American Journal of Hypertension最新文献

Background: Approximately half of US adults have hypertension, with only 1 in 4 having it controlled. Regular visits to primary care can assist with managing hypertension. We estimated the number of US adults aged ≥18 years with self-reported hypertension reporting primary care visits within the last year.

Methods: Using the 2023 National Health Interview Survey, we identified respondents who reported a hypertension diagnosis. Among this population, we calculated the percentage and numbers who reported primary care visits in the last year by select demographic and socioeconomic covariates.

Results: Our analytical sample of 10,953 US adults with self-reported hypertension represented 81.9 million adults nationally. Overall, 91.6% (95% confidence interval [CI]: 90.7%, 92.3%) of US adults with self-reported hypertension reported primary care visits in the last year, representing 75 million nationally. Adults aged 18-44 years had the lowest proportion of visits to primary care by age, 82.3% (95% CI: 79.0%, 85.3%). Males (90.1%, 95% CI: 88.8%, 91.3%) were less likely than females (93.1%, 95% CI: 92.1%, 94.0%) to report visits. Among those with no insurance coverage, only 79.8% (95% CI: 75.3%, 83.8%) reported primary care visits in the last year.

Conclusions: Over 90% of US adults with self-reported hypertension reported a primary care visit in the previous year, representing important opportunities to manage hypertension.

Objective: Cannabis use has been associated with cardiovascular risks, yet its relationship with subclinical vascular markers such as augmentation index (AIx) remains unclear. This study aimed to investigate the association between cannabis use and AIx, stratified by sex, in a middle-aged general population.

Methods: We analyzed data from 20,692 participants of the UK Biobank who had available AIx and cannabis use information. Cannabis exposure was categorized by lifetime use (low, moderate, and heavy), recent vs. past use, and frequency. Linear regression models were stratified by sex and adjusted for cardiovascular and sociodemographic covariates, including blood pressure, heart rate, tobacco and alcohol use, comorbidities, and socioeconomic status.

Results: Men exhibited lower AIx than women (19.06% vs. 21.93%), but a higher prevalence of cannabis use (3.58% vs. 1.68% for heavy users and 7.11% vs. 4.25% for everyday consumption in cannabis users). In men, heavy lifetime cannabis use was associated with increased AIx (β = 1.48, 95% CI [0.76; 2.19]), whereas low use was inversely associated (β = -0.79 [-1.30; -0.27]). Daily cannabis use was associated with higher AIx (β = 1.21 [0.15; 2.27]). In women, heavy use was associated with higher Aix (β = 1.31 [0.20; 2.42]); other patterns of cannabis use were not associated with AIx. In the overall population, there was no evidence of differences in the associations by sex.

Conclusion: Heavy cannabis use was associated with increased arterial stiffness as measured by AIx.

Background: Intensive blood pressure (BP) control in patients with low muscle mass on cardiovascular (CV) and cognitive outcomes remains unclear. Therefore, we aim to examine the impact of intensive BP control on CV and cognitive outcomes in patients with low muscle mass.

Methods: Data from the Systolic Blood Pressure Intervention Trial (SPRINT) were utilized to estimate muscle mass. We employed Cox proportional hazard models and generalized linear models to explore how muscle mass status influences the efficacy of intensive BP control on both cardiovascular and cognitive outcomes on relative and absolute scales. Landmark analyses with cutoffs at 3.4 and 2 years assessed primary outcomes.

Results: Among 6,367 randomized participants, 469 (7.4%) had baseline low muscle mass. Intensive BP control resulted in a 5.2 events per 1,000 person-years reduction in absolute risk (hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.58-0.89) in patients with normal muscle mass. Conversely, it increased the absolute risk of primary cardiovascular events by 11.1 per 1,000 person-years in those with low muscle mass (HR, 1.72; 95% CI, 0.89-3.34; P = 0.013 for interaction), and led to a significantly higher rate of primary cardiovascular events compared to standard treatment after 3.4 years (P = 0.043). Regardless of the presence of low muscle mass, intensive BP control can reduce both the relative and absolute risks of cognitive outcomes, with all interaction P-values > 0.05.

Conclusions: In persons with low muscle mass, intensive BP control was associated with an increased risk for CV events but not for cognitive decline.

Background: Postpartum preeclampsia (PPPE) is a maternal condition characterized by de novo hypertension in the postpartum period with end-organ damage. We investigated the use of perinatal immune changes, through routine complete blood count (CBC), to identify high-risk individuals before PPPE development.

Methods: We performed a retrospective matched case-control study of 100 individuals with PPPE, 200 term pregnancies (Ctrl) and 200 antenatal preeclampsia (PE). Detailed demographic, obstetrical, and laboratory data were retrieved from medical records. Statistical analysis was performed using one-way ANOVA, multivariate regression, and paired or unpaired t-tests, as appropriate.

Results: Individuals who developed PPPE were significantly older and predominantly Black vs Ctrl and PE. Both PE and PPPE had higher pre-pregnancy BMI and increased personal and family history of hypertension/PE vs Ctrl (P < 0.001). Before delivery, individuals who later developed PPPE, had lower total leukocyte counts vs Ctrl (9.61 vs 10.75 × 109/L, P < 0.05) whereas monocytes percentage was elevated (8.07 vs 7.27%, P < 0.01). Comparing the postpartum/antenatal ratio in-between each condition revealed elevated leukocyte ratio in PPPE vs Ctrl (P < 0.001). The Neutrophils ratio was also increased, whereas lymphocytes and monocytes were decreased in PPPE vs both Ctrl and PE. After adjusting for race, maternal age, pre-pregnancy BMI, personal history of PE/HT, and diabetes mellitus, perinatal immune changes were still significantly associated with PPPE.

Conclusions: Globally, perinatal immune changes were observed in individuals with a seemingly uncomplicated pregnancy prior to the development of PPPE. This strongly supports that such changes could be used to identify high-risk individuals prior to disease onset.

Objective: Ventricular-arterial coupling (VAC) evaluates the relationship between the left ventricle (LV) and the arterial system. This study aimed to assess VAC using the ratio of arterial stiffness (arterial velocity pulse index [AVI]) to myocardial deformation (global longitudinal strain [GLS]) in hypertension, and to determine whether it is more closely associated with vascular and cardiac damage than the conventional arterial elastance/left ventricular end-systolic elastance (Ea/Ees) index.

Methods: AVI, GLS, Ea, Ees, left ventricular ejection fraction (LVEF), and markers of left ventricular diastolic function (E/A and E') were measured by echocardiography in 141 healthy controls and 141 hypertensive subjects.

Result: AVI/GLS ratio was significantly lower in hypertensive individuals compared to controls (-0.77 ± 0.29 vs. -0.66 ± 0.28, P = 0.001). A low AVI/GLS ratio was correlated with age (r = -0.450, P < 0.05) and LVEF (r = 0.243, P < 0.05). Receiver operating characteristic analysis demonstrated that the AVI/GLS ratio had higher sensitivity for predicting early cardiovascular changes in hypertensive patients, with an area under the curve of 0.645 (95% confidence interval (CI) [0.565; 0.681]).

Conclusions: Hypertension is associated with worse VAC when expressed by the AVI/GLS ratio compared to normal conditions. The AVI/GLS ratio proved to be more effective than traditional indices (Ea/Ees) in detecting differences in cardiovascular function in hypertensive individuals. The role of the AVI/GLS ratio in various clinical settings requires further investigation.

Background: Arterial stiffness and endothelial dysfunction are two important features of cardiovascular injury. Arterial stiffness can be measured by Pulse Wave Velocity (PWV) and endothelial dysfunction can be assessed with reactive hyperemia measured by flow-mediated dilation (FMD). Cardio-Ankle Vascular Index (CAVI) is a recently developed method for measuring arterial stiffness. Studies assessing CAVI's association with established tests of arterial stiffness and endothelial function are limited.

Methods: In a cross-sectional study of adults (ages 18-80) with a range of cardiovascular disease risk burden, we measured CAVI by VaSera, tonometry measures of arterial stiffness [carotid-radial PWV (CRPWV), carotid-femoral PWV (CFPWV)], and ultrasound based brachial artery measures of vasodilator function.

Results: We enrolled 100 participants with acceptable quality from 93 subjects for primary analysis. The mean value of CAVI measure was 7.7 ± 1.2. There was a significant association between CAVI and CFPWV (r = 0.609, P < 0.001), which remained significant after adjusting for systolic blood pressure while the association of CAVI with CRPWV was more modest. Higher Framingham Risk Score, older age, history of hypertension and diabetes were significantly associated with higher CAVI and CFPWV. There was not any association between CAVI and FMD. Higher CAVI was associated with lower reactive hyperemia, an indicator of vasodilator function in the microvasculature (r = -0.365, P < 0.001).

Conclusion: Our findings suggest that CAVI relates to both central and peripheral artery stiffness though is not identical to tonometry measures. CAVI associates with microvascular but not conduit artery vasodilator function consistent with the interrelation of large artery stiffness with small vessel dysfunction.

Background: Both amlodipine and obtusifolin have been demonstrated to possess antihypertensive effects, which increases their potential to be combined. The interaction between amlodipine and obtusifolin was evaluated with in vivo rat models and in vitro liver microsome experiment, aiming to guide the clinical prescription of these two drugs.

Methods: The antihypertensive effects of amlodipine with or without the combination of obtusifolin were evaluated in hypertension rat models established by abdominal aortic coarctation in male Sprague-Dawley rats. Pharmacokinetics and metabolic stability of amlodipine were assessed in rats and liver microsomes, respectively. The effect of obtusifolin on the activity of CYP3A4 was estimated in liver microsomes.

Results: Obtusifolin significantly enhanced the antihypertensive effect of amlodipine (P < 0.01). The metabolism of amlodipine was suppressed by the coadministration of obtusifolin with increasing Cmax (P < 0.01), prolonging t1/2 (P < 0.01), and decreasing clearance rate (P < 0.001). In vitro results also confirmed the improving metabolic stability of amlodipine by obtusifolin. Obtusifolin showed a significant inhibitory effect on the activity of CYP3A4 in a concentration-dependent manner with the IC50 value of 15.13 μM.

Conclusions: Coadministration of amlodipine with obtusifolin induced increasing systemic exposure of amlodipine through inhibiting CYP3A4. Hypotension should be vigilant under their combination.

Background: The COVID-19 pandemic disrupted healthcare access, potentially impacting cardiovascular prevention by increasing and worsening interruptions in antihypertensive treatment. In this context, we aimed to assess whether the epidemic had modified the effect of antihypertensive interruptions on the risk of major cardiovascular events (MACE).

Methods: From the nationwide SNDS French health insurance databases (2018/01/01-2021/12/31), we identified patients with ≥1 year of continuous antihypertensive drug use. We then constituted a group of patients who interrupted an antihypertensive during the period (interrupters) i.e., who presented with a treatment gap for at least one antihypertensive (entry date: interruption date). Interruption length defined was defined as time to treatment restart. After 1:1 matching, we constituted a second group of patients with continuous antihypertensive treatment at interrupters entry date (persisters; entry date: interrupter entry date). Associations between MACE risk, antihypertensive drug interruption (all durations, ≥15 days, ≥30 days), COVID epidemic period, and the interaction between these were assessed using GEE multivariable models.

Results: A total of 2,072,672 interrupter/persister pairs were included (4,145,344 patients; 43.6% in COVID period). Risk of MACE was not found increased after interruptions overall (OR = 0.99; 95%CI [0.97-1.02]); it was when interruptions lasted at least fifteen days (OR = 1.03 [1.01-1.06]) and during the COVID period independently of the existence of interruptions (OR = 1.44 [1.39-1.50]; P-value for interaction: all interruptions 0.69, exceeding 15 days 0.65).

Conclusions: The COVID epidemic period was associated with an increased risk of MACE or all-cause death in antihypertensive drug users without worsening the effect of antihypertensive drug interruptions.

Background: Black men are underrepresented in hypertension trials, even though this population has higher prevalence and more adverse sequelae from hypertension, compared to other groups. In this article, we present recruitment and community engagement strategies for the Community-to-Clinic Linkage Implementation Program (CLIP), a cluster-randomized trial on hypertension prevention among Black men.

Methods: Using a 2-stage recruitment process, (i) we enrolled Black-owned barbershops from zip codes with high hypertension prevalence and (ii) recruited Black male participants who fulfilled the eligibility criteria and were customers of the barbershops. Barbershop and participant recruitment was conducted by a partner community-based organization.

Results: The study met the recruitment goals for barbershop enrollment (N = 22) and individual participants. Of eligible individuals (N = 461), 430 enrolled in the study (93% consent rate, exceeding the original enrollment goal of N = 420 participants). Throughout recruitment, the study team conducted 101 unique engagements (41 prior to recruitment and 60 during recruitment), totaling engagement with 180 partners across all events, including individual and group meetings, attendance at community events, and educational presentations. In addition to a primary partner community organization, the study team collaborated with a Community Advisory Council, comprised of residents, and civic and community leaders, and with the local health department and varied other organizations.

Conclusions: In CLIP, a high number of academic-community engagement encounters and close collaboration with community partners contributed to successful recruitment of Black men at risk for hypertension and with adverse social determinants. Our experience may serve as to inform investigators focused on recruiting underserved populations in hypertension research trials.

Clinicaltrials.gov identifier: NCT05447962.