Journal of Clinical Hypertension最新文献

Dear Editor:

We read with interest the article by Chen et al. examining the prognostic value of insulin resistance indices for major adverse cardiovascular events in young and middle-aged patients with hypertension [1]. The authors should be acknowledged for addressing an underexplored population and for their long follow-up duration. Their finding that the metabolic score for insulin resistance (METS-IR) outperformed the triglyceride–glucose index and TG/HDL-C ratio in discrimination analyses is noteworthy and contributes to the growing literature on metabolic risk stratification.

Nevertheless, the retrospective single-center design limits causal interpretation. Selection bias and unmeasured confounders are inherent to this approach, particularly in a cohort derived from a tertiary referral center. Prior large population-based studies have demonstrated that associations between insulin resistance surrogates and cardiovascular outcomes are highly sensitive to baseline risk distribution and population characteristics, raising concerns regarding external validity [2].

Another important consideration is residual confounding related to pharmacological treatment. Renin–angiotensin system inhibitors and certain calcium channel blockers are known to improve insulin sensitivity, whereas β-blockers and thiazide diuretics may worsen it. The absence of detailed antihypertensive treatment adjustment may therefore influence both insulin resistance indices and cardiovascular outcomes, potentially inflating observed associations [3].

In addition, although METS-IR demonstrated statistically significant improvements in the area under the curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) the clinical relevance of these increments remains uncertain. Prior methodological work has cautioned that reclassification metrics can appear favorable even when absolute risk discrimination improves marginally, limiting their impact on clinical decision-making [4]. Whether METS-IR meaningfully alters patient management beyond established risk models is not yet clear.

Finally, insulin resistance indices are surrogate measures and do not fully capture heterogeneity in adiposity distribution, inflammatory burden, or ectopic fat accumulation. Imaging-based or biomarker-integrated approaches have shown stronger mechanistic links with cardiovascular risk and may provide complementary or superior prognostic information [5]. Prospective multicenter studies incorporating such measures are required before widespread clinical adoption of METS-IR can be recommended.

Sincerely,

All of the authors contributed planning, writing, and revision.

This work did not receive any specific funding.

The authors declare no conflicts of interest.

No new data was generated or analyzed in support of this letter to the editor.

Trauma is a frequent cause of hospital admission in adults, and while arterial hypertension is common in the general population, reactive hypertension associated with trauma remains poorly studied from a therapeutic perspective. This retrospective cohort study aimed to estimate the impact of antihypertensive treatment on hypotension occurrence, in-hospital mortality, and length of stay in patients with musculoskeletal trauma. We analyzed data from a high-complexity center in Colombia between 2020 and 2024, including adults over 18 years with musculoskeletal trauma who had no previously known hypertension but presented two blood pressure readings >140/90 mm Hg during hospitalization. Patients were categorized into those receiving antihypertensive treatment versus no prescription. Primary outcomes were assessed using logistic, linear, and time-to-event regression models for hypotension requiring medical intervention, in-hospital death, and length of stay. Among 712 patients analyzed, most were young men (77% male, mean age 35 years) with few comorbidities (obesity 6.2%, diabetes 4.6%). Sixty percent had open fractures requiring surgical management. Antihypertensive drug exposure was significantly associated with hypotension (OR 11.9, 95% CI 5.69–26.4) but showed no significant association with in-hospital death (OR 5.18, 95% CI 0.79–39.6), length of stay (1.5 days, 95% CI −0.1 to 3.1), or time-to-discharge alive (HR 0.79, 95% CI 0.59–1.06). Our findings suggest that treating reactive hypertension in hospitalized musculoskeletal trauma patients may increase hypotension risk without improving mortality or length of stay outcomes.

A recent survey in the Philippines, PRESYON-4, showed increasing prevalence of hypertension from 22% in the 1990s to 37% in 2021, of which only 52% were aware of their diagnosis. While rates of treatment and adherence were 68% and 86%, respectively, the rate of BP control was low at 37%. Furthermore, there remained a high degree of unawareness regarding hypertension, its role in CV morbidity and mortality, and how it can be optimally managed. In particular, there is a knowledge gap in the diagnostic approach and management of severe acute elevations in blood pressure. In response to this, the Philippine Society of Hypertension, Philippine Heart Association, and multiple experts from various sectors worked together to develop the 2024 Clinical Practice Guideline on the Diagnosis and Management of Severe Blood Pressure Elevation. The CPG provides eleven (11) recommendations and four (4) best practice statements addressing key clinical questions on the diagnosis and management of severe BP elevation. The guideline development process adhered to the GRADE approach through the Evidence to Decision (EtD2) framework, including the identification of critical questions and outcomes, retrieval of current evidence, appraisal and synthesis of the evidence, and formulation of draft recommendations. A multisectoral consensus panel (CP) was convened to discuss values, preferences, and socioeconomic impact and finalize the strength of the recommendations. The CPG is intended to be used by general practitioners, specialists, family physicians, allied health professionals, emergency medical personnel, and healthcare workers who may encounter adult patients with hypertension, whether in the inpatient or outpatient setting.

The weight-adjusted waist index (WWI) is a novel indicator that could estimate body fat and muscle mass. This study aimed to investigate the relationship between WWI and hypertension plus hyperuricemia (HTN-HUA). The data were drawn from the China Health and Retirement Longitudinal Study. Logistic regression analyses were used to explore the association between WWI with HTN-HUA, hypertension (HTN) alone, and hyperuricemia (HUA) alone. Restricted cubic spline (RCS) analyses were employed to examine potential nonlinear associations. Receiver operating characteristic (ROC) curves were utilized to assess the predictive ability of WWI. A total of 9801 participants were included, among whom 756 (8%) were diagnosed with HTN-HUA, 4381 (45%) with HTN alone, and 1236 (13%) with HUA alone. WWI was significantly associated with HTN-HUA, HTN alone, and HUA alone after adjusting for potential confounders. Compared to the lowest quartiles of WWI, the odds ratios of the highest quartiles were 3.04 (95% confidence interval [CI]: 2.35–3.94) for HTN-HUA, 1.53 (95% CI: 1.34–1.74) for HTN alone, and 1.93 (95% CI: 1.42–2.61) for HUA alone. RCS analyses demonstrated a nonlinear association between WWI with HTN-HUA. The fully adjusted model, which included WWI, exhibited a moderate predictive ability for HTN-HUA (area under the curve: 0.753, 95% CI 0.736–0.771). The association between WWI and HTN-HUA was more prominent among individuals between 45 and 59 years and those without diabetes. In this cross-sectional analysis, higher WWI was significantly associated with the prevalence of the HTN–HUA phenotype, warranting confirmation in prospective studies with clinical endpoints.

Hypertensive disorders of pregnancy (HDP) impact up to 22% of pregnancies. Offspring from HDP, face an increased risk of future cardiovascular disease, with elevated blood pressure reported as early as childhood. Additionally, primary vascular endothelial cells derived from HDP demonstrate dysfunction in vitro. These data suggest that HDP affect fetal development in ways that impair long-term vascular function, supporting the developmental origins of health and disease (DOHaD) theory that health risks begin before birth. However, it remains unclear at what point these physiological changes first emerge and can be detected systemically. To assess whether changes in cardiovascular function can be detected in the immediate post-natal period, we conducted a retrospective analysis of 1655 maternal–infant dyads delivered between the years 2012 and 2025. Using inverse probability weighted regression adjustment, we assessed associations between HDP and newborn heart rate (HR) and blood pressure (BP). Gestational hypertension (GH) and preeclampsia (PE) were associated with higher newborn mean arterial (+2.1 mmHg, p = 0.02; +2.9 mmHg, p = 0.04) and diastolic BP (+2.0 mmHg, p = 0.02; +2.6 mmHg, p = 0.04) compared to normotension (NT). GH was also associated with increased newborn systolic blood pressure (+2.3 mmHg, p = 0.04) and increased variability of newborn HR and diastolic BP (+1 bpm, p = 0.009; +1.4 mmHg, p = 0.001) compared to normotension. These findings suggest that subtle but measurable newborn cardiovascular alterations associated with GH and PE are present at birth. While the mechanisms remain to be elucidated, these early alterations provide additional temporal insight into the DOHaD in HDP and may reflect underlying vascular dysfunction.

Stroke is a leading cause of disability among hypertensive adults, with notable sex differences in risk and outcomes. Neutrophil percentage-to-albumin ratio (NPAR) is an easily obtainable composite index of systemic inflammation with prognostic value in cardiovascular disease, but its utility for primary stroke prevention in hypertension remains unclear. We therefore examined the association of NPAR with first stroke in hypertensive adults and tested for sex-specific effects. We analyzed 13 848 participants from the China Stroke Primary Prevention Trial. NPAR was calculated as the neutrophil percentage (%) × 100/albumin (g/dL). Cox proportional hazards models evaluated the association between NPAR and first stroke, and subgroup analyses assessed sex-specific effects. During a median follow-up of 4.5 years, 371 participants (2.7%) experienced stroke. The risk of stroke was significantly higher in Q2, Q3, and Q4 than in Q1 (HR 1.76, 95% CI 1.31–2.36, p < 0.001 [Q2], HR 1.54, 95% CI 1.14–2.08, p = 0.005 [Q3], and HR 1.57, 95% CI 1.17–2.12, p = 0.003 [Q4] in the adjusted model). The result remained consistent when the Q2 to Q4 groups were combined and compared with the Q1 group. Subgroup analysis revealed a significant sex difference, with higher NPAR associated with increased stroke risk in women but not in men (p = 0.035). These findings suggest that higher NPAR independently predicts stroke risk in patients with hypertension, with a substantially stronger association in women, and highlight sex-specific inflammatory mechanisms and the potential of NPAR as a biomarker for female-focused prevention strategies.

Hypertension is a major cause of morbidity and mortality. Outpatient blood pressure control has declined over the past decade, particularly among Black patients. We examined whether this decline was associated with increased hospitalizations for hypertensive crises and assessed differences by race and gender. We analyzed the National Inpatient Sample (2016–2022) for admissions with hypertensive urgency or emergency. Outcomes included trends in admissions, mortality, length of stay (LOS), and cost of care (COC), with subgroup analyses by race and gender. Among 1 872 760 patients, 34.6% were Black and 50.8% were female. Black patients were younger (57.2 vs. 65.1 years) and almost similar comorbidity scores. Admissions increased from 41 455 (0.1%) in 2016 to 362 475 (1.1%) in 2022, with greater rises in Black (0.3%–2.5%) versus non-Black (0.1%–0.9%) patients, and in males (0.1%–1.1%) versus females (0.1%–0.9%). Mortality rose from 3.6% to 4.1%, remaining higher in non-Black (4.2%–4.8%) than Black (2.6%–2.9%) patients, and slightly higher in males. Median LOS was consistently 4 days without significant differences. Median COC was lower for Black ($44 425) and female ($47 530) patients. Multivariable analysis showed Black race and female gender were independently associated with lower mortality. Females also had a higher LOS and lower COC. Inpatient hypertensive crises increased substantially from 2016 to 2022, especially among Black and male patients. Despite higher admission rates, Black patients and females experienced lower mortality. These findings highlight the need for targeted interventions to improve outpatient hypertension management and reduce disparities.

Elevated blood pressure (BP) following mechanical thrombectomy (MT) has been linked to poorer outcomes, but optimal BP management remains uncertain. This study sought to identify distinct systolic BP (SBP) trajectories in patients after MT and assess their impact on clinical outcomes. We prospectively enrolled 544 acute ischemic stroke patients with large vessel occlusion who underwent MT between July 2017 and December 2024. Hourly SBP measurements were recorded for 24 h post-procedure. Using latent variable mixture modeling, we classified patients into five trajectory groups: low (11.8%), normal (27.4%), relatively stabilized (40.4%), U-shaped (17.5%), and high BP (2.9%). Functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with poor outcome defined as mRS >2. Secondary outcomes included all-cause mortality (mRS = 6) and symptomatic intracranial hemorrhage (sICH). After adjusting for confounders, SBP trajectory groups were independently associated with poor functional outcome (p for trend <0.001) and mortality (p for trend = 0.004), but not with sICH. These findings suggest that post-MT SBP trajectories may help stratify patients at higher risk of disability or death. Higher SBP level in patients after MT may be correlated with poor prognosis of the patients.

The connection between different electrocardiography (ECG) parameters and circadian blood pressure (BP) variations in patients with hypertension (HT) has been investigated. The index of cardio-electrophysiological balance (iCEB), determined as the quotient of the QT interval and the QRS duration, offers an assessment of the comprehensive equilibrium between depolarization and repolarization. This study aimed to explore the relationship between iCEB and circadian BP variability.

After applying exclusion criteria, a total of 144 individuals were diagnosed with HT based on the 24 h ambulatory blood pressure monitoring (ABPM) results. Using the results from 24 h ABPM, the study participants were divided into two groups: those with dipper HT and those with non-dipper HT. The iCEB is calculated by dividing the QT interval by the QRS duration (QT/QRS).

The iCEB was significantly higher in individuals with non-dipper HT compared to those with dipper HT. (3.88 ± 0.6 vs. 4.38 ± 0.89 respectively, p < 0.001). Univariate logistic regression analysis revealed significant correlations between non-dipper hypertensive pattern and creatinine, frontal QRS-T angle (FQRSTA), and iCEB. As a result of multivariate analysis, iCEB (OR:3.125, 95% CI: 1.595–6.117; p = 0.001) was found to be an independent predictor of non-dipper HT. iCEB optimal cut-off value of > 4.1 predicted non-dipper hypertensive pattern with 67.4% sensitivity and 67.3% specificity.

This study indicated that a higher iCEB was linked to non-dipper HT in newly diagnosed hypertensive patients.