Journal of Clinical Hypertension最新文献

To assess the effectiveness and safety of Sacubitril/Valsartan in reducing blood pressure in individuals with non-dialysis-dependent chronic kidney disease (NDD-CKD) Stage 3–5 complicated by hypertension. This study was a multicenter retrospective analysis conducted from March 1, 2022 to March 31, 2024, involving adult patients with NDD-CKD Stage 3–5 and hypertension, who received Sacubitril/Valsartan either as a monotherapy or in addition to current antihypertensive treatments that were insufficient. The main outcomes measured were blood pressure control, changes in blood pressure and laboratory parameters within 8 weeks post-treatment initiation, and incidence of adverse events. The study included a total of 459 individuals with NDD-CKD Stage 3–5 and hypertension. At the study endpoint, mean systolic blood pressure, diastolic blood pressure, and pulse pressure were markedly reduced compared to baseline (all p < 0.001). The average blood pressure reductions were 12.17 (4.66, 22.00), 6.00 (0.67, 12.66), and 6.67 (0.08, 14.00) mmHg, respectively. Throughout the study period, 96 patients (20.92%) with NDD-CKD Stage 3–5 developed worsening renal function, 15 patients (3.27%) developed hyperkalemia, and 49 patients (10.68%) experienced symptomatic hypotension. Overall, there were no significant differences in the changes in serum creatinine, estimated glomerular filtration rate, and serum potassium before and after treatment (p = 0.28, p = 0.91, p = 0.61, respectively). Sacubitril/Valsartan significantly lowers blood pressure in patients with NDD-CKD Stage 3–5 complicated by hypertension, with good safety profiles.

Trial Registration: ClinicalTrials.gov identifier: ChiCTR2400086079

Examining the role of resting heart rate (RHR) in hypertension risk could improve our understanding of its pathogenesis. However, most relevant studies have been conducted in developed countries such as the United States and Brazil, with no evidence for the older Chinese population. Therefore, this study aimed to investigate the association between RHR and the risk of developing hypertension in an older Chinese population. A total of 3836 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this prospective study. Using Cox proportional hazard models, the association between RHR and the risk of incident hypertension was evaluated, with results expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). Multiplicative interaction effects were analyzed for RHR with age, sex, and regular exercise, and subgroup analyses of the association were also conducted based on these factors. Sensitivity analyses were conducted to evaluate the robustness of the results. During a 4.86-year follow-up, 1449 incident cases of hypertension occurred. Every 10 beats per min increase in RHR was associated with a 6% higher risk of incident hypertension (HR = 1.06, 95% CI: 1.01–1.12). Subgroup analyses demonstrated significant associations in women, participants aged ≥80, and those who did not exercise regularly. The sensitivity analyses confirmed the consistency of these results. These findings indicate that a faster RHR is associated with a higher risk of incident hypertension in the older Chinese population, suggesting its potential use in identifying older individuals at greater risk of incident hypertension.

Prognostic significance of the timing in the cardiac cycle of the first (TP1) and second (TP2) systolic peak of the central aortic pulse wave is ill-defined. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of adverse health outcomes associated with TP1 and TP2, estimated by the SphygmoCor software, were assessed in the International Database of Central Arterial Properties for Risk Stratification (IDCARS) (n = 5529). Model refinement was assessed by the integrated discrimination (ID) and net reclassification (NR) improvement. Over 4.1 years (median), 201 participants died and 248 and 159 patients experienced cardiovascular or cardiac endpoints. Mean TP1 and TP2, standardized for cohort, sex, age, and heart rate, were 103 and 228 ms. Shorter TP1 and TP2 were associated with higher mortality and shorter TP1 with a higher risk of cardiovascular and cardiac endpoints (trend p ≤ 0.004). The HRs relating total mortality and cardiovascular endpoints to TP2 were 0.82 (95% confidence interval [CI]: 0.72–0.94) and 0.87 (0.77–0.98), respectively. The HR relating cardiac endpoints to TP1 was 0.81 (0.68–0.97). For total mortality and cardiovascular endpoints in relation to TP2, NRI was significant (p ≤ 0.010), but not for cardiac endpoints in relation to TP1. Integrated discrimination improvement (IDI) was not significant for any endpoint. The HRs relating total mortality to TP2 were smaller (p ≤ 0.026) in women than men (0.67 vs. 0.95) and in older (≥ 60 years) versus younger (< 60 years) participants (0.80 vs. 0.88). Our study adds to the evidence supporting risk stratification based on aortic pulse analysis by showing that TP2 and TP1 carry prognostic information.

The aim of this study was to explore whether 24-h ambulatory central (aortic) blood pressure (BP) has an advantage over office central aortic BP in screening for hypertension-mediated target organ damage (HMOD). A total of 714 inpatients with primary hypertension and the presence of several cardiovascular risk factors or complications involving clinical HMOD were enrolled. Twenty-four hour central aortic BP was measured by means of a noninvasive automated oscillometric device (Mobil-O-Graph). Office BP was measured with a validated oscillometric Omron device after a 5-min rest in a sitting position. Central aortic pressure waveforms were derived from the radial pressure waveforms with a validated transfer function of the Sphygmocor software, version 8.0 (Atcor Medical, Sydney, Australia). Carotid–femoral pulse wave velocity (cf-PWV) measurement was performed by sequential placement of the transducer on the femoral artery and carotid artery and determining transit time between the two pulses in reference to the R wave of the ECG. cf-PWV was calculated as the measured distance from the suprasternal notch to the femoral artery minus the distance from the suprasternal notch to the carotid artery divided by the pulse transit time. HMOD was defined as the presence of carotid intima–media thickness (IMT) above normal values and/or carotid plaque, left ventricular hypertrophy (LVH), renal abnormalities as assessed by urine albumin/creatinine ratio (ACR) above normal values and/or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² and/or increased cf-PWV > 10 m/s. In the study cohort of 714 (age 54.52 ± 13.24 years, 74.6% male) patients with primary hypertension, LV mass index (LVMI) was significantly higher in males (p < 0.002) and eGFR was significantly lower in males (p < 0.001). However, there was no statistical significance between males and females in IMT, ACR, and cfPWV. When accounting for confounding factors (age, sex, BMI, triglycerides, total cholesterol, LDL, glucose, smoking, and heart rate), central systolic (cSBP), diastolic (DBP), and pulse (cPP) pressure obtained with 24-h monitoring was more strongly correlated with LVMI than office measurements. Twenty-four hour cSBP and cPP were more strongly correlated with IMT than those of office monitoring. The 24-h augmentation index (AIx) was more strongly correlated with eGFR than office AIX. Twnety-four hour cSBP and cPP were more strongly correlated with lgACR. Office AIx and cPP were more strongly correlated with c-fPWV than 24-h measurements while cSBP, DBP, and cPP obtained by both methods were equally correlated with c-fPWV. Ambulatory central (aortic) pressure may be more strongly related to HMOD than office CAP which may have an advantage in screening for c-fPWV.

Trial Registration: Registration number: ChiCTR2000040308

Dyslipidemia, abnormal levels of lipids in the bloodstream, is associated with cardiovascular disease risk (CVD). The purpose of this study was to evaluate the effects of dyslipidemia on cardiometabolic health in relatively young, healthy adults. Participants were 54 healthy males and females aged 18–60 years. Participants were assessed for anthropometrics, body composition, blood pressure and vascular stiffness indicators, microvascular health, and glucose and lipid levels. Using a cross-sectional approach, participants were characterized and grouped as having dyslipidemia or not, and then statistically assessed to determine whether differences in other cardiometabolic health measures existed between the groups. There were significant differences between groups for body weight and composition (total mass, muscle mass, visceral fat, bone mass, and body mass index, all, p < 0.027, Cohen's d > 0.605) with the dyslipidemia group being higher. There were significant differences between groups for peripheral and central blood pressures (all, p < 0.003, Cohen's d > 0.899), as well as for vascular stiffness indicators (pulse pressure, augmentation pressure, augmentation index, augmentation index 75) (all, p < 0.022, Cohen's d > 0.672) with elevations noted in the dyslipidemia group. Ten-year CVD risk was significantly different between groups, with an average risk of 0.8% in the normal lipids group and a risk of 5.4% in the dyslipidemia group (p < 0.001, Cohen's d = 1.260). However, there were no significant differences in macro- or micronutrient intake between groups (all, p > 0.166, Cohen's d < 0.412). There is a significant impact on cardiometabolic health in individuals with dyslipidemia who are otherwise healthy, which may increase individual risk for CVD.

Trial Registration: ClinicalTrials.gov identifier: NCT06544915.

Red blood cell distribution width (RDW) has recently been recognized as a novel biomarker associated with various cardiovascular conditions. This study aims to investigate the relationship between RDW and carotid–femoral pulse wave velocity (cfPWV) in a southern Chinese population. A total of 4916 patients were initially enrolled from the First Affiliated Hospital of Fujian Medical University between January 2016 and December 2022. Based on the criteria of inclusion and exclusion, 2830 patients were included in this study. Body weight, height, and blood pressure were measured, and clinical biochemical tests were recorded. cfPWV was assessed using a non-invasive automatic device. Spearman's correlation analysis, generalized linear regression analysis, multivariable logistic regression, and stratified analysis were conducted to assess the correlation between RDW and cfPWV. Participants were stratified into four subgroups based on RDW quartiles: Q1 (RDW ≤ 12.80%), Q2 (12.80% < RDW ≤ 13.40%), Q3 (13.40% < RDW ≤ 14.10%), and Q4 (RDW > 14.10%). A significant increase in age, systolic blood pressure, cfPWV, and HbA1c levels was observed with higher RDW quartiles. Both Spearman's correlation analysis and generalized linear regression analysis revealed a significant association between RDW and cfPWV. Specifically, compared to the lowest quartile, the risk of cfPWV≥10 m/s increased by 56% in the highest quartile (odds ratio = 1.564, p < 0.001). This correlation persisted particularly among the elderly, hypertensive patients who were not taking medication, and those who were taking medication but had poor control. The plasma RDW level was significantly associated with cfPWV in a southern Chinese population, particularly among older adults and individuals with hypertension, suggesting RDW as a potential marker for arterial stiffness.

This population-based, nationally representative cross-sectional study assessed the daily salt consumption status and its associated cardiovascular disease (CVD) risk factors using weighted data from the STEPwise approach to noncommunicable disease risk factor surveillance conducted in 2018 in Bangladesh. It included a non-institutionalized adults’ population of 6189 men and women aged 18–69 years. Their daily salt consumption was estimated using the spot urine sodium concentration following the Tanaka equation and reported according to the standard nomenclature proposed by the World Hypertension League and partner organizations involved in dietary salt reduction. Out of a total of 6189 participants, 2.4% consumed the recommended amount of salt (<5 g/day), 67.8% consumed a high amount of salt (≥5–10 g/day), 27.2% consumed a very high amount of salt (>10–15 g/day), and 2.6% consumed an extremely high amount of salt (>15 g/day). In univariate analysis, a higher than recommended level of salt intake (≥5 g/day) was significantly prevalent among rural residents (high = 78.4%, very-high = 81.6%, extremely-high = 84.9%, p = 0.01), literates (high = 51.6%, very-high = 57.9%, extremely-high = 59.1%, p = 0.02), newly diagnosed hypertension (high = 20.6%, very-high = 23.6%, extremely-high = 24.1%, p = 0.008), and overweight/obese (high = 25.9%, very-high = 33.3%, extremely-high = 29.8%, p = 0.000). Similarly, in ordinal logistic regression analysis, the categories of daily salt consumption showed a significant association with rural residence (OR: 1.300, CI: 1.109–1.524, p = 0.001), literates (OR: 0.777, CI: 0.671–0.900, p = 0.001), newly diagnosed hypertension (OR: 1.204, CI: 1.022–1.419, p = 0.026), and overweight/obesity (OR: 1.353, CI: 1.145–1.598, p = 0.000). The current national pattern of salt consumption in Bangladesh may help reconstruct the salt reduction strategy considering the associated risk factors.

This study aimed to assess the efficacy and safety of a combination therapy of Allisartan Isoproxil 240 mg and Amlodipine 5 mg (ALI/AML) compared to AML 5 mg monotherapy in patients with mild-to-moderate essential hypertension. In this phase III, multicenter, double-blind, parallel-group, randomized controlled trial, patients aged 18–70 years with mean sitting systolic blood pressure (msSBP) between 140 and <180 mmHg and mean sitting diastolic blood pressure (msDBP) between 90 and <110 mmHg, following a 4-week treatment with AML 5 mg, were randomized 1:1 to receive either ALI/AML or AML once daily for 12 weeks. This 12-week double-blind period was followed by an open-label extension of ALI/AML treatment through week 52. A total of 300 patients were enrolled, with 149 and 151 patients randomly assigned to ALI/AML and AML groups, respectively. Of these, 257 patients completed the study. Baseline demographics and characteristics were comparable between groups. After 12 weeks, the reduction in msSBP (the primary endpoint) was significantly greater in the ALI/AML group compared to the AML group (–15.7 vs. –10.2 mmHg, p = 0.0019). Similarly, reductions in msDBP (–5.7 vs. –2.4 mmHg, p < 0.001) and 24-h mean ambulatory SBP and DBP (–10.4 and –7.7 mmHg vs. –5.6 and –3.8 mmHg) were more pronounced in the ALI/AML group. Additionally, a higher proportion of patients achieved both a BP response and target office BP in the ALI/AML group compared to the AML group (51.4% vs. 37.4%, 42.5% vs. 30.6%, both p < 0.05). The ALI/AML combination was generally well tolerated, and the antihypertensive effect was maintained for up to 52 weeks. In patients with essential hypertension inadequately controlled by AML, the ALI/AML combination provided superior reductions in msSBP and was significantly more effective than AML monotherapy. This once-daily single-pill combination demonstrated promising efficacy and tolerability.

Trial Registration: ClinicalTrials.gov identifier: NCT06465264

This study evaluated initial antihypertensive drug prescription patterns in Indian healthcare settings. An observational, cross-sectional, prospective prescription registry analyzed prescriptions for 4723 newly diagnosed hypertension patients. Additionally, it investigated the extent to which physicians adhered to either European or Indian hypertension guidelines. Angiotensin receptor blockers (ARBs) were the most commonly prescribed drugs, given to 79% of patients, followed by calcium channel blockers (CCBs) at 55%. Diuretics and beta-blockers (BBs) were prescribed to 27% and 17% of patients, respectively. Monotherapy was administered to 35% of patients, while combination therapies were more prevalent, with dual therapy at 51% and regimens involving three or more drugs prescribed to 14%. Among multi-drug treatments (n = 3082, 65%), 98% received fixed-dose combination tablets. The most common combinations were ARB + CCB (26%), ARB + diuretic (12%), and ARB + CCB + diuretic (8%). Key predictors for an increasing number of prescribed drugs included statin use/dyslipidemia, age, blood pressure level, and diabetes. Non-adherence to hypertension guidelines was evident as 1364 patients classified from moderate to very high risk received monotherapy. Of these, 496 patients had grade 2 or 3 hypertension. Additionally, 88 patients received the undesirable combination of ACEi + ARB, and 267 (15.9%) type 2 diabetes mellitus (T2DM) patients did not receive RAS-blockers (146 on monotherapy). The findings reveal a trend toward utilizing ARBs, CCBs, and combination tablets, indicating improved adherence to guidelines. However, a significant number of patients did not receive appropriate treatment, highlighting areas for improvement in prescription practices.

Individuals' knowledge and attitudes about hypertension are important in controlling blood pressure (BP) and reducing hypertension-related mortality and morbidity. The current study aimed to investigate the effect of hypertension knowledge level on treatment adherence, BP control, and physical activity of hypertensive individuals. This prospective and cross-sectional study was conducted in the Family Medicine clinic of a tertiary healthcare institution between October 2023 and April 2024. The study included 218 patients with essential hypertension. The BP of all patients was measured with a calibrated mercury sphygmomanometer, and the patients were divided into two groups: uncontrolled BP and controlled BP. The Hypertension Knowledge Level Scale (HK-LS), General Practice Physical Activity Questionnaire (GPPAQ), and Modified Morisky Medication Adherence Scale (MMMAS-6) were administered to all participants. Although 40.8% (n = 89) of the patients had their BP under control, 59.2% (n = 129) did not. The median weight of the participants whose BP was not under control was higher than those whose BP was under control (p < 0.05). A significant positive correlation was found between the hypertension knowledge score and the Morisky total score, Morisky motivation, and Morisky knowledge scores. There was a significant negative correlation between the GPPAQ score and both systolic and diastolic BP, as well as a significant positive correlation with hypertension knowledge levels. Assessing the knowledge level of hypertensive patients about their disease, recognizing their lifestyles, and questioning their habits is crucial for recommending individualized health interventions tailored to the needs and characteristics of this population.