Christopher Wasco DO, Zeryab Khan DO, Aimee Willett DO, Andrew Volio DO, Cody Carter DO, Aditya Kesari DO, Shaili Kothari MD, Andrew Scheidemantel DO, Katelyn Bennett DO, Jessalyn Schafer DO, Marie Lockhart PhD, Nagesh Chopra MD
Sixteen percent of patients referred for cardiology evaluation are found to have no cause for palpitations. Studies show that hypertension intricately influences “heart rate” and “contractility,?” the key components of “palpitation.” While the prevalence of hypertension is 22.4% in 18–39-year-olds, the relationship between palpitations and hypertension remains unknown in this age group. In our study, we assessed the incidence and prevalence of hypertension over 5 years in 18–40-year-olds referred for palpitations who had no known arrhythmic cause for palpitations between January 1, 206 and December 31, 2017. We found that over a period of 2.2 (0.7–4.1) years, an additional 56% patients were diagnosed with stage 1 (65/130) and stage 2 (28/130) hypertension, increasing the prevalence from 16% at the start of the study period to 72% at the end of the study period (p < .0001). Hypertensive patients were obese (BMI: 29 [24–36] kg/m2 vs. 25 [22–31] kg/m2; p = .03), used nonsteroidal anti-inflammatory drugs (NSAIDs) (62 vs. 35%; p = .04), had a stronger family history of hypertension (55 vs. 4%; p < .0001) and exhibited higher systolic (124[120–130] mmHg vs. 112[108–115] mmHg; p < .0001) and diastolic (80[76–83] mmHg vs. 72[69–75] mmHg; p < .0001) blood pressures. Hypertension is commonly diagnosed in 18–40-year-old predominantly white female patients referred for palpitations without a known arrhythmic cause. The possibility of untreated hypertension causing palpitations in this cohort needs further evaluation.
在转诊接受心脏病学评估的患者中,有 16% 的人被发现没有心悸的原因。研究表明,高血压会对 "心率 "和 "收缩力 "产生错综复杂的影响,而这正是 "心悸 "的关键组成部分。在 18-39 岁的人群中,高血压的发病率为 22.4%,但在这一年龄组中,心悸与高血压之间的关系仍然未知。在我们的研究中,我们评估了 206 年 1 月 1 日至 2017 年 12 月 31 日期间因心悸而转诊的 18-40 岁人群中 5 年内高血压的发病率和患病率,这些人的心悸没有已知的心律失常原因。我们发现,在2.2(0.7-4.1)年的时间里,又有56%的患者被诊断为1期(65/130)和2期(28/130)高血压,患病率从研究开始时的16%上升到研究结束时的72%(p <.0001)。高血压患者体型肥胖(体重指数:29 [24-36] kg/m2 vs. 25 [22-31] kg/m2; p = .03),使用非甾体抗炎药(NSAIDs)(62 vs. 35%; p = .04),有较强的高血压家族史(55 vs. 4%; p <.0001)。4%;p = 0.0001),收缩压(124[120-130] mmHg vs. 112[108-115] mmHg;p = 0.0001)和舒张压(80[76-83] mmHg vs. 72[69-75] mmHg;p = 0.0001)较高。因心悸而转诊的 18-40 岁以白人为主的女性患者中,高血压通常被诊断为心律失常。在这一人群中,未经治疗的高血压导致心悸的可能性需要进一步评估。
{"title":"Incidence and prevalence of hypertension in 18–40-year-old patients referred for palpitations with normal cardiac monitor findings","authors":"Christopher Wasco DO, Zeryab Khan DO, Aimee Willett DO, Andrew Volio DO, Cody Carter DO, Aditya Kesari DO, Shaili Kothari MD, Andrew Scheidemantel DO, Katelyn Bennett DO, Jessalyn Schafer DO, Marie Lockhart PhD, Nagesh Chopra MD","doi":"10.1111/jch.14813","DOIUrl":"10.1111/jch.14813","url":null,"abstract":"<p>Sixteen percent of patients referred for cardiology evaluation are found to have no cause for palpitations. Studies show that hypertension intricately influences “heart rate” and “contractility,?” the key components of “palpitation.” While the prevalence of hypertension is 22.4% in 18–39-year-olds, the relationship between palpitations and hypertension remains unknown in this age group. In our study, we assessed the incidence and prevalence of hypertension over 5 years in 18–40-year-olds referred for palpitations who had no known arrhythmic cause for palpitations between January 1, 206 and December 31, 2017. We found that over a period of 2.2 (0.7–4.1) years, an additional 56% patients were diagnosed with stage 1 (65/130) and stage 2 (28/130) hypertension, increasing the prevalence from 16% at the start of the study period to 72% at the end of the study period (<i>p</i> < .0001). Hypertensive patients were obese (BMI: 29 [24–36] kg/m<sup>2</sup> vs. 25 [22–31] kg/m<sup>2</sup>; <i>p</i> = .03), used nonsteroidal anti-inflammatory drugs (NSAIDs) (62 vs. 35%; <i>p</i> = .04), had a stronger family history of hypertension (55 vs. 4%; <i>p</i> < .0001) and exhibited higher systolic (124[120–130] mmHg vs. 112[108–115] mmHg; <i>p</i> < .0001) and diastolic (80[76–83] mmHg vs. 72[69–75] mmHg; <i>p</i> < .0001) blood pressures. Hypertension is commonly diagnosed in 18–40-year-old predominantly white female patients referred for palpitations without a known arrhythmic cause. The possibility of untreated hypertension causing palpitations in this cohort needs further evaluation.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ben Hu MD, Yan Wang MD, Jun Feng MD, Linlin Hou MD
Although in vitro experiments have demonstrated the potential of flavonoid compounds in regulating blood pressure, there is still a lack of evidence from large population studies. We conducted a cross-sectional study using the National Health and Nutrition Examination Survey to investigate the relationship between flavonoid intake levels (natural log transformation) and hypertension events. A total of 15 752 participants aged over 20 years were included, and a weighted multivariable logistic regression analysis was performed to explore the relationship between total flavonoids, five sub types intake, and hypertension events. Smooth curve fitting was used to explore potential nonlinear relationships. Higher total flavonoids intake was associated with a lower risk of hypertension than the lowest group. The adjusted odds ratios (95% CIs) were 0.79 (0.70–0.88) for total flavonoids intake. Elevated total flavonoids intake levels were significantly and linearly associated with a lower risk of hypertension. For each unit increase in the total flavonoids intake level, the adjusted ORs for risk of hypertension decrease by 5% (OR 0.95; 95% CI, 0.92–0.98). In addition, in restricted cubic spline regression, we found that flavan-3-ols, anthocyanidins, and flavonols intake were linearly and negatively related to prevalence of hypertension. Flavones intake showed nonlinear associations with prevalence of hypertension with inflection points of -1.90. Within a certain range, a negative correlation exists between flavonoids intake and hypertension events. This finding provides insights into dietary modifications in the prevention of hypertension.
{"title":"The association between flavonoids intake and hypertension in U.S. adults: A cross-sectional study from The National Health and Nutrition Examination Survey","authors":"Ben Hu MD, Yan Wang MD, Jun Feng MD, Linlin Hou MD","doi":"10.1111/jch.14807","DOIUrl":"10.1111/jch.14807","url":null,"abstract":"<p>Although in vitro experiments have demonstrated the potential of flavonoid compounds in regulating blood pressure, there is still a lack of evidence from large population studies. We conducted a cross-sectional study using the National Health and Nutrition Examination Survey to investigate the relationship between flavonoid intake levels (natural log transformation) and hypertension events. A total of 15 752 participants aged over 20 years were included, and a weighted multivariable logistic regression analysis was performed to explore the relationship between total flavonoids, five sub types intake, and hypertension events. Smooth curve fitting was used to explore potential nonlinear relationships. Higher total flavonoids intake was associated with a lower risk of hypertension than the lowest group. The adjusted odds ratios (95% CIs) were 0.79 (0.70–0.88) for total flavonoids intake. Elevated total flavonoids intake levels were significantly and linearly associated with a lower risk of hypertension. For each unit increase in the total flavonoids intake level, the adjusted ORs for risk of hypertension decrease by 5% (OR 0.95; 95% CI, 0.92–0.98). In addition, in restricted cubic spline regression, we found that flavan-3-ols, anthocyanidins, and flavonols intake were linearly and negatively related to prevalence of hypertension. Flavones intake showed nonlinear associations with prevalence of hypertension with inflection points of -1.90. Within a certain range, a negative correlation exists between flavonoids intake and hypertension events. This finding provides insights into dietary modifications in the prevention of hypertension.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140614693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chineme Onwubueke BS, Saif M Borgan MD, Huijun Xiao MS, Keren Zhou MD
In patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone-to-cortisol lateralization (ACL) ratio of 3.0–4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, p = .17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, p = .043) and a lower contralateral suppression index (0.63 vs. 1.1, p = .14). Post-treatment, the surgical group had a significant reduction in diastolic blood pressure (–5.5 mmHg, p = .043) and aldosterone (4.40 vs. 35.80 ng/mL, p = .035) and required fewer anti-hypertensive medications (2 vs. 3, p = .015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.
{"title":"Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10-year experience of the Cleveland Clinic","authors":"Chineme Onwubueke BS, Saif M Borgan MD, Huijun Xiao MS, Keren Zhou MD","doi":"10.1111/jch.14810","DOIUrl":"10.1111/jch.14810","url":null,"abstract":"<p>In patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone-to-cortisol lateralization (ACL) ratio of 3.0–4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, <i>p</i> = .17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, <i>p</i> = .043) and a lower contralateral suppression index (0.63 vs. 1.1, <i>p</i> = .14). Post-treatment, the surgical group had a significant reduction in diastolic blood pressure (–5.5 mmHg, <i>p</i> = .043) and aldosterone (4.40 vs. 35.80 ng/mL, <i>p</i> = .035) and required fewer anti-hypertensive medications (2 vs. 3, <i>p</i> = .015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Süleyman Cagan Efe MD, Mahmut Buğrahan Cicek MD, Tuba Unkun MD, Enver Yucel MD, Ali Karagöz MD, Cem Doğan MD, Zübeyde Bayram MD, Ali Furkan Tekatlı MD, Baver Bozan MD, Murat Karaçam MD, Gülümser Sevgin Halil MD, Turgut Karabağ MD, Cihangir Kaymaz MD, Nihal Ozdemir MD
Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients’ echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (−20.6 ± −2.3, −19.7 ± −1.9, p:.13; −21.3 ± −2.7, −21 ± −2.4, p:.68; −21.2 ± −2.2, −21.2 ± −2.3, p:.93; and −20.8 ± −1.5, −20.4 ± −1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.
{"title":"Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing","authors":"Süleyman Cagan Efe MD, Mahmut Buğrahan Cicek MD, Tuba Unkun MD, Enver Yucel MD, Ali Karagöz MD, Cem Doğan MD, Zübeyde Bayram MD, Ali Furkan Tekatlı MD, Baver Bozan MD, Murat Karaçam MD, Gülümser Sevgin Halil MD, Turgut Karabağ MD, Cihangir Kaymaz MD, Nihal Ozdemir MD","doi":"10.1111/jch.14814","DOIUrl":"10.1111/jch.14814","url":null,"abstract":"<p>Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients’ echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (−20.6 ± −2.3, −19.7 ± −1.9, <i>p</i>:.13; −21.3 ± −2.7, −21 ± −2.4, <i>p</i>:.68; −21.2 ± −2.2, −21.2 ± −2.3, <i>p</i>:.93; and −20.8 ± −1.5, −20.4 ± −1.5, <i>p</i>:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, <i>p</i>:.10; 142 ± 64, 127 ± 42, <i>p</i>:.31; 94.3 ± 2.5, 95.1 ± 1.5, <i>p</i>:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, <i>p</i> < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), <i>p</i> = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In conclusion, the GRAND study and related studies are vitally important additions to understand the increasing prevalence of hypertension, but should ensure comprehensive evaluation of patient-level, measurement-level, and external environmental factors that may affect BP readings, especially in a diverse country like India.
The authors declare that they have no competing interests.
{"title":"Source of bias in home BP monitoring: Insight into the GRAND study protocol in India","authors":"Kaustav Chattopadhyay, Aayush Visaria MD, MPH","doi":"10.1111/jch.14815","DOIUrl":"10.1111/jch.14815","url":null,"abstract":"<p>In conclusion, the GRAND study and related studies are vitally important additions to understand the increasing prevalence of hypertension, but should ensure comprehensive evaluation of patient-level, measurement-level, and external environmental factors that may affect BP readings, especially in a diverse country like India.</p><p>The authors declare that they have no competing interests.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study is to evaluate the developments in the treatment and prevalence of hypertension by demographic subgroups in least developed area of China in 2012 and 2022. This population-based cross-sectional study was conducted in 2012 and 2022, we applied stratified multistage random sampling to investigate residents aged 18 years or older in Gansu, the least developed province in the northwest of China. Questionnaires and anthropometric measurements were given to all respondents. The standardized prevalence of hypertension in adults in Gansu increased from 26.1% in 2012 to 28.8% in 2022. Compared with 2012, the control rate remains decreased despite the significantly improved awareness and treatment rates of hypertension in 2022. Apart from the reversal of the control rate, the trend of higher prevalence in men and higher awareness and treatment rates in women has not changed. There was an obviously increase in the proportion of participants who had received health education and hypertension management services from medical workers. The treatment was still primarily monotherapy, and there was no significant improvement in the prescription of medication. The prevalence of hypertension has increased mildly in the least developed region of China over the past decade, and the challenge of hypertension management has shifted from increasing awareness and treatment rates to increasing control rates. The onset and control of hypertension are affected by education methods, BMI, local economic conditions and other factors, and targeted strategies can be adopted to strengthen the management of hypertension in economically underdeveloped areas of China.
{"title":"Assessing the evolution of hypertension management in Gansu, China: A comparative study of prevalence, awareness, treatment, and control in 2012 and 2022","authors":"Wei Liang MD, Xiaowei Zhang MD, Qiongying Wang MD, Heng Yu MD, Jing Yu MD","doi":"10.1111/jch.14809","DOIUrl":"10.1111/jch.14809","url":null,"abstract":"<p>The aim of this study is to evaluate the developments in the treatment and prevalence of hypertension by demographic subgroups in least developed area of China in 2012 and 2022. This population-based cross-sectional study was conducted in 2012 and 2022, we applied stratified multistage random sampling to investigate residents aged 18 years or older in Gansu, the least developed province in the northwest of China. Questionnaires and anthropometric measurements were given to all respondents. The standardized prevalence of hypertension in adults in Gansu increased from 26.1% in 2012 to 28.8% in 2022. Compared with 2012, the control rate remains decreased despite the significantly improved awareness and treatment rates of hypertension in 2022. Apart from the reversal of the control rate, the trend of higher prevalence in men and higher awareness and treatment rates in women has not changed. There was an obviously increase in the proportion of participants who had received health education and hypertension management services from medical workers. The treatment was still primarily monotherapy, and there was no significant improvement in the prescription of medication. The prevalence of hypertension has increased mildly in the least developed region of China over the past decade, and the challenge of hypertension management has shifted from increasing awareness and treatment rates to increasing control rates. The onset and control of hypertension are affected by education methods, BMI, local economic conditions and other factors, and targeted strategies can be adopted to strengthen the management of hypertension in economically underdeveloped areas of China.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bambang Widyantoro, Jennifer M Nailes, Apichard Sukonthasarn, Arieska Ann Soenarta
High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.
{"title":"Ambulatory blood pressure monitoring profiles in Asia.","authors":"Bambang Widyantoro, Jennifer M Nailes, Apichard Sukonthasarn, Arieska Ann Soenarta","doi":"10.1111/jch.14799","DOIUrl":"https://doi.org/10.1111/jch.14799","url":null,"abstract":"<p><p>High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xue Zhang MD, Yibo Li MD, Xinyue Wang MD, Tianna Zhou MD, Yun Gao PhD, Mulian Hua MSc(Med), Siqi Zhang MSc(Med), Chao Chen MSc(Med), Xixuan Zhao MSc(Med), Anxia He MD, PhD, Junya Liang MSc, Ming Liu MD, PhD
The association of cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. We aim to examine their relationship in hypertensive patients compared with that in normotensive subjects. Our study included 1887 subjects enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e’), and speckle-tracking to estimate left ventricular (LV) global longitudinal strain (GLS). LV mass index (76.3, 80.0, and 84.0 g/m2), and E/e’ (7.6, 8.2, and 8.8) were increased and GLS (21.1, 21.0, and 20.4%), E/A (1.2, 1.0, and 0.8) and e’ velocity (11.2, 9.4, and 8.2 cm/s) was decreased from tertiles 1–3 of CAVI on unadjusted analyses (P < .001). After adjustment for covariates, GLS, E/A, and e’ were still significantly decreased from tertiles 1–3 of CAVI (P ≤ .04). Further sensitive analyses revealed a similar association pattern for diastolic function but not systolic function. Compared with the lowest tertile, subjects with a top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR = 2.61; P = .005). Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.
{"title":"Hypertension-specific association of cardio-ankle vascular index with subclinical left ventricular function in a Chinese population: Danyang study","authors":"Xue Zhang MD, Yibo Li MD, Xinyue Wang MD, Tianna Zhou MD, Yun Gao PhD, Mulian Hua MSc(Med), Siqi Zhang MSc(Med), Chao Chen MSc(Med), Xixuan Zhao MSc(Med), Anxia He MD, PhD, Junya Liang MSc, Ming Liu MD, PhD","doi":"10.1111/jch.14803","DOIUrl":"10.1111/jch.14803","url":null,"abstract":"<p>The association of cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. We aim to examine their relationship in hypertensive patients compared with that in normotensive subjects. Our study included 1887 subjects enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e’), and speckle-tracking to estimate left ventricular (LV) global longitudinal strain (GLS). LV mass index (76.3, 80.0, and 84.0 g/m<sup>2</sup>), and E/e’ (7.6, 8.2, and 8.8) were increased and GLS (21.1, 21.0, and 20.4%), E/A (1.2, 1.0, and 0.8) and e’ velocity (11.2, 9.4, and 8.2 cm/s) was decreased from tertiles 1–3 of CAVI on unadjusted analyses (<i>P</i> < .001). After adjustment for covariates, GLS, E/A, and e’ were still significantly decreased from tertiles 1–3 of CAVI (<i>P</i> ≤ .04). Further sensitive analyses revealed a similar association pattern for diastolic function but not systolic function. Compared with the lowest tertile, subjects with a top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR = 2.61; <i>P</i> = .005). Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jie Yu PhD, Lauren Houston PhD, Chris Gianacas MBiostat, Vivian Lee PhD, Robert A. Fletcher MSc, Angela Xun-Nan Chen PhD, Clare Arnott PhD
The Australian culturally and linguistically diverse (CALD) communities may be at higher risk of salt intake than recommended given the use of a combination of discretionary sources and exposure to processed foods within a western country. This survey aimed to understand the knowledge, attitudes, and behaviors toward dietary salt and the acceptability of salt substitutes in the CALD communities. An online cross-sectional survey was conducted among adults who self-reported being a part of a CALD community, which was defined as non-Indigenous cultural groups in Australia having cultural or linguistic connections with their overseas place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. A total of 218 respondents opened the survey link. A total of 196 completed the entire survey. The majority of respondents (162, 83%) were aware that high salt intake causes serious health problems. Altogether 134 (69%) respondents were aware that there is a recommended amount for daily salt consumption although only 59 (44%) knew precise recommendations as <5 g salt per day. Around one quarter of the respondents rarely or never looked for ‟low in salt’’ or ‟reduced salt’’ messages on food labels when shopping. Over half specified they always or often added salt during cooking or preparing foods in the household. Almost 4 in 5 CALD respondents were willing to reduce their salt intake for health and 3 in 4 were open to trying a salt substitute. Further research into the utility of a salt substitute intervention in the Australian CALD community is warranted.
{"title":"Knowledge, attitudes, and behaviors related to dietary salt intake and the acceptability of salt substitute among the Australian culturally and linguistically diverse community: An online survey","authors":"Jie Yu PhD, Lauren Houston PhD, Chris Gianacas MBiostat, Vivian Lee PhD, Robert A. Fletcher MSc, Angela Xun-Nan Chen PhD, Clare Arnott PhD","doi":"10.1111/jch.14802","DOIUrl":"10.1111/jch.14802","url":null,"abstract":"<p>The Australian culturally and linguistically diverse (CALD) communities may be at higher risk of salt intake than recommended given the use of a combination of discretionary sources and exposure to processed foods within a western country. This survey aimed to understand the knowledge, attitudes, and behaviors toward dietary salt and the acceptability of salt substitutes in the CALD communities. An online cross-sectional survey was conducted among adults who self-reported being a part of a CALD community, which was defined as non-Indigenous cultural groups in Australia having cultural or linguistic connections with their overseas place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. A total of 218 respondents opened the survey link. A total of 196 completed the entire survey. The majority of respondents (162, 83%) were aware that high salt intake causes serious health problems. Altogether 134 (69%) respondents were aware that there is a recommended amount for daily salt consumption although only 59 (44%) knew precise recommendations as <5 g salt per day. Around one quarter of the respondents rarely or never looked for ‟low in salt’’ or ‟reduced salt’’ messages on food labels when shopping. Over half specified they always or often added salt during cooking or preparing foods in the household. Almost 4 in 5 CALD respondents were willing to reduce their salt intake for health and 3 in 4 were open to trying a salt substitute. Further research into the utility of a salt substitute intervention in the Australian CALD community is warranted.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Modou Jobe PhD, Islay Mactaggart PhD, Abba Hydara MMed, Min J. Kim MPH, Suzannah Bell MB, ChB, Gaetan Brezesky Kotanmi MSc, Omar Badjie MSc, Andrew M. Prentice PhD, Matthew J. Burton PhD
Community treatment of hypertension in sub-Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7–119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8–78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7–149.7) among those unaware of their hypertension, 152.2 mmHg (151.0–153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3–161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4–94.4) among the unaware, 95.1 mmHg (94.4–95.8) among the treated and highest at 99.1 mmHg (98.1–100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade.
{"title":"Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey","authors":"Modou Jobe PhD, Islay Mactaggart PhD, Abba Hydara MMed, Min J. Kim MPH, Suzannah Bell MB, ChB, Gaetan Brezesky Kotanmi MSc, Omar Badjie MSc, Andrew M. Prentice PhD, Matthew J. Burton PhD","doi":"10.1111/jch.14806","DOIUrl":"10.1111/jch.14806","url":null,"abstract":"<p>Community treatment of hypertension in sub-Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7–119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8–78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7–149.7) among those unaware of their hypertension, 152.2 mmHg (151.0–153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3–161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4–94.4) among the unaware, 95.1 mmHg (94.4–95.8) among the treated and highest at 99.1 mmHg (98.1–100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}