Journal of Clinical Hypertension最新文献

In this study, we investigated the applicability of the ankle–brachial index (ABI) and brachial–ankle index (BAI) in distinguishing aortic stenosis (AS) from lower-extremity arterial stenosis. The difference between the ABI on both sides (∆ABI) was defined as the absolute value of the left ABI minus the right ABI. Lower BAI (L-BAI) was defined as the value of the side with the lowest BAI. We obtained four-limb blood pressure measurement data from 6435 patients. AS and bilateral lower-extremity arterial stenosis (BLEAS) were diagnosed. The performance of combined bilateral ABI decline, ΔABI, and L-BAI in diagnosing AS was evaluated. The control group showed normal bilateral ABI values, whereas the AS and BLEAS groups exhibited a bilateral ABI decline. The BLEAS group had the highest ∆ABI compared to the other groups. L-BAI in the BLEAS and AS groups was higher than that in the control group. AS screening using bilateral ABI ≤0.90 combined with ΔABI ≤0.10 and L-BAI >1.00 yielded an area under the receiver operating characteristic curve of 0.873 and a Youden index, sensitivity, and specificity of 0.724, 85.2%, and 87.2%, respectively. Validation in 1004 patients revealed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 90.0%, 96.0%, 54.2%, 99.5%, and 95.7%, respectively. In conclusion, combining bilateral ABI ≤0.90, ∆ABI ≤0.10, and L-BAI >1.00 can effectively screen for AS; this is useful in distinguishing AS from BLEAS, especially in cases of bilateral decline in lower-extremity ABI values.

The aim of this study was to evaluate the accuracy of the single upper-arm cuff oscillometric blood pressure (BP) monitor RBP-9000 c developed for office and home blood pressure measurement in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060–2:2018). Subjects were recruited to fulfill the age, gender, BP, and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in the general population using the same-arm sequential BP measurement method. The test device incorporates a single built-in cuff suitable for 17–42 cm arm circumference. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 2.4 ± 6.7/3.3 ± 6.3 mmHg (systolic/ diastolic). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5.28/5.32 mmHg (systolic/diastolic). The RBP-9000c oscillometric device for office and home BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018) in the general population and can be recommended for clinical and self-use at home.

Trial Registration: ChiCTR2300075747

The cardio–ankle vascular index (CAVI) and accelerated photoplethysmography (APG) are noninvasive methods for assessing arteriosclerosis, but differences in measurement principles and anatomical targets may lead to discrepancies in reported values. This study evaluated the correlation between CAVI and APG and identified factors contributing to inconsistent results. A retrospective chart review was conducted for patients who underwent both examinations between 2021 and 2023. Right and left CAVI and APG wave types were classified as normal, borderline, or abnormal, and participants were grouped (G0–G3) based on combined results. Clinical data including demographics and medical history were analyzed. Pearson correlation analysis showed statistically significant but modest positive correlations between CAVI and APG in all participants (Right: r = 0.261; Left: r = 0.235; both p < 0.001). In males, correlations were slightly stronger (Right: r = 0.298; Left: r = 0.280; both p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated only modest discriminatory ability of APG for identifying high arterial stiffness defined as CAVI ≥ 9 (AUC 0.59–0.66). Subgroup analysis revealed that age was the only significant factor associated with abnormal results in males. In females, age and diabetes were associated with abnormal findings in both CAVI and APG, while age and hypertension (HTN) were associated with abnormal CAVI despite normal APG. Although CAVI and APG reflect different aspects of vascular health, they provide complementary information in clinical evaluation. Sex-specific risk factors, particularly age, diabetes, and HTN in females, should be considered when interpreting these vascular assessments.

Young and middle-aged adults with hypertension develop the disease earlier and accrue longer exposure to elevated blood pressure, conferring higher lifetime cardiovascular risk. However, reliable markers predicting long-term major adverse cardiovascular events (MACEs) in this group remain unclear. Insulin resistance (IR) is crucial to hypertensive pathophysiology, but direct measurement is impractical. We evaluated the prognostic value of three laboratory-derived IR indices, the triglyceride—glucose (TyG) index, the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C), and the metabolic score for IR (METS-IR), in predicting MACEs. In this retrospective cohort of 4861 patients aged 18–65 years with primary hypertension, baseline indices were calculated and classified into tertiles. Patients were followed for a median of 73 months, during which 372 MACEs occurred. Multivariable Cox regression showed that higher TyG, TG/HDL-C, and METS-IR were independently associated with increased MACEs risk. In fully adjusted models, each standard deviation increase in METS-IR conferred a 55.7% higher risk (HR = 1.557, 95% CI: 1.154–2.101, p < 0.01), and patients in the highest tertile had more than double the risk vs. the lowest. METS-IR showed superior discrimination (AUC = 0.803, 95% CI: 0.774–0.886) and significant net reclassification improvement (NRI = 0.147, 95% CI: 0.073–0.239, p = 0.001) and integrated discrimination improvement (IDI = 0.006, 95% CI: 0.002–0.010, p = 0.002), whereas TyG showed borderline benefit and TG/HDL-C offered no incremental value. These findings highlight METS-IR as a pragmatic predictor of long-term cardiovascular risk in younger hypertensive patients, supporting its integration into clinical risk stratification.

The Arterial Stiffness Index (AASI) is a calculation obtained through Ambulatory Blood Pressure Monitoring (ABPM), and is an indirect measure of the elastic properties of the arterial wall; but there is heterogeneity in its scope as a predictor of vascular wall health. A comparison is made between linear regression and exponential regression of the AASI, as well as an analysis of variance, according to circadian patterns and pulse pressure (PP) values. This work is an analytical observational study in 106 individuals, most of them women (63%) with a mean age of 53 ± 17.32 years. The coefficient of determination (r2) for the linear relationship was 0.53 ± 0.17, similar to the exponential relationship with an r² of 0.52 ± 0.17 (p = 0.7032). Patients with PP < 52 mmHg had an AASI of 0.3839 ± 0.1428 and for PP > 53 mmHg an AASI of 0.5330 ± 0.1108 (p < 0.0001). When comparing the AASI between Dipper vs. Riser circadian patterns, there was homoscedasticity (p = 0.3717); on the contrary, in the intergroup evaluation with Non-Dippers, heteroscedasticity was observed (Dipper vs. Non-Dipper; p = 0.0316 and Non-Dipper vs. Riser; p = 0.01978). This study concludes that the best determination of AASI is linear regression, robustly correlating with the values of PP > 53 mmHg and AASI > 0.5 (r = 0.9628). The behavior of the data in the Non-Dipper group is heterogeneous, probably due to their own physiological characteristics. In addition, AASI could be an indirect measure of arterial stiffness and be more directly associated with arterial elasticity and its deformation capacity.

Prediabetes is the period in which serum glucose levels begin to rise but do not yet meet the criteria for diabetes. Non-dipper blood pressure (BP) is related to a significant increase in cardiovascular disease (CVD) and organ damage compared to those with dipper BP in hypertensive individuals. Inflammation plays a role in the development of atherosclerosis and CVD. The data on whether nighttime status is important in normotensive individuals are limited. We aimed to investigate the relationship between dipper and non-dipper BP status and inflammatory parameters in normotensive patients with prediabetes. The study had a cross-sectional design. Of the 208 prediabetic and normotensive individuals included in the study, 90 were in the dipper BP group, and 118 were in the non-dipper BP group. In all subjects, the collection of venous peripheral blood samples was performed on admission. The two groups exhibited similar clinical baseline characteristics. C-reactive protein (CRP) and systemic immune-inflammation index (SII) were significantly higher in the non-dipper BP group (CRP: 7.19 ± 4.01 vs. 6.20 ± 4.32 mg/L, p = 0.043; SII: 782.79 vs. 613.43, p = 0.014). In the logistic regression analysis, SII was independently associated with non-dipper BP status [OR = 1.001, CI (1.000–1.001), p = 0.017]. In prediabetic patients, non-dipper BP status may be associated with inflammation and, consequently, increased CVD risk, even in normotensive individuals. Identifying factors that increase the risk in prediabetic patients may be important in terms of improving their future cardiovascular health.

This retrospective cohort study assessed the effect of COVID-19 infection on blood pressure variability (BPV) and cardiovascular outcomes in hypertensive patients using 24-h ambulatory blood pressure monitoring and structural equation modeling (SEM). Among 318 patients followed for 2 years, those with infection and poor prognosis showed the most abnormal hemodynamic patterns, including markedly elevated nocturnal SBP load (70.0% vs. 50.1%), higher ARVDBP (9.8% vs. 8.2%), wider pulse pressure (60.9 mmHg), and lower time in target range (30.9% vs. 74.7%, p < 0.001). Cox regression identified infection status, nocturnal BP load, and BP variability as major risk factors, while multivariate models confirmed 11 independent predictors. Neither diabetes nor antihypertensive medication class modified these associations. SEM demonstrated that infection influenced prognosis indirectly through elevated nighttime BP level, load, and variability (indirect effect β = 0.098, p < 0.001). Mechanistically, infection-driven endothelial dysfunction, microthrombotic activation, and autonomic dysregulation, rather than prolonged inactivity, likely underlie the nocturnal amplification of BP instability. These findings support the need for individualized hypertension management during and after infection, focusing on renin–angiotensin system balance, continuation of ACEI/ARB therapy, nighttime dosing of long-acting agents, and circadian BP monitoring to mitigate long-term cardiovascular risk.

Branch atheromatous disease (BAD)-related stroke shows distinct prognostic features from other stroke subtypes, with modifiable prognostic factors remaining inconclusive. The present research investigated the association between systolic blood pressure variability (BPV) and 90-day functional outcomes of BAD-related stroke. We enrolled 423 patients (median age 60 years; 70.2% male) with radiologically confirmed BAD from a prospective multicenter study in China. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) of systolic blood pressure measurements during hospitalization. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2. The secondary outcome was early neurological deterioration (END) within 7 days. Multivariable logistic regression models were used to evaluate the association between BPV and outcomes. Subgroup and sensitivity analyses were conducted. Overall, 13.9% of patients experienced poor functional outcome. A higher BPV was associated with increased risk of END. Compared with the lowest tertile, patients in the highest tertile of systolic BPV had a significantly increased risk of poor functional outcome (OR: 3.10 for SD, 2.77 for CV, and 2.97 for VIM; all p < 0.05, p for trend <0.05 for all indices). Sensitivity analysis and subgroup analysis results were consistent with the primary findings. In conclusion, elevated systolic BPV during the acute phase is independently associated with END and poor 90-day functional outcome in BAD-related stroke, highlighting the importance of BPV monitoring and blood pressure stabilization in the management of BAD-related stroke.

Screening for primary aldosteronism (PA) remains exceedingly low, despite the fact that the disorder contributes to or underlies hypertension (HT) in as many as 20% of unselected patients. Conventionally, withdrawal of medications interfering with the renin‒angiotensin‒aldosterone system (RAAS) has been recommended before PA work-up. Previous research showed that combining objective thresholds and 2-day cosyntropin suppression was highly accurate in diagnosing PA among HT patients off interfering drugs. Here, we present the protocol of a study designed to generate and temporally validate aldosterone-to-renin ratio (ARR) thresholds following overnight cosyntropin suppression in PA screening on interfering medications. We hypothesize that overnight cosyntropin suppression with 1 mg dexamethasone will result in 25% higher diagnostic interpretability compared to conventional ARR testing. This single-center study consists of a development and confirmation cohort (both n = 80). Patients with an adrenal incidentaloma are enrolled in a 1-day clinic. Aldosterone-to-renin ratios (ARRs) are determined before and after overnight intake of 1 mg dexamethasone (DXM) on, partially off, and off medications interfering with the RAAS. Emphasis on screening and limitation of PA confirmatory (suppression) tests have been included in the current Endocrine Society guideline on PA due to low evidence of benefits of the latter in diagnosing the disorder. In light of poor PA screening rates, the ODEPRASC study may provide a rationale for an optimized diagnostic approach.

Trial Registration: ClinicalTrials.gov identifier: NCT06740838.