American Journal of Hypertension最新文献

Background: The non-exercise estimated cardiorespiratory fitness (eCRF) has been recognized as an important predictor of mortality among the general population. This study sought to evaluate the relationship between eCRF and mortality from all causes, cardiovascular disease (CVD), and cancer in hypertensive adults.

Methods: We included 27,437 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) III and 10 NHANES cycles from 1999 to 2018. Multivariate Cox proportional hazard models were used to assess the hazard ratios and 95% confidence intervals (CIs) of eCRF for mortality.

Results: A total of 8,023 deaths were recorded throughout a median 8.6-year follow-up, including 2,338 from CVD, and 1,761 from cancer. The eCRF with per 1 metabolic equivalent increase was linked to decreased risk of all-cause (adjusted HR 0.78, 95% CI: 0.75-0.81) and CVD mortality (adjusted HR 0.79, 95% CI: 0.74-0.84), rather than cancer mortality (adjusted HR 0.94, 95% CI: 0.86-1.03). Moreover, a stronger protective effect of eCRF was observed for females (HR 0.66 (95% CI: 0.62-0.72) versus HR 0.78 (95% CI: 0.73-0.83), Pinteraction < 0.001 for all-cause mortality; HR 0.70 (95% CI: 0.61-0.80;) versus HR 0.82 (95% CI: 0.73-0.92), Pinteraction = 0.026 for CVD mortality) compared with males. Findings did not significantly differ in subgroup analyses and sensitivity analyses.

Conclusions: Among adults with hypertension, eCRF was inversely related to all-cause and CVD mortality, but not cancer mortality. A significant interaction effect existed between sex and eCRF. Further studies are needed to verify this association in different populations.

Background: Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension.

Methods: Data from 2016-2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features.

Results: The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01).

Conclusions: We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.

Background: Cuffless blood pressure (BP) devices are an emerging technology marketed as providing frequent, non-intrusive and reliable BP measurements. With the increasing interest in these devices, it is important for Hypertension Canada to provide a statement regarding the current place of cuffless BP measurements in hypertension management.

Methods: An overview of the technology in cuffless BP devices, the potential with this technology and the challenges related to determining the accuracy of these devices.

Results: Cuffless BP monitoring is an emerging field where various technologies are applied to measure BP without the use of a brachial cuff. None of the devices currently sold have been validated in static and dynamic conditions using a recognized validation standard. Important issues persist in regard to the accuracy and the place of these devices in clinical practice. Current data only support using validated cuff-based devices for the diagnosis and management of hypertension. Presently, readings from cuffless devices that are used for diagnosis or clinical management need to be confirmed using measurements obtained from a clinically validated BP device.

Conclusion: Cuffless BP devices are a developing technology designed to track BP in most daily-life activities. However, many steps remain before they should be used in clinical practice.

The diagnosis and management of hypertension have been based primarily on blood pressure (BP) measurement in the office setting. Higher out-of-office BP is associated with increased risk of cardiovascular disease, independent of office BP. Home BP monitoring (HBPM) consists of the measurement of BP by a person outside of the office at home and is a validated approach for out-of-office BP measurement. HBPM provides valuable data for diagnosing and managing hypertension. Another validated approach, ambulatory BP monitoring (ABPM), has been considered to be the reference standard of out-of-office BP measurement. However, HBPM offers potential advantages over ABPM including being a better measure of basal BP, wide availability to patients and clinicians, evidence supporting its use for better office BP control, and demonstrated efficacy when using telemonitoring along with HBPM. This state-of-the-art review examines the current state of HBPM and includes discussion of recent hypertension guidelines on HBPM, advantages of using telemonitoring with HBPM, use of self-titration of antihypertensive medication with HBPM, validation of HBPM devices, best practices for conducting HBPM in the clinical setting, how HBPM can be used as an implementation strategy approach to improve BP control in the US, health equity in HBPM use, and HBPM use among specific populations. Finally, research gaps and future directions of HBPM are reviewed.

Background: In a post-hoc analysis of a multinational, randomized trial, we investigated whether the efficacy and safety of nifedipine gastrointestinal therapeutic system (GITS) and ramipril differed between Chinese and European patients with hypertension.

Methods: Previously treated (after 2-week washout) and untreated patients with clinic blood pressure (BP) ≥140/90 mmHg (systolic/diastolic), daytime ambulatory BP ≥135/85 mmHg and standard deviation of home systolic BP >7 mmHg and/or daytime BP >12 mmHg were randomly assigned to treatment based on nifedipine GITS 30 mg or ramipril 10 mg for 12 months. Clinic, ambulatory and home BP were measured at baseline, 10 weeks and 12 months after randomization.

Results: A total of 67 Chinese and 101 European patients were analyzed and they differed in age (50.9 vs. 54.6 years, respectively), body mass index (24.5 vs. 27.0 kg/m2), clinic diastolic BP (87.9 vs. 92.5 mmHg), heart rate (75.0 vs. 70.8 beats/minute) and nighttime diastolic BP (79.3 vs. 75.9 mmHg) (all P<0.05). However, within each ethnicity, patients were comparable for clinical characteristics between the nifedipine GITS and ramipril groups (P>0.05). In both the Chinese and European patients, BP was similarly reduced with nifedipine GITS and ramipril, except that daytime systolic/diastolic BP reductions were 7.4/4.1 mmHg greater in the ramipril than nifedipine GITS group in Chinese (P=0.02). The safety profile differed between the Chinese and European patients (P for drug*ethnicity interaction ≤0.05) for all adverse events (lower incidence on nifedipine GITS in Chinese), ankle edema (higher on nifedipine GITS in Europeans) and dry cough (higher on ramipril in Chinese).

Conclusion: In the Chinese and European patients with hypertension, nifedipine GITS and ramipril had similar BP lowering efficacy, but different safety profile and tolerability.

Background: Increased circulating bilirubin attenuates angiotensin (Ang) II-induced hypertension and improves renal hemodynamics. However, the intrarenal mechanisms that mediate these effects are not known. The goal of the present study was to test the hypothesis that bilirubin generation in the renal medulla plays a protective role against Ang II-induced hypertension.

Methods: Twenty-week-old male C57Bl/6J mice were implanted with intrarenal medullary interstitial (IRMI) catheters following unilateral nephrectomy. After this time, biliverdin IXα was specifically infused into the kidney (3.6 mg/day) for 3 days before implantation with an osmotic minipump delivering Ang II (1000 ng/kg/min). BP was recorded for 3 days, 1 week after minipump infusion, in conscious mice. To further explore the antihypertensive role of renal medullary bilirubin generation, mice with specific deletion of biliverdin reductase-A (Blvra) in the thick ascending loop of Henle (TALH) were generated. At 20 weeks, BlvraTALHKO and control mice (Blvrafl/fl) were infused with Ang II for 2 weeks.

Results: IRMI infusion of biliverdin significantly decreased blood pressure compared to mice infused with vehicle (118 ± 4 vs. 158 ± 2 mmHg, p<0.05). Angiotensin-II infusion resulted in significantly higher blood pressure measured in conscious mice 7 days after implantation in BlvraTALHKO as compared to Blvrafl/fl mice (152 ± 2 vs. 140 ± 3 mmHg, p<0.05).

Conclusions: Together, these findings show that medullary bilirubin and biliverdin reductase can improve hypertension and that mechanisms that increase bilirubin and biliverdin reductase in the renal medulla could be an effective approach to treat hypertension.

Background: The 24-hour activity cycle (sleep, sedentary behavior, light physical activity, moderate to vigorous physical activity) may have deleterious or beneficial associations with 24-hour blood pressure.

Purpose: Estimate the short-term associated changes in 24H-BP with acutely replacing 30 min/d from one behavior of the 24H-ACT to other behaviors in employed adults.

Methods: Participants (N=659) wore an ambulatory blood pressure monitor and two accelerometers (waist and wrist) to measure 24-hour blood pressure and the 24-hour activity cycle.

Results: Replacing 30 minutes of sedentary behavior with 30 minutes of sleep was associated with lower 24-hour mean systolic [ß=-0.32 mmHg per 0.5hr (95% CI: -0.58, 0.06)] and diastolic [ß=-0.31 mmHg per 0.5hr (95% CI: -0.50, -0.12)] blood pressure. Replacing 30 minutes of light physical activity with 30 minutes of sleep was associated with lower 24-hour mean systolic [ß=-0.30 mmHg per 0.5hr (95% CI: -0.62, 0.03,)] and diastolic blood pressure [ß=-0.34 mmHg per 0.5hr (95% CI: -0.58, -0.11,)]. No other time reallocations between 24-hour activity cycle behaviors were associated with changes in 24-hour blood pressure.

Conclusion: Replacing time in sedentary behavior or light physical activity with sleep may provide small short-term reductions in that day's 24-hour blood pressure.