Journal of Clinical Hypertension最新文献

Primary aldosteronism (PA) independently increases renal impairment risk beyond blood pressure effects. Although hyperaldosteronism is known to mediate renal injury, associations between plasma aldosterone concentration (PAC) and early kidney damage biomarkers such as retinol-binding protein (RBP) and β2-microglobulin (β2-MG) remain insufficiently explored. We investigated the association of PAC with renal function indicators—including RBP, β2-MG, albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR)—comparing matched patients with PA and essential hypertension (EH). In this cross-sectional study, 546 PA patients and 546 propensity score-matched EH patients were assessed. Spearman correlations and multivariate regression analyses assessed PAC-renal marker associations, with interactions tested to determine differences between PA and EH groups. In PA, PAC strongly correlated with lower eGFR (r = −0.597, p < 0.001) and higher RBP (r = 0.559), β2-MG (r = 0.632), and ACR (r = 0.583), persisting after adjustment. In contrast, EH patients showed only weak correlations between PAC and eGFR (r = −0.204, p < 0.001), without links with other markers. Interaction analysis confirmed stronger PAC-biomarker associations in PA than EH (all p < 0.05). This study is the first to demonstrate robust associations between PAC and sensitive early renal damage biomarkers, especially RBP, in PA patients, distinct from matched EH patients. It highlights hyperaldosteronism's unique pathogenic role in renal impairment in PA, suggesting early biomarker monitoring and aldosterone-targeted interventions could reduce chronic kidney disease risk in PA populations.

Orthostatic hypotension (OH) is a common inpatient condition associated with falls, syncope, and mortality. However, standardized approaches for inpatient management of OH are lacking and may vary across clinical specialties. In this retrospective observational cohort study, we reviewed the electronic medical records of patients admitted to Beth Israel Deaconess Medical Center between April 1, 2015 and June 1, 2021 with a diagnosis of OH or medication-related hypotension. Variables of interest included admitting service, presenting symptoms, suspected etiology, and management. Among the 400 inpatients with OH, one-third had OH documented on admission. Dizziness and lightheadedness were the most common symptoms; medical patients experienced dizziness, falls, and other symptoms more frequently than surgical patients. Volume depletion and medications were the leading suspected causes of OH. Surgical patients were less likely to have medication-related OH and were more likely to lack an identified etiology. Cardiovascular disease was more frequently implicated in cardiology patients. Volume depletion, neurodegenerative disease, and other conditions were more often suspected among medical patients. Management commonly involved volume resuscitation and medication adjustment, though medication changes were less frequent in surgical patients. Nonpharmacologic interventions were more common among medical patients. By discharge, OH had resolved in only one-third of patients. In summary, inpatient OH was most often identified after admission, attributed to hypovolemia, treated with fluids, and unresolved at discharge, with differences in symptoms, etiology, and management between specialties. Prospective studies are needed to formalize diagnostic and treatment strategies for OH in the hospital setting.

A common barrier to the timely treatment of hypertension is the accurate measurement of blood pressure (BP). Although measuring BP is a common procedure, training and retraining on this skill is often inadequate. A study led by the American Medical Association (AMA), found that the education system has failed to establish and maintain this skill among a sample of medical students who were tested. The AMA Student BP Measurement eLearning Series is designed to address this gap in training and ensure all students feel confident and competent in performing this critical skill. By creating a readily implementable eLearning Series and collaborating with 10 healthcare education institutions, significant strides have been made toward standardizing BP measurement training. However, to truly address both the gaps in training and the performance gaps in BP measurement skills, faculty across healthcare disciplines must take an active role in standardizing this essential skill for all students. We urge all healthcare faculty to adopt and champion this standardized approach, embedding it early in education, reinforcing it throughout training, and assessing proficiency regularly. A universal commitment to standardization will equip the next generation of healthcare professionals with the competence and confidence needed to measure BP accurately, ultimately improving hypertension diagnosis, treatment, and health outcomes for patients nationwide.

Hypertensive cardiac hypertrophy (HCH) is a compensatory response to chronic pressure overload, ultimately progressing to heart failure if left unmanaged. Emerging evidence highlights the critical role of mitochondrial dysfunction in HCH pathogenesis, with impaired mitophagy—a selective autophagic process that removes damaged mitochondria—contributing to cardiomyocyte death, oxidative stress, and fibrosis. Protective mitophagy eliminates damaged mitochondria, averting reactive oxygen species (ROS)/calcium overload in HCH. Conversely, its dysregulation—either insufficient clearance or excessive removal—exacerbates mitochondrial dysfunction, driving pathological hypertrophy, fibrosis, and bioenergetic crisis. This dual nature presents a therapeutic paradox demanding contextual modulation. This review comprehensively examines the molecular mechanisms underlying mitophagy dysregulation in HCH, focusing on key pathways such as PINK1/Parkin, BNIP3/NIX, and FUNDC1. We also discuss the interplay between mitophagy and other cellular processes, including mitochondrial biogenesis, inflammasome activation, and metabolic remodeling. Furthermore, we explore potential therapeutic strategies targeting mitophagy to ameliorate HCH, including pharmacological agents, lifestyle interventions, and gene therapy approaches. Understanding the dual role of mitophagy in HCH—both protective and detrimental—may pave the way for novel precision medicine strategies in cardiovascular disease.

Ramadan fasting involves abstaining from food and drink from dawn to sunset, yet its impact on blood pressure (BP) and kidney function in newly diagnosed hypertensive patients remains unclear. This retrospective study examined 200 newly diagnosed hypertensive patients from Konya, Turkey, during Ramadan 2023. Half of the patients (n = 100) observed daily fasting throughout Ramadan, while the other half (n = 100) did not. All patients received a diuretic-containing regimen consisting of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker combined with hydrochlorothiazide. Baseline clinical and laboratory data, including serum creatinine and estimated glomerular filtration rate (eGFR), were compared with those obtained at a one-month follow-up (end of Ramadan). Both fasting and non-fasting groups exhibited significant reductions in systolic and diastolic BP from baseline to the first month, with no statistically significant difference in final BP between the two groups. Kidney function, as indicated by creatinine levels and eGFR, remained stable in both groups, suggesting that Ramadan fasting did not adversely affect renal parameters. Modest improvements in lipid profiles were also observed in both cohorts. These findings indicate that, among newly diagnosed hypertensive patients on diuretic-containing therapy, Ramadan fasting may be safe if accompanied by individualized clinical advice. However, larger and more prolonged studies are warranted to validate these results and explore potential variations in other hypertensive populations.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) polymorphisms exhibit ethnic-specific associations with cardiovascular risk. However, their prognostic value for major adverse cardiovascular and cerebrovascular events (MACCE) in Asian populations remains undefined. This prospective cohort study enrolled 1969 patients (mean age 54.5 ± 10.7 years, 60.2% male) with hyperlipidemia and followed them for a median of 62 months (IQR 24–89 months). We evaluated the association of three PCSK9 polymorphisms (rs2483205, rs2495477, and rs562556) with metabolic parameters and MACCE. A genotype-integrated nomogram was developed using Least Absolute Shrinkage and Selection Operator (LASSO) – selected predictors and validated in an independent cohort. The rs2483205 TT, rs2495477 GG, and rs562556 GG genotypes were significantly associated with atherogenic dyslipidemia (elevated triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a) [Lp(a)], all p < 0.001) and predicted MACCE risk independently of conventional factors (HR = 2.94, 95% CI: 1.80–4.80 for rs2483205 TT). The nomogram demonstrated excellent discrimination (3 and 4 year area under the curve (AUC) = 0.989, concordance index (C-index) = 0.868) and calibration (slope = 1.02, 95% CI: 0.98–1.06), with decision curve analysis confirming clinical utility across risk thresholds (20%–75%). Net Reclassification Improvement (NRI) increase of 0.059 and an Integrated Discrimination Improvement (IDI) increase of 0.022. PCSK9 genotyping provides independent prognostic value for MACCE risk stratification in hyperlipidemia, with genotype-specific effects on cardiovascular outcomes. The developed nomogram offers a precision medicine tool for individualized risk prediction and therapeutic decision-making.

Sodium intake in China is among the highest in the world, particularly in rural areas. A government-led national sodium reduction program has been implemented but evaluations of its implementation and effectiveness remain limited. The study will use a combined qualitative and quantitative approach and a before-after design, to monitor and evaluate the implementation and effectiveness of the sodium reduction program in the rural areas of four provinces geographically distributed throughout China: Heilongjiang, Shanxi, Guizhou, and Guangdong. Baseline data collected in 2021–2023 will be compared to follow-up data collected in 2024–2025. Population surveys will quantify changes in community knowledge, behaviors, dietary patterns, and sodium intake. Food retail surveys will assess changes in the sodium content of packaged food products, while stakeholder interviews will assess the extent to which the program has been implemented as planned across government, industry, health, and community organizations. The study has received funding and ethics committee approvals though timelines and study processes were significantly delayed by COVID-19. Baseline surveys of 2790 community members have now been completed, food composition data for 20 240 products has been collected, and there have been 37 stakeholders interviewed to date. This project will provide a robust evaluation of progress with implementation of China's national sodium reduction program in rural areas of the country. It will quantify impact to date and provide insight into what has worked, as well as what has not, and inform future sodium reduction strategies.

Blood pressure (BP) is a crucial component of the APACHE II scoring system for assessing the severity of illness in ICU patients, and it plays a pivotal role in predicting patient mortality. Based on fluctuations, the 24-h BP patterns of ICU patients can be categorized into dippers (10% ≤ the fall < 20%), extreme-dippers (fall ≥ 20%), non-dippers (0% ≤ the fall < 10%), and reverse-dippers (fall < 0%). This study aims to investigate whether there are statistically significant differences in ICU mortality, in-hospital mortality, 28-day mortality, and 1-year mortality among the dipper, non-dipper, extreme-dipper, and reverse-dipper groups. We enrolled all adult patients with continuous BP monitoring within 24 h of ICU admission. Using Navicat Premium 16 software, we extracted the first 24-h BP values of 10462 patients from the MIMIC IV v2.2 database. Patients were then classified into the dipper group (n = 1244), non-dipper group (n = 6162), reverse-dipper group (n = 2940), and extreme-dipper group (n = 116). Among ICU patients, the non-dipper pattern group constituted the largest proportion (58.90%), followed by the reverse-dipper pattern group (28.10%). After adjusting for relevant confounding factors, we found that the reverse-dipper group had the strongest correlation with in-hospital mortality (OR: 1.592, p < 0.05), 28-day mortality (OR: 1.607, p < 0.01), 90-day mortality (OR: 1.402, p < 0.01), 180-day mortality (OR: 1.403, p < 0.01), and 1-year mortality (OR: 1.525, p < 0.001), with statistical significance observed for all these associations. In the ICU setting, the non-dipper BP pattern is the most prevalent. However, the reverse-dipper pattern is the most significantly associated with mortality.

Dear Editor,

We write regarding the article by Guo et al., “Association of Cumulative Exposure to Triglyceride and Remnant Cholesterol With the Risk of Cardiovascular Disease in Hypertensive Patients With Target LDL-C,” published in the Journal of Clinical Hypertension (2025) [1]. This study highlights the role of cumulative remnant cholesterol (cumRC) over cumulative triglycerides (cumTG) in residual cardiovascular disease (CVD) risk among hypertensive patients with controlled LDL-C. While the findings advance our understanding of lipid-related CVD risk, several methodological and interpretive limitations warrant discussion to ensure accurate clinical translation.

First, the observational design of Guo et al.’s study precludes establishing causality between elevated cumRC and increased CVD risk. Although associations are reported, causality is essential for guiding clinical practice. For instance, the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) demonstrated a 25% reduction in CVD events with icosapent ethyl, which lowers triglycerides and likely remnant cholesterol, suggesting a causal link that requires confirmation through randomized controlled trials (RCTs) [2]. This evidence challenges the study's assertion that maintaining optimal RC levels alone sufficiently mitigates CVD risk.

Second, the study's reliance on a Chinese cohort limits its generalizability to other populations due to ethnic differences in lipid metabolism. The Northern Manhattan Study (NOMAS) found that lipid-CVD associations, such as those involving HDL-C and TG/HDL-C, vary significantly, with no predictive value for myocardial infarction in Hispanics compared to non-Hispanic whites and Blacks [3]. This ethnic specificity undermines the universal applicability of Guo et al.’s conclusions.

Third, the study's calculation of remnant cholesterol, likely using the Friedewald formula, is susceptible to inaccuracies, particularly in hypertriglyceridemic patients prevalent in this cohort. A 2021 study showed that directly measured remnant cholesterol better identifies high-risk individuals, indicating potential misclassification bias in Guo et al.’s findings [4]. Such measurement limitations weaken the study's conclusions regarding cumRC's role in CVD risk.

Fourth, unmeasured confounders, such as dietary patterns or genetic predispositions, may drive the observed cumRC-CVD association. A 2023 study identified lipid level variability as an independent predictor of CVD risk, a factor not addressed in Guo et al.’s adjustments [5]. This residual confounding casts doubt on attributing CVD risk solely to cumRC.

Finally, the study overlooks comparisons with non-HDL-C or apolipoprotein B (apoB), which are superior predictors of residual CVD risk. The 2019 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines e

Understanding class-specific antihypertensive adherence is crucial for optimizing hypertension management. This retrospective cohort study analyzed adherence to antihypertensive medication among commercially insured adults (18–64 years) from 2018 to 2023 using Merative MarketScan data. Adherence was defined as the proportion of days covered (PDC) ≥ 80%. Among 2 770 855 hypertensive patients with single-pill therapy, the majority were older (43% aged 55–64 years) and predominantly male (53%). The South had the highest prevalence of hypertension (53%). Overall adherence improved significantly from 56.61% in 2018–2019 to 75.55% in 2022–2023 across all medication classes. Patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) combination therapies had the highest adherence rate (79.18%), while diuretics (67.58%) and “Other Drugs” (57.38%) had the lowest in 2022–2023. Logistic regression showed that younger patients (18–34 years) were significantly less adherent than older adults (OR = 0.434, 95% CI: 0.420–0.448). Males were more likely to adhere than females (OR = 1.142, 95% CI: 1.129–1.156). Regional variations were notable, with patients in the Northeast exhibiting 15% higher adherence than those in the West. Insurance types also influenced adherence, with managed care plan enrollees showing better adherence than those in fee-for-service plans (OR = 1.165, 95% CI: 1.151–1.179). Surprisingly, prescription refill monitoring reduced adherence, decreasing odds by 52% (OR = 0.482, 95% CI: 0.470–0.490). Monotherapy and combination therapy users differed significantly across all demographics (p < 0.0001). Higher comorbidity burden correlated with lower adherence, with diabetes being most prevalent among users of diuretics (12.88%), beta-blockers (12.8%), and other antihypertensives (26.01%). These findings highlight the multifaceted barriers to antihypertensive adherence and emphasize the need for targeted interventions that address medication-specific and patient-specific factors.