Journal of Clinical Hypertension最新文献

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.

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.

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.

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.

Nuclear receptor subfamily 3 group C member 2 (NR3C2) encodes the mineralocorticoid receptor (MR), which plays a pivotal role in the regulation of electrolyte and fluid homeostasis by mediating the physiological actions of mineralocorticoids, primarily aldosterone. In this study, we analyzed data from the Baoji Salt-Sensitivity Study, a population-based dietary intervention conducted in 2004 in northern China. A total of 514 adults from 124 families were enrolled and underwent a controlled salt intake protocol consisting of a 3-day baseline diet, followed by sequential 7-day low-salt (3.0 g/day) and high-salt (18.0 g/day) phases. Participants were prospectively followed for 14 years to evaluate the long-term incidence of hypertension. Our results demonstrated a significant negative association between the NR3C2 single nucleotide polymorphism (SNP) rs5522 and pulse pressure (PP) response during the low-salt intervention. During the high-salt phase, rs5522 was significantly associated with systolic blood pressure (SBP), while SNP rs3910053 showed significant negative correlations with SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP). Furthermore, rs3910053 was significantly associated with the incidence of hypertension over 14 years. These findings highlight the important role of NR3C2 in salt sensitivity (SS) and the risk of developing hypertension in the Chinese population.

Trial Registration: ClinicalTrials.gov. registration number: NCT02734472

To the Editor,

We have recently, with great interest, read the recent article by Zhao et al., “Association of 24-h Blood Pressure Pattern with Mortality in ICU Patients: A Retrospective Cohort Study” [1]. The study provides valuable insight into the prognostic role of ambulatory blood pressure monitoring (ABPM) patterns in critically ill patients, an area with limited prior evidence. The authors report that non-dipper and reverse-dipper patterns were associated with higher all-cause mortality, potentially offering a simple yet powerful risk stratification tool in the intensive care unit (ICU) setting.

However, some methodological limitations should be considered. First, the retrospective single-center design and reliance on electronic health records raise the risk of selection bias and missing data [2]. Second, the study's definition of dipping status was based on a fixed percentage threshold (10%), which, while conventional, may not optimally discriminate risk in heterogeneous ICU populations [3]. Additionally, the absence of repeated ABPM assessments limits the ability to account for hemodynamic variability over the ICU stay.

Another concern is the potential confounding effect of disease severity, vasoactive medication use, and mechanical ventilation. These factors can substantially influence circadian BP profiles in ICU patients, yet the multivariate models may not have fully adjusted for them [4]. Moreover, causality cannot be inferred, as abnormal BP patterns may be more reflective of critical illness severity than independent predictors of mortality [5]. A stratified analysis by diagnosis, hemodynamic status, or therapeutic interventions could have helped clarify this issue.

Finally, while the authors suggest incorporating BP pattern analysis into routine ICU monitoring, the clinical feasibility and cost-effectiveness of continuous or repeated ABPM in this setting remain uncertain [3]. Prospective multicenter studies are needed to validate these findings, explore dynamic BP pattern changes during recovery, and determine whether targeted interventions to restore normal dipping patterns can improve survival outcomes.

Sincerely,

Macit Kalçık

Emrah Bayam

The authors declare no conflicts of interest.

Dear Editor,

In summary, the authors advance the discussion on metabolically mediated organ injury in hypertension. Future studies should prioritize time-to-event modeling with continuous TyG-BMI and preplanned covariates, standardize TOD definitions (e.g., eGFR-based renal criteria), account for surveillance intensity, and perform external validation with transparent calibration and decision-analytic metrics. These steps will determine whether TyG-BMI adds actionable value to risk assessment in essential hypertension.

Naghmeh Ziaie: investigation, writing – original draft preparation. Mohsen Mohammadi: investigation, writing – original draft preparation. Mohammad Barary: investigation, writing – original draft preparation, writing – review and editing. Pouya Tayyebi: investigation, writing – original draft preparation. Soheil Ebrahimpour: investigation, supervision, writing – original draft preparation. All authors contributed significantly to the work and approved the final version of the manuscript. Their contributions align with the latest guidelines of the International Committee of Medical Journal Editors.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

Dear Editor,

In summary, BMP-9 shows biologic plausibility and modest discriminative power for arterial stiffness, but residual confounding, single-time-point measurement, and limited external validity temper enthusiasm for immediate clinical adoption. Future longitudinal, population-based studies incorporating richer lifestyle, pharmacologic, and inflammatory data, and reporting decision-analytic metrics, are essential to define the incremental value of BMP-9-guided risk stratification in hypertension care.

Majid Khalilizad: investigation, writing - original draft preparation. Mehdi Tavassoli: investigation, writing - original draft preparation. Mohammad Barary: investigation, writing - original draft preparation, writing - review and editing. Mostafa Javanian: investigation, writing - original draft preparation. Soheil Ebrahimpour: investigation, supervision, writing - original draft preparation. All authors contributed significantly to the work and approved the final version of the manuscript. Their contributions align with the latest guidelines of the International Committee of Medical Journal Editors.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

This study aims to fill this gap by leveraging Global Burden of Disease 2021 (GBD 2021) data to conduct a comprehensive assessment of the disease burden attributable to high systolic blood pressure (SBP) in young adults. Data from the Global Health Data Exchange were utilized to estimate the disease burden attributable to high SBP in young adults, stratified by overall disease, sex, socio-demographic index (SDI) level, GBD region, nation, and specific disease. In 2021, the overall disease attributable to high SBP in young adults was substantial, with approximately 24,626,362 disability-adjusted life years (DALYs) and 477,992 deaths, and the DALYs and mortality rates were 623.68 and 12.11 per 100,000 populations, respectively. The DALYs and mortality rates of specific disease were highest for ischemic heart disease (IHD), followed by intracerebral hemorrhage (ICH), and hypertensive heart disease (HHD). From 1990 to 2021, the DALYs and mortality rates for overall disease attributable to high SBP in young adults showed no significant change.However, there were greater declines in HHD and ICH, while the majority of diseases exhibited an upward trend. The DALYs and mortality rates for overall disease attributable to high SBP in young adults showed no significant change in females but increased in males. The SDI regions like middle and low-middle SDI regions, GBD regions like Oceania and Caribbean, and countries like Lesotho and Zimbabwe presented the largest increases in the DALYs and mortality rates for overall disease attributable to high SBP in young adults. The trends for certain diseases attributable to high SBP in young adults, when analyzed by sex, SDI level, and region, diverge from the overall disease trends. This study highlights the significant overall disease burden attributable to high SBP in young adults. Despite an overall steady trend in the DALYs and mortality rates since 1990, significant disparities persist across overall diseases, sexes, SDI levels, regions, countries, and specific diseases. These disparities highlight the need for strategic interventions to reduce the health impact of high SBP in young adults.