Journal of Clinical Hypertension最新文献

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.

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.