Journal of Clinical Hypertension最新文献

The Arterial Stiffness Index (AASI) is a calculation obtained through Ambulatory Blood Pressure Monitoring (ABPM), and is an indirect measure of the elastic properties of the arterial wall; but there is heterogeneity in its scope as a predictor of vascular wall health. A comparison is made between linear regression and exponential regression of the AASI, as well as an analysis of variance, according to circadian patterns and pulse pressure (PP) values. This work is an analytical observational study in 106 individuals, most of them women (63%) with a mean age of 53 ± 17.32 years. The coefficient of determination (r2) for the linear relationship was 0.53 ± 0.17, similar to the exponential relationship with an r² of 0.52 ± 0.17 (p = 0.7032). Patients with PP < 52 mmHg had an AASI of 0.3839 ± 0.1428 and for PP > 53 mmHg an AASI of 0.5330 ± 0.1108 (p < 0.0001). When comparing the AASI between Dipper vs. Riser circadian patterns, there was homoscedasticity (p = 0.3717); on the contrary, in the intergroup evaluation with Non-Dippers, heteroscedasticity was observed (Dipper vs. Non-Dipper; p = 0.0316 and Non-Dipper vs. Riser; p = 0.01978). This study concludes that the best determination of AASI is linear regression, robustly correlating with the values of PP > 53 mmHg and AASI > 0.5 (r = 0.9628). The behavior of the data in the Non-Dipper group is heterogeneous, probably due to their own physiological characteristics. In addition, AASI could be an indirect measure of arterial stiffness and be more directly associated with arterial elasticity and its deformation capacity.

Prediabetes is the period in which serum glucose levels begin to rise but do not yet meet the criteria for diabetes. Non-dipper blood pressure (BP) is related to a significant increase in cardiovascular disease (CVD) and organ damage compared to those with dipper BP in hypertensive individuals. Inflammation plays a role in the development of atherosclerosis and CVD. The data on whether nighttime status is important in normotensive individuals are limited. We aimed to investigate the relationship between dipper and non-dipper BP status and inflammatory parameters in normotensive patients with prediabetes. The study had a cross-sectional design. Of the 208 prediabetic and normotensive individuals included in the study, 90 were in the dipper BP group, and 118 were in the non-dipper BP group. In all subjects, the collection of venous peripheral blood samples was performed on admission. The two groups exhibited similar clinical baseline characteristics. C-reactive protein (CRP) and systemic immune-inflammation index (SII) were significantly higher in the non-dipper BP group (CRP: 7.19 ± 4.01 vs. 6.20 ± 4.32 mg/L, p = 0.043; SII: 782.79 vs. 613.43, p = 0.014). In the logistic regression analysis, SII was independently associated with non-dipper BP status [OR = 1.001, CI (1.000–1.001), p = 0.017]. In prediabetic patients, non-dipper BP status may be associated with inflammation and, consequently, increased CVD risk, even in normotensive individuals. Identifying factors that increase the risk in prediabetic patients may be important in terms of improving their future cardiovascular health.

This retrospective cohort study assessed the effect of COVID-19 infection on blood pressure variability (BPV) and cardiovascular outcomes in hypertensive patients using 24-h ambulatory blood pressure monitoring and structural equation modeling (SEM). Among 318 patients followed for 2 years, those with infection and poor prognosis showed the most abnormal hemodynamic patterns, including markedly elevated nocturnal SBP load (70.0% vs. 50.1%), higher ARVDBP (9.8% vs. 8.2%), wider pulse pressure (60.9 mmHg), and lower time in target range (30.9% vs. 74.7%, p < 0.001). Cox regression identified infection status, nocturnal BP load, and BP variability as major risk factors, while multivariate models confirmed 11 independent predictors. Neither diabetes nor antihypertensive medication class modified these associations. SEM demonstrated that infection influenced prognosis indirectly through elevated nighttime BP level, load, and variability (indirect effect β = 0.098, p < 0.001). Mechanistically, infection-driven endothelial dysfunction, microthrombotic activation, and autonomic dysregulation, rather than prolonged inactivity, likely underlie the nocturnal amplification of BP instability. These findings support the need for individualized hypertension management during and after infection, focusing on renin–angiotensin system balance, continuation of ACEI/ARB therapy, nighttime dosing of long-acting agents, and circadian BP monitoring to mitigate long-term cardiovascular risk.

Branch atheromatous disease (BAD)-related stroke shows distinct prognostic features from other stroke subtypes, with modifiable prognostic factors remaining inconclusive. The present research investigated the association between systolic blood pressure variability (BPV) and 90-day functional outcomes of BAD-related stroke. We enrolled 423 patients (median age 60 years; 70.2% male) with radiologically confirmed BAD from a prospective multicenter study in China. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) of systolic blood pressure measurements during hospitalization. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2. The secondary outcome was early neurological deterioration (END) within 7 days. Multivariable logistic regression models were used to evaluate the association between BPV and outcomes. Subgroup and sensitivity analyses were conducted. Overall, 13.9% of patients experienced poor functional outcome. A higher BPV was associated with increased risk of END. Compared with the lowest tertile, patients in the highest tertile of systolic BPV had a significantly increased risk of poor functional outcome (OR: 3.10 for SD, 2.77 for CV, and 2.97 for VIM; all p < 0.05, p for trend <0.05 for all indices). Sensitivity analysis and subgroup analysis results were consistent with the primary findings. In conclusion, elevated systolic BPV during the acute phase is independently associated with END and poor 90-day functional outcome in BAD-related stroke, highlighting the importance of BPV monitoring and blood pressure stabilization in the management of BAD-related stroke.

Screening for primary aldosteronism (PA) remains exceedingly low, despite the fact that the disorder contributes to or underlies hypertension (HT) in as many as 20% of unselected patients. Conventionally, withdrawal of medications interfering with the renin‒angiotensin‒aldosterone system (RAAS) has been recommended before PA work-up. Previous research showed that combining objective thresholds and 2-day cosyntropin suppression was highly accurate in diagnosing PA among HT patients off interfering drugs. Here, we present the protocol of a study designed to generate and temporally validate aldosterone-to-renin ratio (ARR) thresholds following overnight cosyntropin suppression in PA screening on interfering medications. We hypothesize that overnight cosyntropin suppression with 1 mg dexamethasone will result in 25% higher diagnostic interpretability compared to conventional ARR testing. This single-center study consists of a development and confirmation cohort (both n = 80). Patients with an adrenal incidentaloma are enrolled in a 1-day clinic. Aldosterone-to-renin ratios (ARRs) are determined before and after overnight intake of 1 mg dexamethasone (DXM) on, partially off, and off medications interfering with the RAAS. Emphasis on screening and limitation of PA confirmatory (suppression) tests have been included in the current Endocrine Society guideline on PA due to low evidence of benefits of the latter in diagnosing the disorder. In light of poor PA screening rates, the ODEPRASC study may provide a rationale for an optimized diagnostic approach.

Trial Registration: ClinicalTrials.gov identifier: NCT06740838.

To the Editor:

We read with great interest the study by Li et al., which examined the long-term outcomes of percutaneous transluminal renal angioplasty with stenting in unilateral atherosclerotic renal artery occlusion (RAO) [1]. The investigators should be commended for directly comparing successful versus failed revascularization in a well-characterized cohort and for including dialysis-free and event-free survival curves over a median follow-up period of nearly 30 months. The findings suggesting improved renal preservation after successful stenting provide valuable insights into interventional decision-making in this challenging population. However, several methodological and interpretive issues merit consideration to contextualize these conclusions in the present study.

First, the grouping of the study by procedural outcome rather than by randomized allocation introduced a substantial baseline imbalance. Patients in the failed stenting arm had a lower estimated glomerular filtration rate (eGFR) and a higher renal resistive index (RI) before the intervention, both markers of irreversible parenchymal injury [2]. This selection bias may have exaggerated the apparent protective effect of successful stenting. A propensity-weighted or covariate-adjusted survival analysis could clarify whether the observed differences in major adverse cardiovascular or renal events (MACRE) truly reflect procedural benefits rather than baseline disease severity. Clinically, this distinction determines whether stenting should be viewed as restorative or merely prognostic in nature.

Second, the study defined renal benefit through serum creatinine and eGFR changes without accounting for single-kidney function. Since unilateral RAO often coexists with compensatory hyperfiltration of the contralateral kidney, global eGFR improvements may not represent the recovery of the treated kidney [3]. Incorporating split-renal scintigraphy or duplex-derived flow indices at follow-up would better delineate parenchymal rescue versus contralateral adaptation, which has implications for patient selection and counseling in the future.

Third, reliance on the composite MACRE endpoint from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial may have limited clinical specificity. Death, myocardial infarction, and renal replacement therapy (RRT) capture distinct pathophysiological trajectories. Parsing cardiovascular events from renal components could reveal whether stenting mainly delays dialysis initiation or modifies systemic vascular risk [4]. Translationally, this distinction affects whether the intervention should be considered renal protective or cardiorenal integrative therapy.

Finally, the potential predictive value of preprocedural RI, which is markedly elevated in failed cases, warrants formal validation. Integrating RI thresholds with dynamic imaging modalities, such as bloo

Nocturnal blood pressure is a significant predictor of cardiovascular risk, but traditional ambulatory blood pressure monitoring (ABPM) can disrupt sleep. This study aimed to validate the accuracy of the Huawei Watch D2 (WD2), a wrist-worn oscillometric device, and assess its impact on sleep quality compared to conventional ABPM. This prospective, single-center trial first validated the WD2 against a mercury sphygmomanometer in 85 participants according to ANSI/AAMI/ISO 81060-2:2018 standards in both seated and supine positions. Subsequently, the device's nocturnal accuracy and sleep impact were compared against a traditional ABPM device in 46 participants over a three-night protocol. The WD2 met all ISO accuracy standards. During nighttime monitoring, there was no significant difference between the WD2 and ABPM for mean systolic or diastolic blood pressure. However, the number of awakenings was significantly lower on nights with the WD2 alone compared to nights with the ABPM device (p = 0.016). In conclusion, the Huawei Watch D2 is a clinically validated device that provides nocturnal blood pressure readings comparable to traditional ABPM with the significant advantage of minimal sleep disruption, positioning it as a valuable alternative for nocturnal hypertension monitoring.

This study aimed to investigate the associations between health-related physical fitness (HPF) indicators and hypertension (HTN) risk among adults living in sub-plateau regions and to explore gender-specific differences, providing empirical evidence for cardiovascular health promotion and intervention. A cross-sectional study was conducted from 2020 to 2022 in Ningxia, China, recruiting 3026 adults aged 20–59 years (1328 males and 1698 females). Ten HPF indicators across five dimensions, including body composition (body mass index, BMI; waist-to-hip ratio, WHR; waist-to-height ratio, WHtR), cardiorespiratory endurance (vital capacity, VC), muscular strength (grip strength, GS; back strength, BS; vertical jump, VJ), muscular endurance (push-ups/knee push-ups, PU/KPU; sit-ups, SU), and flexibility fitness (sit-and-reach, SAR). Binary logistic regression was used to identify HTN-related indicators, and receiver operating characteristic (ROC) analyses were performed to evaluate their predictive ability. The results showed that the prevalence of HTN was 26.75% in males, significantly higher than 18.36% in females (p < 0.05), both lower than the national average (males: 36.8%, females: 26.3%). Regarding the association, in males, BMI (odds ratio, OR = 1.120) and WHtR (OR = 1.673) were positively associated with HTN risk (p < 0.05), whereas SAR (OR = 0.975) showed a negative association (p < 0.05). In females, WHR (OR = 1.240) was positively associated with HTN (p < 0.05), while SU (OR = 0.960) showed a negative association (p < 0.05). ROC analysis indicated that WHtR and WHR were the best single predictors for males (area under the curve, AUC = 0.662) and females (AUC = 0.633), respectively, while combined indicators (BMI + WHtR + SAR in males; WHR + SU in females) further improved discrimination (AUC = 0.679 and 0.655). In conclusion, adults in the sub-plateau region exhibited a lower prevalence of HTN with notable gender differences. WHtR and WHR are the most valuable gender-specific screening indicators, and combined indices enhance predictive accuracy, offering practical guidance for early HTN prevention and management in sub-plateau populations.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality globally. Emerging evidence suggests that inflammation plays a pivotal role in the pathogenesis of atherosclerosis and subsequent cardiovascular events. Traditional treatments primarily focus on lipid-lowering and antithrombotic strategies; however, these approaches do not fully address the inflammatory component of CVD. Recent advancements have highlighted the potential of targeted anti-inflammatory therapies in mitigating cardiovascular risk. This review explores the efficacy and safety of these novel therapeutic agents. Interleukin (IL)-1β inhibitors, such as canakinumab, have shown promising results in reducing recurrent cardiovascular events in post-myocardial infarction patients. By directly modulating inflammatory pathways, canakinumab significantly lowered the incidence of major adverse cardiovascular events (MACE) independent of lipid levels. Similarly, colchicine, an ancient anti-inflammatory drug, has gained renewed interest due to its efficacy in reducing cardiovascular events in patients with chronic coronary disease and recent myocardial infarction. Furthermore, emerging therapies targeting other inflammatory mediators like IL-6 and tumor necrosis factor-α are under investigation, offering additional avenues for intervention. Despite these advancements, challenges such as identifying appropriate patient populations, long-term safety, and cost-effectiveness remain. Ongoing research aims to refine these therapies, ensuring a balance between risk reduction and adverse effects. In conclusion, targeted anti-inflammatory therapy represents a promising adjunct to traditional CVD treatments, potentially revolutionizing the management of cardiovascular events. Future studies are essential to optimize these strategies and fully integrate them into clinical practice, enhancing outcomes for patients with CVD.