Journal of Clinical Hypertension最新文献

Hypertension is a major modifiable risk factor for cardiovascular disease and a leading cause of morbidity and mortality worldwide. This study aimed to identify factors associated with hypertension among Peruvian adults using nationally representative data from the 2023 Demographic and Family Health Survey (ENDES). We conducted an analytical cross-sectional study including adults aged ≥ 18 years with self-reported hypertension status available and the a priori covariates. Associations were evaluated using survey-weighted bivariate analyses and modified Poisson regression to estimate crude and adjusted prevalence ratios (aPRs), accounting for the complex design. Among 29 826 adults, the prevalence of self-reported hypertension was 9.2%. In survey-weighted, multivariable models, age showed a strong gradient (aPRs 1.01–1.25 vs. 18–29 years), diabetes was associated with higher prevalence (aPR 1.17), and body mass index (BMI) categories showed a dose–response pattern (overweight aPR 1.02; obesity aPR 1.05). Male sex had a slightly lower prevalence than females (aPR 0.98). Smoking and alcohol use showed minimal or null associations in the primary model; sensitivity analyses for missingness produced stable inferences for alcohol, but smoking estimates varied. Hypertension remains a public health challenge in Peru. Older age, diabetes, and excess body weight are key targets for prevention; BMI disaggregation clarifies a dose–response signal. Given high item nonresponse for smoking/alcohol, we emphasize cautious interpretation and the value of improved exposure ascertainment.

This study aimed to report the effects of policosanol (20 mg/day) on blood pressure values in Cuban patients with grade I hypertension. A double-blind multicenter trial randomized 400 eligible patients divided into two strata of patients with either prehypertension or grade I hypertension (200 patients each) treated with either placebo or policosanol 20 mg/day (100 patients/group/stratum) for 12 weeks. Having published the results of pre-hypertensive patients, here we report the grade I hypertension stratum (SBP 140–159 mmHg, DBP 90–99 mmHg) results. The primary outcome targeted whether policosanol could achieve significant systolic blood pressure (SBP) reductions ≥10 mmHg versus baseline and significantly different from placebo. Changes in diastolic blood pressure (DBP) and lipid profile variables were secondary outcomes. Safety indicators and adverse events were assessed. Statistical analyses were conducted by Intention to Treat. Both groups were similar at randomization. At study completion, policosanol significantly lowered (p < 0.001) SBP, the primary outcome, by more than 10 mmHg related to baseline and placebo, while also significantly decreasing (p < 0.001) DBP values versus baseline and placebo. Also, more (p < 0.001) policosanol patients reached SBP reductions ≥10 mmHg and DBP reductions ≥5 mmHg versus baseline (74% and 91%, respectively) than placebo patients (12% and 15%, respectively). Policosanol significantly lowered low-density lipoprotein-cholesterol (LDL-C) and total cholesterol, while increasing high-density lipoprotein-cholesterol (HDL-C). It is concluded that oral administration of policosanol 20 mg/day for twelve weeks significantly lowered SBP and DBP in Cuban patients with grade I hypertension, and improved lipid profile variables, being safe and well tolerated.

Trial registration: Cuban Public Registry of Clinical Trials identifier: RPCEC00000377; IRB approval number: IRB-120721.

To the Editor,

We read with great interest the article “Influenza vaccination and short-term risk of stroke among elderly patients with chronic comorbidities in a population-based cohort study ”by Wang et al. [1]. While this study shed light on valuable clinical and stroke outcomes of influenza vaccination in a Shanghai Cohort, a few additional elements could have strengthened the article's robustness.

First, the vaccination rate in this cohort was very low (1.25%–1.55%), resulting in only 786 and 589 vaccinated participants in the 2017–2018 and 2018–2019 influenza seasons, respectively. Within these small subgroups, merely 5 and 7 stroke events occurred. Such sparse outcomes render hazard ratio estimates unstable and associated confidence intervals wide, raising concerns about the robustness of the findings [2, 3].

Additionally, despite the application of multivariable adjustment and propensity score matching, residual confounding is highly likely. Vaccinated participants differed significantly from their unvaccinated counterparts—they were younger, more often male, more likely to smoke or drink, more frequently hypertensive, and less often diabetic [4]. Furthermore, important covariates such as medication use (antiplatelets, anticoagulants, antihypertensives, statins), stroke subtype (ischemic vs. hemorrhagic), and prior influenza infection history were not available. These unmeasured factors may strongly bias effect estimates [5].

Thirdly, the exposure definition—vaccination at any time between August and March—does not account for temporal variation in influenza circulation and risk periods [6]. The use of Poisson regression as a sensitivity analysis is also problematic, as extremely low event counts may artificially inflate effect sizes. Additionally, the BMI categories applied do not align with population-specific Chinese cutoffs, which could lead to misclassification [7].

In light of these limitations, the impressive reduction in stroke risk reported should be interpreted with caution. While the hypothesis that influenza vaccination may confer cardiovascular protection is biologically plausible and of great clinical relevance, more definitive evidence will require larger, multicenter cohorts with longer follow-up, precise stroke classification, and comprehensive adjustment for potential confounders.

We appreciate the authors’ contribution and hope that these observations will help guide future investigations in this important area.

In conclusion, I commend the authors for their significant work and recommend that further studies consider these limitations. Doing so would help enhance the strength, consistency, and clinical applicability of the findings.

Pediatric hypertension (HTN) affects 3%–5% of children in the United States, yet only 25% are diagnosed and 60% lack recommended follow-up care. Skepticism about elevated blood pressure (BP) readings and reluctance to use antihypertensive medications by parents and clinicians highlight the need for stakeholder-informed strategies to address these challenges. This study examined parents’ perceived needs, their recommended strategies to improve HTN detection, and contextual health system challenges. Parents and clinicians from 10 pediatric primary care clinics participated in semi-structured qualitative interviews. Only parents of children with documented stage 2 BP readings and a HTN diagnosis, but with gaps in care of 1 year or longer, were included. Participants were recruited from clinics in diverse communities. Thematic analysis identified major themes and recommendations guided by the Consolidated Framework for Implementation Research (CFIR). A total of 38 stakeholders participated, including 13 parents and 25 healthcare clinicians. Parents reported limited discussions in the clinic around pediatric HTN, logistical barriers related to social determinants of health, including financial burdens and insurance issues, and scheduling conflicts. Clinicians cited systemic constraints such as time limitations, staffing shortages, and insufficient resources to address social determinants of health-related needs. Parents recommended strategies, including enhanced education on pediatric HTN, flexible scheduling, telehealth, remote BP monitoring, and improved care coordination, to overcome barriers and align with systemic improvements. Parent-recommended strategies can address pediatric HTN detection challenges. However, aligning these strategies with systemic constraints is essential for effective, stakeholder-informed improvements in HTN detection.

Hypertension (HTN) is the leading cause of death worldwide, yet only 8% of individuals have controlled blood pressure (BP) in low- and middle-income countries, with particular challenges in humanitarian crisis settings including Haiti. The Haiti Cardiovascular Disease Cohort, an observational population-based cohort in Port-au-Prince, offers a unique opportunity to evaluate the HTN Care Continuum in a setting of extreme poverty and civil unrest. From 2019 to 2021, 3005 adults were enrolled, with BP measured every 6 months and free clinical care provided. HTN was defined as SBP ≥ 140, DBP ≥ 90, or antihypertensive medication use. We assessed screening, awareness, treatment, and BP control (BP < 140/90 on antihypertensives) at enrollment and 24 months. Multivariable Poisson regression identified sociodemographic factors associated with BP control. Of 3005 adults, 878 had HTN at enrollment (median age 57; 62% female; 71% earned < $1/day). Among 568 hypertensive participants with 24-month follow-up, awareness increased from 67% to 95%, treatment from 40% to 71%, and BP control from 11% to 32%. Median BP decreased from 150/91 to 138/82 mmHg. Across visits, 67% had ≥ 1 controlled BP and 35% had control at more than half of visits. Younger age (18–39 vs. ≥60 years) was associated with lower BP control (PR: 0.40, 95% CI: 0.18–0.77). Substantial improvements in HTN care, including a threefold rise in BP control and a mean SBP decrease of 12 mmHg, are achievable even in settings of extreme adversity and humanitarian crises.

Trial Registration: ClinicalTrials.gov identifier: NCT03892265

To the Editor,

We have read the article “Association of Triglyceride–Glucose Body Mass Index with Target Organ Damage in Essential Hypertension: A Retrospective Cohort Study” by Huang et al. [1] with great interest. We would like to acknowledge the author's rigorous work in this important area that will be appreciated by the readers. We agree with their final conclusion that TyG-BMI is a simple and inexpensive index that measures obesity and incorporates insulin resistance, and that having prognostic ability similar to traditional risk factor models may be helpful in identifying and monitoring children at risk for future poor health outcomes.

We do, however, think that a couple of additional points could potentially strengthen the conclusion of the article.

First, the method of a retrospective cohort study [2] has inherent biases; we need to consider including selection bias and residual confounding. Although the authors describe that multivariable adjustments were made for baseline characteristics, it will be challenging to control for the dynamic nature of the baseline factors, like medication compliance, lifestyle changes, or clinical management over 23 months of follow-up. As with all unmeasured variables, they may have effects on both TyG-BMI and the progression of target organ damage, which limits conclusions of causation. Large-scale prospective studies of long duration need to validate these findings.

Second, even though Huang et al. [1] used TyG-BMI as a surrogate measure for insulin resistance (IR), there are concerns over the generalizability and diagnostic accuracy of the measure. A recent systematic review concluded that the hyperinsulinemic-euglycemic clamp remains the gold standard of assessing IR. While the TyG index had variable performance across different populations, it lacks standardized cut-offs [3]. The absence of the gold-standard assessment in the study prevents us from identifying the true diagnostic accuracy of the TyG-BMI. More importantly, a singular, simplified index may overlook the complexities and relationships between IR, hypertension, and the progression of target organ damage, which could limit its clinical utility across different groups of patients.

Third, metabolic markers, including fasting glucose and triglycerides, which are the fundamental elements of the TyG-BMI calculation, were assessed only once at baseline and do not necessarily reflect long-term changes or variation, which makes them more prone to misclassification risk. For example, one study that investigated the cardiovascular risk with longitudinal comparisons demonstrated that it is useful to repeat key measurements in people with high blood pressure [4]. Future studies should attempt to compare various measurements in order to establish if there is any relationship between multiple parameters with the development of cardiovascular-related outcome

This systematic review and meta-analysis evaluated the efficacy and safety of lorundrostat in adults with uncontrolled hypertension. Following PRISMA guidelines and PROSPERO registration (CRD420251088503), five databases were systematically searched through July 2025 for randomized controlled trials comparing lorundrostat with placebo in this population. The primary outcome was change in systolic blood pressure (SBP), while secondary outcomes included diastolic blood pressure, severe BP events, and adverse effects. Three RCTs comprising 1568 participants across 10 study arms were included. Lorundrostat significantly reduced 24-h ambulatory SBP (mean difference [MD]: –7.45 mmHg; 95% CI: −12.54 to −2.36; p = 0.0041; p² = 0%) and diastolic BP (MD: −3.49 mmHg; 95% CI: −5.56 to −1.41; p = 0.0010; I² = 0%). While office SBP showed a non-significant reduction in the primary analysis (MD: −13.55 mmHg; p = 0.077; I² = 94%), it became statistically significant in a sensitivity analysis (MD: −9.08 mmHg; p < 0.0001). Lorundrostat also significantly lowered the risk of severely elevated BP events (odds ratio [OR]: 0.37; 95% CI: 0.17–0.81; p = 0.028). Adverse effects included an increased risk of hyperkalemia (OR: 3.22; p < 0.001) and hyponatremia (OR: 2.16; p = 0.037), with no significant difference in serious adverse events between groups. In conclusion, lorundrostat demonstrates significant reductions in both ambulatory and diastolic BP in patients with uncontrolled hypertension, with a generally tolerable safety profile. Hyperkalemia and hyponatremia remain notable risks. Further long-term trials are warranted to validate its sustained efficacy and safety.

All authors conceptualized the current manuscript; L.Y. Lin, J. Yang, and V.C. Wu drafted the manuscript; all authors thoroughly revising the manuscript critically for important intellectual content and approved the submitted manuscript.

The authors have nothing to report.

No patient enrollment.

The authors declare no conflicts of interest.

Dear Editor,

We read with interest the article by Sesa-Ashton et al., which examined electrocardiographic changes in left ventricular mass index (LVMI) and atrial fibrillation (AF) incidence over more than 8 years of follow-up after renal denervation (RDN) [1]. The study demonstrated no significant alterations in ECG-derived LVMI or AF burden, though reductions in ambulatory blood pressure were correlated with modest improvements in LVMI. These findings are notable; however, several considerations warrant further reflection.

The reliance on electrocardiographic criteria, such as Cornell voltage indices, may limit the capacity to detect subtle or progressive structural cardiac changes. Previous research has shown that echocardiography and especially cardiac magnetic resonance imaging (CMR) provide superior accuracy in identifying left ventricular remodeling, often capturing changes missed by voltage-based criteria [2]. The absence of these imaging modalities may therefore explain the lack of significant long-term differences in LVMI observed in the study.

The relatively small cohort size and absence of a comparator group further constrain interpretation of the results. Larger randomized and sham-controlled trials have consistently demonstrated reductions in blood pressure with RDN and, in some cases, improvements in cardiac structure [3]. Without a control group, it remains difficult to distinguish whether the stability in LVMI represents a true absence of effect or methodological limitation.

An additional point relates to AF outcomes. Given the advancing age of the cohort, an increase in AF incidence might have been expected. The stability reported could reflect a potential benefit of RDN in attenuating sympathetic drive. Nonetheless, evidence from randomized studies indicates that RDN may reduce AF recurrence when combined with pulmonary vein isolation in selected patients, underscoring the importance of patient characteristics and disease stage in determining outcomes [4].

Future studies should build on these findings by employing imaging-based endpoints, enrolling larger and more diverse populations, and stratifying participants according to baseline cardiac remodeling. Such approaches could clarify whether RDN provides sustained cardioprotective effects beyond blood pressure control. The work of Sesa-Ashton et al. makes a valuable contribution to the field, yet further rigorous investigations are necessary to fully establish the long-term cardiac implications of RDN [5].

Sincerely,

All of the authors contributed to planning, writing, and revision.

Not appliable.

Not appliable.

Not appliable.

The authors declare no conflicts of interest.