Journal of Clinical Hypertension最新文献

While both cardiovascular health (CVH) and urinary albumin-to-creatinine ratio (UACR) are individually associated with mortality, their combined prognostic significance and potential mechanistic interplay in adults with hypertension remain unclear. This cohort study analyzed data from 9154 hypertensive adults in the National Health and Nutrition Examination Survey 2007–2018. CVH was assessed using the American Heart Association's Life's Essential 8 score, and UACR was measured from spot urine samples. Multivariable Cox proportional hazards models, restricted cubic spline analyses, joint exposure modeling, and causal mediation analysis were used to evaluate the independent, combined, and mediating effects of UACR and CVH on all-cause mortality. Both lower CVH scores and higher UACR levels were independently associated with increased mortality. A nonlinear association was observed for each. Individuals with severely elevated UACR and poor CVH had the highest mortality risk (HR = 6.61; 95% CI, 3.72–11.74), while those with normal UACR (<10 mg/g) showed no significant mortality difference across CVH strata. Notably, even mildly elevated UACR (10–29.9 mg/g), considered within the conventional “normal” range, was associated with significantly increased mortality. Mediation analysis revealed that UACR explained 4.01% (95% CI, 2.83%–6.40%; p < 0.001) of the association between CVH and mortality. This study is the first to demonstrate that UACR not only modifies but also mediates the association between CVH and mortality in individuals with hypertension. These findings underscore the prognostic value of integrating renal and cardiovascular metrics and suggest that even low-grade albuminuria has clinical relevance.

To the Editor:

We thank Bashir et al. for their interest in our article and for the constructive comments. We respond point by point, citing pertinent literature and our own results.

First, we agree that retrospective cohort studies are susceptible to selection bias and unmeasured confounding. To mitigate these risks, we applied strict inclusion and exclusion criteria (e.g., exclusion of any baseline target organ damage [TOD]) and adjusted for established confounders (age, sex, blood pressure, and comorbidities). We explicitly acknowledged in the discussion that a single-center, retrospective design limits control of residual confounding. Even so, we consider our findings valuable preliminary evidence. As noted in our article, future multicenter, prospective, large-scale studies are warranted to validate these findings, and we plan such studies to minimize bias and better assess causality.

Second, regarding TyG-BMI as a surrogate for insulin resistance (IR): we agree that the hyperinsulinemic–euglycemic clamp is the gold standard, but it is impractical for large human cohorts. Consequently, simple non-insulin-based indices are commonly used. A systematic review of the TyG index reported moderate diagnostic accuracy versus the clamp (AUC, 0.59–0.88 across studies) [1]. Evidence also suggests that adding BMI enhances performance [2]. In addition to being a low-cost surrogate that correlates closely with established IR markers, TyG-BMI is associated with increased cardiovascular risk and confers measurable prognostic value for adverse cardiovascular outcomes [3, 4]. Thus, while standardized cut-offs are still evolving, using TyG-BMI as a continuous or stratified predictor is reasonable and has been validated in diverse cohorts. We did not include the clamp or HOMA-IR, but our TyG-BMI findings align with expected metabolic associations. Future work will incorporate direct IR measures where feasible to strengthen validation.

Third, we appreciate the concern that fasting glucose and triglycerides—the components of TyG-BMI—were measured only once at baseline, which may not capture long-term variability. However, many validated cardiovascular risk algorithms (e.g., Framingham [5] and SCORE [6]) are derived from single baseline measurements and maintain robust predictive performance. In our real-world cohort, we deliberately used the first fasting measurement to mirror initial clinical risk stratification, avoid time-dependent bias and reverse causation from post-baseline treatment or behavior change, and maximize comparability given heterogeneous testing intervals in routine care. Nonetheless, we acknowledge this limitation and plan prospective studies with serial measurements and time-updated and trajectory analyses of TyG-BMI to determine whether dynamic changes improve prediction of TOD.

Fourth, regarding anthropometric and lifestyle factors: BMI was incl

Hypertension management requires precise treatment decisions that balance medication efficacy with patient-specific factors. While clinical guidelines exist, physician decision-making often incorporates nuanced experience that remains challenging to quantify. This study aimed to develop and validate a deep learning model capable of simulating hypertension specialists' prescription patterns and predicting subsequent physiological responses using clinical trial data. We designed a dual-block deep neural network (DNN) framework, where one block predicts optimal medication prescriptions and the other forecasts next-day blood pressure (BP) and heart rate (HR). The model was trained simultaneously using a multi-objective approach that captures the relationship between drug selection and physiological outcomes. Training employed the Huber loss function for robustness, and performance was evaluated using mean absolute error (MAE), error variance, and mean relative error (MRE). The model demonstrated high predictive accuracy, with post-medication BP prediction errors consistently below 10 mmHg (MAE = 6.2 ± 1.8 mmHg). Drug dosage predictions showed strong alignment with actual prescriptions (MRE = 0.12%). These results indicate that the DNN framework effectively replicates physician decision-making within clinically acceptable margins. Our findings suggest that deep learning models trained on structured clinical data can accurately simulate hypertension specialists' treatment strategies. This approach may assist in standardizing care, reducing decision variability, and enhancing precision medicine in hypertension management. This study serves as a proof-of-concept investigation, demonstrating the feasibility of our dual-block DNN architecture. While performance on our single-center dataset is encouraging, future multicenter collaborations with larger datasets are essential to validate this approach for clinical decision support.

Stenting for renal artery occlusion (RAO) remains a subject of considerable debate. We aim to observe whether stenting can improve the clinical outcomes of patients with RAO. Patients with atherosclerotic unilateral RAO and at least 12 months of follow-up were included (n = 42) and were divided into the stenting group (n = 30) and the failed-stenting group (n = 12) based on their surgical outcomes. Blood pressure, serum creatinine, and clinical end point (major adverse cardiovascular or renal events) were recorded. At the last follow-up, there was no significant difference in BP and medication usage between the two groups of patients. Compared with failed revascularization, successful stenting was associated with reduced risk for renal function deterioration (p = 0.035) and clinical end point (p = 0.009). Kaplan–Meier (K–M) analysis showed a benefit of stenting on event-free survival (log-rank p = 0.029) and dialysis-free survival (log-rank p = 0.049). In conclusion, stenting plus medical therapy is effective in slowing the deterioration of renal function and preventing clinical events in patients with atherosclerotic unilateral RAO.

Perirenal adipose tissue (PRAT) contributes to the maintenance of elevated blood pressure through afferent nerves and serves as an important peripheral, modifiable target for hypertension management. This single-center, prospective pilot trial assessed the feasibility and safety of a novel focused power ultrasound device for perirenal adipose tissue modification (PRATM) therapy in essential hypertension. Twenty patients (mean age 47.5 ± 11.0 years, 85% male) with office systolic blood pressure (OSBP) 140–180 mmHg or diastolic blood pressure (ODBP) ≥90 mmHg were enrolled. All underwent PRATM therapy and were followed for 3 months. The primary endpoint was all-cause mortality or device-related adverse events (AEs). Four patients experienced transient mild lumbar pain, and one had mild skin redness, all resolving spontaneously. No serious AEs or clinically significant abnormalities were observed. OSBP decreased by 14.6 mmHg at 1 month and 18.2 mmHg at 3 months; ODBP decreased by 5.8 mmHg and 2.8 mmHg, respectively. For the 24-hour ambulatory blood pressure monitoring (ABPM), 24-hour ambulatory SBP decreased by 3.6 mmHg (95% CI: -3.6-10.8 mmHg) and 24-hour ambulatory DBP decreased by 2.2 mmHg (95% CI: −2.7–7.0 mmHg) at 1 month. At 3 months, 24-hour ambulatory SBP decreased by 2.8 mmHg (95% CI: −5.4–11.0 mmHg) and 24-hour ambulatory DBP decreased by 1.7 mmHg (95% CI: −4.0-7.3 mmHg). PRATM shows preliminary feasibility and safety, but larger, randomized trials are needed for definitive efficacy and long-term safety validation.

Bilateral renal artery stenosis is a major cause of secondary hypertension, yet the benefits of percutaneous transluminal renal angioplasty and stenting in patients without Pickering syndrome remain uncertain. This retrospective study evaluated its effects on blood pressure control, medication burden, and renal function stability in 69 patients treated between 2010 and 2021. Patients with heart failure or pulmonary edema were excluded. Over a mean follow-up of 67.25 months, systolic and diastolic blood pressure significantly decreased, from 152.97 ± 16.97 to 135.48 ± 15.09 mmHg (p < 0.01) and from 84.33 ± 10.69 to 77.83 ± 11.94 mmHg (p < 0.01), respectively. The number of antihypertensive medications was also reduced, from 2.41 ± 1.28 to 1.68 ± 0.93 (p < 0.01). Renal function remained stable overall, with no significant change in serum creatinine (p = 0.094). However, patients with preoperative proteinuria exhibited greater deterioration in renal function during follow-up (p = 0.039), suggesting it may predict post-procedural outcomes. These findings indicate that percutaneous transluminal renal angioplasty and stenting provide sustained benefits in blood pressure control and medication reduction for bilateral renal artery stenosis patients without Pickering syndrome, though those with proteinuria may be at higher risk of renal function decline. Further studies are needed to refine treatment strategies based on individual risk factors.

W. M. Abel, J. T. Efird, P. B. Crane, K. C. Ferdinand, C. G. Foy, and M. J. DeHaven, “Use of Coaching and Technology to Improve Blood Pressure Control in Black Women With Hypertension: Pilot Randomized Controlled Trial Study,” Journal of Clinical Hypertension 25, no. 1 (2023): 95–105, https://doi.org/10.1111/jch.14617.

An incorrect trial registration number appeared in the published article. The correct ClinicalTrials.gov identifier is NCT03577990.

We apologize for this error.

Leukocyte telomere length (LTL) has been associated with hypertension. However, this association remains unclear in middle-aged populations. This study aimed to investigate the association between LTL and hypertension in middle-aged Koreans, considering genetic and non-genetic factors. We used baseline data from middle-aged participants (aged 30–55 years) in the Korean Medicine Daejeon Citizen Cohort. LTL was measured in 1914 participants using quantitative polymerase chain reaction. We calculated the genome-wide association study-based polygenic risk score (PRS) for telomere length. Multivariable regression analysis was conducted to examine the association between LTL and hypertension and to explore this association based on non-genetic and genetic factors. After adjusting most variables (Model 1), individuals in the highest LTL quartile showed an inverse association with hypertension compared to those in the lowest quartile (odds ratio [OR] = 0.60, 95% confidence interval [CI] 0.41–0.86). When further adjusted for antihypertensive medication (Model 2), the association remained but was borderline (OR = 0.66, 95% CI = 0.42–1.04). This inverse association was more clearly observed in stratified subgroups of younger individuals (<45 years), those with optimal low-density lipoprotein cholesterol levels (<130 mg/dL), and those with adequate sleep duration (≥ 6 h). Hypertension showed a weak association with PRS; there was no significant relationship between PRS and age. Our findings suggest that LTL is independently associated with hypertension in middle-aged populations; this association varied according to non-genetic factors. These results demonstrate the potential of using LTL as a measure for hypertension screening and for the development of personalized intervention strategies in healthy populations.