR 14.11, 95% CI 5.74–34.69, P < 0.001). Total arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.
{"title":"Incremental prognostic value of combined information of arterial stiffness and the result of treadmill exercise test in patients with suspected coronary artery disease","authors":"Jaehoon Chung, Hack-Lyoung Kim, Hyun Sung Joh, Woo-Hyun Lim, Jae-Bin Seo, Sang-Hyun Kim, Joo-Hee Zo, Myung-A Kim","doi":"10.1038/s41371-025-01044-2","DOIUrl":"10.1038/s41371-025-01044-2","url":null,"abstract":"The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether total arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1 610 consecutive subjects (mean age 56.3 ± 9.8 years, 59.4% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 938 days (interquartile range, 125–2 252 days), there were 61 cases of MACE (3.8%). The elevated baPWV (≥1 526 cm/s) (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.64–5.46, P < 0.001) and positive ETT result (HR 4.18, 95% CI 2.48–7.06, P < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects’ risk (low baPWV and negative ETT result vs high baPWV and positive ETT result; HR 14.11, 95% CI 5.74–34.69, P < 0.001). Total arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"566-571"},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600697","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/s41371-025-01038-0
Manson Chon In Kuok, Joanna Newton, Cheentan Singh, Manish D. Sinha
An accurate measurement of blood pressure (BP) is essential in making a diagnosis of hypertension, however lack of reference values in children <5 years old makes out-of-office BP measurement using ambulatory blood pressure monitoring difficult in this age group. We conducted a retrospective analysis in children aged under 5 years referred to our hypertension service for suspected hypertension. We included those who underwent home doppler blood pressure measurement (HDBPM) for hypertension diagnosis confirmation, and evaluated the investigations performed for suspected hypertension before the diagnosis was confirmed using out-of-office BP measurements. Children receiving anti-hypertensive medication at the time of initial review were excluded. Fifty-five children (62% male) with a median age of 1.6 years completed HDBPM and were included. Nearly 90% of them referred for hypertension were found to be normotensive following out-of-office BP assessment using HDBPM. In these normotensive patients, different investigations for secondary hypertension, including blood tests (creatinine, renin, aldosterone, cortisol, thyroid function tests, and catecholamine levels), doppler kidney ultrasound, and echocardiograms were performed before referral, most of which yielded unremarkable results. Our finding suggested that whilst some initial investigations were essential, second-line tests for less common secondary causes of hypertension are often unnecessary before hypertension is confirmed. We recommend deferring some of these investigations in asymptomatic children until hypertension is verified by home blood pressure measurements.
准确测量血压（BP）对诊断高血压至关重要，但对儿童缺乏参考价值
{"title":"Utility of home doppler blood pressure measurement to minimise unnecessary investigations in children with suspected hypertension","authors":"Manson Chon In Kuok, Joanna Newton, Cheentan Singh, Manish D. Sinha","doi":"10.1038/s41371-025-01038-0","DOIUrl":"10.1038/s41371-025-01038-0","url":null,"abstract":"An accurate measurement of blood pressure (BP) is essential in making a diagnosis of hypertension, however lack of reference values in children <5 years old makes out-of-office BP measurement using ambulatory blood pressure monitoring difficult in this age group. We conducted a retrospective analysis in children aged under 5 years referred to our hypertension service for suspected hypertension. We included those who underwent home doppler blood pressure measurement (HDBPM) for hypertension diagnosis confirmation, and evaluated the investigations performed for suspected hypertension before the diagnosis was confirmed using out-of-office BP measurements. Children receiving anti-hypertensive medication at the time of initial review were excluded. Fifty-five children (62% male) with a median age of 1.6 years completed HDBPM and were included. Nearly 90% of them referred for hypertension were found to be normotensive following out-of-office BP assessment using HDBPM. In these normotensive patients, different investigations for secondary hypertension, including blood tests (creatinine, renin, aldosterone, cortisol, thyroid function tests, and catecholamine levels), doppler kidney ultrasound, and echocardiograms were performed before referral, most of which yielded unremarkable results. Our finding suggested that whilst some initial investigations were essential, second-line tests for less common secondary causes of hypertension are often unnecessary before hypertension is confirmed. We recommend deferring some of these investigations in asymptomatic children until hypertension is verified by home blood pressure measurements.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"580-584"},"PeriodicalIF":3.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01038-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591442","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 : 2025-07-08DOI: 10.1038/s41371-025-01042-4
Andrea Vitali, Giuseppe Biondi Zoccai, George W. Booz, Raffaele Altara
Ventricular-arterial coupling (VAC) is altered by aging and cardiovascular comorbidities, indicating myocardial dysfunction and/or arterial stiffness. Our aim was to demonstrate whether lifestyle changes and anti-hypertensive drug treatment would improve VAC in recently diagnosed, early stage middle-aged hypertensives (HTN) without organ damage. Arterial elastance (Ea), carotid-femoral pulse wave velocity (cfPWV), global longitudinal strain (GLS), and myocardial work (MW) [global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE)] were investigated. This retrospective observational study involved 126 individuals (mean age 40 years; 55% female), divided into HTN and normotensives (NT). Clinical, echocardiographic and echo vascular parameters were assessed. Lifestyle changes were recommended for HTN. If blood pressure (BP) values still remained high, anti-hypertensive drug treatment was administered. Higher values of systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), GWI, GCW, and GWW were observed in HTN. By following lifestyle changes, BP [diastolic blood pressure (DBP) and MAP], HR, VAC, Ea, cfPWV, GWE, and GLS were changed in HTN; after 6 months of anti-hypertensive drug treatment, BP (SBP, DBP and MAP), HR, VAC, Ea, cfPWV, GWI, GCW, GWW, GWE, and GLS were found to be changed. VAC was linearly related to cfPWV and GLS at two follow ups. No statistically significant difference in VAC between HTN and NT was found. Along with a decrease in BP, smoking cessation, and HR control highlighted a significant role in cardiovascular prevention by improvement of VAC, Ea, cfPWV, GLS and MW.
{"title":"Assessment of ventricular-arterial coupling in early stage middle-aged hypertensives","authors":"Andrea Vitali, Giuseppe Biondi Zoccai, George W. Booz, Raffaele Altara","doi":"10.1038/s41371-025-01042-4","DOIUrl":"10.1038/s41371-025-01042-4","url":null,"abstract":"Ventricular-arterial coupling (VAC) is altered by aging and cardiovascular comorbidities, indicating myocardial dysfunction and/or arterial stiffness. Our aim was to demonstrate whether lifestyle changes and anti-hypertensive drug treatment would improve VAC in recently diagnosed, early stage middle-aged hypertensives (HTN) without organ damage. Arterial elastance (Ea), carotid-femoral pulse wave velocity (cfPWV), global longitudinal strain (GLS), and myocardial work (MW) [global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE)] were investigated. This retrospective observational study involved 126 individuals (mean age 40 years; 55% female), divided into HTN and normotensives (NT). Clinical, echocardiographic and echo vascular parameters were assessed. Lifestyle changes were recommended for HTN. If blood pressure (BP) values still remained high, anti-hypertensive drug treatment was administered. Higher values of systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), GWI, GCW, and GWW were observed in HTN. By following lifestyle changes, BP [diastolic blood pressure (DBP) and MAP], HR, VAC, Ea, cfPWV, GWE, and GLS were changed in HTN; after 6 months of anti-hypertensive drug treatment, BP (SBP, DBP and MAP), HR, VAC, Ea, cfPWV, GWI, GCW, GWW, GWE, and GLS were found to be changed. VAC was linearly related to cfPWV and GLS at two follow ups. No statistically significant difference in VAC between HTN and NT was found. Along with a decrease in BP, smoking cessation, and HR control highlighted a significant role in cardiovascular prevention by improvement of VAC, Ea, cfPWV, GLS and MW.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"549-558"},"PeriodicalIF":3.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01042-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591441","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 : 2025-06-30DOI: 10.1038/s41371-025-01037-1
Shengming Li, Tianjing Zhang, Jia He, Chen He, Fang Liu, Yan Yao, Xiaofei Li, Rutai Hui, Xiaohan Fan
The American Heart Association recommends sex-specific thresholds for defining exaggerated systolic blood pressure response to exercise (ESBPR), primarily based on data from young healthy populations. However, their applicability and the sex differences in systolic blood pressure (SBP) response to exercise in real-world clinical settings remain unclear. We conducted a cross-sectional study of 44 418 adults (40.6% female) with a mean age of 49, who underwent treadmill exercise testing at Fuwai Hospital from 2016–2022. ESBPR was defined as peak SBP during exercise ≥ 210 mmHg for males and ≥ 190 mmHg for females. Multivariate regression models stratified by sex were used to explore whether sex modifies age-related patterns in SBP response to exercise. ESBPR was over five times more prevalent in females than males (10.1 vs. 1.9%, P < 0.001). While the mean, 90th, and 95th percentiles of peak SBP were at least 12 mmHg higher in males than females in younger age groups (18–44), the gap narrowed to less than 4 mmHg in older age groups (≥45). Stratified multivariate analysis revealed that age was a strong predictor of ESBPR in females but not in males. Using age ≥ 51 as a proxy for menopause, females older than 51 had significantly higher odds of ESBPR compared to younger females (adjusted OR: 1.904, 95% CI: 1.683–2.155, P < 0.001). Our findings reveal that females and males display distinct age-related patterns in SBP response to exercise. The lower threshold for females may disproportionately classify postmenopausal females as abnormal.
{"title":"Sex differences in systolic blood pressure response to exercise testing: a real-world clinical analysis","authors":"Shengming Li, Tianjing Zhang, Jia He, Chen He, Fang Liu, Yan Yao, Xiaofei Li, Rutai Hui, Xiaohan Fan","doi":"10.1038/s41371-025-01037-1","DOIUrl":"10.1038/s41371-025-01037-1","url":null,"abstract":"The American Heart Association recommends sex-specific thresholds for defining exaggerated systolic blood pressure response to exercise (ESBPR), primarily based on data from young healthy populations. However, their applicability and the sex differences in systolic blood pressure (SBP) response to exercise in real-world clinical settings remain unclear. We conducted a cross-sectional study of 44 418 adults (40.6% female) with a mean age of 49, who underwent treadmill exercise testing at Fuwai Hospital from 2016–2022. ESBPR was defined as peak SBP during exercise ≥ 210 mmHg for males and ≥ 190 mmHg for females. Multivariate regression models stratified by sex were used to explore whether sex modifies age-related patterns in SBP response to exercise. ESBPR was over five times more prevalent in females than males (10.1 vs. 1.9%, P < 0.001). While the mean, 90th, and 95th percentiles of peak SBP were at least 12 mmHg higher in males than females in younger age groups (18–44), the gap narrowed to less than 4 mmHg in older age groups (≥45). Stratified multivariate analysis revealed that age was a strong predictor of ESBPR in females but not in males. Using age ≥ 51 as a proxy for menopause, females older than 51 had significantly higher odds of ESBPR compared to younger females (adjusted OR: 1.904, 95% CI: 1.683–2.155, P < 0.001). Our findings reveal that females and males display distinct age-related patterns in SBP response to exercise. The lower threshold for females may disproportionately classify postmenopausal females as abnormal.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"559-565"},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528289","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 : 2025-06-30DOI: 10.1038/s41371-025-01041-5
Alavi Hossain, Raymond R. Townsend, Jordana B. Cohen
{"title":"An Updated Meta-analysis of White Coat Hypertension and Mortality","authors":"Alavi Hossain, Raymond R. Townsend, Jordana B. Cohen","doi":"10.1038/s41371-025-01041-5","DOIUrl":"10.1038/s41371-025-01041-5","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 8","pages":"595-597"},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528288","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 : 2025-06-24DOI: 10.1038/s41371-025-01036-2
Yasemin Karacan, Ayşe Gül Parlak
This study aims to examine how health anxiety and demographic characteristics influence attitudes toward hypertension prevention in individuals with and without a family history of hypertension (family HHT). This cross-sectional study included 1,139 individuals over the age of 18. Data were collected through an online survey and analyzed using the Attitudes Scale Towards Prevention of HT (ASPH) and the Health Anxiety Scale (HAS). In addition to scale scores, demographic characteristics and family history of hypertension were also collected. The survey link was shared via social media, allowing participants to distribute it within their networks. The mean ASPH score was 98.31 ± 21.91, highest in prevention and control (31.55 ± 7.28). Age correlated with mental and physical activity (p = 0.026) and nutritional behavior (p = 0.041), while BMI was linked to hypertension attitudes (p = 0.006). Regression analysis showed that gender (B = −6.609, p < 0.001) and a family HHT (B = −0.574, p = 0.013) significantly influenced attitudes toward hypertension prevention, with men and those with a family HHT scoring lower than their counterparts. Scatter plots revealed higher health anxiety and stronger hypertension attitudes in those with hypertensive parents, while attitudes were more varied among individuals with hypertensive siblings or grandparents. These findings highlight the impact of family hypertension history and demographics on hypertension attitudes and health anxiety, emphasizing early awareness, targeted health education for gender differences, and preventive strategies for high-risk groups.
本研究旨在探讨健康焦虑和人口统计学特征如何影响有和无高血压家族史的个体（家族HHT）对高血压预防的态度。这项横断面研究包括1139名18岁以上的人。数据通过在线调查收集，并使用对HT预防态度量表（ASPH）和健康焦虑量表（HAS）进行分析。除量表得分外，还收集了人口统计学特征和高血压家族史。调查链接通过社交媒体分享，允许参与者在他们的网络中分发。ASPH平均评分为98.31±21.91分，预防和控制评分最高，为31.55±7.28分。年龄与心理和身体活动（p = 0.026）以及营养行为（p = 0.041）相关，而BMI与高血压态度相关（p = 0.006）。回归分析显示，性别差异(B = -6.609, p
{"title":"The effect of health anxiety on attitudes toward disease prevention in individuals with and without a family history of hypertension","authors":"Yasemin Karacan, Ayşe Gül Parlak","doi":"10.1038/s41371-025-01036-2","DOIUrl":"10.1038/s41371-025-01036-2","url":null,"abstract":"This study aims to examine how health anxiety and demographic characteristics influence attitudes toward hypertension prevention in individuals with and without a family history of hypertension (family HHT). This cross-sectional study included 1,139 individuals over the age of 18. Data were collected through an online survey and analyzed using the Attitudes Scale Towards Prevention of HT (ASPH) and the Health Anxiety Scale (HAS). In addition to scale scores, demographic characteristics and family history of hypertension were also collected. The survey link was shared via social media, allowing participants to distribute it within their networks. The mean ASPH score was 98.31 ± 21.91, highest in prevention and control (31.55 ± 7.28). Age correlated with mental and physical activity (p = 0.026) and nutritional behavior (p = 0.041), while BMI was linked to hypertension attitudes (p = 0.006). Regression analysis showed that gender (B = −6.609, p < 0.001) and a family HHT (B = −0.574, p = 0.013) significantly influenced attitudes toward hypertension prevention, with men and those with a family HHT scoring lower than their counterparts. Scatter plots revealed higher health anxiety and stronger hypertension attitudes in those with hypertensive parents, while attitudes were more varied among individuals with hypertensive siblings or grandparents. These findings highlight the impact of family hypertension history and demographics on hypertension attitudes and health anxiety, emphasizing early awareness, targeted health education for gender differences, and preventive strategies for high-risk groups.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"523-533"},"PeriodicalIF":3.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01036-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484736","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}
Hypertensive urgencies (HU) and hypertensive emergencies (HE) are common conditions in the cardiology emergency department (ED), often requiring urgent intervention. Despite their clinical significance, data on patient characteristics, etiologies, and management strategies remain limited. This study aimed to assess the epidemiology, clinical profile, and management of HU and HE in a tertiary cardiology ED. A single-center, observational study was conducted over 12 months, enrolling patients diagnosed with HU/HE (BP ≥ 180/120 mmHg). Demographic data, medical history, symptoms, etiologic factors, and antihypertensive treatments were recorded. Serial blood pressure (BP) measurements were taken to assess BP reduction during the ED stay. Of 4010 cardiology ED visits, 83 patients (2.1%) had HU/HE (median age 65 years, 45.8% male). Most had a history of hypertension (73.5%), with frequent coexisting smoking (56.6%) and dyslipidemia (43.4%). Common symptoms included dyspnea (19.3%) and chest pain (25.3%). Stress (26.8%) and increased salt intake (15.9%) were common etiologic factors. HE was diagnosed in 18 cases (21.7%), and 12.7% of HU cases required hospitalization. Mean BP on admission was 200/100 mmHg, with SBP and DBP reductions of 41 mmHg (−21%) and 18 mmHg (−17%), respectively. Nitrates, anxiolytics, and combination therapies resulted in the greatest BP reductions. In conclusion, HU and HE are frequently observed in hypertensive patients with additional cardiovascular risk factors. Target-organ damage is not solely related to BP levels, emphasizing the need for individualized management strategies.
{"title":"Hypertensive urgencies and emergencies in the cardiology emergency department: epidemiology, patient profile, and management","authors":"Panagiotis Theofilis, Nikolaos Nakas, Thomais Lamprou, Kalliopi Touchantzidou, Aikaterini Vordoni, Vasilios Thimis, Despina Smirloglou, Athanasios Kotsakis, Rigas G. Kalaitzidis","doi":"10.1038/s41371-025-01033-5","DOIUrl":"10.1038/s41371-025-01033-5","url":null,"abstract":"Hypertensive urgencies (HU) and hypertensive emergencies (HE) are common conditions in the cardiology emergency department (ED), often requiring urgent intervention. Despite their clinical significance, data on patient characteristics, etiologies, and management strategies remain limited. This study aimed to assess the epidemiology, clinical profile, and management of HU and HE in a tertiary cardiology ED. A single-center, observational study was conducted over 12 months, enrolling patients diagnosed with HU/HE (BP ≥ 180/120 mmHg). Demographic data, medical history, symptoms, etiologic factors, and antihypertensive treatments were recorded. Serial blood pressure (BP) measurements were taken to assess BP reduction during the ED stay. Of 4010 cardiology ED visits, 83 patients (2.1%) had HU/HE (median age 65 years, 45.8% male). Most had a history of hypertension (73.5%), with frequent coexisting smoking (56.6%) and dyslipidemia (43.4%). Common symptoms included dyspnea (19.3%) and chest pain (25.3%). Stress (26.8%) and increased salt intake (15.9%) were common etiologic factors. HE was diagnosed in 18 cases (21.7%), and 12.7% of HU cases required hospitalization. Mean BP on admission was 200/100 mmHg, with SBP and DBP reductions of 41 mmHg (−21%) and 18 mmHg (−17%), respectively. Nitrates, anxiolytics, and combination therapies resulted in the greatest BP reductions. In conclusion, HU and HE are frequently observed in hypertensive patients with additional cardiovascular risk factors. Target-organ damage is not solely related to BP levels, emphasizing the need for individualized management strategies.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"509-514"},"PeriodicalIF":3.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336616","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 : 2025-06-17DOI: 10.1038/s41371-025-01035-3
Hongjie Chi, Xin Zhang, Shumei Ma, Gang Pan, Xiaojuan Lian, Yuanyuan Chen, Yan Chen, Hao Tang, Zichen Liu, Peng Mi, Xiangmin Lin
This multicenter, double-blind, parallel-group, randomised controlled phase III study evaluated the efficacy and safety of the Allisartan Isoproxil 240 mg /Amlodipine 5 mg (ALI/AML) combination compared with ALI 240 mg monotherapy in patients with mild-to-moderate essential hypertension. Patients aged 18 to 70 years with mean sitting systolic blood pressure (msSBP) between 140 and <180 mmHg and mean sitting diastolic blood pressure (msDBP) between 90 and <110 mmHg were randomised 1:1 to receive ALI/AML or ALI once-daily for 12 weeks after a 4-week treatment with ALI, followed by an open-label extension period with ALI/AML up to week 52. A total of 199 patients were randomised (ALI/AML: n = 99, ALI: n = 100) with 169 completing the study. Baseline characteristics were comparable between groups. After 12 weeks of randomisation, the reduction in msSBP (primary endpoint) was significantly greater in the ALI/AML group vs the ALI group (−18.3 vs. −9.3 mmHg, p < 0.001). Reductions in msDBP (−6.0 vs. −1.9 mmHg, p < 0.001) and 24-hour mean ambulatory systolic/diastolic blood pressure (−19.9/−10.1 vs. −6.9/−4.2 mmHg) were more pronounced in the ALI/AML group. Additionally, a greater proportion of patients achieved the BP response and target office BP in the ALI/AML group compared to the ALI group (53.6% vs. 25.5%, p < 0.001; 40.2% vs. 20.4%, p=0.0026). AML/ALI combination was generally safe and well tolerated, with sustained efficacy up to 52 weeks. The study concluded that ALI/AML offers a convenient, single-pill option for effective BP reduction in hypertensive patients.
{"title":"Efficacy and Safety of Allisartan Isoproxil/Amlodipine in Patients with Essential Hypertension: A Phase III, Multicenter, Double-Blind, Parallel-Group, Randomised study","authors":"Hongjie Chi, Xin Zhang, Shumei Ma, Gang Pan, Xiaojuan Lian, Yuanyuan Chen, Yan Chen, Hao Tang, Zichen Liu, Peng Mi, Xiangmin Lin","doi":"10.1038/s41371-025-01035-3","DOIUrl":"10.1038/s41371-025-01035-3","url":null,"abstract":"This multicenter, double-blind, parallel-group, randomised controlled phase III study evaluated the efficacy and safety of the Allisartan Isoproxil 240 mg /Amlodipine 5 mg (ALI/AML) combination compared with ALI 240 mg monotherapy in patients with mild-to-moderate essential hypertension. Patients aged 18 to 70 years with mean sitting systolic blood pressure (msSBP) between 140 and <180 mmHg and mean sitting diastolic blood pressure (msDBP) between 90 and <110 mmHg were randomised 1:1 to receive ALI/AML or ALI once-daily for 12 weeks after a 4-week treatment with ALI, followed by an open-label extension period with ALI/AML up to week 52. A total of 199 patients were randomised (ALI/AML: n = 99, ALI: n = 100) with 169 completing the study. Baseline characteristics were comparable between groups. After 12 weeks of randomisation, the reduction in msSBP (primary endpoint) was significantly greater in the ALI/AML group vs the ALI group (−18.3 vs. −9.3 mmHg, p < 0.001). Reductions in msDBP (−6.0 vs. −1.9 mmHg, p < 0.001) and 24-hour mean ambulatory systolic/diastolic blood pressure (−19.9/−10.1 vs. −6.9/−4.2 mmHg) were more pronounced in the ALI/AML group. Additionally, a greater proportion of patients achieved the BP response and target office BP in the ALI/AML group compared to the ALI group (53.6% vs. 25.5%, p < 0.001; 40.2% vs. 20.4%, p=0.0026). AML/ALI combination was generally safe and well tolerated, with sustained efficacy up to 52 weeks. The study concluded that ALI/AML offers a convenient, single-pill option for effective BP reduction in hypertensive patients.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"500-508"},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01035-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317107","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 : 2025-06-05DOI: 10.1038/s41371-025-01034-4
Wenlang Zhao, Mingdan Wang, Pan Zhou, Ziyu Wang, Xuan Deng, Jiangtao Li, Na Yang, Lizhen Han, Zhao Yang, Yue Qi, Jing Liu
The multidimensional echocardiographic features associated with BP level are unclear. This study aimed to identify the multidimensional echocardiographic features associated with BP. In total, 2 092 adult participants (aged ≥18 years) with hypertension who underwent echocardiography in Beijing between July 2017 and January 2020 as part of the Multi-provincial Cohort for Hypertension study were enrolled. The associations between BP levels and echocardiographic features were investigated by multivariate regression analysis. After multivariable adjustment, a 1 SD (15.4 mmHg) increase in systolic BP was associated with a 0.21-mm increment (95% CI 0.06–0.35) in left atrial diameter, a 2.17-g/m2 increment (95% CI 1.46–2.88) in LV mass index, a 0.25-mm increment (95% CI 0.11–0.39) in ascending aorta diameter and a 0.03 decrement (95% CI −0.04, −0.01) in the E/A ratio. A 1 SD (10.1 mmHg) increase in diastolic BP was associated with a 1.51-g/m2 increment (95% CI 0.80–2.21) in LV mass index, a 0.46-mm increment (95% CI 0.31–0.61) in aortic root diameter, a 0.77-mm increment (95% CI 0.63–0.91) in ascending aorta diameter, and a 0.05 decrement (95% CI −0.07, −0.04) in E/A ratio. In conclusion, specific echocardiographic features were associated with the BP level. LV structure, ascending aorta diameter, and the E/A ratio were associated with systolic and diastolic BP. Left atrial diameter was positively associated only with systolic BP, and aortic root diameter was positively associated only with diastolic BP. These echocardiographic features may be valuable for early identification of target organ damage caused by elevated BP.
与血压水平相关的多维超声心动图特征尚不清楚。本研究旨在确定与BP相关的多维超声心动图特征。作为多省高血压队列研究的一部分，2017年7月至2020年1月期间在北京接受超声心动图检查的2092名成年高血压患者（年龄≥18岁）共入组。通过多元回归分析探讨血压水平与超声心动图特征之间的关系。多变量校正后，收缩压每升高1 SD (15.4 mmHg)，左房内径增加0.21 mm (95% CI 0.06-0.35)，左室质量指数增加2.17 g/m2 (95% CI 1.46-2.88)，升主动脉内径增加0.25 mm (95% CI 0.11-0.39)， E/ a比减少0.03 （95% CI -0.04, -0.01）。舒张压升高1 SD (10.1 mmHg)，左室质量指数增加1.51 g/m2 (95% CI 0.80-2.21)，主动脉根直径增加0.46 mm (95% CI 0.31-0.61)，升主动脉直径增加0.77 mm (95% CI 0.63-0.91)， E/A比减少0.05 （95% CI -0.07, -0.04）。总之，特定的超声心动图特征与血压水平相关。左室结构、升主动脉直径和E/A比值与收缩压和舒张压相关。左心房内径仅与收缩压呈正相关，主动脉根内径仅与舒张压呈正相关。这些超声心动图特征可能对早期识别血压升高引起的靶器官损害有价值。
{"title":"Profiles of echocardiographic features associated with blood pressure in patients with hypertension","authors":"Wenlang Zhao, Mingdan Wang, Pan Zhou, Ziyu Wang, Xuan Deng, Jiangtao Li, Na Yang, Lizhen Han, Zhao Yang, Yue Qi, Jing Liu","doi":"10.1038/s41371-025-01034-4","DOIUrl":"10.1038/s41371-025-01034-4","url":null,"abstract":"The multidimensional echocardiographic features associated with BP level are unclear. This study aimed to identify the multidimensional echocardiographic features associated with BP. In total, 2 092 adult participants (aged ≥18 years) with hypertension who underwent echocardiography in Beijing between July 2017 and January 2020 as part of the Multi-provincial Cohort for Hypertension study were enrolled. The associations between BP levels and echocardiographic features were investigated by multivariate regression analysis. After multivariable adjustment, a 1 SD (15.4 mmHg) increase in systolic BP was associated with a 0.21-mm increment (95% CI 0.06–0.35) in left atrial diameter, a 2.17-g/m2 increment (95% CI 1.46–2.88) in LV mass index, a 0.25-mm increment (95% CI 0.11–0.39) in ascending aorta diameter and a 0.03 decrement (95% CI −0.04, −0.01) in the E/A ratio. A 1 SD (10.1 mmHg) increase in diastolic BP was associated with a 1.51-g/m2 increment (95% CI 0.80–2.21) in LV mass index, a 0.46-mm increment (95% CI 0.31–0.61) in aortic root diameter, a 0.77-mm increment (95% CI 0.63–0.91) in ascending aorta diameter, and a 0.05 decrement (95% CI −0.07, −0.04) in E/A ratio. In conclusion, specific echocardiographic features were associated with the BP level. LV structure, ascending aorta diameter, and the E/A ratio were associated with systolic and diastolic BP. Left atrial diameter was positively associated only with systolic BP, and aortic root diameter was positively associated only with diastolic BP. These echocardiographic features may be valuable for early identification of target organ damage caused by elevated BP.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"515-522"},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234342","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 : 2025-06-04DOI: 10.1038/s41371-025-01032-6
Yaqiong Zhou, Sen Liu, Guo Ji, Changqiang Yang, Lingling Zhang, Tao Luo, Fei Huang, Zongling Chen, Jixin Hou, Peijian Wang
Although unilateral adrenal artery embolization (AAE) has emerged as an alternative treatment for patients with primary aldosteronism (PA), it may be insufficient for treating patients with idiopathic hyperaldosteronism (IHA) due to the bilateral nature of their condition. This study aimed to investigate the safety and efficacy of alcohol-mediated bilateral adrenal artery embolization (Bi-AAE) in patients with idiopathic hyperaldosteronism (IHA). A total of 72 patients were randomly assigned in a (1:1) ratio to receive either Bi-AAE or spironolactone (20–60 mg/day). The primary endpoint was the change in office systolic blood pressure (SBP) from baseline to 6 months. Key secondary endpoints included changes in 24 h blood pressure, aldosterone levels, aldosterone-to-renin ratio (ARR), and serum potassium. At 6 months, Bi-AAE significantly reduced office SBP compared to spironolactone (−18.9 ± 16.4 mmHg vs. −11.6 ± 9.3 mmHg; treatment difference: −7.4 mmHg; P = 0.03), with a greater proportion of Bi-AAE patients achieving target SBP (<140 mmHg; 77.1% vs. 51.5%; P = 0.027). Bi-AAE also resulted in significantly greater reductions in 24 h and home SBP at 1, 3, and 6 months (all P < 0.05). Furthermore, Bi-AAE was more effective in correcting biochemical abnormalities, including hyperaldosteronism and renin suppression (all P < 0.05). Importantly, Bi-AAE preserved zona fasciculata function, as evidenced by normal morning serum cortisol levels and intact responses to ACTH stimulation post-procedure. No serious adverse events occurred during the perioperative or 6-month follow-up period. These findings support Bi-AAE as a safe, minimally invasive, and highly effective alternative to medical therapy for managing IHA. Although the findings support Bi-AAE as a safe, minimally invasive, and highly effective alternative to medical therapy for managing IHA, the need for long-term data before drawing definitive conclusions is emphasized. Future studies with extended follow-up are necessary to confirm its long-term benefits and risks. Trial registration: The trial has been registered at ClinicalTrials.gov (NCT05262660).
虽然单侧肾上腺动脉栓塞（AAE）已成为原发性醛固酮增多症（PA）患者的替代治疗方法，但由于其双侧性，它可能不足以治疗特发性高醛固酮增多症（IHA）患者。本研究旨在探讨酒精介导的双侧肾上腺动脉栓塞（Bi-AAE）治疗特发性高醛固酮增多症（IHA）患者的安全性和有效性。共有72例患者按1:1的比例随机分配接受双aae或螺内酯（20-60 mg/天）治疗。主要终点是从基线到6个月的办公室收缩压（SBP）变化。关键次要终点包括24小时血压、醛固酮水平、醛固酮与肾素比值（ARR）和血清钾的变化。6个月时，与螺内酯相比，Bi-AAE显著降低办公室收缩压(-18.9±16.4 mmHg vs -11.6±9.3 mmHg；治疗差异：-7.4 mmHg；P = 0.03)， Bi-AAE患者达到目标收缩压的比例更高(
{"title":"Safety and efficacy of alcohol-mediated bilateral adrenal artery embolization in patients with idiopathic hyperaldosteronism: a 6-month follow-up of a randomized controlled trial","authors":"Yaqiong Zhou, Sen Liu, Guo Ji, Changqiang Yang, Lingling Zhang, Tao Luo, Fei Huang, Zongling Chen, Jixin Hou, Peijian Wang","doi":"10.1038/s41371-025-01032-6","DOIUrl":"10.1038/s41371-025-01032-6","url":null,"abstract":"Although unilateral adrenal artery embolization (AAE) has emerged as an alternative treatment for patients with primary aldosteronism (PA), it may be insufficient for treating patients with idiopathic hyperaldosteronism (IHA) due to the bilateral nature of their condition. This study aimed to investigate the safety and efficacy of alcohol-mediated bilateral adrenal artery embolization (Bi-AAE) in patients with idiopathic hyperaldosteronism (IHA). A total of 72 patients were randomly assigned in a (1:1) ratio to receive either Bi-AAE or spironolactone (20–60 mg/day). The primary endpoint was the change in office systolic blood pressure (SBP) from baseline to 6 months. Key secondary endpoints included changes in 24 h blood pressure, aldosterone levels, aldosterone-to-renin ratio (ARR), and serum potassium. At 6 months, Bi-AAE significantly reduced office SBP compared to spironolactone (−18.9 ± 16.4 mmHg vs. −11.6 ± 9.3 mmHg; treatment difference: −7.4 mmHg; P = 0.03), with a greater proportion of Bi-AAE patients achieving target SBP (<140 mmHg; 77.1% vs. 51.5%; P = 0.027). Bi-AAE also resulted in significantly greater reductions in 24 h and home SBP at 1, 3, and 6 months (all P < 0.05). Furthermore, Bi-AAE was more effective in correcting biochemical abnormalities, including hyperaldosteronism and renin suppression (all P < 0.05). Importantly, Bi-AAE preserved zona fasciculata function, as evidenced by normal morning serum cortisol levels and intact responses to ACTH stimulation post-procedure. No serious adverse events occurred during the perioperative or 6-month follow-up period. These findings support Bi-AAE as a safe, minimally invasive, and highly effective alternative to medical therapy for managing IHA. Although the findings support Bi-AAE as a safe, minimally invasive, and highly effective alternative to medical therapy for managing IHA, the need for long-term data before drawing definitive conclusions is emphasized. Future studies with extended follow-up are necessary to confirm its long-term benefits and risks. Trial registration: The trial has been registered at ClinicalTrials.gov (NCT05262660).","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"489-499"},"PeriodicalIF":3.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225615","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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