American Journal of Hypertension最新文献

Background: Nocturnal blood pressure (BP) is superior to daytime BP in predicting cardiovascular mortality. It is of clinical relevance to evaluate the effect of esaxerenone combination therapy on nighttime BP in patients with uncontrolled hypertension.

Methods: A post hoc analysis of a multicenter, open-label, phase 3 study evaluated the nighttime BP-lowering effects of esaxerenone as monotherapy or in combination with a calcium channel blocker (CCB) or renin-angiotensin system inhibitor (RASi) in Japanese patients with uncontrolled hypertension. In addition, the effect on N-terminal pro B-type natriuretic peptide (NT-proBNP), a known biomarker of cardiovascular disease prognosis, was evaluated.

Results: In total, 270 patients were included in this analysis (172, 49, and 49 patients in the monotherapy, CCB, and RASi groups, respectively). The 24-hour ambulatory systolic BP reduction from baseline was -10.0, -6.0, and -17.0 mmHg in the monotherapy, CCB, and RASi groups, respectively. Nighttime systolic BP decreased significantly from baseline to Week 28 in all groups (P <0.001 each); the RASi group showed the greatest change (-20.6 mmHg). NT-proBNP decreased significantly in all three treatment groups.

Conclusions: Esaxerenone when used in combination with a CCB or RASi, but especially when used in combination with a RASi, may be a useful treatment option for patients with uncontrolled hypertension to control nocturnal BP.

Hypertension is a major contributor to cardiovascular disease and premature mortality. Yet despite extensive research, aspects of the disease remain incompletely understood. Indeed, even with the availability of numerous medications, achieving optimal blood pressure control continues to be a challenge for some patients. These challenges may be attributable to the inherent heterogeneity in disease phenotype and to co-morbidities. The recent explosion in healthcare data has presented an opportunity for progress: Artificial intelligence (AI), which is particularly adept in identifying patterns and regularity in a dataset, may facilitate a breakthrough in hypertension. This review summarizes the ways in which AI has transformed clinical practices, patient care, medical education, and research methodologies in hypertension. A focus of the review is on ChatGPT, an AI-powered conversational model that has enhanced data analysis, decision support, and patient education, and has the potential to revolutionize hypertension research, diagnosis, and treatment.

Discrimination in cardiovascular healthcare, particularly concerning hypertension treatment, is a significant and complex issue in Latin America, driven by biases related to gender, ethnicity, and economic status. Although cardiovascular disease (CVD) is the leading cause of death worldwide, disparities in healthcare delivery endure, especially impacting marginalized populations. Women, ethnic minorities, and economically disadvantaged groups encounter considerable barriers, including underrepresentation in clinical research, delayed diagnoses, and unequal access to guideline-recommended treatments. Economic disparities maintain a divided healthcare system in which the quality of treatment often directly correlates with socioeconomic status, reinforcing inequities and adversely affecting health outcomes in lower-income communities. Ethnic discrimination, stemming from deeply ingrained social biases, leads to inadequate care and limited access to advanced medical technologies, disproportionately impacting indigenous and Afro-descendant populations. Addressing these systemic inequities requires comprehensive strategies that ensure equitable participation in clinical trials, develop tailored public health policies sensitive to socioeconomic and cultural contexts, and implement targeted educational initiatives. Healthcare systems must actively dismantle entrenched biases, improve access for economically disadvantaged communities, and guarantee that ethnic minorities receive treatment of equal quality. The Inter-American Society of Hypertension emphasizes that removing these discriminatory barriers reduces the burden of cardiovascular disease and enhances overall health outcomes across Latin America. This document endorses consensus recommendations detailed in positions 1 through 4, which tackle specific challenges related to personalized care, racial biases in treatment algorithms, socioeconomic healthcare inequalities, and gender disparities in hypertension management.

Background: This study evaluated recent trends in hypertension prevalence and management among US young adults, and assessed disparities by age, sex, or race and ethnicity, as well as potential factors contributing to the age-related disparities.

Methods: Data from 51,291 adults aged ≥18 years in the National Health and Nutrition Examination Survey 2003-2004 to 2021-2023 were analyzed. Stage 1 or 2 hypertension was defined as systolic/diastolic blood pressure (BP) ≥130/80 mmHg or antihypertensive medication use. Hypertension awareness and treatment were based on self-report.

Results: In 2021-2023, 21.3% (20.4 million) young adults aged 18-39 years had stage 1 or 2 hypertension, of whom only 28.3% were aware of their condition and 5.6% achieved BP control to <130/80 mm Hg. While hypertension prevalence among young adults remained stable from 2003-2004 to 2021-2023, awareness and control declined after 2013-2014, though no apparent change in control rates was observed between 2017-2020 and 2021-2023. Compared to adults aged ≥40 years, young adults had lower rates of awareness, treatment, and control, with lower rates of having a routine place for healthcare explaining 7%-16% of the gaps. Disparities in hypertension awareness, treatment, and control were greatest among young adult men, non-Hispanic Black, and Hispanic individuals compared with other sex and racial and ethnic subgroups.

Conclusions: In 2021-2023, one in five US young adults had hypertension, yet awareness and control have declined since 2013-2014 and remain low.

Background: Nocturnal hypertension is associated with increased risk for renal and cardiovascular events in patients with chronic-kidney-disease(CKD). Endothelial dysfunction and microvascular damage are highly prevalent in CKD and related to CKD progression and adverse cardiovascular outcomes. The aim of this analysis was to compare for first time microcirculatory function parameters and central hemodynamics in CKD patients with and without nocturnal hypertension.

Methods: 96 pre-dialysis CKD patients underwent 24-h ABPM (Mobil-O-Graph-NG device) and nailfold video-capillaroscopy, during which capillary density was measured at baseline, after 4-min arterial occlusion (postocclusive-reactive-hyperemia) and following 2-min venous occlusion (congestion phase). Arterial stiffness and central hemodynamic were captured in office conditions with Sphygmocor.

Results: The two groups (with and without nocturnal hypertension) were similar in terms of age, eGFR, BMI and major comorbidities. Patients with nocturnal hypertension presented significantly lower capillary density at baseline (30.6±3.6 vs 33.1±3.2 capillaries/mm2; p=0.003), during post-occlusive reactive hyperemia (36.6±4 vs. 39.5±3.9 capillaries/mm2; p=0.003), and during venous congestion (38.1±4.2 vs. 41±3.5 capillaries/mm2; p=0.003) compared to those without nocturnal hypertension. Participants with nocturnal hypertension had significantly higher aortic BP; no differences were found in the other parameters of arterial stiffness. The above observations were more prominent in patients with diabetes.

Conclusions: Capillary density during postocclusive hyperemia and after venous congestion is lower in patients with nocturnal hypertension compared to those with normotension, suggesting that nocturnal hypertension is a factor superimposed on the microvascular changes characterizing CKD to further impair capillary recruitment.

Background: Among the 119.9 million U.S. adults with hypertension, an estimated 92.9 million have systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mm Hg. Million Hearts® is an initiative co-led since 2011 by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). The program drives improvement in hypertension control by celebrating high-achieving clinicians, practices, and health systems each year as Million Hearts Hypertension Control Champions. Champions have validated control rates of 80% or higher.

Methods: Using data from each Champion, we summarized their key characteristics and quantified their use of various evidence-based strategies. We calculated summary statistics for application data provided by Champions based on the initiative's five-year cycles of operation (2012-2015; 2017-2020; 2022-2024).

Results: From 2012 to 2024, a total of 199 Hypertension Control Champions from 44 states were recognized; mean prevalence of systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg was 82%. Overall, Champions reported using multiple evidence-based strategies to help their patients achieve hypertension control. The top 3 strategies were electronic medical record (EMR) usage, patient supports including self-measured blood pressure monitoring (SMBP), and team-based care.

Conclusions: The Million Hearts® Hypertension Control Champions demonstrate that hypertension control may be achievable among patients across diverse settings by implementation of evidence-based approaches.