Journal of Clinical Hypertension最新文献

Large gaps persist in the diagnosis, awareness, treatment, and control of hypertension globally. Standardized treatment protocols (STPs) have been widely proposed to guide hypertension treatment, particularly in primary healthcare settings. However, there has been no review that quantifies the effects of hypertension STPs on blood pressure (BP) reduction and control. We conducted a systematic review of randomized clinical trials (RCTs) among adults with hypertension, comparing hypertension STPs (intervention) with usual care (comparator) for effects on BP. Relevant RCTs were identified by searching multiple electronic databases. Random-effects meta-analyses were conducted to evaluate between-group differences in systolic BP reduction (primary outcome), diastolic BP reduction, BP control, and adverse events (AEs). Sixteen RCTs involving 59,945 participants (baseline mean BP: 149/91 mmHg) were included. Reductions in systolic and diastolic BP with STPs compared to usual care were 6.7 (95% CI 3.7-9.8) mmHg and 2.6 (1.2-4.1) mmHg, respectively (p < 0.001 for both). BP control achieved was 57% in the STP group compared to 24% in the usual care group (p < 0.001). The overall incidence of any AEs was 14.5% versus 13.5% (RR 1.27 [0.88-1.82]) with STPs and usual care, respectively. In summary, interventions involving hypertension STPs significantly reduce systolic and diastolic BP and improve BP control compared to usual care. STPs can, therefore, be an efficient strategy to implement evidence-based treatments and upscale treatment coverage, given the large untreated and uncontrolled hypertension burdens globally.

The aim was to study if nurse-managed hypertension care was associated with differences in pharmacotherapy, lifestyle counseling, and prevalence of comorbid cardiometabolic diseases among patients receiving care at primary health care centers. To assess the extent of nurses' involvement in the hypertension care, a questionnaire was distributed to all primary health care centers in Region Stockholm. Age-adjusted logistic regression models were used to analyze the results, odds ratios with 99% confidence intervals. Data was acquired from VAL, the administrative databases of Region Stockholm in Sweden, encompassing all individuals 30 years or older with a registered hypertension diagnosis who attended to the primary health care center they were registered at. Our analysis comprised 119 267 patients diagnosed with hypertension registered in one of the 224 included primary health care centers. Of the 81 primary health care centers that responded to the questionnaire, 54 reported having nurse-managed hypertension care. Nurse-managed hypertension care was not significantly associated with differences in pharmacotherapy or patients' comorbidity, except for diabetes. Primary health care centers with nurse-managed hypertension care had a 10% greater adherence to national guidelines for lifestyle counseling (33.5%) compared to those without nurse-managed hypertension care (22.5%). Regardless of the organizational form of hypertension care management, more men received lifestyle counseling according to guidelines compared to women. In-house routines for hypertension care, with designated nurses, and booking systems were associated with more lifestyle counseling, which has been associated with signs of better hypertension care.

Circulating lipids play a crucial role during pregnancy and may impact various pregnancy-related diseases. This study employed a two-sample Mendelian randomization (MR) framework to investigate the causal relationship between alterations in multidimensional plasma lipid levels and the risk of preeclampsia or eclampsia, offering deeper insight into this association. The inverse variance weighted (IVW) method was utilized as the main analysis. Summary statistics from plasma lipidomics of 7174 Finnish individuals and summary data on preeclampsia/eclampsia from the FinnGen consortium involving 219 817 European participants were employed. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. The study identified 17 lipid species from a total of 179 lipid species associated with susceptibility to preeclampsia/eclampsia. Notably, ten species, including six triacylglycerols (TAGs) (50:1, 48:1, 56:4, 49:2, 48:2, 54:3), a diacylglycerol (DAG) (16:1_18:1), and three sphingomyelins (SMs) (d36:1, d34:1, d38:1), were found to increase the risk of preeclampsia/eclampsia. Conversely, seven species, including five phosphatidylcholines (PCs) (16:1_20:4, O-18:1_20:4, 18:1_20:4, 16:0_20:4, 17:0_20:4) and two phosphatidylethanolamines (PEAs) (18:0_20:4, 16:0_20:4), all containing arachidonic acid (ARA) in the sn-2 position, were associated with a reduced risk of preeclampsia/eclampsia (all p < 0.05). The results of the stratified analysis were consistent with these findings. Furthermore, reverse MR analysis indicated that preeclampsia/eclampsia does not causally affect plasma levels of these lipids. Our findings established a causal relationship between specific plasma lipid species and modulation of preeclampsia/eclampsia risk, providing improved resolution for risk assessment and potential therapeutic targets in the disease.

The relationship between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and kidney function in patients with primary aldosteronism (PA) is unclear. Therefore, this research explored the link between the UHR and kidney function in PAs. This research was conducted at the 2nd Affiliated Hospital of Nanchang University and involved PA individuals hospitalized between October 2017 and April 2022. A total of 653 eligible participants were included in the analysis for this research. The kidney function was assessed by the estimated glomerular filtration rate (eGFR), which is calculated using the modification of diet in renal disease (MDRD) equation. Chronic kidney disease (CKD) was defined as an eGFR <60 mL/min per 1.73 m² or the ratio of urine microalbumin to creatinine (UACR) ≥30 mg/g. The study used multivariable-adjusted linear regression analyses to investigate the association between log-transformed UHR levels and, eGFR and CKD. After multivariable adjustments, the results indicated an inverse association between Lg-UHR and eGFR (per SD increment; β: -9.02; 95% CI: -11.59, -6.46). Compared to PA patients with the lowest level of Lg-UHR (T1), patients with the highest level of Lg-UHR (T3) had a lower eGFR (β: -20.14, 95% CI: -26.25, -14.04). Conversely, Lg-UHR and CKD showed a positive association cross-sectionally (per SD increment; OR: 1.67; 95% CI: 1.26, 2.23). Compared to PA patients in T1 level, patients in T3 level had a higher prevalence of CKD (OR: 2.52, 95% CI: 1.26, 5.05). In patients with PA, UHR is inversely associated with eGFR and positively associated with CKD.

Sarcopenia worsens the prognosis in hypertensive patients, leading to complications such as proteinuria, osteoporosis, disability, and cognitive impairment. Early screening and intervention for sarcopenia in these patients may improve outcomes. This cross-sectional study utilized data from 9253 hypertensive patients in the 1999-2018 National Health and Nutrition Examination Survey (NHANES). We used logistic and linear regression models, restricted cubic splines (RCS), and subgroup analyses to evaluate the relationship between pan-immune-inflammation value (PIV) and sarcopenia. Patients were divided into quartiles based on PIV levels. After controlling for confounding factors, our study found that those in the highest PIV quartile faced a 36% greater risk of developing sarcopenia compared to those in the lowest quartile (OR = 1.36, 95% confidence interval [CI]: 1.04-1.77). The RCS analysis indicated a linear increase in sarcopenia risk as PIV levels rose (non-linear p = 0.130). Subgroup analysis demonstrated that diabetes synergistically increased sarcopenia risk (p for interaction = 0.007). Elevated PIV levels were identified as an independent risk factor for sarcopenia, with diabetes amplifying this risk. These findings highlight the importance of early identification and management of elevated PIV levels to improve outcomes for hypertensive patients at risk of sarcopenia.

This study investigated the association between adherence to the Mediterranean diet (MD) and new-onset hypertension (HTN) in a cohort of community-dwelling, middle-aged, older Korean individuals with obesity. We used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort study. The Korean version of the MD Adherence Screener was used to evaluate compliance with the MD. The primary endpoint was the incidence of new-onset HTN. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval for HTN incidence with increasing MD adherence. Data from 1995 participants with obesity without HTN at baseline were analyzed. After adjusting for confounders, participants with moderate (Group 2) and high adherence (Group 3) to the MD had HRs for new-onset HTN of 0.72 (0.57-0.90) and 0.73 (0.56-0.95), respectively, compared with those with low adherence (Group 1). Sex and age differences were associated with MD adherence and HTN incidence. The association between MD adherence and HTN incidence was only significant in males and in participants aged 40-64 years. There was no significant association between MD adherence and new-onset HTN in females or those aged ≥ 65 years. In conclusion, this study found a significant association between adherence to the MD and a reduction in new-onset HTN in Korean adults with obesity. Considering its value and sustainability, the adoption of the MD may contribute to the prevention of new-onset HTN in populations with obesity.

Hypertension is a prevalent health issue in Bangladesh, impacting a significant portion of the population. This meta-analysis explored how social status inequalities impact hypertension risk in Bangladesh. We systematically searched various electronic databases and rigorously selected 12 studies for inclusion in the analyses. The I² statistic measured between study heterogeneity, and pooled effect estimates were obtained using the DerSimonian and Laird random effects model to address this variability. Publication bias was assessed through a funnel plot and Egger's test. Sensitivity analysis was conducted to evaluate the robustness of the findings. All analyses were performed using STATA 17. The analyses indicated that females had a significantly higher risk of developing hypertension compared to males, with a pooled odds ratio (OR) of 1.15 (95% confidence interval [CI]: 1.02-1.27). Urban residents showed a pooled OR of 1.11 (95% CI: 1.03-1.19) compared to rural residents. The pooled ORs for hypertension were 1.02 (95% CI: 0.89-1.14) for primary education, 1.07 (95% CI: 0.94-1.21) for secondary education, and 1.25 (95% CI: 1.03-1.47) for higher secondary education, suggesting an increasing risk with higher education levels. Wealth status showed a pooled OR of 1.08 (95% CI: 0.87-1.29) for the poorer class, 1.13 (95% CI: 1.04-1.22) for the middle class, 1.38 (95% CI: 0.68-2.07) for the richer class, and 1.49 (95% CI: 0.97-2.00) for the richest class, indicating a greater risk of hypertension among wealthier individuals. Working individuals had a 39% lower risk of hypertension (OR = 0.61, 95% CI: 0.43-0.80) compared to nonworking individuals.

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.

Our study aims to assess gender differences in blood pressure (BP) control among hypertensive patients in Jordan and identify factors influencing these differences. We conducted a cross-sectional study at Jordan University Hospital (JUH), collecting data from 601 hypertensive patients following up in JUH clinics. Patients were eligible if they were >18 years old, diagnosed with hypertension, taking anti-hypertensive medication for at least 6 months, and had no chronic kidney disease. BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg. Poor BP control was observed in 59.1% of females and 62.7% of males. Females demonstrated better BP control, even though they had lower incomes, lower education levels, and higher BMIs compared to males. Among females, good medication adherence (p = 0.042) was linked to improved control, while stress and a history of preeclampsia were negatively associated (p = 0.01 and p = 0.030, respectively). Among males, concurrent systemic medication use (p = 0.025) was a positive predictor of BP control, whereas smoking negatively impacted BP control (p = 0.019). Home BP monitoring was common but did not improve control in either gender. In conclusion, females showed better outcomes in BP management, largely due to treatment adherence. A history of preeclampsia and high stress was linked to poorer control in females. Both genders were aware of normal BP levels, but females were more preemptive in maintaining control. To improve hypertension care, we should consider these differences when treating patients.

Self-efficacy is tightly intertwined with person-centered care and correlates with engaging in self-care behaviors, an important part of hypertension treatment. Evidence indicates that e-Health-based self-management interventions could increase self-efficacy. The objectives of this study were to investigate whether an intervention with a person-centered approach supported by e-Health technology can impact self-efficacy. Furthermore, to examine the impact of self-efficacy on hypertension management, and assess if self-efficacy can indicate which patients might see the greatest improvement on blood pressure from an e-Health-based self-management intervention for hypertension. This multicenter randomized controlled trial included 949 primary healthcare patients with hypertension. After exclusions, data was analyzed for 862 patients. The intervention group used an e-Health-based self-management system for 8 weeks. Self-efficacy was measured with the general self-efficacy (GSE) scale at inclusion, 8-week follow-up and 1-year follow-up. A significant increase in the mean GSE score in the intervention group was identified (p 0.042). No significant association between self-efficacy and blood pressure control was found. GSE scores did not significantly differ between the patients that had the best effect on blood pressure and those that had none. This study showed a significant increase in self-efficacy after the intervention. Self-management-based e-Health interventions might have a role in clinical practice to increase self-efficacy and improve general health. We found no association between self-efficacy and achieving a blood pressure below 140/90. Furthermore, no support was found to claim that self-efficacy would be an indicator of which patients might have the greatest effect from a self-management-based e-Health intervention for hypertension.