Journal of Clinical Hypertension最新文献

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

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

Trial Registration: ClinicalTrials.gov identifier: NCT03892265

To the Editor,

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

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

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

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

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

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

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

The authors have nothing to report.

No patient enrollment.

The authors declare no conflicts of interest.

Dear Editor,

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

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

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

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

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

Sincerely,

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

Not appliable.

Not appliable.

Not appliable.

The authors declare no conflicts of interest.

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.