Journal of Clinical Hypertension最新文献

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.

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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.

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).

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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.

Trial Registration: chinadrugtrials.org.cn identifier: ChiCTR20212877.

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.

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.

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.