American Journal of Hypertension最新文献

Background: Timely blood pressure (BP) screening is not consistently performed for new mothers. Only 60% complete a 6-week postpartum visit, and even fewer are evaluated within 1 week. This timing is crucial since mortality is highest in the first 6 days. Primary care has a role to play in improving postpartum BP care. However, research has yet to fully explore primary care-driven strategies for postpartum BP screening.

Objective: This review aims to identify primary care postpartum BP screening strategies and to understand the characteristics of patients who are completing BP screenings within 1 week.

Methods: We used the PubMed and Web of Science databases to identify peer-reviewed studies published since 2010. Included studies were conducted in the United States and of English-language publications.

Results: We identified 13,452 articles and synthesized 32 studies. Of 11,270 postpartum patients, 40% (n = 4,790) identified as Black/African American race. For recruitment, 24 (75.0%) studies focused on high-risk patients, 5 (15.6%) compared high-risk to low-risk patients, and 3 (9.4%) studies recruited all patients with no restrictions. Studies often reported BP ascertainment within 1-week postpartum (53.1%; n = 17). Further, 12 (37.5%) studies incorporated both in-clinic and in-home settings for postpartum BP screening, 10 (31.2%) were in-clinic, and 10 (31.2%) were in-home.

Conclusions: We found that primary care systems are evaluating BP within 1-week postpartum, leveraging remote BP monitoring and child-wellness checks. Those strategies, however, less often included low-risk patients. Updated guidelines are needed to cover postpartum BP screening for patients with uncomplicated pregnancies and the absence of other risk factors.

Background: A substantial proportion of adults with hypertension die from causes other than cardiovascular disease (CVD), but the frequencies are unknown.

Methods: We calculated the frequency of causes of death for adults with and without hypertension using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which enrolled non-Hispanic Black and White adults aged ≥ 45 years in 2003-2007. Participants were followed until death or 31 December 2019. Blood pressure (BP) was measured at baseline and at a follow-up examination in 2013-2016. Hypertension was defined as systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg, or self-reported antihypertensive medication use, and modeled a time-varying exposure. The outcome was the adjudicated underlying cause of death, determined from all available information, including death certificates, medical records, autopsy reports, and interviews with proxies or next of kin.

Results: There were 8,933 deaths among 23,622 participants with hypertension and 1,709 deaths among 5,744 participants without hypertension over a median 8.1 years of follow-up. Among participants who died, the most common causes of death were CVD (31.2%), cancer (22.1%), and infection (11.6%) among participants with hypertension and cancer (29.8%), CVD (23.2%), and dementia (11.8%) among participants without hypertension. Among participants with and without hypertension, the 10-year cumulative incidence was 8.2% and 3.6% for CVD mortality, respectively, 5.8% and 4.9% for cancer mortality, and 2.8% and 1.5% for infection mortality, respectively.

Conclusions: Among adults with hypertension, a majority of deaths were from non-CVD causes, including one-third of deaths from cancer and infection.

Background: Black US adults experience a greater hypertension burden and have lower levels of soluble receptors for advanced glycation end products (sRAGE). sRAGE may reduce inflammation, which is itself a hypertension risk factor. We hypothesized that higher sRAGE levels are associated with a lower risk of incident hypertension in a cohort of Black and White adults.

Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) enrolled 30,239 Black and White adults from the contiguous United States in 2003-2007; a second visit occurred in 2013-2016. sRAGE was measured at baseline by ELISA in 4,400 participants attending both visits. Hypertension was defined as BP > 140/90 mm Hg or use of antihypertensive medications. Participants with baseline hypertension were excluded. Poisson regression estimated incident hypertension risk ratios (RR) by sRAGE levels, adjusting for confounders.

Results: Among 1,799 participants without baseline hypertension (mean [SD] age 62 [8] years, 55% females, 25% Black), 46% of Black participants and 31% of White participants developed hypertension. Median sRAGE was lower in Black than White persons (P < 0.0001). Relative to quartile 1, White participants in quartile 4 of sRAGE had a 24% lower risk of incident hypertension (RR 0.76; 95% CI 0.59, 0.96) in a minimally adjusted model, but no differences in a fully adjusted model (0.81; 0.63 to 1.05). There was no association of sRAGE with hypertension in Black participants.

Conclusions: Higher baseline sRAGE levels were not associated with lower risk of incident hypertension after adjusting for known confounders. Low sRAGE might represent adverse inflammation that drives hypertension rather than being a primary driver of hypertension development itself.

Background: Data on risk factors for new-onset atrial fibrillation (NOAF) in hypertensive Asian populations are limited. This study aimed to identify predictors of NOAF in Thai adults with hypertension (HTN).

Methods: We conducted a retrospective cohort study of adults (≥18 years) newly diagnosed with HTN at Ramathibodi Hospital, Bangkok, from 2010 to 2023. Patients with prior AF or predisposing conditions (e.g., valvular disease and hyperthyroidism) were excluded. Baseline demographics, comorbidities, and medication use were analyzed as time-varying covariates using multivariable Cox models.

Results: Of 293,798 hypertensive patients, 168,441 met the criteria. Over a median follow-up of 3.7 years, 5,028 developed NOAF (5.7 per 1,000 person-years). A significant interaction between age and body mass index (BMI) was observed. In patients <60 years, low BMI increased NOAF risk (HR: 2.3; 95% CI: 1.4-3.6), while overweight and obesity did not. In those ≥60-79 years, NOAF risk increased 2- to 3-fold in underweight, overweight, and obese individuals compared to normal BMI. In patients ≥80 years, the risk was 3- to 4-fold higher across all BMI categories. Male sex and comorbidities (vascular disease, stroke, heart failure, chronic kidney disease, and hyperuricemia) were associated with a 1.2-1.8-fold increased risk. Statin use reduced NOAF risk (HR: 0.8; 95% CI: 0.7-0.9), while SGLT2 inhibitors and GLP-1 receptor agonists showed a non-significant protective trend (HR: 0.8; 95% CI: 0.7-1.1).

Conclusions: In Thai hypertensive patients, older age, male sex, abnormal BMI, and comorbidities predict NOAF, while statin use may be protective. Further prospective studies are needed to confirm these findings.

Background: It is not well established whether blood pressure variability (BPV) is associated with risk of incident heart failure (HF) as well as with subclinical markers of HF and myocardial injury.We investigated these relationships in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: We examined the association between visit-to-visit BPV (estimated by variability independent of the mean-VIM) and HF in MESA (2000-2012), a community-based cohort study of 6,814 individuals free of clinical cardiovascular disease (including HF) at baseline, using Cox models and joint longitudinal-survival models. VIM was calculated from Exams 1-5. Serial measurements (Exams 1 and 5) of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin-T (hs-cTnT) were used to test the early onset and directionality of the relationships by logistic regression.

Results: Over a median of 9.4 years of follow-up, VIM-SBP was associated with HF in adjusted Cox models including CVD risk factors (HR = 1.33 [95% CI = 1.03-1.69]), as well as in joint longitudinal-survival models. BPV was associated with elevated Exam 5 NT-proBNP (> 125 pg/mL) after multivariable adjustment (VIM-SBP: OR = 1.26 [95% CI = 1.17-1.37]; VIM-DBP: OR = 1.23 [95% CI = 1.14-1.33]) and Exam 5 elevation in hs-cTnT (for VIM-SBP, OR = 1.27).

Conclusions: BPV was associated with incident HF and longitudinal increases of subclinical markers of HF and myocardial injury in a multi-ethnic community-based cohort. These data indicate that visit-to-visit BPV may contribute to the development of HF.

Background: Blood pressure (BP) present a diurnal pattern with a nocturnal decrease and an increase in early morning. Evidence suggests that an exaggerated morning BP surge is associated with higher cardiovascular risk. This is the first study evaluating the association between dialysis timing and morning BP surge in hemodialysis.

Methods: 113 patients dialyzed on the morning shift were age- and sex-matched in a 1:1 ratio with 113 patients dialyzed on the midday/evening shifts. All patients underwent 48-h ambulatory BP monitoring. Morning BP surge at the first and second days of the recording was calculated using three definitions: pre-awakening, sleep-trough and rising morning BP surge.

Results: The two groups were similar in terms of age, BMI and comorbidities. Morning shift patients presented higher mean sleep-through SBP/DBP surges (SBP: 18.71 ± 13.11 vs 14.22 ± 10.25mmHg, p = 0.005; DBP: 12.05 ± 8.04 vs 9.46 ± 8.53mmHg, p = 0.020) and higher mean pre-awakening SBP/DBP surges (SBP: 12.05 ± 8.04 vs 9.46 ± 8.53mmHg, p = 0.020; DBP: 10.16 ± 9.56 vs 6.53 ± 10.78mmHg, p = 0.008). No between-groups differences were observed in mean rising SBP surge. During the 1st 24-h period, morning shift patients showed higher pre-awakening SBP/DBP surges (SBP: 9.85 ± 11.15 vs 6.22 ± 11.77mmHg, p = 0.018) and, during the 2nd 24-h period, higher sleep-through SBP/DBP surges (SBP: 20.02 ± 18.17 vs 12.79 ± 12.91mmHg, p = 0.001; DBP: 12.49 ± 10.76 vs 9.64 ± 10.53, p = 0.046). Dipping patterns did not differ between groups.

Conclusions: Patients dialyzed on the morning shift exhibited significantly higher morning BP surge compared to the other two shifts. Future studies should confirm these observations and examine the need for individualizing the choice of dialysis shift for patients with specific circadian BP profiles.

Out-of-office blood pressure (BP) monitoring is a critical component of modern hypertension diagnosis and management. Measuring BP outside of clinic reduces the stress response that contributes to white coat hypertension and also allows for the identification of masked hypertension, yielding more accurate cardiovascular disease (CVD) risk assessment and improved CVD prevention. Home BP monitoring and 24-hour ambulatory BP monitoring outperform office BP in predicting CVD outcomes and are cost-effective aspects to cardiovascular health promotion by preventing unnecessary treatment, reducing clinic visits, and lowering event-related costs. Despite these advantages, routine implementation remains limited due to patient, provider, and system-level barriers, including validated device access, workflow integration, patient-provider communication tools, and adherence. Efforts to minimize or eliminate these barriers are crucial to CVD prevention. Evidence is also needed to support alternative out-of-office BP measurement strategies, including community-based strategies, such as BP assessment by school nurses, pharmacists, or community health workers. The utility of these modalities in diagnosing and managing children with hypertension are greatly needed as the long-term prognostic data in this population are sparse. Expanding adoption and evidence for out-of-office monitoring is essential to optimize hypertension care and CVD risk reduction.