Journal of Clinical Hypertension最新文献

Obesity is a major contributor to the development and progression of hypertension, and its coexistence significantly increases cardiovascular risk. Although numerous guidelines exist for the management of arterial hypertension, none are dedicated specifically to obese patients, despite their increasing prevalence. Since 2018, both European and Polish guidelines have recommended the use of single-pill combinations (SPCs) at every stage of treatment. This retrospective study aimed to evaluate antihypertensive treatment patterns over the past eight years among obese patients. This analysis was restricted to obese patients with hypertension to explore prescribing patterns in a subgroup with unique pathophysiological features and high cardiovascular risk, for which specific therapeutic recommendations remain limited. The study cohort was limited to obese patients hospitalized for preoperative assessment prior to planned bariatric surgery. We analyzed medical records of 233 obese hypertensive patients divided into two cohorts: those diagnosed before 2020 and those diagnosed in 2020 or later. We observed a significant increase in the use of three or more antihypertensive drugs and a rise in the prescription of beta-blockers and angiotensin receptor blockers after 2020. Despite these changes, the use of SPCs remained low: two-drug SPCs were used in 35.6% of patients, and three-drug SPCs in only 11.2%, with no significant increase in their use over time. Additionally, SGLT2 inhibitors were introduced into therapy after 2020. Our findings highlight the discrepancy between clinical guidelines and real-world prescribing habits. Improved adherence to treatment recommendations may enhance therapeutic outcomes and medication adherence in this high-risk group.

This study aimed to compare systolic blood pressure (SBP) time in target range (TTR), long-term blood pressure (BP) variability (BPV), and BP control across age groups (18–45, 46–64, 65–79, ≥80 years) in patients with primary hypertension treated with amlodipine-based antihypertensive therapy for ≥12 months. Data were obtained from adult patients enrolled in the China Hypertension Center who received amlodipine-based antihypertensive therapy. Demographics, BP measurements, and laboratory results were recorded. Baseline characteristics, SBP TTR, long-term BPV, and BP control were compared among age groups. A total of 36 153 patients were included: 2681 in the 18–45 group, 14 300 in the 46–64 group, 15 595 in the 65–79 group, and 3577 in the ≥ 80 group. Younger and middle-aged patients demonstrated better indicator improvements. SBP TTR declined with age (82.52% ± 19.68%, 81.98% ± 20.69%, 79.10% ± 22.96%, and 78.33% ± 23.50%, respectively; p < 0.001). BP control also declined with age (84.04%, 83.20%, 80.44%, and 79.59%, respectively; p < 0.001). BPV increased with age, though not significantly (p = 0.051). During follow-up, SBP TTR and BP control improved, while BPV declined, with most changes reaching statistical significance. Across all age groups, SBP TTR remained above 78% throughout follow-up. Long-term continuous use of amlodipine is beneficial for achieving improved BP control, enhanced TTR, and reduced BPV.

Hypertensive patients exhibit elevated risk for cardiometabolic multimorbidity (CMM). The platelet-to-high-density lipoprotein cholesterol ratio (PHR) has emerged as a biomarker for cardiovascular risk assessment. However, the precise relationship between PHR and CMM remains inconclusive. To assess the association between PHR and CMM risk among middle-aged and elderly Chinese hypertensive patients. We included patients with documented hypertension history using data from the China Health and Retirement Longitudinal Study. Participants were stratified into tertiles per baseline PHR. Logistic regression models examined the PHR-CMM risk association. To evaluate nonlinear relationships, restricted cubic splines (RCS) were built. Subgroup analyses were used to assess effect modification across population characteristics. Sensitivity analysis was performed by reclassifying participants into quartiles per baseline PHR. 4355 middle-aged and elderly Chinese hypertensive patients were included. Logistic regression showed that in the fully adjusted model, each one-standard-deviation (Per SD) increase in PHR was significantly associated with a 19% higher CMM risk (OR = 1.19, 95% CI: 1.06–1.32, p < 0.01). Compared with the lowest tertile group, patients in the highest PHR tertile exhibited a significantly increased CMM risk (OR = 1.76, 95% CI: 1.27–2.46, p < 0.001), with no significant nonlinear relationship (p for nonlinear = 0.613). PHR-CMM association showed no significant interaction across subgroups (p for interaction >0.05). Sensitivity analysis results were consistent with primary findings. Elevated PHR levels were associated with increased CMM risk among middle-aged and elderly Chinese hypertensive patients. Monitoring PHR may help predict CMM risk in elderly individuals with hypertension.

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.

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.

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.

Trial Registration: ISRCTN number: ISRCTN83772183; ClinicalTrials.gov identifier: NCT01038583

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.

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.