Xin Meng, Chaonan Gao, Jingfan Xiong, QianJin Qi, Wei Liu, Yongxi Xue, Hongbo Dong, Jie Mi, Yinkun Yan
Hypertension represents a significant public health issue globally, yet the age-related changes in prevalence and transition patterns of blood pressure (BP) categories and hypertension subtypes throughout the lifespan remain unclear. This dynamic cohort study included 22 858 participants aged 3–80 years from the China Health and Nutrition Survey 1989–2015. Participants were categorized into eight sub-cohorts based on baseline age in 10-year intervals, i.e., 3–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, and 71–80 years. The study found that for participants with normal BP, the probabilities of developing hypertension over a 10-year follow-up period increased with age during adulthood, with the probabilities of developing systolic hypertension surpassing those of diastolic hypertension beginning at 41–50 years. In comparison, for participants with hypertension, the probabilities of reverting to normal BP generally decreased with age during adulthood, with those aged 11–20 years having the highest probabilities. The probabilities of maintaining hypertension showed contrasting age-related trends. These findings remained largely unchanged in additional analyses of adjustment for covariates, being restricted to a 20-year follow-up or being stratified by sex. In conclusion, individuals with normal BP are more likely to develop hypertension in late adulthood, whereas those with hypertension are more likely to revert to normal BP during adolescence. The age-related changes in prevalence and dynamic transition of hypertension over the lifespan underscore the necessity for developing age-appropriate prevention and intervention strategies.
{"title":"Identify Sensitive Periods for Onset and Resolution of Hypertension and Its Subtypes Over the Lifespan","authors":"Xin Meng, Chaonan Gao, Jingfan Xiong, QianJin Qi, Wei Liu, Yongxi Xue, Hongbo Dong, Jie Mi, Yinkun Yan","doi":"10.1111/jch.70154","DOIUrl":"https://doi.org/10.1111/jch.70154","url":null,"abstract":"<p>Hypertension represents a significant public health issue globally, yet the age-related changes in prevalence and transition patterns of blood pressure (BP) categories and hypertension subtypes throughout the lifespan remain unclear. This dynamic cohort study included 22 858 participants aged 3–80 years from the China Health and Nutrition Survey 1989–2015. Participants were categorized into eight sub-cohorts based on baseline age in 10-year intervals, i.e., 3–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, and 71–80 years. The study found that for participants with normal BP, the probabilities of developing hypertension over a 10-year follow-up period increased with age during adulthood, with the probabilities of developing systolic hypertension surpassing those of diastolic hypertension beginning at 41–50 years. In comparison, for participants with hypertension, the probabilities of reverting to normal BP generally decreased with age during adulthood, with those aged 11–20 years having the highest probabilities. The probabilities of maintaining hypertension showed contrasting age-related trends. These findings remained largely unchanged in additional analyses of adjustment for covariates, being restricted to a 20-year follow-up or being stratified by sex. In conclusion, individuals with normal BP are more likely to develop hypertension in late adulthood, whereas those with hypertension are more likely to revert to normal BP during adolescence. The age-related changes in prevalence and dynamic transition of hypertension over the lifespan underscore the necessity for developing age-appropriate prevention and intervention strategies.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110936","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>It is with pleasure that we read the work of Agarwal et al. titled “Association of Systolic Blood Pressure Time in Target Range With Cardiovascular Events Among PRECISION Participants” [<span>1</span>], which demonstrated that participants with systolic blood pressure (SBP) within a target range (TTR) of 110–130 mmHg for a longer duration (>75% vs. <25%) had a lower risk of major adverse cardiovascular events (MACE) using both traditional and Rosendaal TTR methods. We were particularly surprised with the significant effect modification of sex and hypertension status on SBP TTR and would like to provide additional insight.</p><p>Women had lower risks of MACE at each level of TTR compared to men. Men, in fact, demonstrated no significant association between TTR and MACE. We speculate that this is due to both selection bias and physiologic differences: (1) the PRECISION trial used different inclusion criteria for men and women, including differences in age, insulin use, and cardiometabolic morbidities. This was likely in part due to the high prevalence of women with rheumatoid arthritis necessitating amended criteria to ensure adequate inclusion of men [<span>2</span>]. Such differences may reflect baseline differences in ASCVD risk and an imbalance of comorbidities. For example, women, in general, are less likely to have hypertension and be using antihypertensives for primary prevention rather than secondary prevention. This coincides with lack of significant effects in the subgroup for secondary prevention and with hypertension; (2) secondly, the selected target range (110–130 mm Hg) may have aligned more with average women BP, as women tend to have lower BP than men and only begin approaching that of men in the eighth decade [<span>3</span>].</p><p>Hypertension status was also an effect modifier. We speculate that differential misclassification bias from measurement error likely drives some of the lack of difference seen in participants with hypertension. Those with hypertension are more likely to have higher SBP variability, which is not captured from routine office visit-based TTR. Thus, there may be individuals in the >75% TTR group with actual lower TTR, regressing the effect estimates towards the null. Those without hypertension are less likely to have SBP variability, and thus, TTR is likely prone to less misclassification [<span>4</span>]. Additionally, participants in the PRECISION trial were administered nonsteroidal anti-inflammatory drugs (NSAIDs), which are known to increase BP, CKD risk, and may have contributed to elevated MACE risk in participants with hypertension [<span>5</span>].</p><p>Future studies should also report diastolic BP TTR and HR TTR to get a more complete picture of hemodynamics. Abnormal DBP patterns may have influenced the effect modifications observed [<span>6</span>]. Furthermore, the study cohort consisted mostly of older adults whose vessels are likely of lower elasticity, lea
致编辑：我们很高兴地阅读Agarwal等人题为“PRECISION参与者中收缩压时间在目标范围内与心血管事件的关联”的研究，该研究表明收缩压（SBP）在目标范围（TTR） 110-130 mmHg内持续时间较长（>75% vs <25%）的参与者使用传统和Rosendaal TTR方法发生主要不良心血管事件（MACE）的风险较低。我们对性别和高血压状态对收缩压TTR的显著影响感到特别惊讶，并希望提供更多的见解。与男性相比，女性在每个TTR水平下发生MACE的风险都较低。事实上，男性在TTR和MACE之间没有明显的联系。我们推测这是由于选择偏倚和生理差异造成的：(1)PRECISION试验对男性和女性采用了不同的纳入标准，包括年龄、胰岛素使用和心脏代谢发病率的差异。这可能部分是由于女性类风湿关节炎患病率高，需要修订标准以确保充分纳入男性bbb。这种差异可能反映了ASCVD风险的基线差异和合并症的不平衡。例如，一般来说，妇女患高血压的可能性较小，并且使用抗高血压药物进行一级预防而不是二级预防。这与二级预防亚组和高血压亚组缺乏显著效果相吻合；(2)其次，选择的目标范围（110-130毫米汞柱）可能更符合女性的平均血压，因为女性的血压往往比男性低，直到80岁才开始接近男性的血压。高血压状况也是一个影响因素。我们推测，测量误差造成的差异误分类偏差可能导致高血压患者缺乏差异。高血压患者更有可能有更高的收缩压变异性，这在常规的基于办公室就诊的TTR中无法捕捉到。因此，在75% TTR组中，可能存在实际TTR较低的个体，将效应估计回归为零。那些没有高血压的人不太可能有收缩压变异性，因此，TTR可能倾向于更少的错误分类[4]。此外，PRECISION试验的参与者被给予非甾体抗炎药（NSAIDs），这些药物已知会增加血压、CKD风险，并可能导致高血压患者MACE风险升高。未来的研究也应该报告舒张期BP TTR和HR TTR，以获得更完整的血流动力学图像。异常DBP模式可能影响了观察到的[6]的效果改变。此外，研究队列主要由老年人组成，他们的血管可能具有较低的弹性，导致舒张压降低和收缩压升高。最后，虽然TTR已经被很好地捕获，但不能完全排除白大褂效应、情境差异和一天中的时间的混淆。TTR和收缩压变异性的临床意义不断增加，但在2025年ACC/AHA高血压指南中并未提及。英国的QRisk评分通过使用5年期间收缩压读数的标准偏差来解释收缩压变异性，以便更好地识别可能具有较高CV风险的患者，即使他们的平均血压在控制范围内。该方法强调了将BP值纳入风险评估可以通过同时使用平均BP值和BP值来改善CV风险预测。在临床实践中考虑BPV测量，包括TTR，可能导致更有针对性的管理策略，如更密集的血压监测或选择替代药物，以减少变异性，支持更全面的心血管风险降低。作者没有什么可报告的。作者声明无利益冲突。
{"title":"Effect Modification of Sex and Hypertension Status on the Association Between Systolic Time-in-Target-Range and Cardiovascular Outcomes","authors":"Neil Garg, Aayush Visaria","doi":"10.1111/jch.70148","DOIUrl":"10.1111/jch.70148","url":null,"abstract":"<p>To the Editor,</p><p>It is with pleasure that we read the work of Agarwal et al. titled “Association of Systolic Blood Pressure Time in Target Range With Cardiovascular Events Among PRECISION Participants” [<span>1</span>], which demonstrated that participants with systolic blood pressure (SBP) within a target range (TTR) of 110–130 mmHg for a longer duration (>75% vs. <25%) had a lower risk of major adverse cardiovascular events (MACE) using both traditional and Rosendaal TTR methods. We were particularly surprised with the significant effect modification of sex and hypertension status on SBP TTR and would like to provide additional insight.</p><p>Women had lower risks of MACE at each level of TTR compared to men. Men, in fact, demonstrated no significant association between TTR and MACE. We speculate that this is due to both selection bias and physiologic differences: (1) the PRECISION trial used different inclusion criteria for men and women, including differences in age, insulin use, and cardiometabolic morbidities. This was likely in part due to the high prevalence of women with rheumatoid arthritis necessitating amended criteria to ensure adequate inclusion of men [<span>2</span>]. Such differences may reflect baseline differences in ASCVD risk and an imbalance of comorbidities. For example, women, in general, are less likely to have hypertension and be using antihypertensives for primary prevention rather than secondary prevention. This coincides with lack of significant effects in the subgroup for secondary prevention and with hypertension; (2) secondly, the selected target range (110–130 mm Hg) may have aligned more with average women BP, as women tend to have lower BP than men and only begin approaching that of men in the eighth decade [<span>3</span>].</p><p>Hypertension status was also an effect modifier. We speculate that differential misclassification bias from measurement error likely drives some of the lack of difference seen in participants with hypertension. Those with hypertension are more likely to have higher SBP variability, which is not captured from routine office visit-based TTR. Thus, there may be individuals in the >75% TTR group with actual lower TTR, regressing the effect estimates towards the null. Those without hypertension are less likely to have SBP variability, and thus, TTR is likely prone to less misclassification [<span>4</span>]. Additionally, participants in the PRECISION trial were administered nonsteroidal anti-inflammatory drugs (NSAIDs), which are known to increase BP, CKD risk, and may have contributed to elevated MACE risk in participants with hypertension [<span>5</span>].</p><p>Future studies should also report diastolic BP TTR and HR TTR to get a more complete picture of hemodynamics. Abnormal DBP patterns may have influenced the effect modifications observed [<span>6</span>]. Furthermore, the study cohort consisted mostly of older adults whose vessels are likely of lower elasticity, lea","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083296","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}
This study evaluated the effects of allisartan isoproxil combined with amlodipine besylate tablets (Group A+C) or metoprolol succinate extended-release tablets (Group A+B) on sexual function and nighttime blood pressure (nBP) in 130 male patients with essential hypertension (EH). Patients were randomized to two groups. After 6-month, the IIEF-15 total score (ITS) of sexual function significantly improved in Group A+C (p = 0.015), including intercourse satisfaction (IS) (p = 0.003), orgasmic function (OF) (p = 0.021), and overall satisfaction (OS) (p = 0.019), while erectile function (EF) (p = 0.081) and sexual desire (SD) (p = 0.08) were unchanged. In contrast, the ITS was decreased (p = 0.008), including EF (p = 0.005), IS (p = 0.048), SD (p = 0.003), and OS (p = 0.010), but OF remained unchanged (p = 0.076) in Group A+B. Between-group comparisons confirmed significant differences across IIEF-15 domains (all p < 0.05). Compared to baseline, office systolic BP (OSBP), office diastolic BP (ODBP), nighttime average SBP (nSBP), and nighttime average DBP (nDBP) were significantly reduced at 6 months in two groups (all p < 0.05). Although nSBP fall (nSBPF) (p = 0.010) and nDBP fall (nDBPF) (p = 0.002) significantly increased in Group A+C. In Group A+C, the nighttime-daytime BP fall ratio of SBP was 1.04 (0.45, 1.70) and that of DBP was 1.13 (0.38, 1.44) after treatment, with a median value > 1, indicating that nBP fall after treatment was greater than dBP fall. Compared to Group A+B, ODBP (difference = −4.00 mmHg, 95% CI [−7.64, −0.36], p = 0.032), daytime average DBP (difference = −5.47 mmHg, 95% CI [−10.05, −0.79], p = 0.023) and 24-h average DBP (difference = −5.77 mmHg, 95% CI [−10.31, −1.24], p = 0.014) decreased more significantly in Group A+C, nDBPF increased significantly (difference = 4.99 mmHg, 95% CI [0.04, 9.93], p = 0.048), and the decrease in the nighttime-daytime BP fall ratio of SBP and DBP was higher (p < 0.05). It was concluded that combined antihypertension of allisartan isoproxil with amlodipine besylate tablets improved sexual function in male hypertensive patients in terms of the ITS, IS, OF, and OS, but there was no significant improvement in EF and SD. Both combined antihypertensive regimens were effective in lowering BP, but allisartan isoproxil combined with amlodipine besylate tablets demonstrated more advantageous in lowering DBP and nBP.
{"title":"Effects of Two Allisartan Isoproxil-Based Antihypertensive Therapies on Sexual Function and Blood Pressure in Male Hypertensive Patients: A Single-Center, Open-Label, and Randomized Controlled Trial","authors":"Mingming Wang, Jianshu Chen, Miaomiao Qi, Runmin Sun, Zhangyou Long, Quanbin Su, Yanhong Mou, Hengxia Liu, Qiongying Wang, Qiang Wu, Xiaowei Zhang, Jing Yu","doi":"10.1111/jch.70145","DOIUrl":"10.1111/jch.70145","url":null,"abstract":"<p>This study evaluated the effects of allisartan isoproxil combined with amlodipine besylate tablets (Group A+C) or metoprolol succinate extended-release tablets (Group A+B) on sexual function and nighttime blood pressure (nBP) in 130 male patients with essential hypertension (EH). Patients were randomized to two groups. After 6-month, the IIEF-15 total score (ITS) of sexual function significantly improved in Group A+C (<i>p</i> = 0.015), including intercourse satisfaction (IS) (<i>p</i> = 0.003), orgasmic function (OF) (<i>p</i> = 0.021), and overall satisfaction (OS) (<i>p</i> = 0.019), while erectile function (EF) (<i>p</i> = 0.081) and sexual desire (SD) (<i>p</i> = 0.08) were unchanged. In contrast, the ITS was decreased (<i>p</i> = 0.008), including EF (<i>p</i> = 0.005), IS (<i>p</i> = 0.048), SD (<i>p</i> = 0.003), and OS (<i>p</i> = 0.010), but OF remained unchanged (<i>p</i> = 0.076) in Group A+B. Between-group comparisons confirmed significant differences across IIEF-15 domains (all <i>p</i> < 0.05). Compared to baseline, office systolic BP (OSBP), office diastolic BP (ODBP), nighttime average SBP (nSBP), and nighttime average DBP (nDBP) were significantly reduced at 6 months in two groups (all <i>p</i> < 0.05). Although nSBP fall (nSBPF) (<i>p</i> = 0.010) and nDBP fall (nDBPF) (<i>p</i> = 0.002) significantly increased in Group A+C. In Group A+C, the nighttime-daytime BP fall ratio of SBP was 1.04 (0.45, 1.70) and that of DBP was 1.13 (0.38, 1.44) after treatment, with a median value > 1, indicating that nBP fall after treatment was greater than dBP fall. Compared to Group A+B, ODBP (difference = −4.00 mmHg, 95% CI [−7.64, −0.36], <i>p</i> = 0.032), daytime average DBP (difference = −5.47 mmHg, 95% CI [−10.05, −0.79], <i>p</i> = 0.023) and 24-h average DBP (difference = −5.77 mmHg, 95% CI [−10.31, −1.24], <i>p</i> = 0.014) decreased more significantly in Group A+C, nDBPF increased significantly (difference = 4.99 mmHg, 95% CI [0.04, 9.93], <i>p</i> = 0.048), and the decrease in the nighttime-daytime BP fall ratio of SBP and DBP was higher (<i>p</i> < 0.05). It was concluded that combined antihypertension of allisartan isoproxil with amlodipine besylate tablets improved sexual function in male hypertensive patients in terms of the ITS, IS, OF, and OS, but there was no significant improvement in EF and SD. Both combined antihypertensive regimens were effective in lowering BP, but allisartan isoproxil combined with amlodipine besylate tablets demonstrated more advantageous in lowering DBP and nBP.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083291","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}
Kerry M. Sheets, Katherine L. Webb, Robyn L. Woods, Suzanne G. Orchard, Lawrence Beilin, Michelle A. Fravel, Christopher M. Reid, Kevan R. Polkinghorne, Rory Wolfe, Zhen Zhou, Joanne Ryan, Anne M. Murray, Michael E. Ernst
High variability in long-term blood pressure (BPV) independently predicts cardiovascular disease and cognitive decline. Increased BPV and declining physical performance may share mechanistic pathways. However, associations of BPV with gait speed and grip strength have not been examined. We completed a gender-stratified analysis of 16 692 participants enrolled in ASPREE/ASPREE-XT. Systolic and diastolic BPV were estimated from baseline-year 2 (Y2); gait speed/grip strength were assessed every 1–2 years following this period. Linear mixed models examined gait speed/grip strength trajectories over a median of 7.3 years of follow-up after Y2. Following adjustment, men with SBPV in tertile 3 (T3) versus T1 had slower gait speed at Y2 (0.021 m/s slower) and greater declines in gait speed (0.003 m/s greater decline/year, p < 0.001). Women with SBPV in T3 versus T1 had slower gait speed at Y2 (0.018 m/s slower), but similar rates of gait speed decline. Men with higher SBPV had weaker grip strength at Y2 (0.994 kg weaker for BPV T3 vs. T1) and greater declines in grip strength (0.016 kg greater decline/year/5 mmHg increase in BPV, p = 0.006). Women with BPV in T3 versus T1 had 0.486 kg weaker grip strength at Y2, but similar rates of grip strength decline. Associations of DBPV and SBPV with gait speed/grip strength were largely consistent. In summary, we found that higher BPV was independently associated with slower gait speed and weaker grip strength cross-sectionally in men and women, but only associated with trajectories of gait speed and grip strength in men. Future studies should examine high BPV as a target to preserve physical performance.
{"title":"Long-Term Blood Pressure Variability and Physical Performance in Older Adults","authors":"Kerry M. Sheets, Katherine L. Webb, Robyn L. Woods, Suzanne G. Orchard, Lawrence Beilin, Michelle A. Fravel, Christopher M. Reid, Kevan R. Polkinghorne, Rory Wolfe, Zhen Zhou, Joanne Ryan, Anne M. Murray, Michael E. Ernst","doi":"10.1111/jch.70139","DOIUrl":"10.1111/jch.70139","url":null,"abstract":"<p>High variability in long-term blood pressure (BPV) independently predicts cardiovascular disease and cognitive decline. Increased BPV and declining physical performance may share mechanistic pathways. However, associations of BPV with gait speed and grip strength have not been examined. We completed a gender-stratified analysis of 16 692 participants enrolled in ASPREE/ASPREE-XT. Systolic and diastolic BPV were estimated from baseline-year 2 (Y2); gait speed/grip strength were assessed every 1–2 years following this period. Linear mixed models examined gait speed/grip strength trajectories over a median of 7.3 years of follow-up after Y2. Following adjustment, men with SBPV in tertile 3 (T3) versus T1 had slower gait speed at Y2 (0.021 m/s slower) and greater declines in gait speed (0.003 m/s greater decline/year, <i>p</i> < 0.001). Women with SBPV in T3 versus T1 had slower gait speed at Y2 (0.018 m/s slower), but similar rates of gait speed decline. Men with higher SBPV had weaker grip strength at Y2 (0.994 kg weaker for BPV T3 vs. T1) and greater declines in grip strength (0.016 kg greater decline/year/5 mmHg increase in BPV, <i>p</i> = 0.006). Women with BPV in T3 versus T1 had 0.486 kg weaker grip strength at Y2, but similar rates of grip strength decline. Associations of DBPV and SBPV with gait speed/grip strength were largely consistent. In summary, we found that higher BPV was independently associated with slower gait speed and weaker grip strength cross-sectionally in men and women, but only associated with trajectories of gait speed and grip strength in men. Future studies should examine high BPV as a target to preserve physical performance.</p><p><b>Trial Registration</b>: ISRCTN number: ISRCTN83772183; ClinicalTrials.gov identifier: NCT01038583</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077190","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}
Kaiwen Sun, Minghui Gong, Yang Yu, Minghui Yang, Yinong Jiang, Ying Zhang, Wei Song
This study aimed to evaluate the diagnostic accuracy of 24-hour urinary aldosterone (UALD) for primary aldosteronism (PA) in Northeast China. A total of 423 patients with hypertension were consecutively enrolled. After 1:2 propensity score matching (PSM), 100 patients were classified into the PA group, and 194 patients were classified into the essential hypertension (EH) group. The clinical characteristics and biochemistry measurements were collected and analyzed. A receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated to determine optimal diagnostic thresholds. No significant difference in age was observed between the groups (PA: 53.4 ± 11.3 years vs. EH: 52.8 ± 11.3 years, p > 0.05). The median 24-hour UALD was significantly greater in the PA group (6.4 [3.7, 13.9] µg/24 h vs. 4.8 [2.5, 7.8] µg/24 h, p < 0.05), with levels declining with age in both cohorts. The optimal UALD cutoff value was 11.4 µg/24 h (AUC = 0.652; Youden index = 0.257). For patients over 55 years, the 24-hour urinary aldosterone-to-creatinine ratio (UACR) showed superior diagnostic performance, with an optimal cutoff of 0.8 µg/mmol/L (AUC = 0.695). 24-Hour UALD was a promising diagnostic marker for PA in North China, whereas 24-hour UACR might increase accuracy in older populations. However, further studies are needed to validate these findings.
本研究旨在评估24小时尿醛固酮（UALD）对东北地区原发性醛固酮增多症（PA）的诊断准确性。共纳入423例高血压患者。经1:2倾向评分匹配（PSM）后，100例患者分为PA组，194例患者分为原发性高血压（EH）组。收集并分析临床特征及生化指标。生成受试者工作特征（ROC）曲线，计算曲线下面积（AUC），确定最佳诊断阈值。两组患者年龄差异无统计学意义（PA: 53.4±11.3岁，EH: 52.8±11.3岁，p < 0.05）。PA组24小时UALD的中位值显著更高（6.4 [3.7,13.9]μ g/24 h vs. 4.8 [2.5, 7.8] μ g/24 h, p < 0.05），且两组的UALD水平均随年龄增长而下降。最佳UALD临界值为11.4µg/24 h （AUC = 0.652，约登指数= 0.257）。对于55岁以上的患者，24小时尿醛固酮与肌酐比值（UACR）具有较好的诊断性能，最佳临界值为0.8µg/mmol/L （AUC = 0.695）。在华北地区，24小时UALD是一种很有希望的PA诊断指标，而24小时UACR可能会提高老年人的准确性。然而，需要进一步的研究来验证这些发现。
{"title":"Diagnostic Accuracy of 24-Hour Urinary Aldosterone for Primary Aldosteronism in Northeast China","authors":"Kaiwen Sun, Minghui Gong, Yang Yu, Minghui Yang, Yinong Jiang, Ying Zhang, Wei Song","doi":"10.1111/jch.70130","DOIUrl":"10.1111/jch.70130","url":null,"abstract":"<p>This study aimed to evaluate the diagnostic accuracy of 24-hour urinary aldosterone (UALD) for primary aldosteronism (PA) in Northeast China. A total of 423 patients with hypertension were consecutively enrolled. After 1:2 propensity score matching (PSM), 100 patients were classified into the PA group, and 194 patients were classified into the essential hypertension (EH) group. The clinical characteristics and biochemistry measurements were collected and analyzed. A receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated to determine optimal diagnostic thresholds. No significant difference in age was observed between the groups (PA: 53.4 ± 11.3 years vs. EH: 52.8 ± 11.3 years, <i>p</i> > 0.05). The median 24-hour UALD was significantly greater in the PA group (6.4 [3.7, 13.9] µg/24 h vs. 4.8 [2.5, 7.8] µg/24 h, <i>p</i> < 0.05), with levels declining with age in both cohorts. The optimal UALD cutoff value was 11.4 µg/24 h (AUC = 0.652; Youden index = 0.257). For patients over 55 years, the 24-hour urinary aldosterone-to-creatinine ratio (UACR) showed superior diagnostic performance, with an optimal cutoff of 0.8 µg/mmol/L (AUC = 0.695). 24-Hour UALD was a promising diagnostic marker for PA in North China, whereas 24-hour UACR might increase accuracy in older populations. However, further studies are needed to validate these findings.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077151","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}
More than 40 years of research has consolidated ambulatory blood pressure monitoring (ABPM) as a validated choice in out-of-office blood pressure (BP) measurement methods other than home BP measurement (HBPM). ABPM can evaluate 24-h BP and BP variability. ABPM improves the diagnosis of hypertension phenotypes such as white coat hypertension, masked hypertension, dipper or non-dipper. BP values derived from ABPM had better prognostic values than clinic BP. Ambulatory BP devices have been available in Thailand for several years. This recommendation of the Thai Hypertension Society for ABPM was designed to apply this practical knowledge, based on our limited health resource circumstances, to help guide clinical practice and improve the treatment and control of hypertension among the adult Thai population.
{"title":"2025 Thai Hypertension Society Guidance for Ambulatory Blood Pressure Monitoring in Adults","authors":"Sirisawat Wanthong, Pairoj Chattranukulchai, Chavalit Chotruangnapa, Praew Kotruchin, Weranuj Roubsanthisuk, Prin Vathesatogkit, Apichard Sukonthasarn","doi":"10.1111/jch.70136","DOIUrl":"10.1111/jch.70136","url":null,"abstract":"<p>More than 40 years of research has consolidated ambulatory blood pressure monitoring (ABPM) as a validated choice in out-of-office blood pressure (BP) measurement methods other than home BP measurement (HBPM). ABPM can evaluate 24-h BP and BP variability. ABPM improves the diagnosis of hypertension phenotypes such as white coat hypertension, masked hypertension, dipper or non-dipper. BP values derived from ABPM had better prognostic values than clinic BP. Ambulatory BP devices have been available in Thailand for several years. This recommendation of the Thai Hypertension Society for ABPM was designed to apply this practical knowledge, based on our limited health resource circumstances, to help guide clinical practice and improve the treatment and control of hypertension among the adult Thai population.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077175","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>Dear Editor,</p><p>We have read with great interest the article by Tezcan and Büyükterzi on the effect of Ramadan fasting on blood pressure and kidney function in newly diagnosed hypertensive patients [<span>1</span>]. The study contributes valuable data on a unique and culturally relevant context. However, we would like to raise several methodological and interpretative issues that may affect the generalizability of the conclusions.</p><p>The retrospective design and single-center setting may limit the strength of causal inferences. Previous studies have emphasized that prospective, multicenter cohorts are better suited to capture the heterogeneous impact of fasting across different populations [<span>2</span>]. The authors acknowledge this limitation, but its implications deserve stronger emphasis, particularly considering dietary, lifestyle, and medication adherence variability.</p><p>All patients in the study received a diuretic-containing regimen. While this provides uniformity, it restricts external validity. Other antihypertensive classes, such as calcium channel blockers or beta-blockers, may interact differently with fasting physiology. Dietary sodium intake and hydration patterns that strongly influence blood pressure and renal function were not systematically assessed. Prospective trials with structured food-frequency questionnaires and biochemical markers have shown that these parameters substantially modify outcomes during Ramadan [<span>3</span>]. Neglecting them may underestimate important confounders. Therefore, it remains uncertain whether the findings apply broadly to hypertensive patients treated with varied regimens.</p><p>Another important factor that warrants attention is the alteration of sleep patterns during Ramadan. The practice of waking up for suhoor (pre-dawn meal) often leads to fragmented nocturnal sleep and daytime somnolence. Disrupted circadian rhythms are known to influence blood pressure variability and autonomic balance, potentially confounding the observed outcomes [<span>4</span>]. Since sleep quality was not evaluated in the present study, its interaction with blood pressure and kidney function during fasting remains uncertain.</p><p>Although the authors report no significant deterioration in kidney function, longer follow-up is essential. Renal adaptation to repeated annual fasting periods may differ from short-term observations. Indeed, longitudinal studies highlight that subtle cumulative effects may only emerge over years rather than a single month [<span>5</span>].</p><p>In conclusion, this article provides a useful foundation for understanding Ramadan fasting in newly diagnosed hypertensive patients, but further prospective, multicenter, and regimen-diverse studies—also accounting for sleep patterns and lifestyle changes—are warranted to establish robust clinical recommendations.</p><p>Sincerely,</p><p>Mucahit Yetim, Abdullah Sarıhan, and Macit Kalçık</p><p>Department of Cardiology, Faculty of Medi
尊敬的编辑，我们饶有兴趣地阅读了Tezcan和b y kterzi关于斋月禁食对新诊断的高血压患者[1]血压和肾功能影响的文章。这项研究为独特的文化背景提供了宝贵的数据。然而，我们想提出几个方法学和解释性问题，这些问题可能会影响结论的普遍性。回顾性设计和单中心设置可能会限制因果推断的强度。先前的研究强调，前瞻性、多中心队列更适合于捕捉禁食在不同人群中的异质影响[10]。作者承认这一局限性，但其含义值得更加强调，特别是考虑到饮食、生活方式和药物依从性的可变性。研究中所有患者均接受含利尿剂治疗。虽然这提供了一致性，但它限制了外部有效性。其他抗高血压药物，如钙通道阻滞剂或β受体阻滞剂，可能与禁食生理有不同的相互作用。饮食钠摄入量和水合作用模式对血压和肾功能的影响没有系统评估。使用结构化食物频率问卷和生化标记的前瞻性试验表明，这些参数实质上改变了斋月期间的结果。忽视它们可能会低估重要的混杂因素。因此，研究结果是否适用于不同治疗方案的高血压患者仍不确定。另一个值得注意的重要因素是斋月期间睡眠模式的改变。起床吃suhoor（黎明前的晚餐）的做法经常导致夜间睡眠不完整，白天嗜睡。已知昼夜节律紊乱会影响血压变异性和自主神经平衡，可能混淆观察到的结果[b]。由于本研究未对睡眠质量进行评估，因此其与禁食期间血压和肾功能的相互作用仍不确定。虽然作者报告肾功能没有明显恶化，但长期随访是必要的。肾脏对每年反复禁食期的适应可能与短期观察不同。事实上，纵向研究强调，微妙的累积效应可能只会在数年内出现，而不是一个月。总之，这篇文章为理解新诊断的高血压患者斋月禁食提供了一个有用的基础，但进一步的前瞻性、多中心和方案多样化的研究——也考虑到睡眠模式和生活方式的改变——有必要建立强有力的临床建议。衷心感谢土耳其科鲁姆希提特大学医学院心脏病学的Mucahit Yetim， Abdullah Sarıhan和Macit KalçıkDepartment所有作者都对计划，写作和修订做出了贡献。作者声明他们没有利益冲突。
{"title":"Integrating Sleep Disruption, Dietary Changes, and Therapy in Assessing the Effects of Ramadan Fasting on Blood Pressure","authors":"Mucahit Yetim, Abdullah Sarıhan, Macit Kalçık","doi":"10.1111/jch.70142","DOIUrl":"https://doi.org/10.1111/jch.70142","url":null,"abstract":"<p>Dear Editor,</p><p>We have read with great interest the article by Tezcan and Büyükterzi on the effect of Ramadan fasting on blood pressure and kidney function in newly diagnosed hypertensive patients [<span>1</span>]. The study contributes valuable data on a unique and culturally relevant context. However, we would like to raise several methodological and interpretative issues that may affect the generalizability of the conclusions.</p><p>The retrospective design and single-center setting may limit the strength of causal inferences. Previous studies have emphasized that prospective, multicenter cohorts are better suited to capture the heterogeneous impact of fasting across different populations [<span>2</span>]. The authors acknowledge this limitation, but its implications deserve stronger emphasis, particularly considering dietary, lifestyle, and medication adherence variability.</p><p>All patients in the study received a diuretic-containing regimen. While this provides uniformity, it restricts external validity. Other antihypertensive classes, such as calcium channel blockers or beta-blockers, may interact differently with fasting physiology. Dietary sodium intake and hydration patterns that strongly influence blood pressure and renal function were not systematically assessed. Prospective trials with structured food-frequency questionnaires and biochemical markers have shown that these parameters substantially modify outcomes during Ramadan [<span>3</span>]. Neglecting them may underestimate important confounders. Therefore, it remains uncertain whether the findings apply broadly to hypertensive patients treated with varied regimens.</p><p>Another important factor that warrants attention is the alteration of sleep patterns during Ramadan. The practice of waking up for suhoor (pre-dawn meal) often leads to fragmented nocturnal sleep and daytime somnolence. Disrupted circadian rhythms are known to influence blood pressure variability and autonomic balance, potentially confounding the observed outcomes [<span>4</span>]. Since sleep quality was not evaluated in the present study, its interaction with blood pressure and kidney function during fasting remains uncertain.</p><p>Although the authors report no significant deterioration in kidney function, longer follow-up is essential. Renal adaptation to repeated annual fasting periods may differ from short-term observations. Indeed, longitudinal studies highlight that subtle cumulative effects may only emerge over years rather than a single month [<span>5</span>].</p><p>In conclusion, this article provides a useful foundation for understanding Ramadan fasting in newly diagnosed hypertensive patients, but further prospective, multicenter, and regimen-diverse studies—also accounting for sleep patterns and lifestyle changes—are warranted to establish robust clinical recommendations.</p><p>Sincerely,</p><p>Mucahit Yetim, Abdullah Sarıhan, and Macit Kalçık</p><p>Department of Cardiology, Faculty of Medi","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062356","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}
Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. In East Africa, its burden is increasing, yet estimates remain fragmented across countries, limiting effective regional health planning. We estimate the pooled prevalence of hypertension and identify its major determinants among adult populations in East Africa. We conducted a systematic review and meta-analysis of studies published between January 2007 and December 2024, following PRISMA 2020 guidelines. Databases searched included PubMed, Embase, Scopus, Web of Science, CINAHL, and grey literatures. Studies were eligible if they reported the prevalence or risk factors of hypertension in East African adults. Random-effects model was applied to compute pooled estimates, and heterogeneity was assessed using prediction interval, I2, Q-test, tau2, and tau. A total of 21 studies involving 56 503 participants from seven East African countries were included. The pooled prevalence of hypertension was 21.0% [95% confidence interval (95% CI): 17.9–24.4, I2: 98.8%]. The risk of hypertension was associated with overweight [odds ratio (OR) = 1.845; 95%: 1.534–2.219, I2: 66.7%], general obesity (OR = 3.045; 95% CI: 2.511–3.693; I2: 90.1%), abdominal obesity (OR = 2.010; 95% CI: 1.443–2.800; I2: 97.6%), alcohol consumption (OR = 1.232; 95% CI: 1.005–2.011; I2: 80.8%), tobacco smoking (OR = 1.479; 95% CI: 1.130–1.935; I2: 83.7%), and diabetes (OR = 2.458; 95% CI: 1.362–4.437; I2: 95.7%). In conclusion, hypertension affects nearly one in four adults in East Africa. Overweight, obesity, general obesity, WHR, T2DM, and age are associated with onset of hypertension.
{"title":"Hypertension in East Africa: A Systematic Review and Meta-Analysis of Prevalence and Associated Risk Factors","authors":"Monday Nwankwo, Wusa Makena, Aisha Idris, Chikezie Jude Okamkpa, Elizabeth Bessey Umoren, Elna Owembabazi","doi":"10.1111/jch.70140","DOIUrl":"https://doi.org/10.1111/jch.70140","url":null,"abstract":"<p>Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. In East Africa, its burden is increasing, yet estimates remain fragmented across countries, limiting effective regional health planning. We estimate the pooled prevalence of hypertension and identify its major determinants among adult populations in East Africa. We conducted a systematic review and meta-analysis of studies published between January 2007 and December 2024, following PRISMA 2020 guidelines. Databases searched included PubMed, Embase, Scopus, Web of Science, CINAHL, and grey literatures. Studies were eligible if they reported the prevalence or risk factors of hypertension in East African adults. Random-effects model was applied to compute pooled estimates, and heterogeneity was assessed using prediction interval, <i>I</i><sup>2</sup>, <i>Q</i>-test, tau<sup>2</sup>, and tau. A total of 21 studies involving 56 503 participants from seven East African countries were included. The pooled prevalence of hypertension was 21.0% [95% confidence interval (95% CI): 17.9–24.4, <i>I</i><sup>2</sup>: 98.8%]. The risk of hypertension was associated with overweight [odds ratio (OR) = 1.845; 95%: 1.534–2.219, <i>I</i><sup>2</sup>: 66.7%], general obesity (OR = 3.045; 95% CI: 2.511–3.693; <i>I</i><sup>2</sup>: 90.1%), abdominal obesity (OR = 2.010; 95% CI: 1.443–2.800; <i>I</i><sup>2</sup>: 97.6%), alcohol consumption (OR = 1.232; 95% CI: 1.005–2.011; <i>I</i><sup>2</sup>: 80.8%), tobacco smoking (OR = 1.479; 95% CI: 1.130–1.935; <i>I</i><sup>2</sup>: 83.7%), and diabetes (OR = 2.458; 95% CI: 1.362–4.437; <i>I</i><sup>2</sup>: 95.7%). In conclusion, hypertension affects nearly one in four adults in East Africa. Overweight, obesity, general obesity, WHR, T2DM, and age are associated with onset of hypertension.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062774","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}
This study aimed to investigate the relationship between the hemoglobin-to-red blood cell distribution width (RDW) ratio (HRR), a composite marker of inflammation and oxidative stress, and arterial stiffness. A total of 3657 participants from Health examination center, the Department of General Practice and Geriatrics at the First Affiliated Hospital of Fujian Medical University were included in a cross-sectional analysis conducted between January 2016 and December 2023. Arterial stiffness was defined as a carotid-femoral pulse wave velocity (cfPWV) of ≥10 m/s. HRR was calculated by dividing the hemoglobin concentration by the RDW. Participants were categorized into quartiles (Q1–Q4) based on their HRR values. Associations between HRR and arterial stiffness were evaluated using linear regression analysis, logistic regression models, stratified analyses, and restricted cubic splines (RCS) to identify potential non-linear associations. Age and cfPWV increased significantly across decreasing HRR quartiles. In a fully adjusted model, compared with Q1, participants in Q3 (OR 0.95, 95% CI: 0.91–0.99, p = 0.024) and Q4 (OR 0.93, 95% CI: 0.88–0.97, p < 0.001) exhibited a progressive reduction in arterial stiffness. RCS analysis revealed a linear association between HRR and arterial stiffness. Stratified analysis indicated a stronger inverse association between higher HRR and lower arterial stiffness in individuals with diabetes or hypertension. This study offers additional evidence that supports the role of inflammation and oxidative stress in arterial stiffness.
本研究旨在探讨炎症和氧化应激的复合指标血红蛋白-红细胞分布宽度（RDW）比（HRR）与动脉硬度之间的关系。2016年1月至2023年12月，来自福建医科大学第一附属医院健康检查中心全科与老年科的3657名参与者被纳入横断面分析。动脉硬度定义为颈-股脉波速度(cfPWV)≥10m /s。HRR由血红蛋白浓度除以RDW计算。根据HRR值将参与者分为四分位数（Q1-Q4）。使用线性回归分析、逻辑回归模型、分层分析和限制性三次样条（RCS）来评估HRR和动脉僵硬之间的关联，以确定潜在的非线性关联。年龄和cfPWV在HRR下降的四分位数中显著增加。在一个完全调整的模型中，与Q1相比，Q3 （OR 0.95, 95% CI: 0.91-0.99, p = 0.024）和Q4 （OR 0.93, 95% CI: 0.88-0.97, p < 0.001）的参与者表现出动脉硬度的渐进式降低。RCS分析显示HRR与动脉僵硬度呈线性相关。分层分析表明，在糖尿病或高血压患者中，较高的HRR与较低的动脉僵硬度之间存在较强的负相关。这项研究提供了额外的证据，支持炎症和氧化应激在动脉硬化中的作用。
{"title":"Association Between Hemoglobin-to-Red Blood Cell Distribution Width Ratio and Arterial Stiffness","authors":"Fang Liu, Beijia Lin, Wenhui Huang, Jingrong Dai, Yangfan Hu, Ziheng Wu, Guoyan Xu, Liangdi Xie, Tingjun Wang","doi":"10.1111/jch.70141","DOIUrl":"https://doi.org/10.1111/jch.70141","url":null,"abstract":"<p>This study aimed to investigate the relationship between the hemoglobin-to-red blood cell distribution width (RDW) ratio (HRR), a composite marker of inflammation and oxidative stress, and arterial stiffness. A total of 3657 participants from Health examination center, the Department of General Practice and Geriatrics at the First Affiliated Hospital of Fujian Medical University were included in a cross-sectional analysis conducted between January 2016 and December 2023. Arterial stiffness was defined as a carotid-femoral pulse wave velocity (cfPWV) of ≥10 m/s. HRR was calculated by dividing the hemoglobin concentration by the RDW. Participants were categorized into quartiles (Q1–Q4) based on their HRR values. Associations between HRR and arterial stiffness were evaluated using linear regression analysis, logistic regression models, stratified analyses, and restricted cubic splines (RCS) to identify potential non-linear associations. Age and cfPWV increased significantly across decreasing HRR quartiles. In a fully adjusted model, compared with Q1, participants in Q3 (OR 0.95, 95% CI: 0.91–0.99, <i>p</i> = 0.024) and Q4 (OR 0.93, 95% CI: 0.88–0.97, <i>p</i> < 0.001) exhibited a progressive reduction in arterial stiffness. RCS analysis revealed a linear association between HRR and arterial stiffness. Stratified analysis indicated a stronger inverse association between higher HRR and lower arterial stiffness in individuals with diabetes or hypertension. This study offers additional evidence that supports the role of inflammation and oxidative stress in arterial stiffness.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062368","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}
Wen Gu, Lingling Li, Ashfaq Ahmad, Jing Lv, Songling Zhang, Yajuan Du, Jite Shi, Yiming Ding, Ting Liu, Fenling Fan
Pulmonary hypertension (PH) is a common complication in patients with chronic kidney disease (CKD) and is associated with high mortality. Early detection and proper management may improve outcomes in high-risk patients. This study aimed to develop a simple and effective model for screening PH risk in this population. We retrospectively screened 1082 CKD patients. Feature selection was performed using the least absolute shrinkage and selection operator, univariate and multivariate logistic regression (LR). Nomograms were developed for PH risk assessment. The discriminative ability was estimated by the area under the receiver operating characteristic curve (AUROC), and the accuracy was assessed with a Brier score. Models were validated externally by calculating their performance on a validation cohort. Eight machine learning models were developed, and their performance was evaluated. Decision curve analysis and clinical impact curve were used to assess the model's clinical usefulness. A total of 440 patients were included in the analysis, with 308 in the development cohort and 132 in the validation cohort. The final nomogram included five variables as follows: haemoglobin, gamma-glutamyl transferase, triglycerides, coronary heart disease and NT-proBNP. The AUROC of the model was 0.772 (95% CI: 0.731–0.806). External validation confirmed the model's good performance, with an AUROC of 0.782 (95% CI: 0.696–0.854). Among the eight machine learning models, LR showed the best performance. We developed a machine learning model based on clinical and biochemical features to assess PH risk in CKD patients. It enables early detection and risk stratification during follow-up.
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