American Journal of Hypertension最新文献

Background: Nocturnal hypertension (NH) is associated with adverse cardiovascular outcomes beyond and even independent of daytime hypertension (DH). Although cohort studies have evaluated correlates of NH, there is comparably less data available from real-world clinical practice and for population subsets that tend to be under-represented in cohort studies.

Methods: This retrospective cohort study included all patients who underwent ambulatory blood pressure monitor (ABPM) testing at a large US academic medical center from 1 January 2013 to 31 December 2023. We used multivariable-adjusted logistic regression to assess DH as a correlate of NH, covariates related to the co-occurrence of DH and NH, and correlates of isolated NH.

Results: Of 1,566 patients, 812 (51.9%) had DH, 1,125 (71.8%) had NH, and 363 (23.2%) had isolated NH. A total of 762 (48.7%) patients had co-occurring daytime and NH. In multivariable analysis, significant correlates of NH included DH, male sex, age, Black race, and Hispanic ethnicity. By comparison, significant correlates of co-occurrent DH and NH included male sex, age, Asian race, Black race, and renal disease; coronary artery disease (CAD) was inversely associated with this co-occurrence. Among all covariates, only CAD was associated with isolated NH.

Conclusions: Our real-world study results highlight the generally under-recognized prominence of isolated NH, as well as the presence of NH among Hispanic and Asian-American populations. Further prospective investigations are needed to evaluate whether broader ABPM screening for NH is needed across all populations at risk, including but not limited to persons with more easily identified DH.

Background: The relationship between childhood and adulthood obesity and the risk of gestational diabetes mellitus (GDM) remains unclear. To clarify the independent and joint effects of childhood and adulthood body size on GDM risk, and explore inflammation's role.

Methods: Using female-specific UK Biobank genome-wide association study data, genetic instruments for childhood/adult body size ("thinner," "about average," "plumper") and C-reactive protein (CRP) were identified. GDM variants came from FinnGen. Univariable and multivariable Mendelian randomization (MR) assessed causality and mediation.

Results: Univariable MR analyses provided strong evidence for genetically predicted effects of both childhood body size (odds ratio [OR] per category = 1.72, 95% CI: 1.42-2.09, P < 0.001) and adulthood body size (OR = 1.59, 95% CI: 1.42-1.79, P < 0.001) on GDM risk. However, in multivariable MR analysis, the effect of childhood body size was attenuated and no longer significant after adjusting for adulthood body size (OR = 1.19, 95% CI: 0.91-1.48, P = 0.221), whereas the effect of adulthood body size remained significant even after controlling for birth weight, childhood body size, and age at menarche (OR = 1.42, 95% CI: 1.15-1.68, P = 0.011). Further analysis indicated that CRP partially mediated the effect of adulthood body size on GDM risk.

Conclusions: Our findings suggest that childhood obesity increases the future risk of GDM primarily through its persistence into adulthood, and that inflammation, as indicated by elevated CRP levels, partially mediates the effect of adult obesity on GDM risk. These results highlight the importance of early obesity prevention and intervention, as well as inflammation control, to reduce the risk of GDM later in life.

Background: The optimal blood pressure (BP) target for adults with type 2 diabetes (T2DM) remains a topic of debate. This systematic review and meta-analysis aimed to investigate the efficacy of intensive BP control strategies compared to standard or less intensive approaches in adults with T2DM.

Methods: We comprehensively searched databases for studies comparing intensive vs. less intensive BP targets in individuals with T2DM. In this study, the group with the most intensive target was compared to the group with the least intensive target. Also, studies were analyzed based on current guideline recommendations. Outcomes of interest included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, heart failure, retinopathy, neuropathy, nephropathy, and end-stage renal disease. Risk ratios with 95% confidence intervals were calculated.

Results: The meta-analysis included 21 studies (16 RCTs) with 290,907 participants (mean age 61.84 years, 55.03% male). Guideline-based analyses showed comparable clinical outcomes between groups with no significant differences. However, the most intensive targets vs. the least intensive targets revealed that the intensive BP control group experienced a significantly lower risk of MACE (RR = 0.75, 0.58; 0.98), nonfatal MI (RR = 0.61, 0.41; 0.91), nonfatal stroke (RR = 0.60, 0.39; 0.92), and total stroke (RR = 0.61, 0.39; 0.95). Other outcomes were similar between groups. Subgroup analysis of RCTs mirrored the overall findings.

Conclusions: In adults with T2DM, intensive BP control reduces the risk of cardiovascular events, such as MACE, stroke, and MI. Additionally, it demonstrates comparable diabetes-related complications to less intensive or standard controls.

Background: Hypertension (HTN) predisposes individuals to arterial stiffness (AS) and dysfunction of the left atrial (LA) and left ventricular (LV). AS, characterized by increased pulse wave velocity (PWV) may impair LA phasic function. This study investigates the associations of brachial-ankle PWV and the left atrioventricular coupling index (LACI) as well as LA phasic function in hypertensive patients, and to evaluate the predictive value for LA dysfunction.

Methods: A prospective cohort of 150 patients with essential hypertension was enrolled. Patients were stratified into Group I (baPWV < 1600 cm/s, n = 75) and Group II (baPWV ≥ 1600 cm/s, n = 75) based on the median baPWV. Intergroup comparisons were performed. Correlations were assessed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of baPWV.

Results: Compared with Group I, Group II exhibited reduced LAEFtotal, LAEFpass, εs, and εe (all P < 0.05). LACI was significantly higher in Group II (P < 0.05). After adjusting for cardiovascular risk factors, multivariate linear regression analysis revealed that baPWV remained independently associated with LAVImin, LACI, εs, and εe. baPWV integration with conventional risk factors significantly improved predictive performance. The AUC increased from 0.709 to 0.845 for LACI, from 0.681 to 0.892 for LAVImin, from 0.672 to 0.881 for εs, and from 0.685 to 0.919 for εe.

Conclusion: Hypertension-mediated AS exhibits concurrent abnormalities in LA-arterial and LA-LV-arterial coupling. Integrating baPWV into conventional risk stratification models enhances the predictive value for preclinical cardiac target organ damage in hypertension.

Background: Visceral obesity, insulin resistance, and glycolipid abnormalities are associated with an increased risk of hypertension (HTN). The study aimed to explore the correlation between novel triglyceride- and triglyceride-glucose-derived obesity indices associated with these hypertension risk factors, and the prevalence of HTN among nonobese adults.

Methods: We extracted data from 12,717 nonobese adults from the National Health and Nutrition Examination Survey between 1999 and 2020 and calculated triglyceride-derived obesity indices (lipid accumulation product (LAP), visceral adiposity index (VAI), and cardiometabolic index (CMI)), triglyceride-glucose-derived obesity indices (triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist-to-height ratio (TyG-WHtR)) and traditional anthropometric indices. Logistic regression, curve fitting and subgroup analyses were employed to investigate the associations between these novel obesity indices and HTN prevalence. Receiver operating characteristic curve analysis was performed to assess the predictive accuracy of all the above obesity parameters.

Results: After weighted analysis of the data, the results of this study represented approximately 119.00 million nonobese US adults. The prevalence of HTN was 49.74% (men 53.45%). The multivariate logistic regression analysis revealed that LAP, VAI, CMI, TyG-BMI, TyG-WC and TyG-WHtR were significantly associated with HTN. Smoothed curve-fitting analysis revealed that the LAP, VAI and CMI correlated nonlinearly with HTN. The area under the curve for HTN was greater for all novel obesity indices compared to commonly used traditional anthropometric parameters such as BMI, WC, and WHtR.

Conclusions: LAP, VAI, CMI, TyG-BMI, TyG-WC, and TyG-WHtR were significantly associated with HTN and demonstrated potentially better predictive capability than commonly used traditional anthropometric measures.

Background: Compared to individuals of European or African ancestry, individuals of South Asian (SA) ancestry have greater cardiovascular disease (CVD) risk. We aimed to compare arterial stiffness and central hemodynamics, surrogates of CVD, in adolescents and young adults (AYA) of SA, White, and African American (AA) ancestry with overweight or obesity.

Methods: Pulse wave velocity (PWV) and pulse wave analysis (PWA metrics: Pulse Pressure Amplification [PPA]; Augmentation Index adjusted to heart rate of 75 [Aix75]) were performed in a cross-sectional study of 40 (18M/22F) SA, 45 (16M/29F) AA, and 44 (21M/24F) White AYA (age 12-21 years) of comparable age, sex, and BMI. Between-group comparisons of PWV, PPA, and AIx-75 were tested using linear regression models adjusted for covariates (BMI, mean arterial pressure, sex, age), as appropriate.

Results: As expected, BMI (kg/m2) did not differ (SA: 27.1, AA: 28.4, White: 27.4). Mean PWV (m/s) did not differ in SA (5.5), AA (5.1), and White (5.5). The typical relationship of BMI with PWV was absent in SA. PPA was lower in SA (1.45, P = 0.001) and AA (1.48, P = 0.014) vs. White (1.56). Aix75 was higher in SA (108, P = 0.004) but not in AA (105, P = 0.12) vs. White (101).

Conclusions: Although their PWV did not differ, SA AYA had lower PPA and higher Aix75 compared to White counterparts. As lower PPA associates with higher likelihood of future CV events, these findings could reflect an early CVD predisposition in SA and underscore the potential value of pulse waveform analysis in studies of emerging adults, a life stage in which interventions may mitigate CVD risk.