Journal of Clinical Hypertension最新文献

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.

This study aimed to elucidate the temporal trends and distribution characteristics of the cardiovascular disease (CVD) burden attributable to high sodium intake, while forecasting future shifts by 2030 in this disease burden to inform resource allocation and the development of health policies. We calculated the estimated annual percent change (EAPC) and project future disease burden using the general additive model. Global data for 2021 revealed that the age-standardized mortality rate of CVD attributable to high sodium intake was 20.40 per 100 000 population, and the DALY rate was 437.70 per 100 000 population. By 2030, Southeast Asia, East Asia, and Oceania are projected to have the highest age-standardized mortality and DALY rates at 36.8 and 756.33 per 100 000 population, respectively. Concurrently, the GBD super regions Southeast Asia, East Asia, and Oceania are anticipated to exhibit the second smallest reductions in these metrics, with declines of 6.84% and 7.85%, a performance surpassed only by Sub-Saharan Africa, where the respective reductions are projected to be 5.89% and 6.81%. Considering the large population size of Southeast Asia, East Asia, and Oceania, the burden of CVD attributable to high sodium intake is expected to remain the most severe globally. The worldwide burden of CVD attributable to high sodium intake remained significant and displays marked variability across different geographical regions and age groups. Given the disparities in dietary habits and genetic predisposition to sodium sensitivity, it is essential to focus on facilitating tailored interventions aimed at curbing excessive salt intake, thereby alleviating the CVD burden.

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.