Journal of Clinical Hypertension最新文献

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.

To the Editor:

We read with great interest the study by Li et al., which examined the long-term outcomes of percutaneous transluminal renal angioplasty with stenting in unilateral atherosclerotic renal artery occlusion (RAO) [1]. The investigators should be commended for directly comparing successful versus failed revascularization in a well-characterized cohort and for including dialysis-free and event-free survival curves over a median follow-up period of nearly 30 months. The findings suggesting improved renal preservation after successful stenting provide valuable insights into interventional decision-making in this challenging population. However, several methodological and interpretive issues merit consideration to contextualize these conclusions in the present study.

First, the grouping of the study by procedural outcome rather than by randomized allocation introduced a substantial baseline imbalance. Patients in the failed stenting arm had a lower estimated glomerular filtration rate (eGFR) and a higher renal resistive index (RI) before the intervention, both markers of irreversible parenchymal injury [2]. This selection bias may have exaggerated the apparent protective effect of successful stenting. A propensity-weighted or covariate-adjusted survival analysis could clarify whether the observed differences in major adverse cardiovascular or renal events (MACRE) truly reflect procedural benefits rather than baseline disease severity. Clinically, this distinction determines whether stenting should be viewed as restorative or merely prognostic in nature.

Second, the study defined renal benefit through serum creatinine and eGFR changes without accounting for single-kidney function. Since unilateral RAO often coexists with compensatory hyperfiltration of the contralateral kidney, global eGFR improvements may not represent the recovery of the treated kidney [3]. Incorporating split-renal scintigraphy or duplex-derived flow indices at follow-up would better delineate parenchymal rescue versus contralateral adaptation, which has implications for patient selection and counseling in the future.

Third, reliance on the composite MACRE endpoint from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial may have limited clinical specificity. Death, myocardial infarction, and renal replacement therapy (RRT) capture distinct pathophysiological trajectories. Parsing cardiovascular events from renal components could reveal whether stenting mainly delays dialysis initiation or modifies systemic vascular risk [4]. Translationally, this distinction affects whether the intervention should be considered renal protective or cardiorenal integrative therapy.

Finally, the potential predictive value of preprocedural RI, which is markedly elevated in failed cases, warrants formal validation. Integrating RI thresholds with dynamic imaging modalities, such as bloo

Nocturnal blood pressure is a significant predictor of cardiovascular risk, but traditional ambulatory blood pressure monitoring (ABPM) can disrupt sleep. This study aimed to validate the accuracy of the Huawei Watch D2 (WD2), a wrist-worn oscillometric device, and assess its impact on sleep quality compared to conventional ABPM. This prospective, single-center trial first validated the WD2 against a mercury sphygmomanometer in 85 participants according to ANSI/AAMI/ISO 81060-2:2018 standards in both seated and supine positions. Subsequently, the device's nocturnal accuracy and sleep impact were compared against a traditional ABPM device in 46 participants over a three-night protocol. The WD2 met all ISO accuracy standards. During nighttime monitoring, there was no significant difference between the WD2 and ABPM for mean systolic or diastolic blood pressure. However, the number of awakenings was significantly lower on nights with the WD2 alone compared to nights with the ABPM device (p = 0.016). In conclusion, the Huawei Watch D2 is a clinically validated device that provides nocturnal blood pressure readings comparable to traditional ABPM with the significant advantage of minimal sleep disruption, positioning it as a valuable alternative for nocturnal hypertension monitoring.

This study aimed to investigate the associations between health-related physical fitness (HPF) indicators and hypertension (HTN) risk among adults living in sub-plateau regions and to explore gender-specific differences, providing empirical evidence for cardiovascular health promotion and intervention. A cross-sectional study was conducted from 2020 to 2022 in Ningxia, China, recruiting 3026 adults aged 20–59 years (1328 males and 1698 females). Ten HPF indicators across five dimensions, including body composition (body mass index, BMI; waist-to-hip ratio, WHR; waist-to-height ratio, WHtR), cardiorespiratory endurance (vital capacity, VC), muscular strength (grip strength, GS; back strength, BS; vertical jump, VJ), muscular endurance (push-ups/knee push-ups, PU/KPU; sit-ups, SU), and flexibility fitness (sit-and-reach, SAR). Binary logistic regression was used to identify HTN-related indicators, and receiver operating characteristic (ROC) analyses were performed to evaluate their predictive ability. The results showed that the prevalence of HTN was 26.75% in males, significantly higher than 18.36% in females (p < 0.05), both lower than the national average (males: 36.8%, females: 26.3%). Regarding the association, in males, BMI (odds ratio, OR = 1.120) and WHtR (OR = 1.673) were positively associated with HTN risk (p < 0.05), whereas SAR (OR = 0.975) showed a negative association (p < 0.05). In females, WHR (OR = 1.240) was positively associated with HTN (p < 0.05), while SU (OR = 0.960) showed a negative association (p < 0.05). ROC analysis indicated that WHtR and WHR were the best single predictors for males (area under the curve, AUC = 0.662) and females (AUC = 0.633), respectively, while combined indicators (BMI + WHtR + SAR in males; WHR + SU in females) further improved discrimination (AUC = 0.679 and 0.655). In conclusion, adults in the sub-plateau region exhibited a lower prevalence of HTN with notable gender differences. WHtR and WHR are the most valuable gender-specific screening indicators, and combined indices enhance predictive accuracy, offering practical guidance for early HTN prevention and management in sub-plateau populations.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality globally. Emerging evidence suggests that inflammation plays a pivotal role in the pathogenesis of atherosclerosis and subsequent cardiovascular events. Traditional treatments primarily focus on lipid-lowering and antithrombotic strategies; however, these approaches do not fully address the inflammatory component of CVD. Recent advancements have highlighted the potential of targeted anti-inflammatory therapies in mitigating cardiovascular risk. This review explores the efficacy and safety of these novel therapeutic agents. Interleukin (IL)-1β inhibitors, such as canakinumab, have shown promising results in reducing recurrent cardiovascular events in post-myocardial infarction patients. By directly modulating inflammatory pathways, canakinumab significantly lowered the incidence of major adverse cardiovascular events (MACE) independent of lipid levels. Similarly, colchicine, an ancient anti-inflammatory drug, has gained renewed interest due to its efficacy in reducing cardiovascular events in patients with chronic coronary disease and recent myocardial infarction. Furthermore, emerging therapies targeting other inflammatory mediators like IL-6 and tumor necrosis factor-α are under investigation, offering additional avenues for intervention. Despite these advancements, challenges such as identifying appropriate patient populations, long-term safety, and cost-effectiveness remain. Ongoing research aims to refine these therapies, ensuring a balance between risk reduction and adverse effects. In conclusion, targeted anti-inflammatory therapy represents a promising adjunct to traditional CVD treatments, potentially revolutionizing the management of cardiovascular events. Future studies are essential to optimize these strategies and fully integrate them into clinical practice, enhancing outcomes for patients with CVD.

This study aims to investigate the impact of exacerbated systemic inflammatory status on the degree of myocardial fibrosis and strain impairment in hypertensive patients with preserved ejection fraction, as well as the role played by epicardial adipose tissue (EAT) in this process. A total of 236 hypertensive patients who underwent cardiovascular magnetic resonance (CMR) and blood routine examinations at two medical centers in China were included. Thirty healthy volunteers were included as the control group. Compared with the low systemic inflammatory response index (SIRI) group, patients in the high SIRI group exhibited greater EAT volume, higher Native T1 value, and increased extracellular volume (ECV) (all p < 0.01). Additionally, significant differences were observed between the two groups in cardiac MRI parameters (all p < 0.001). Hypertensive patients had a significantly higher SIRI than healthy controls (p < 0.001). Binary logistic regression analysis indicated that SIRI and indexed EAT volume were independently associated with high ECV value (SIRI: p < 0.001; indexed EAT volume: p < 0.001), with results remaining stable after adjusting for confounding factors. Furthermore, mediation analysis showed that even after adjusting for confounding factors, EAT continued to play a role in SIRI-mediated changes in ECV (indirect effect: 0.1773 [95% CI 0.0173–0.3147]). HTN may contribute to the increase in systemic inflammatory severity. The relationship between the degree of myocardial fibrosis and the severity of systemic inflammatory status in patients with early HTN is mediated by EAT. Early mitigation of systemic inflammatory status in patients with early-stage HTN can reduce the adverse effects of EAT, thereby alleviating myocardial fibrosis and strain impairment.

Patients with hypertension (HTN) face an increased risk of complications and mortality from influenza; a risk that may be modified by influenza vaccination. There is limited evidence on the effectiveness of high-dose (HD-IIV) compared with standard-dose (SD-IIV) inactivated influenza vaccines in hypertensive individuals. This study, a post hoc analysis of DANFLU-1, a pragmatic, and open-label, individually randomized trial of HD-IIV vs. SD-IIV conducted during the 2021–2022 influenza season among participants aged 65–79 years. Prespecified outcomes in DANFLU-1 included hospitalization for influenza or pneumonia, cardiovascular, cardiorespiratory, and respiratory hospitalizations, all-cause hospitalization, and all-cause mortality. Outcomes were analyzed as both time-to-first and recurrent events. DANFLU-1 randomized 12 477 participants randomized to HD-IIV or SD-IIV, of these 6469 (51.9%) had a history of HTN. HD-IIV was associated with lower hazards for hospitalizations for pneumonia or influenza, respiratory disease, and all-cause mortality compared with SD-IIV and these associations were consistent regardless of HTN status (p_interaction = 0.09, = 0.09, and = 0.59, respectively). HD-IIV was associated with lower incidence rates of recurrent hospitalizations for pneumonia or influenza and all-cause hospitalizations compared with SD-IIV, irrespective of HTN status (p_interaction = 0.09 and = 0.75, respectively). There was evidence of potential effect modification of HD-IIV vs. SD-IIV in relation to recurrent respiratory hospitalizations, where the relative effect may be greater among those without vs. with HTN (p_interaction = 0.04). In conclusion, this post hoc analysis of a large-scale pragmatic trial, HD-IIV was associated with lower risk of clinical outcomes, including hospitalizations for pneumonia or influenza, all-cause mortality, and all-cause hospitalizations irrespective of the presence of HTN.

Trial Registration: ClinicalTrials.gov identifier: NCT05048589

Hypertensive disorders in pregnancy (HDP) are a major cause of maternal and perinatal morbidity and mortality. The impact of HDP on labor stage duration and maternal and neonatal outcomes in nulliparous women remains unclear. To assess labor stage duration and maternal and neonatal outcomes in nulliparous women with HDP. A retrospective cohort of 31 472 singleton pregnancies from January 2018 to December 2023 at the Obstetrics and Gynecology Hospital of Fudan University was analyzed using 1:4 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Labor stage durations and maternal and neonatal outcomes were analyzed between women with and without HDP. HDP pregnancies had shorter first and total labor stages but longer second and third stages. The HDP group also had higher oxytocin (OCT) use, reduced fetal distress, intrapartum fever, and increased postpartum hemorrhage. Subgroup analysis by labor onset showed that for spontaneous onset, the HDP group had a significantly shorter first stage and total labor duration, with a significantly longer second and third stage duration. In subgroup analysis by HDP type, among pregnancies with spontaneous onset, those with superimposed preeclampsia on chronic hypertension had the shortest labor duration, followed by gestational hypertension and preeclampsia groups, with chronic hypertension alone showing the longest. Similarly, in the induced labor subgroup, gestational hypertension had the shortest duration, followed by superimposed preeclampsia and preeclampsia, with chronic hypertension again exhibiting the longest. The study indicates HDP affects labor duration, with implications for obstetric policies and childbirth safety.

For over half a century, the scientific community has been trying to optimize the tools to classify the risk of future fatal and non-fatal cardiovascular (CV) disease in the general population as well as in different clinical settings (i.e., diabetes, hypertension, obesity). A milestone in this journey is represented by the Framingham Heart Study begun in 1948, in which factors such as age, gender, cigarette-smoking, blood cholesterol, high-density lipoprotein (HDL) cholesterol, systolic blood pressure (BP), left ventricular hypertrophy (LVH), and diabetes mellitus have been used for the prediction of coronary artery disease (CAD) in a population-based cohort of 5573 participants (53% men) aged 30 to 74 years at baseline [1]. Estimates generated from the Framingham data showed that the 10-year incidence of CAD in a hypothetical 42-year-old adult increased progressively from 5.2% and 2.8% in men and women, respectively, with a single risk factor, to approximately 40% in both sexes with six risk factors.

Starting from the experience of the Framingham study, numerous CV risk prediction models have been developed and validated in recent decades to stratify individuals into various risk categories. The rationale behind CV risk stratification is to identify high-risk patients deserving prompt and more aggressive intervention, thus personalizing the intensity of lifestyle and risk factor management [2, 3]. In this perspective, several risk assessment tools have reached clinical relevance and have been incorporated in the current guidelines for the prevention of CV diseases.

Addressing the issue of CV risk assessment, the International and European guidelines on arterial hypertension underline that hypertension-mediated organ damage (HMOD) is a condition that identifies a high CV risk regardless of BP levels and conventional risk factors [4-6]. Consequently, these guidelines provide, through ad hoc tables and/or figures, incisive information on high CV risk conditions that include cardiac and extracardiac HMOD, warranting BP-lowering treatment. This practical approach has the merit of making the risk stratification algorithm easier and more applicable in everyday clinical practice.

Extending the landscape on the clinical significance of CV risk assessment methods, the study by Palomo-Piñón et al. [7] provides new insights into this area of research, comparing the prevalence of CV risk categories using three validated equations (Globorisk, SCORE2, and PREVENT) and assessing their association with HMOD in adult patients with hypertension. For this purpose, cross-sectional data of 4512 hypertensive patients (mean age 64 years, 61% women, BMI 28.8 kg/m², 38% with type 2 diabetes) from primary care enrolled in the Registry of Arterial Hypertension in Mexico were analyzed. The prevalence of CV risk categories varied widely across three risk equations, and this was also the case