Journal of Clinical Hypertension最新文献

Exaggerated orthostatic changes in systolic blood pressure (SBP) were associated with adverse cardiovascular events. We aim to assess the association between orthostatic SBP changes and incident atrial fibrillation (AF). We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial). Orthostatic SBP changes were defined as standing SBP minus seated SBP. Patients were grouped into tertiles of orthostatic SBP changes. We used Cox proportional regression models to assess the association of orthostatic SBP changes with incident AF. Among 8455 participants included in this analysis, 327 incident AF cases occurred during follow-up. After adjusting for age, female, race, smoking, alcohol use, history of cardiovascular disease, history of chronic kidney disease, and body mass index, an SBP increase ≥6 mmHg to standing was independently associated with a 43% higher risk of incident AF (HR: 1.43; 95% CI: 1.07–1.90; p = 0.014) compared to nonsignificant orthostatic SBP changes (>–4 to <6 mmHg). A SBP decrease ≥4 mmHg to standing showed a nonsignificant higher risk of developing AF compared to SBP changes of >–4 to <6 mmHg. In subgroup analysis, the results presented a similar tendency to the main result. Sensitivity analyses also generated consistent results while additionally adjusting for seated and standing blood pressure or heart rate. In this post hoc analysis of the SPRINT trial, exaggerated SBP increase on standing independently predicts incident AF.

Trial Registration: ClinicalTrials.gov identifier: NCT00000620.

The study aims to evaluate the long-term incidence of cardiovascular events (CVE) and compare the effectiveness of medical and surgical interventions using a combined cardiovascular endpoint in individuals diagnosed with primary aldosteronism (PA). The authors carried out a multicentric, retrospective study in Marseille on a total of 106 inpatients divided into two samples with biologically proven primary aldosteronism, of whom 55 underwent surgical treatment and 51 received medical therapy between January 2014 and December 2022. The mean age of the sample was 53 years. Over a 54-month follow-up period, five patients in the medical group (10.64%) and three in the surgical group (5.45%) experienced a CVE (p = 0.46). Although the difference was not statistically significant, the surgical group had more cardiovascular morbidity at baseline. At the end of the follow-up, the surgical group demonstrated a significant reduction in blood pressure (BP) (mean 126/74 mmHg) compared to the medical group (mean 136/81 mmHg) (p = 0.02), with a significantly lower number of antihypertensive medications (1.23 ± 1.5 vs. 2.83 ± 1.8, p < 0.01). Additionally, the surgical group had a significantly higher serum potassium level at the end of follow-up despite similar potassium supplementation. The long-term incidence of CVE in PA did not significantly differ between medical and surgical treatment. However, there appears to be a trend toward reduced CVE over the long term in surgically treated patients who had excess cardiovascular morbidity at baseline. In addition, surgical treatment significantly improved BP control, with patients requiring fewer and demonstrating better serum potassium regulation.

Hypertension (HTN) is common among young adults, but often undiagnosed. Early diagnosis and management are crucial to prevent cardiovascular events. However, young adults are less aware of their HTN and are diagnosed less frequently. This study aims to identify adults aged 18–40 in Iowa with high blood pressure (HBP) and determine the percentage diagnosed with HTN and associated risk factors. This retrospective observational study analyzed electronic health records from the University of Iowa Healthcare outpatient, inpatient, and emergency departments between 2016 and 2022. We included adults aged 18–40 with at least three elevated BP readings (systolic ≥140 or diastolic ≥90). Patients were followed for 2 years to identify those diagnosed with HTN. Summary statistics were calculated, and a Cox regression model assessed the time to HTN diagnosis. We identified 22,299 adults with at least three HBP readings. Among 7,523 young adults with at least three elevated BP readings, only 17.4% received a HTN diagnosis within 2 years. Most diagnoses occurred in outpatient (57.2%), followed by emergency (24%) and inpatient (17.5%) settings. Young adults had a significantly longer time to diagnosis than older populations. Young males, African Americans, Hispanics, patients with diabetes or dyslipidemia, and patients with more healthcare visits had shorter times to diagnosis. In conclusion, 7,523 out of 22,299 (33.7%) patients with HBP were young adults, with only 17.4% diagnosed with HTN within 2 years. The low diagnosis rate is concerning, given the potential for long-term cardiovascular complications. Improved screening protocols and targeted interventions are needed to address age-related underdiagnosis.

High blood pressure (BP) is a risk factor for cognitive decline. Increasingly, studies have found the relationship to be nonlinear, with low BP also indicating higher risk. This UK Biobank study examines the nonlinear relationships between BP and cognitive function, including whether the relationships differ by cognitive domain. Systolic (SBP) and diastolic BP (DBP) were measured at baseline. Cognitive domains included fluid intelligence, attention, and reaction time, measured at baseline and over time. Nonlinear mixed-effects regression models, including natural spline terms for SBP and DBP, were used to assess the relationships. Additional models evaluated interactions with age, sex, and hypertension history/antihypertensive use. There were 439 301 (mean age = 56.3, SD = 8.1, 45.1% male) included participants. Baseline SBP had significant inverted U-shaped relationships with fluid intelligence (p < 0.0001), attention (p < 0.0001), and reaction time (p < 0.0001), with substantially different ideal SBPs for each domain (118, 127.5, and 150.5 mmHg, respectively). Baseline DBP had significant relationships with fluid intelligence (p < 0.0001) and attention (p < 0.0001), again with varying ideal DBPs (57.5 and 74.5 mmHg, respectively). Higher baseline SBP had a small, inverse relation with trajectories of attention during the study (p < 0.0001), but no relationship with trajectories of either fluid intelligence or reaction time. Older, male, and untreated hypertension subgroups had significantly poorer reaction time at lower baseline SBP and DBP (p < 0.0001). The relationship between BP and cognitive function is nonlinear with the three domains optimal at differing BP levels. Older persons, males, or hypertensive patients may be particularly susceptible to negative cognitive effects of low BP.

Primary aldosteronism (PA) independently increases renal impairment risk beyond blood pressure effects. Although hyperaldosteronism is known to mediate renal injury, associations between plasma aldosterone concentration (PAC) and early kidney damage biomarkers such as retinol-binding protein (RBP) and β2-microglobulin (β2-MG) remain insufficiently explored. We investigated the association of PAC with renal function indicators—including RBP, β2-MG, albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR)—comparing matched patients with PA and essential hypertension (EH). In this cross-sectional study, 546 PA patients and 546 propensity score-matched EH patients were assessed. Spearman correlations and multivariate regression analyses assessed PAC-renal marker associations, with interactions tested to determine differences between PA and EH groups. In PA, PAC strongly correlated with lower eGFR (r = −0.597, p < 0.001) and higher RBP (r = 0.559), β2-MG (r = 0.632), and ACR (r = 0.583), persisting after adjustment. In contrast, EH patients showed only weak correlations between PAC and eGFR (r = −0.204, p < 0.001), without links with other markers. Interaction analysis confirmed stronger PAC-biomarker associations in PA than EH (all p < 0.05). This study is the first to demonstrate robust associations between PAC and sensitive early renal damage biomarkers, especially RBP, in PA patients, distinct from matched EH patients. It highlights hyperaldosteronism's unique pathogenic role in renal impairment in PA, suggesting early biomarker monitoring and aldosterone-targeted interventions could reduce chronic kidney disease risk in PA populations.

Orthostatic hypotension (OH) is a common inpatient condition associated with falls, syncope, and mortality. However, standardized approaches for inpatient management of OH are lacking and may vary across clinical specialties. In this retrospective observational cohort study, we reviewed the electronic medical records of patients admitted to Beth Israel Deaconess Medical Center between April 1, 2015 and June 1, 2021 with a diagnosis of OH or medication-related hypotension. Variables of interest included admitting service, presenting symptoms, suspected etiology, and management. Among the 400 inpatients with OH, one-third had OH documented on admission. Dizziness and lightheadedness were the most common symptoms; medical patients experienced dizziness, falls, and other symptoms more frequently than surgical patients. Volume depletion and medications were the leading suspected causes of OH. Surgical patients were less likely to have medication-related OH and were more likely to lack an identified etiology. Cardiovascular disease was more frequently implicated in cardiology patients. Volume depletion, neurodegenerative disease, and other conditions were more often suspected among medical patients. Management commonly involved volume resuscitation and medication adjustment, though medication changes were less frequent in surgical patients. Nonpharmacologic interventions were more common among medical patients. By discharge, OH had resolved in only one-third of patients. In summary, inpatient OH was most often identified after admission, attributed to hypovolemia, treated with fluids, and unresolved at discharge, with differences in symptoms, etiology, and management between specialties. Prospective studies are needed to formalize diagnostic and treatment strategies for OH in the hospital setting.

A common barrier to the timely treatment of hypertension is the accurate measurement of blood pressure (BP). Although measuring BP is a common procedure, training and retraining on this skill is often inadequate. A study led by the American Medical Association (AMA), found that the education system has failed to establish and maintain this skill among a sample of medical students who were tested. The AMA Student BP Measurement eLearning Series is designed to address this gap in training and ensure all students feel confident and competent in performing this critical skill. By creating a readily implementable eLearning Series and collaborating with 10 healthcare education institutions, significant strides have been made toward standardizing BP measurement training. However, to truly address both the gaps in training and the performance gaps in BP measurement skills, faculty across healthcare disciplines must take an active role in standardizing this essential skill for all students. We urge all healthcare faculty to adopt and champion this standardized approach, embedding it early in education, reinforcing it throughout training, and assessing proficiency regularly. A universal commitment to standardization will equip the next generation of healthcare professionals with the competence and confidence needed to measure BP accurately, ultimately improving hypertension diagnosis, treatment, and health outcomes for patients nationwide.

Hypertensive cardiac hypertrophy (HCH) is a compensatory response to chronic pressure overload, ultimately progressing to heart failure if left unmanaged. Emerging evidence highlights the critical role of mitochondrial dysfunction in HCH pathogenesis, with impaired mitophagy—a selective autophagic process that removes damaged mitochondria—contributing to cardiomyocyte death, oxidative stress, and fibrosis. Protective mitophagy eliminates damaged mitochondria, averting reactive oxygen species (ROS)/calcium overload in HCH. Conversely, its dysregulation—either insufficient clearance or excessive removal—exacerbates mitochondrial dysfunction, driving pathological hypertrophy, fibrosis, and bioenergetic crisis. This dual nature presents a therapeutic paradox demanding contextual modulation. This review comprehensively examines the molecular mechanisms underlying mitophagy dysregulation in HCH, focusing on key pathways such as PINK1/Parkin, BNIP3/NIX, and FUNDC1. We also discuss the interplay between mitophagy and other cellular processes, including mitochondrial biogenesis, inflammasome activation, and metabolic remodeling. Furthermore, we explore potential therapeutic strategies targeting mitophagy to ameliorate HCH, including pharmacological agents, lifestyle interventions, and gene therapy approaches. Understanding the dual role of mitophagy in HCH—both protective and detrimental—may pave the way for novel precision medicine strategies in cardiovascular disease.

Ramadan fasting involves abstaining from food and drink from dawn to sunset, yet its impact on blood pressure (BP) and kidney function in newly diagnosed hypertensive patients remains unclear. This retrospective study examined 200 newly diagnosed hypertensive patients from Konya, Turkey, during Ramadan 2023. Half of the patients (n = 100) observed daily fasting throughout Ramadan, while the other half (n = 100) did not. All patients received a diuretic-containing regimen consisting of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker combined with hydrochlorothiazide. Baseline clinical and laboratory data, including serum creatinine and estimated glomerular filtration rate (eGFR), were compared with those obtained at a one-month follow-up (end of Ramadan). Both fasting and non-fasting groups exhibited significant reductions in systolic and diastolic BP from baseline to the first month, with no statistically significant difference in final BP between the two groups. Kidney function, as indicated by creatinine levels and eGFR, remained stable in both groups, suggesting that Ramadan fasting did not adversely affect renal parameters. Modest improvements in lipid profiles were also observed in both cohorts. These findings indicate that, among newly diagnosed hypertensive patients on diuretic-containing therapy, Ramadan fasting may be safe if accompanied by individualized clinical advice. However, larger and more prolonged studies are warranted to validate these results and explore potential variations in other hypertensive populations.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) polymorphisms exhibit ethnic-specific associations with cardiovascular risk. However, their prognostic value for major adverse cardiovascular and cerebrovascular events (MACCE) in Asian populations remains undefined. This prospective cohort study enrolled 1969 patients (mean age 54.5 ± 10.7 years, 60.2% male) with hyperlipidemia and followed them for a median of 62 months (IQR 24–89 months). We evaluated the association of three PCSK9 polymorphisms (rs2483205, rs2495477, and rs562556) with metabolic parameters and MACCE. A genotype-integrated nomogram was developed using Least Absolute Shrinkage and Selection Operator (LASSO) – selected predictors and validated in an independent cohort. The rs2483205 TT, rs2495477 GG, and rs562556 GG genotypes were significantly associated with atherogenic dyslipidemia (elevated triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a) [Lp(a)], all p < 0.001) and predicted MACCE risk independently of conventional factors (HR = 2.94, 95% CI: 1.80–4.80 for rs2483205 TT). The nomogram demonstrated excellent discrimination (3 and 4 year area under the curve (AUC) = 0.989, concordance index (C-index) = 0.868) and calibration (slope = 1.02, 95% CI: 0.98–1.06), with decision curve analysis confirming clinical utility across risk thresholds (20%–75%). Net Reclassification Improvement (NRI) increase of 0.059 and an Integrated Discrimination Improvement (IDI) increase of 0.022. PCSK9 genotyping provides independent prognostic value for MACCE risk stratification in hyperlipidemia, with genotype-specific effects on cardiovascular outcomes. The developed nomogram offers a precision medicine tool for individualized risk prediction and therapeutic decision-making.