Journal of Clinical Hypertension最新文献

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.

This prospective birth cohort study, conducted in China with 21 893 singleton pregnant women, aimed to investigate the association between metabolic obesity phenotypes and the risks of gestational hypertension (GH) and preeclampsia (PE), as well as to explore the potential interaction between obesity and metabolic abnormalities in relation to these conditions. Participants were categorized according to their pre-pregnancy BMI and metabolic status into different obesity metabolic phenotypes. The diagnosis of GH and PE was based on blood pressure measurements, evidence of end-organ dysfunction, or proteinuria occurring after 20 weeks of gestation. The results indicated that, compared to metabolically healthy normal-weight women, those with metabolically unhealthy normal weight, metabolically healthy overweight/obesity, and metabolically unhealthy overweight/obesity all had significantly elevated risks for both GH (with adjusted odds ratios ranging from 1.77 to 3.89) and PE (adjusted ORs from 1.58 to 4.51). In contrast, metabolically healthy underweight women were found to have a lower risk of GH. Furthermore, an additive interaction was observed between overweight and metabolic unhealthiness, which increased the risk of GH by 1.15 times, representing a 28% relative excess risk. The combined risk for women exposed to both factors was 1.58 times greater than the risk associated with either factor alone. In conclusion, both metabolic abnormalities and overweight/obesity elevate the risks of GH and PE, and a significant interaction effect exists between these two factors.

This study investigated whether patients receiving renin-angiotensin system inhibitors (RASIs) can undergo reliable screening for primary aldosteronism (PA) without discontinuation of therapy. Consecutive patients with hypertension who underwent PA screening at our hospital between 2016 and 2024 while on RASIs were recruited. Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured at three time points: pre-washout, post-washout, and post-captopril-challenge test (CCT). Subsequently, the aldosterone-to-renin ratio (ARR) was calculated, and PAC, DRC, and ARR were compared across time points. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal diagnostic cutpoints. A total of 412 patients on RASIs, with or without calcium-channel blockers (CCBs) or α1-receptor antagonists, were analyzed. Among these, 175 had PA and 237 had essential hypertension (EH). PAC, DRC, and ARR were significantly different between the PA and EH groups across all three time points. Within the PA cohort, PAC (p < 0.001) and ARR (p = 0.016) differed significantly between the pre-washout and post-CCT measurements, whereas DRC did not (p = 0.456). The optimal pre-washout ARR cutpoint of 2.69 demonstrated a sensitivity of 83.3%, specificity of 87.2%, positive predictive value (PPV) of 82.2%, and negative predictive value (NPV) of 88.1% for diagnosing PA. These findings indicate that pre-washout PAC, DRC, and ARR retain high diagnostic performance for PA in patients treated with RASIs, provided that other agents affecting the renin-angiotensin-aldosterone system are not co-administered.

Hypertension is considered a potential risk factor for perioperative ischemic stroke (PIS). However, the association between elevated first systolic blood pressure measured in the operating room (first-OR-SBP) and the incidence of PIS has not been well documented. We conducted a single-center retrospective cohort study including patients who underwent elective non-brain, non-cardiac surgery at Peking University First Hospital between January 1, 2018, and December 31, 2024. Data were extracted from a perioperative database, and patient demographics, intraoperative and perioperative variables—particularly the relationship between first-OR-SBP and PIS—were analyzed. Multivariate logistic regression was performed before and after propensity score matching to adjust for perioperative confounders. The minimum p value approach was used to identify a potential threshold of first-OR-SBP independently associated with PIS risk. We found that, among 105 059 surgeries, 195 patients (0.19%) experienced PIS. The threshold for first-OR-SBP associated with PIS was identified as 186 mm Hg. The adjusted odds ratios for PIS were 1.69 (95% CI, 1.12–2.55; p = 0.013) before matching and 1.62 (95% CI, 1.03–2.54; p = 0.036) after propensity score matching. We conclude that a first-OR-SBP≥186 mm Hg was significantly associated with an increased risk of perioperative ischemic stroke in patients undergoing elective non-brain, non-cardiac surgery.