Siyuan Shen, Pengyu Li, Bihui Zhang, Ziguang Yan, Guochen Niu, Min Yang
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.
{"title":"Optimized Blood Pressure Control and Medication Burden Reduction in Bilateral Renal Artery Stenosis Patients Without Pickering Syndrome: A Retrospective Study","authors":"Siyuan Shen, Pengyu Li, Bihui Zhang, Ziguang Yan, Guochen Niu, Min Yang","doi":"10.1111/jch.70168","DOIUrl":"10.1111/jch.70168","url":null,"abstract":"<p>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 (<i>p</i> < 0.01) and from 84.33 ± 10.69 to 77.83 ± 11.94 mmHg (<i>p</i> < 0.01), respectively. The number of antihypertensive medications was also reduced, from 2.41 ± 1.28 to 1.68 ± 0.93 (<i>p</i> < 0.01). Renal function remained stable overall, with no significant change in serum creatinine (<i>p</i> = 0.094). However, patients with preoperative proteinuria exhibited greater deterioration in renal function during follow-up (<i>p</i> = 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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12560113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Arterial stiffness is characterized by a progressive loss of vascular elasticity that results from structural and functional changes in the arterial wall. Arterial stiffness is thus both a consequence of vascular aging and a predictor of future cardiovascular events, and it has been shown to be an independent predictor of major adverse cardiovascular events, e.g., myocardial infarction, stroke, and cardiovascular mortality [<span>1</span>]. The early assessment of arterial stiffness has emerged as a valuable approach for cardiovascular risk assessment, offering the potential to identify high-risk individuals before the onset of cardiovascular disease (Figure 1). Although the carotid-femoral pulse wave velocity (cfPWV) is recognized as the gold standard for assessing arterial stiffness, it is not routinely measured in clinical practice due to high costs, technical complexity, and the need for skilled operators that have limited its widespread adoption [<span>1</span>]. In contrast, the hemoglobin-to-red cell distribution width ratio (HRR), calculated as the ratio of the patient's hemoglobin concentration (g/L) to the red cell distribution width (RDW), is a novel inflammatory marker that reflects the prognostic contributions of both hemoglobin and the RDW. The HRR has shown significant prognostic value in several diseases, including coronary artery disease [<span>2</span>], peripheral arterial disease [<span>3</span>], heart failure, and chronic kidney disease [<span>4</span>], highlighting its potential value as an indicator of systemic inflammation. However, the relationship between the HRR and arterial stiffness is unclear.</p><p>The study by Liu et al., in this issue of <i>The Journal of Clinical Hypertension</i>, presents compelling evidence for an inverse association between the HRR and arterial stiffness in a cohort of 3657 Chinese participants recruited between January 2016 and December 2023 [<span>5</span>]. The study addresses an important gap in cardiovascular risk assessment by examining whether commonly available hematological parameters could serve as biomarkers for vascular health. Liu et al. recruited participants from an initial cohort of 5886 subjects who underwent cfPWV measurement, with 2229 subjects excluded according to predefined criteria, yielding the final analytical sample. The comprehensive exclusion criteria appropriately eliminated individuals with acute cardiovascular events within the prior 6 months, congestive heart failure, severe arrhythmias, significant renal or hepatic dysfunction, malignancy, autoimmune disease, acute infectious disease, or current pregnancy and those using medications that could confound hematological parameters, such as folic acid and vitamin B12. The study's methodological strength is evident in its use of the cfPWV to measure arterial stiffness, a widely accepted and clinically relevant technique.</p><p>The measurements were performed with a Complior analyzer following standardized protoc
动脉硬化的特征是由于动脉壁的结构和功能改变导致血管弹性的逐渐丧失。因此，动脉僵硬既是血管老化的结果，也是未来心血管事件的预测因子，并且已被证明是主要不良心血管事件的独立预测因子，例如心肌梗死、中风和心血管死亡bb0。动脉僵硬度的早期评估已经成为心血管风险评估的一种有价值的方法，提供了在心血管疾病发病前识别高危个体的潜力（图1）。尽管颈动脉-股动脉脉搏波速度（cfPWV）被认为是评估动脉僵硬度的黄金标准，但由于成本高、技术复杂以及对熟练操作人员的需求限制了其广泛采用，因此在临床实践中并未常规测量cfPWV。相比之下，血红蛋白与红细胞分布宽度比（HRR），即患者血红蛋白浓度（g/L）与红细胞分布宽度（RDW）之比，是一种新的炎症标志物，反映血红蛋白和RDW对预后的贡献。HRR在冠状动脉疾病[2]、外周动脉疾病[3]、心力衰竭和慢性肾脏疾病[4]等多种疾病中显示出显著的预后价值，突出了其作为全身性炎症指标的潜在价值。然而，HRR与动脉硬度之间的关系尚不清楚。Liu等人发表在这期《临床高血压杂志》上的研究提出了令人信服的证据，证明在2016年1月至2023年12月期间招募的3657名中国参与者的HRR和动脉僵硬度之间存在负相关。该研究通过检查常用的血液学参数是否可以作为血管健康的生物标志物，解决了心血管风险评估的一个重要空白。Liu等人从5886名接受cfPWV测量的初始队列中招募参与者，根据预先确定的标准排除2229名受试者，从而获得最终的分析样本。综合排除标准适当地排除了在过去6个月内发生急性心血管事件、充血性心力衰竭、严重心律失常、严重肾功能或肝功能障碍、恶性肿瘤、自身免疫性疾病、急性感染性疾病、或当前怀孕以及使用可能混淆血液参数的药物（如叶酸和维生素B12）的个体。该研究的方法学优势体现在使用cfPWV测量动脉僵硬度，这是一项被广泛接受且与临床相关的技术。使用Complior分析仪按照标准化方案进行测量，包括计算记录的距离(D)，将测量的D乘以0.8。动脉刚度定义为cfPWV≥10 m/s。根据HRR值将参与者分为四分位数：Q1 (HRR < 9.57), Q2 (> 9.57 -< 10.55), Q3 （> 10.55 -< 11.50）和Q4 （> 11.50）。他们的基线特征揭示了整个HRR四分位数的惊人模式。年龄由Q1（64.1±12.4岁）逐渐下降至Q4(54.3±11.7岁，p < 0.001)，男性比例由Q1的36.8%显著上升至Q4的88.5%。重要的是，cfPWV值在四分位数中一致下降：Q1(10.2±3.9 m/s), Q2(9.6±2.6 m/s), Q3（9.6±2.5 m/s）和Q4（9.3±2.2 m/s, p < 0.001）。相应地，动脉僵硬的患病率表现出明确的剂量-反应模式：Q1（30.0%）、Q2（25.0%）、Q3（24.5%）和Q4 (20.5%) （χ2 = 35.88, p < 0.001）。因此，Liu等人的研究证明了HRR四分位数与动脉僵硬风险之间存在显著的剂量-反应关系。在未调整的模型中，第二季度、第三季度和第四季度的优势比（or）分别为0.93（95%可信区间[CI]: 0.89-0.97, p = 0.002）、0.92 （95%CI: 0.88 - 0.96, p < 0.001）和0.88 （95%CI: 0.84-0.91, p < 0.001）。在完全调整后的模型中，与最低四分位数相比，第三四分位数的参与者动脉僵硬的几率降低了5% (OR 0.95, 95%CI: 0.91-0.99, p = 0.024)，而最高四分位数的参与者动脉僵硬的几率降低了7% （OR 0.93, 95%CI: 0.88-0.97, p < 0.001）。在完全调整的线性回归模型中，将HRR作为一个连续变量进行检查显示，每增加一个单位，cfPWV降低0.12 m/s （β = - 0.12, 95%CI: - 0.17 - - 0.06, p < 0.001）。这种线性关系得到了限制三次样条分析的证实（非线性p = 0.277），增强了对真实生物关联的信心，而不是统计伪像。 此外，与没有动脉僵硬的参与者相比，动脉僵硬的参与者显示出明显更高的药物使用，包括降压药（52.6%对37.3%）、降糖（25.9%对12.7%）和降脂（36.2%对27.7%）药物（均p <； 0.001）。这表明，尽管进行了密集的医疗管理，HRR和动脉僵硬度之间的负相关关系仍然存在。Liu等人研究的分层分析揭示了该研究的一个特别有价值的方面，即糖尿病（OR 0.79, 95% CI: 0.67-0.94, p = 0.006）和高血压（OR 0.84, 95% CI: 0.75-0.94, p = 0.002）的参与者之间存在更强的负相关。这些结果表明，HRR所反映的炎症过程在已经经历血管应激的个体中更为重要，这支持了所提出机制的生物学合理性。在两种情况下观察到显著的相互作用效应（相互作用p =糖尿病= 0.031，高血压= 0.030），这表明HRR可能与高危人群特别相关。Liu等人通过两种主要途径对HRR与动脉僵硬度的关系进行了全面和机制的讨论。首先，RDW值升高和血红蛋白水平降低反映了慢性炎症，其中促炎细胞因子（如白细胞介素-6和肿瘤坏死因子[TNF]-α）损害红细胞（RBC）的产生，增加细胞的大小变变性，同时通过异常胶原沉积和减少弹性蛋白合成促进血管重塑。Liu等人通过引用研究来强化这一炎症假说，其中包括一项荟萃分析，显示TNF-α拮抗剂治疗后cfPWV改善，以及c反应蛋白与动脉僵硬度呈正相关的研究[6,7]。其次，血红蛋白降低和RDW值升高可能表明机体红细胞抗氧化能力受损。红细胞变形能力降低和细胞异质性增加破坏微血管灌注，通过血红蛋白介导的一氧化氮猝灭、铁催化的超氧化物形成和抗氧化防御受损来促进血管氧化应激。Liu等人指出，这些炎症和氧化应激途径在糖尿病和高血压中被放大，这可以解释为什么HRR在这些高危人群中关联更强。尽管Liu等人的研究有其优势，但也有一些局限性。其中最重要的是分析的横截面性质。虽然研究显示HRR和动脉僵硬度之间有很强的关系，但作者无法确定原因或影响。目前尚不清楚低HRR是否有助于动脉硬化的发展，动脉硬化及其相关的炎症环境是否会导致HRR的降低，或者低HRR和动脉硬化是否是共同的潜在病理过程的结果。此外，该研究的单中心设计和来自中国南方特定地区的参与者的招募限制了研究结果的普遍性。心血管风险概况和遗传背景在不同种族和地理人群中可能存在显著差异。该研究的另一个有趣发现是HRR与参与者基线特征中的常规脂质参数（如总胆固醇和低密度脂蛋白胆固醇）之间的反比关系。这与血脂异常与心血管风险之间典型的正相关相矛盾。Liu等人假设，这可能是由于在动脉僵硬的参与者中更普遍地使用降脂药物。这突出了在治疗人群中解释观察数据的复杂性。总之，Liu等人提供了有价值的证据，支持HRR作
{"title":"The Hemoglobin-to-Red Blood Cell Distribution Width Ratio as a Novel Inflammatory Biomarker for Arterial Stiffness Assessment","authors":"Chengjie Zhu, Vipin Kumar, Megumi Narisawa, Kai Meng, Yanglong Li, Xian Wu Cheng","doi":"10.1111/jch.70171","DOIUrl":"10.1111/jch.70171","url":null,"abstract":"<p>Arterial stiffness is characterized by a progressive loss of vascular elasticity that results from structural and functional changes in the arterial wall. Arterial stiffness is thus both a consequence of vascular aging and a predictor of future cardiovascular events, and it has been shown to be an independent predictor of major adverse cardiovascular events, e.g., myocardial infarction, stroke, and cardiovascular mortality [<span>1</span>]. The early assessment of arterial stiffness has emerged as a valuable approach for cardiovascular risk assessment, offering the potential to identify high-risk individuals before the onset of cardiovascular disease (Figure 1). Although the carotid-femoral pulse wave velocity (cfPWV) is recognized as the gold standard for assessing arterial stiffness, it is not routinely measured in clinical practice due to high costs, technical complexity, and the need for skilled operators that have limited its widespread adoption [<span>1</span>]. In contrast, the hemoglobin-to-red cell distribution width ratio (HRR), calculated as the ratio of the patient's hemoglobin concentration (g/L) to the red cell distribution width (RDW), is a novel inflammatory marker that reflects the prognostic contributions of both hemoglobin and the RDW. The HRR has shown significant prognostic value in several diseases, including coronary artery disease [<span>2</span>], peripheral arterial disease [<span>3</span>], heart failure, and chronic kidney disease [<span>4</span>], highlighting its potential value as an indicator of systemic inflammation. However, the relationship between the HRR and arterial stiffness is unclear.</p><p>The study by Liu et al., in this issue of <i>The Journal of Clinical Hypertension</i>, presents compelling evidence for an inverse association between the HRR and arterial stiffness in a cohort of 3657 Chinese participants recruited between January 2016 and December 2023 [<span>5</span>]. The study addresses an important gap in cardiovascular risk assessment by examining whether commonly available hematological parameters could serve as biomarkers for vascular health. Liu et al. recruited participants from an initial cohort of 5886 subjects who underwent cfPWV measurement, with 2229 subjects excluded according to predefined criteria, yielding the final analytical sample. The comprehensive exclusion criteria appropriately eliminated individuals with acute cardiovascular events within the prior 6 months, congestive heart failure, severe arrhythmias, significant renal or hepatic dysfunction, malignancy, autoimmune disease, acute infectious disease, or current pregnancy and those using medications that could confound hematological parameters, such as folic acid and vitamin B12. The study's methodological strength is evident in its use of the cfPWV to measure arterial stiffness, a widely accepted and clinically relevant technique.</p><p>The measurements were performed with a Complior analyzer following standardized protoc","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>To the Editor,</p><p>Garg et al. raise questions that merit further discussion when discussing our recent publication regarding systolic blood pressure (SBP) time in target range (TTR) and incidence of major adverse cardiovascular events (MACE) [<span>1, 2</span>].</p><p>The authors hypothesize why men and women demonstrated different associations between SBP TTR and MACE. While baseline risk profiles and physiology differed between sexes due to PRECISION inclusion criteria, it is necessary to consider our findings within the context of the existing literature for BP lowering [<span>3</span>]. The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive SBP control (<120 mmHg) provided significant and comparable benefits for both men and women, and there was no statistical interaction between sex and the treatment effect (<i>p</i> for interaction = 0.45), indicating that the magnitude of benefit from intensive control did not differ between men and women [<span>4</span>]. Therefore, while the target range of 110–130 mmHg may appear to align with average female BP, the therapeutic principle of achieving this target is strongly supported for men as well. The lack of a statistically significant association in men of our cohort may reflect factors beyond the choice of target range, such as differences in medication adherence, underlying pathophysiology, or as the authors mentioned, the differential inclusion criteria.</p><p>The authors also note the methodological limitations inherent in using office-based BP measurements to calculate SBP TTR, particularly the potential for misclassification in individuals with higher SBP variability due to hypertension. We concur that out-of-office assessment is crucial; however, the prognostic significance of visit-to-visit variability derived from office measurements is well-established and provides independent predictive information for MACE, even beyond mean BP levels [<span>5-7</span>]. Additionally, existing literature demonstrates that patients with hypertension typically have higher office-based BP measurements, which would have placed them in their appropriate TTR group due to their overall higher mean BP despite enhanced variability<sup>.</sup> The use of office-based measurements for SBP TTR is a well-established approach that reflects the data most commonly available to clinicians and researchers. The fact that this metric yielded significant associations highlights its real-world clinical utility.</p><p>Further, the authors mention SBP variability as a potential confounder of TTR. Based on the formula used to calculate TTR, visit-to-visit variability, particularly over variable time intervals, is factored into its derivation [<span>8</span>].</p><p>Regarding the potential confounding effect of nonsteroidal anti-inflammatory drugs, it is critical to appraise that the PRECISION trial was a randomized controlled trial that inherently minimizes confounding factors, and our stati
{"title":"In Reply: Time in Target Range, Sex-Specific Effects, and the Path to Clinical Integration","authors":"Neel Agarwal, Julie St. John, Luke J. Laffin","doi":"10.1111/jch.70170","DOIUrl":"10.1111/jch.70170","url":null,"abstract":"<p>To the Editor,</p><p>Garg et al. raise questions that merit further discussion when discussing our recent publication regarding systolic blood pressure (SBP) time in target range (TTR) and incidence of major adverse cardiovascular events (MACE) [<span>1, 2</span>].</p><p>The authors hypothesize why men and women demonstrated different associations between SBP TTR and MACE. While baseline risk profiles and physiology differed between sexes due to PRECISION inclusion criteria, it is necessary to consider our findings within the context of the existing literature for BP lowering [<span>3</span>]. The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive SBP control (<120 mmHg) provided significant and comparable benefits for both men and women, and there was no statistical interaction between sex and the treatment effect (<i>p</i> for interaction = 0.45), indicating that the magnitude of benefit from intensive control did not differ between men and women [<span>4</span>]. Therefore, while the target range of 110–130 mmHg may appear to align with average female BP, the therapeutic principle of achieving this target is strongly supported for men as well. The lack of a statistically significant association in men of our cohort may reflect factors beyond the choice of target range, such as differences in medication adherence, underlying pathophysiology, or as the authors mentioned, the differential inclusion criteria.</p><p>The authors also note the methodological limitations inherent in using office-based BP measurements to calculate SBP TTR, particularly the potential for misclassification in individuals with higher SBP variability due to hypertension. We concur that out-of-office assessment is crucial; however, the prognostic significance of visit-to-visit variability derived from office measurements is well-established and provides independent predictive information for MACE, even beyond mean BP levels [<span>5-7</span>]. Additionally, existing literature demonstrates that patients with hypertension typically have higher office-based BP measurements, which would have placed them in their appropriate TTR group due to their overall higher mean BP despite enhanced variability<sup>.</sup> The use of office-based measurements for SBP TTR is a well-established approach that reflects the data most commonly available to clinicians and researchers. The fact that this metric yielded significant associations highlights its real-world clinical utility.</p><p>Further, the authors mention SBP variability as a potential confounder of TTR. Based on the formula used to calculate TTR, visit-to-visit variability, particularly over variable time intervals, is factored into its derivation [<span>8</span>].</p><p>Regarding the potential confounding effect of nonsteroidal anti-inflammatory drugs, it is critical to appraise that the PRECISION trial was a randomized controlled trial that inherently minimizes confounding factors, and our stati","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
J. M. Abel， J. T. Efird， P. B. Crane， K. C. Ferdinand， C. G. Foy， M. J. DeHaven，“使用训练和技术改善黑人女性高血压患者的血压控制：随机对照试验研究”，《临床高血压杂志》，第25期。1 (2023): 95-105, https://doi.org/10.1111/jch.14617.An发表文章中出现试验注册号错误。正确的ClinicalTrials.gov标识符是NCT03577990。我们为这个错误道歉。
{"title":"Correction to “Use of Coaching and Technology to Improve Blood Pressure Control in Black Women With Hypertension: Pilot Randomized Controlled Trial Study”","authors":"","doi":"10.1111/jch.70085","DOIUrl":"10.1111/jch.70085","url":null,"abstract":"<p>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,” <i>Journal of Clinical Hypertension</i> 25, no. 1 (2023): 95–105, https://doi.org/10.1111/jch.14617.</p><p>An incorrect trial registration number appeared in the published article. The correct ClinicalTrials.gov identifier is NCT03577990.</p><p>We apologize for this error.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Younghwa Baek, Hyo-Jeong Ban, Kyoungsik Jeong, Siwoo Lee, Hee-Jeong Jin
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.
{"title":"Association of Hypertension With Telomere Length, Considering Non-Genetic and Genetic Factors, in Middle-Aged Koreans","authors":"Younghwa Baek, Hyo-Jeong Ban, Kyoungsik Jeong, Siwoo Lee, Hee-Jeong Jin","doi":"10.1111/jch.70163","DOIUrl":"10.1111/jch.70163","url":null,"abstract":"<p>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.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The study by Dr. Yang et al. [<span>1</span>] in this issue of <i>The Journal of Clinical Hypertension</i> contributes to the understanding of how individuals in different age groups respond to amlodipine-based therapy for primary hypertension, which affects nearly 1.3 billion people worldwide and is the leading modifiable risk factor for cardiovascular morbidity and mortality [<span>2</span>]. The accurate diagnosis of hypertension is challenged by the inherent variability of blood pressure (BP) measurements, since BP naturally fluctuates and is influenced by circadian rhythms and various environmental and physiological factors [<span>3</span>]. The variability in BP values complicates hypertension diagnoses and can result in misclassification when measured at a single time; this is further complicated by white-coat hypertension and masked hypertension [<span>4</span>]. Long-term BP variability (BPV) has emerged as an independent predictor of cardiovascular outcomes, providing additional prognostic information beyond that of the mean BP. BPV is associated with an increased risk of cardiovascular events in patients with hypertension, regardless of their baseline cardiovascular risk [<span>5</span>].</p><p>The systolic BP time in the target range (TTR) discussed by Yang et al. in their study was introduced as a comprehensive metric for evaluating long-term hypertension management. The TTR integrates both the mean BP level and BPV, offering a more robust assessment of BP control over extended periods. BP in the TTR is negatively associated with mortality, cardiovascular disease, and kidney complications in hypertensive patients [<span>6, 7</span>]. Amlodipine, a widely prescribed calcium channel blocker (CCB), has received particular attention among antihypertensive agents for its potential to optimize these newer metrics (Figure 1). Treatment with amlodipine provides sustained antihypertensive effects and has been shown to reduce BPV more effectively than other CCBs in clinical settings [<span>8</span>].</p><p>Yang et al.’s retrospective cohort study encompassing >36 000 patients in the China Hypertension Center database provides valuable insights into the effectiveness of amlodipine treatment across different age groups, with particular emphasis on novel measures including the TTR and BPV. Their study's focus on the TTR and BPV reflects the increasing recognition that these measures may be as important as mean BP readings. The TTR and BPV have gained importance due to evidence that visit-to-visit BPV may be as significant as the mean BP level in predicting cardiovascular outcomes, as demonstrated in landmark studies such as the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) [<span>9</span>]. That trial included patients receiving amlodipine-based therapy (including amlodipine monotherapy or combination therapy) at baseline and during the follow-up, representing a clinically relevant population and reflecting real-world therapeutic approa
{"title":"Systolic Blood Pressure Time in the Target Range and Blood Pressure Variability: The Effects of Amlodipine-Based Therapy","authors":"Longguo Zhao, Vipin Kumar, Megumi Narisawa, Yanglong Li, Chunzi Jin, Xian Wu Cheng","doi":"10.1111/jch.70160","DOIUrl":"10.1111/jch.70160","url":null,"abstract":"<p>The study by Dr. Yang et al. [<span>1</span>] in this issue of <i>The Journal of Clinical Hypertension</i> contributes to the understanding of how individuals in different age groups respond to amlodipine-based therapy for primary hypertension, which affects nearly 1.3 billion people worldwide and is the leading modifiable risk factor for cardiovascular morbidity and mortality [<span>2</span>]. The accurate diagnosis of hypertension is challenged by the inherent variability of blood pressure (BP) measurements, since BP naturally fluctuates and is influenced by circadian rhythms and various environmental and physiological factors [<span>3</span>]. The variability in BP values complicates hypertension diagnoses and can result in misclassification when measured at a single time; this is further complicated by white-coat hypertension and masked hypertension [<span>4</span>]. Long-term BP variability (BPV) has emerged as an independent predictor of cardiovascular outcomes, providing additional prognostic information beyond that of the mean BP. BPV is associated with an increased risk of cardiovascular events in patients with hypertension, regardless of their baseline cardiovascular risk [<span>5</span>].</p><p>The systolic BP time in the target range (TTR) discussed by Yang et al. in their study was introduced as a comprehensive metric for evaluating long-term hypertension management. The TTR integrates both the mean BP level and BPV, offering a more robust assessment of BP control over extended periods. BP in the TTR is negatively associated with mortality, cardiovascular disease, and kidney complications in hypertensive patients [<span>6, 7</span>]. Amlodipine, a widely prescribed calcium channel blocker (CCB), has received particular attention among antihypertensive agents for its potential to optimize these newer metrics (Figure 1). Treatment with amlodipine provides sustained antihypertensive effects and has been shown to reduce BPV more effectively than other CCBs in clinical settings [<span>8</span>].</p><p>Yang et al.’s retrospective cohort study encompassing >36 000 patients in the China Hypertension Center database provides valuable insights into the effectiveness of amlodipine treatment across different age groups, with particular emphasis on novel measures including the TTR and BPV. Their study's focus on the TTR and BPV reflects the increasing recognition that these measures may be as important as mean BP readings. The TTR and BPV have gained importance due to evidence that visit-to-visit BPV may be as significant as the mean BP level in predicting cardiovascular outcomes, as demonstrated in landmark studies such as the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) [<span>9</span>]. That trial included patients receiving amlodipine-based therapy (including amlodipine monotherapy or combination therapy) at baseline and during the follow-up, representing a clinically relevant population and reflecting real-world therapeutic approa","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Zheng, S. Wu, W. Wang, W. Qiu, Y. Feng. Dissecting Causal Relationships Between Antihypertensive Drug, Gut Microbiota, and Type 2 Diabetes Mellitus and Its Complications: A Mendelian Randomization Study. Journal of Clinical Hypertension 27 no. 1 (2025): e14968. https://doi.org/10.1111/jch.14968
The original version of this article was revised: changes include adjusting the author affiliation order and funding information to reflect updated institutional details.
The primary affiliation is now: “Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.” The secondary affiliation is “School of Medicine, South China University of Technology, Guangzhou, China.”
Funding statement was updated to: This work was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project of China (no. 2023ZD0508906 and no. 2024ZD0526803), The Climbing Plan of Guangdong Provincial People's Hospital (DFJH2020022), Guangdong Special Funds for Science and Technology Innovation Strategy (Stability support for scientific research institutions affiliated to Guangdong Province-GDCI 2024), and The Key Area R&D Program of Guangdong Province (no. 2019B020227005).
{"title":"Correction to “Dissecting Causal Relationships Between Antihypertensive Drug, Gut Microbiota, and Type 2 Diabetes Mellitus and Its Complications: A Mendelian Randomization Study”","authors":"","doi":"10.1111/jch.70156","DOIUrl":"10.1111/jch.70156","url":null,"abstract":"<p>H. Zheng, S. Wu, W. Wang, W. Qiu, Y. Feng. Dissecting Causal Relationships Between Antihypertensive Drug, Gut Microbiota, and Type 2 Diabetes Mellitus and Its Complications: A Mendelian Randomization Study. <i>Journal of Clinical Hypertension</i> 27 no. 1 (2025): e14968. https://doi.org/10.1111/jch.14968</p><p>The original version of this article was revised: changes include adjusting the <b>author affiliation order</b> and <b>funding information</b> to reflect updated institutional details.</p><p>The primary <b>affiliation</b> is now: “Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.” The secondary affiliation is “School of Medicine, South China University of Technology, Guangzhou, China.”</p><p><b>Funding</b> statement was updated to: This work was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project of China (no. 2023ZD0508906 and no. 2024ZD0526803), The Climbing Plan of Guangdong Provincial People's Hospital (DFJH2020022), Guangdong Special Funds for Science and Technology Innovation Strategy (Stability support for scientific research institutions affiliated to Guangdong Province-GDCI 2024), and The Key Area R&D Program of Guangdong Province (no. 2019B020227005).</p><p>We apologize for this error.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertensive crises require rapid blood pressure control to prevent stroke and myocardial injury. Despite Cleviprex's efficacy, its high cost limits accessibility in China. This Phase III, multicenter, randomized, double-blind study evaluated the efficacy and safety of a generic clevidipine (China's first injectable generic clevidipine emulsion) versus the branded drug Cleviprex in managing hypertensive emergencies and urgencies among Chinese patients. A total of 377 patients of 33 medical centers from December 2021 to December 2022 were randomized, with 189 in the generic clevidipine group and 188 in the control. As a result, 95.6% of patients in the generic clevidipine group and 93.6% in the control achieved the target systolic blood pressure (SBP) reduction within 30 min (rate difference 0.020, 90% CI: −0.019 to 0.060). The mean area under the curve (AUC) of SBP outside the target range within the first hour was comparable between groups (329.8 ± 238.16 in generic clevidipine vs. 347.9 ± 302.79 in control). The median time to first achieve the target range within 30 min was 12.0 min in both groups. The proportion of patients successfully transitioning to oral therapy within 6 h was 93.4% in the generic clevidipine group and 93.6% in the control group. The incidence of drug-related adverse events (AEs) was reported in 50 patients (27.3%) in the generic clevidipine group and in 48 (27.9%) in the control, with no unexpected safety signals. The generic clevidipine demonstrated comparable efficacy and safety to the branded drug, supporting its potential as an effective and accessible therapeutic alternative for acute hypertension management.
{"title":"Efficacy and Safety of a Generic Clevidipine in Hypertensive Urgencies and Non-Fulminant Hypertensive Emergencies: A Phase III, Multicenter, Randomized, Double-Blind, Positive Drug Parallel-Controlled Study","authors":"Xiaoning Han, Wei Ma, Bo Wang, Xiang Gu, Guangjun Wang, Ling Lin, Qiufang Lian, Dongna Guo, Xiaoqun Wan, Jiaying Zhu, Wei Guo, Zhenzhong Zhu, Zijing Liang, Dexiong Chen, Anbao Chen, Zhiming Shi, Baofeng Zhu, Anyong Yu, Lishan Yang, Chunhua Zheng, Wenkai Bin, Dapeng Cheng, Yanfen Chai, Jianlong Sheng, Lang Hong, Qiuping Mo, Yu Wang, Lizhen Tang, Shugui Li, Xiwen Zhang, Xiaomei Guo, Ningru Zhang, Yong Huo","doi":"10.1111/jch.70144","DOIUrl":"10.1111/jch.70144","url":null,"abstract":"<p>Hypertensive crises require rapid blood pressure control to prevent stroke and myocardial injury. Despite Cleviprex's efficacy, its high cost limits accessibility in China. This Phase III, multicenter, randomized, double-blind study evaluated the efficacy and safety of a generic clevidipine (China's first injectable generic clevidipine emulsion) versus the branded drug Cleviprex in managing hypertensive emergencies and urgencies among Chinese patients. A total of 377 patients of 33 medical centers from December 2021 to December 2022 were randomized, with 189 in the generic clevidipine group and 188 in the control. As a result, 95.6% of patients in the generic clevidipine group and 93.6% in the control achieved the target systolic blood pressure (SBP) reduction within 30 min (rate difference 0.020, 90% CI: −0.019 to 0.060). The mean area under the curve (AUC) of SBP outside the target range within the first hour was comparable between groups (329.8 ± 238.16 in generic clevidipine vs. 347.9 ± 302.79 in control). The median time to first achieve the target range within 30 min was 12.0 min in both groups. The proportion of patients successfully transitioning to oral therapy within 6 h was 93.4% in the generic clevidipine group and 93.6% in the control group. The incidence of drug-related adverse events (AEs) was reported in 50 patients (27.3%) in the generic clevidipine group and in 48 (27.9%) in the control, with no unexpected safety signals. The generic clevidipine demonstrated comparable efficacy and safety to the branded drug, supporting its potential as an effective and accessible therapeutic alternative for acute hypertension management.</p><p><b>Trial Registration</b>: chinadrugtrials.org.cn identifier: ChiCTR20212877.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mengyuan Wang, Yucong Zhang, Shouling Wu, Ben Niu, Cuntai Zhang, Lei Ruan
Estimated pulse wave velocity (ePWV) is a widely used metric for assessing arterial stiffness, a key pathophysiological mechanism contributing to major adverse cardiovascular events (MACEs). While cross-sectional and short-term associations of ePWV with cardiovascular risk are recognized, the long-term impact of cumulative exposure to elevated ePWV levels on the risk of developing MACEs remains poorly understood, particularly in middle-aged and older adults. This longitudinal study analyzed data from two large prospective cohorts: the Kailuan Study (n = 3568; 65% male) and the China Health and Retirement Longitudinal Study (CHARLS) (n = 4831; 48% male). Individual ePWV was calculated based on age and mean arterial pressure. Cumulative ePWV exposure was quantified as the summed area under the curve between serial measurements. The primary outcome was the incidence of MACEs. Cox regression revealed significant positive associations between cumulative ePWV and MACEs risk, with the highest ePWV quartile showing substantially elevated risk compared to the lowest quartile in both the Kailuan (HR = 2.01; 95% CI: 1.34-3.01) and CHARLS cohorts (HR = 1.73; 95% CI: 1.03–2.91). Subgroup analyses demonstrated similar positive associations across key demographic and clinical strata. Long-term cumulative exposure to elevated ePWV independently predicts MACEs in adults aged ≥45 years. Critically, this association persists after rigorous adjustment for baseline ePWV and key confounders, highlighting the unique prognostic value of tracking arterial stiffness burden over time.
{"title":"Association Between Cumulative Estimated Pulse Wave Velocity and the Risk of Major Adverse Cardiovascular Events in Adults over 45 Years of Age: A Longitudinal Study Based on the CHARLS and Kailuan Cohorts","authors":"Mengyuan Wang, Yucong Zhang, Shouling Wu, Ben Niu, Cuntai Zhang, Lei Ruan","doi":"10.1111/jch.70162","DOIUrl":"10.1111/jch.70162","url":null,"abstract":"<p>Estimated pulse wave velocity (ePWV) is a widely used metric for assessing arterial stiffness, a key pathophysiological mechanism contributing to major adverse cardiovascular events (MACEs). While cross-sectional and short-term associations of ePWV with cardiovascular risk are recognized, the long-term impact of cumulative exposure to elevated ePWV levels on the risk of developing MACEs remains poorly understood, particularly in middle-aged and older adults. This longitudinal study analyzed data from two large prospective cohorts: the Kailuan Study (<i>n</i> = 3568; 65% male) and the China Health and Retirement Longitudinal Study (CHARLS) (<i>n</i> = 4831; 48% male). Individual ePWV was calculated based on age and mean arterial pressure. Cumulative ePWV exposure was quantified as the summed area under the curve between serial measurements. The primary outcome was the incidence of MACEs. Cox regression revealed significant positive associations between cumulative ePWV and MACEs risk, with the highest ePWV quartile showing substantially elevated risk compared to the lowest quartile in both the Kailuan (HR = 2.01; 95% CI: 1.34-3.01) and CHARLS cohorts (HR = 1.73; 95% CI: 1.03–2.91). Subgroup analyses demonstrated similar positive associations across key demographic and clinical strata. Long-term cumulative exposure to elevated ePWV independently predicts MACEs in adults aged ≥45 years. Critically, this association persists after rigorous adjustment for baseline ePWV and key confounders, highlighting the unique prognostic value of tracking arterial stiffness burden over time.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wesley Teck Wee Loo, Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren Sng, Lian Kiat Lim, Huai Yang Lim
Dear Editor,
We thank Fatima et al. [1] for their interest in our work [2] and for their insightful comments on improving the generalizability and interpretation of our results. They also raise important areas for further research.
Our study was conducted among adolescent and young adult (AYA) males in Singapore, a city-state in South East Asia with limited geographical and environmental diversity. Regular cross-sectional surveys conducted among its citizens [3] provide insight into dietary habits and nutritional status of Singapore citizens. However, data specific to our cohort was not collected. We acknowledge the potential impact of dietary habits on hypertension and that our cohort may reflect country-specific trends [4, 5].
Our study involves a national male cohort, taking place at centralized screening center with consistency in measurement and data collection. However, we acknowledge the exclusion of females from our study cohort and emphasize caution when extrapolating our data to the other gender. Results from our study did not show a significant association between smoking and hypertension; this was also seen in recent studies also showing an inconsistent relationship shown between smoking and hypertension [6, 7]. Additionally, as mentioned in the discussion section of our paper, a dose-dependent relationship between smoking and hypertension may account for our findings [8, 9]. Nonetheless, further longitudinal studies, particularly in the AYA population, can help further clarify this relationship.
Our study was designed to evaluate the blood pressure (BP) norms of our cohort. We agree that additional longitudinal studies may provide greater insight into disease progression and trajectory of elevated BP and hypertension in the AYA population, as well as on the prognostic impact of the various diagnostic thresholds discussed in our study.
Finally, we note Fatima et al.’s comment regarding the importance of evaluating for secondary hypertension in the AYA population. We agree with its importance, and this is also reflected in the latest European Society of Cardiology Guidelines for hypertension [10], which now gives a Class IIa recommendation for screening for primary aldosteronism in individuals with hypertension. We will be conducting further analysis on individuals with hypertension from our cohort, and look forward to sharing our results in the near future.
Wesley Teck Wee Loo drafted this letter. Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren Sng, Lian Kiat Lim, and Huai Yang Lim critically revised this letter. All authors approve the final version of this letter.
The authors declare that they have no competing interests.
尊敬的编辑：我们感谢Fatima等人对我们的工作感兴趣，并就提高我们研究结果的普遍性和解释提出了富有见地的意见。它们还提出了需要进一步研究的重要领域。我们的研究在新加坡的青少年和年轻成人（AYA）男性中进行，新加坡是东南亚的一个城市国家，地理和环境多样性有限。在新加坡公民中进行的定期横断面调查提供了对新加坡公民饮食习惯和营养状况的深入了解。然而，没有收集到我们队列的特定数据。我们承认饮食习惯对高血压的潜在影响，我们的队列可能反映了国家特定的趋势[4,5]。我们的研究涉及一个全国性的男性队列，在集中筛查中心进行，测量和数据收集保持一致。然而，我们承认在我们的研究队列中排除了女性，并强调在将我们的数据外推到其他性别时要谨慎。我们的研究结果没有显示吸烟和高血压之间的显著关联；最近的研究也发现了这一点，吸烟与高血压之间的关系并不一致[6,7]。此外，正如我们论文讨论部分所提到的，吸烟与高血压之间的剂量依赖关系可能解释了我们的发现[8,9]。尽管如此，进一步的纵向研究，特别是在AYA人群中，可以帮助进一步阐明这种关系。我们的研究旨在评估我们的队列的血压（BP）标准。我们同意，额外的纵向研究可以更深入地了解AYA人群中血压升高和高血压的疾病进展和轨迹，以及我们研究中讨论的各种诊断阈值对预后的影响。最后，我们注意到Fatima等人关于评估AYA人群继发性高血压的重要性的评论。我们同意它的重要性，这也反映在最新的欧洲心脏病学会高血压指南中，该指南现在给出了高血压患者原发性醛固酮增多症筛查的IIa级建议。我们将对队列中的高血压患者进行进一步分析，并期待在不久的将来分享我们的结果。韦斯利·德克·威·卢起草了这封信。Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren sung， Lian Kiat Lim和Huai Yang Lim对这封信进行了批判性的修改。所有作者都同意这封信的最终版本。作者宣称他们没有竞争利益。
{"title":"Author Response to Letter on “Blood Pressure and Hypertension in Adolescents and Young Adults: Results From a Nationwide Screening Program”","authors":"Wesley Teck Wee Loo, Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren Sng, Lian Kiat Lim, Huai Yang Lim","doi":"10.1111/jch.70161","DOIUrl":"10.1111/jch.70161","url":null,"abstract":"<p>Dear Editor,</p><p>We thank Fatima et al. [<span>1</span>] for their interest in our work [<span>2</span>] and for their insightful comments on improving the generalizability and interpretation of our results. They also raise important areas for further research.</p><p>Our study was conducted among adolescent and young adult (AYA) males in Singapore, a city-state in South East Asia with limited geographical and environmental diversity. Regular cross-sectional surveys conducted among its citizens [<span>3</span>] provide insight into dietary habits and nutritional status of Singapore citizens. However, data specific to our cohort was not collected. We acknowledge the potential impact of dietary habits on hypertension and that our cohort may reflect country-specific trends [<span>4, 5</span>].</p><p>Our study involves a national male cohort, taking place at centralized screening center with consistency in measurement and data collection. However, we acknowledge the exclusion of females from our study cohort and emphasize caution when extrapolating our data to the other gender. Results from our study did not show a significant association between smoking and hypertension; this was also seen in recent studies also showing an inconsistent relationship shown between smoking and hypertension [<span>6, 7</span>]. Additionally, as mentioned in the discussion section of our paper, a dose-dependent relationship between smoking and hypertension may account for our findings [<span>8, 9</span>]. Nonetheless, further longitudinal studies, particularly in the AYA population, can help further clarify this relationship.</p><p>Our study was designed to evaluate the blood pressure (BP) norms of our cohort. We agree that additional longitudinal studies may provide greater insight into disease progression and trajectory of elevated BP and hypertension in the AYA population, as well as on the prognostic impact of the various diagnostic thresholds discussed in our study.</p><p>Finally, we note Fatima et al.’s comment regarding the importance of evaluating for secondary hypertension in the AYA population. We agree with its importance, and this is also reflected in the latest European Society of Cardiology Guidelines for hypertension [<span>10</span>], which now gives a Class IIa recommendation for screening for primary aldosteronism in individuals with hypertension. We will be conducting further analysis on individuals with hypertension from our cohort, and look forward to sharing our results in the near future.</p><p>Wesley Teck Wee Loo drafted this letter. Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren Sng, Lian Kiat Lim, and Huai Yang Lim critically revised this letter. All authors approve the final version of this letter.</p><p>The authors declare that they have no competing interests.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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