Journal of Clinical Hypertension最新文献

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.

Arterial hypertension often coexists with comorbidities that increase vascular damage. Although the primary goal is to reduce cardiovascular risk, the available risk scores can produce varying estimates. Here, we aim to compare the prevalence of cardiovascular risk categories using three equations (Globorisk, SCORE2, and PREVENT) in adults living with arterial hypertension and to assess their association as stratification tools for end-organ damage (EOD). To achieve this, we performed a cross-sectional sub-analysis of the RIHTA study, an electronic health record-based registry of adults with arterial hypertension in Mexican primary care centers. EOD was defined as aortic stiffness, reduced eGFR, hypertensive retinopathy, peripheral artery disease, or left ventricular hypertrophy. Inverse probability weighting (IPW) was used to evaluate the association between cardiovascular risk and EOD, adjusting for relevant confounders, and areas under the receiver operator curve (AUROC) were calculated to assess detection capacity. Among 4512 participants (median age 64 years; 61% women), EOD was present in 33% (n = 1492). The PREVENT equation yielded the highest median 10-year risk (15%, IQR 8–24), followed by Globorisk laboratory-based (12%, 7–22), Globorisk office-based (11%, 7–19), and SCORE2 (5.06%, 3.86–7.18). In IPW models, each 1% increase in score was associated with higher odds of EOD (PREVENT OR 1.16, 95% CI 1.15–1.17; Globorisk-office 1.09, 1.08–1.10; Globorisk-lab 1.07, 1.06–1.08; SCORE2 1.04, 1.02–1.06). The PREVENT score demonstrated the strongest discrimination for detecting EOD (AUROC: 0.751, 0.735–0.750). These findings suggest that among adults with arterial hypertension, the PREVENT score identifies high-risk individuals and improves discrimination for EOD.

The triglyceride–glucose body mass index (TyG-BMI) is an emerging composite metabolic indicator in cardiovascular research. However, the link between TyG-BMI and target organ damage (TOD) in essential hypertension (EH) remains uncertain. This study investigated the association between TyG-BMI and TOD in patients with EH. We conducted a retrospective cohort study involving 493 individuals with EH. Participants were divided at the cohort-specific median into high and low TyG-BMI groups. Over a median follow-up of 23 months, 191 participants experienced TOD. Kaplan–Meier curves showed a significantly higher cumulative incidence of TOD in the high TyG-BMI group than in the low TyG-BMI group (p < 0.05). In multivariable logistic regression, TyG-BMI remained an independent correlate of TOD (adjusted OR = 1.83, 95% CI: 1.08–3.10; p < 0.05). Least absolute shrinkage and selection operator–Cox regression further selected TyG-BMI, age, and smoking status as key predictors of TOD. Subgroup analyses revealed that the TyG-BMI–TOD association was stronger among younger or middle-aged, normal-weight, non-diabetic, non-smoking subjects (p < 0.05). Finally, the TyG-BMI-based model achieved predictive accuracy comparable to that of a conventional risk-factor model. In conclusion, TyG-BMI is independently associated with TOD in EH patients. Its predictive value closely mirrors that of combined traditional risk factors, highlighting TyG-BMI as a promising clinical marker.

Idiopathic hyperaldosteronism (IHA) is the most common subtype of primary aldosteronism, typically managed with mineralocorticoid receptor antagonists (MRAs). However, long-term MRA therapy is associated with suboptimal cardiovascular outcomes and adverse effects. Superselective adrenal arterial embolization (SAAE) is a novel minimally invasive alternative, but its long-term efficacy, particularly regarding quality of life and cost-effectiveness, remains underexplored. In this study, 62 patients with bilateral IHA were prospectively enrolled and assigned to two groups: SAAE (n = 42) and MRA therapy (n = 20). Outcomes, including blood pressure, serum potassium, aldosterone-renin ratio normalization, and quality of life (measured by SF-36 and EQ-5D), were assessed at 12 months. A supervised Random Forest model was developed to predict treatment success. A 5-year cost-utility analysis compared SAAE and MRA therapy from a healthcare system perspective. Results showed that SAAE led to greater reductions in blood pressure (mean −27.4 ± 21.3 mmHg systolic, −23.1 ± 17.4 mmHg diastolic) compared to MRA therapy (−15.6 ± 11.4 mmHg systolic, −12.4 ± 10.1 mmHg diastolic, p < 0.001). Clinical success was achieved in 63.2% of the SAAE group, with biochemical remission in 39.6%. SAAE also led to greater improvements in quality of life and demonstrated lower costs and higher quality-adjusted life years (QALYs) compared to MRA therapy. SAAE is a safe, effective, and cost-effective treatment for IHA, offering superior blood pressure control, hormonal normalization, and improved quality of life compared to MRAs.

Trial Registration: ClinicalTrials.gov identifier: ChiCTR2200062738.

Renal denervation (RDN) is an adjunct therapy for resistant hypertension, reducing blood pressure (BP) by inhibiting both afferent sensory and efferent sympathetic renal nerve activity. The resulting reduction in central sympathetic outflow including that directed toward the heart may beneficially impact cardiac remodeling, left ventricular hypertrophy (LVH) and atrial fibrillation (AF). RDN has been shown to reduce left ventricular mass and AF burden but long-term data is sparse. Forty patients (72.5% male, 69.2 ± 9.6 years) underwent 12-lead ECG at baseline prior to RDN and at a mean long-term follow-up (LTFU) of 8.3 ± 0.9 years post-intervention. A 24-h ambulatory blood pressure monitor (ABPM) was obtained at both time points. Cornell voltage indices were calculated at baseline and LTFU, then converted to left ventricular mass based on validated formulae accounting for sex. ECGs underwent cardiologist review for determination of AF at both time-points. There was no difference in Cornell voltages or left ventricular mass index (LVMI) between baseline and long-term follow-up in neither males (p = 0.89) nor females (p = 0.91). BP lowering at LTFU was correlated with a more pronounced reduction in LVMI (r = 0.50, p = 0.0011) No change was observed in the incidence of atrial fibrillation between baseline or long-term follow-up (p = 0.99). There was no reduction in mean Cornell voltage or LVMI across the cohort between baseline and long-term follow-up. However, changes in ambulatory systolic BP correlated with reduction in LVMI suggestive of an RDN-induced BP dependent long-term reduction in LVMI out to eight years post-RDN.

The protective effect of influenza vaccination on stroke risk has been inconclusive. In this study, we aimed to investigate the impact of influenza vaccination on the 1-year risk of stroke in individuals aged 60 years and older with COPD and hypertension or diabetes mellitus. We conducted a retrospective cohort study in four districts of Shanghai, China, from August 2017 to July 2019. Data were collected from various information systems related to chronic disease management, cardiovascular reporting, and immunizations. The incidence of stroke within 1 year was compared between vaccinated and unvaccinated chronic disease patients. Cox proportional hazards regression was used to calculate hazard ratios (HRs). Sensitivity analysis was performed using the Poisson regression model to examine the association between influenza vaccination and stroke incidence, and propensity score matching was employed to address confounding. We found that influenza vaccination was associated with a lower risk of stroke during the two influenza seasons, 2017–2018 (adjusted HR, 0.27; 95% CI, 0.10–0.73) and 2018–2019 (adjusted HR, 0.46; 95% CI, 0.21–1.02). The results from the Poisson regression model (RR, 0.26; 95% CI, 0.10–0.70) were consistent with those obtained from the Cox model analysis. The reduction in stroke risk associated with influenza vaccination ranged from 54% to 73%. Our findings suggest that influenza vaccination is associated with a lower 1-year risk of stroke in individuals with chronic illnesses, compared to those who are not vaccinated.

One of the leading causes of poor adherence to antihypertensive medications is forgetfulness. A better understanding of the impact of forgetfulness can help in developing targeted interventions to improve blood pressure (BP) control. This study aimed to (1) examine the prevalence of forgetfulness to take antihypertensive medications and its associated factors in older adults with type 2 diabetes and hypertension, and (2) investigate the relationship between forgetfulness to take antihypertensive medications and poor BP control in this population. This observational study was conducted at the outpatient clinics of two hospitals in Vietnam from June 2023 to June 2024. Forgetfulness was assessed using the question: “Do you sometimes forget to take your prescribed antihypertensive medications?”. Poor BP control was defined as a mean systolic BP ≥140 mm Hg or a mean diastolic BP ≥90 mm Hg. There were 448 participants. They had a mean age of 73.5 years (SD 7.2), 32.1% were female. The prevalence of forgetfulness to take antihypertensives was 29.5%, highest among participants in the first 5 years of hypertension (43.8%), followed by those with >15 years (28.0%), 11–15 years (25.2%), and 6–10 years (23.9%) (p = 0.009). Logistic regression analysis revealed that hypertension duration and disability in activities of daily living were significantly associated with forgetfulness. Forgetfulness increased the odds of poor BP control, with an adjusted OR of 1.64 (95% CI 1.03–2.56). These findings suggest the need for future studies focusing on interventions on forgetfulness to improve medication adherence for this population.

Dear editor,

We read with interest the paper by Zhang et al. [1] entitled “Neutrophil Percentage to Albumin Ratio Is Associated With In-Hospital Mortality in Patients With Acute Type A Aortic Dissection.” We congratulate the authors for their valuable contribution. However, we want to discuss some issues about in-hospital mortality risk factors after Stanford Type A aortic dissection (STAAD) surgery.

The current retrospective study included 813 consecutive patients who underwent STAAD surgery. In-hospital mortality occurred in 137 (16.9%) patients. According to the multivariate analysis results, long cardiopulmonary bypass times, prolonged mechanical ventilation and the neutrophil percentage to albumin ratio value were determined as independent predictors of in-hospital mortality [1]. However, it should not be forgotten that parameters other than the data used in the study may also affect mortality.

Left ventricular ejection fraction is an important predictor of mortality in all cardiac surgery operations. It is also known as an important predictor of early mortality after STAAD surgery [2]. Other important predictors of mortality are the presence of preoperative malperfusion syndrome and hemodynamic instability (shock, hypotension, cardiac tamponade) at the time of admission. The presence of patients in shock or cerebral and gastrointestinal malperfusion before STAAD surgery will increase in-hospital mortality. In addition, the Penn classification, which also includes different organ malperfusion, is an important predictor of early mortality after STAAD operations [3].

Prolonged mechanical ventilation was found to be a significant predictor of in-hospital mortality in the study [1]. The cause of prolonged mechanical ventilation after STAAD surgery may be cerebrovascular problems that develop due to operative management. Antegrade and retrograde brain protection methods can be used in surgeries involving the aortic arch. Failure to complete these applications at the specified body temperatures and within the specified periods may lead to significant problems. In addition, the complexity of the surgery on the aortic arch may also affect early mortality [4].

Stanford Type A aortic dissection affects the ascending aorta and can spread to the descending aorta and aortic arch. It can be referred to as DeBakey type II if it just extends to the ascending aorta, and DeBakey type I if it extends from the ascending aorta to the distal aorta. In hemodynamically stable DeBakey type II dissection, the operation can be completed easily and with a high success rate under a single aortic cross-clamp. In DeBakey type I dissection, the operation can be more complicated depending on malperfusion in the distal structures and the status of the aortic arch. In a study conducted in this direction, in-hospital mortality was found to be three times less after De