American Journal of Hypertension最新文献

Background: Rapid decline in estimated glomerular filtration rate (eGFR) is linked to increased mortality and morbidity in chronic kidney disease (CKD). Few studies have focused on the risk of rapid eGFR decline. This study evaluates the association between antihypertensive drug use, blood pressure (BP) levels, and rapid eGFR decline in Japanese CKD patients.

Methods: Data from 100,746 Japanese individuals aged 40-74 years with CKD were analyzed. Rapid eGFR decline was defined as an annual reduction >25%. Logistic regression was used to assess associations between antihypertensive drug use, BP levels, and rapid eGFR decline, stratified by eGFR and urinary proteinuria.

Results: Rapid eGFR decline occurred in 5.8% of participants. Higher BP levels increased the risk compared to normal BP: high-normal + elevated BP (odds ratio [OR], 1.26; 95% CI: 1.12-1.41) and high BP (OR, 1.79; 95% CI: 1.59-2.02). Controlling BP to high-normal or elevated levels in patients receiving antihypertensives reduced this risk. Overall, antihypertensive drug users had approximately twice the risk of rapid eGFR decline compared to non-users. However, in proteinuric patients with preserved eGFR, the risk increase was lower (1.27 times) in the high-normal + elevated BP group compared to that in the overall cohort.

Conclusion: The risk of rapid eGFR decline increased with increasing BP and decreased with controlling BP. Antihypertensive treatment was associated with a higher risk of rapid eGFR decline at all BP levels. For CKD patients with proteinuria, maintaining BP in the high-normal or elevated range may further mitigate this risk.

Background: High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) events. The ideal cardiovascular health metrics (ICVHMs) have beneficial effects on the cardiovascular system. The present study examined the association between ICVHMs and the risk of hypertension-related CVD in hypertensive patients across different BP ranges.

Methods: Analyses included 31,427 adults from the National Health and Nutrition Examination Survey 2005-2018. The BP target was <130/80 mmHg and ICVHMs were defined based on the 2022 American Heart Association Presidential Advisory. Fatal major adverse cardiovascular events (MACE) were the primary outcomes. Cox proportional hazards models were used to calculate the HR and 95% CI for MACE mortality.

Results: Among 31,427 participants, hypertensive patients with ≥5 ICVHMs did not appear significantly additional risk of MACE mortality compared to participants without hypertension (BP at target: HR, 1.09; 95%CI, 0.72-1.64; BP above target: HR, 0.98; 95%CI, 0.69-1.39). Compared to patients with 0-1 ICVHMs, experiencing ≥5 ICVHMs was associated with a lower MACE mortality risk (BP at target: HR, 0.60; 95%CI, 0.36-0.98; BP above target: HR, 0.43; 95%CI, 0.30-0.62). Among hypertensive patients, each increase in the number of ICVHMs was associated with a lower risk of MACE mortality (BP at target: HR, 0.86; 95%CI, 0.76-0.97; BP above target: HR, 0.84; 95%CI, 0.78-0.91), even in patients with high risk factors for CVD.

Conclusions: Compared to participants without hypertension, hypertensive patients with fewer ICVHMs, regardless of whether their blood pressure is well-controlled, face a significantly higher risk of MACE mortality.

Hypertension remains a major global health challenge, contributing to significant morbidity and mortality. Advances in artificial intelligence (AI) and machine learning (ML) are transforming hypertension care by enhancing blood pressure (BP) measurement, risk assessment, and personalized treatment. AI-powered technologies have the potential to enable accurate non-invasive BP monitoring and facilitate tailored lifestyle modifications, enhancing adherence and outcomes. ML models can also predict hypertension risk based on demographic, lifestyle, and clinical data, enabling earlier intervention and prevention strategies. However, challenges such as the lack of standardized validation protocols and potential biases in AI systems may widen health disparities. Future research must prioritize rigorous validation across diverse populations and ensure algorithm transparency. By leveraging AI responsibly, we can revolutionize hypertension management, enhance health equity, and improve cardiovascular outcomes.

Background: Percutaneous adrenal ablation (PAA) is an effective and safe therapy for treating patients with primary aldosteronism (PA). However, its effectiveness in comparison to that of adrenalectomy (ADX) and mineralocorticoid receptor antagonists (MRAs) remains unclear.

Methods: Databases were searched including: Pubmed, Embase, and The Cochrane Library. Studies were included if patients with PA who received two of three different treatments (ADX, MRAs, or PAA) and reported our interested outcomes, including blood pressure, serum potassium and the aldosterone-to-renin ratio (ARR).

Results: In total of 10,681 patients from forty-seven studies were identified. Both ADX and PAA showed superior clinical success (systolic BP: ADX: -4.69 [-6.4, -2.95], PAA: -3.96 [-9.05, 0.99]; diastolic BP: ADX: -3.14 [-4.55, -1.85], PAA: -2.99 [-6.96, 0.98]) compared with MRAs. According to the Bayesian ranking curves (SUCRA values), ADX ranked first for all outcomes of interest (systolic BP: 81.02%, diastolic BP: 76.95%, serum potassium: 96.55%, and ARR: 88.03%), while PAA ranked second for all outcomes (systolic BP: 65.94%, diastolic BP: 69.66%, serum potassium: 50%, and ARR: 45.14%).

Conclusions: The findings of this network meta-analysis suggest that PAA could be an alternative treatment for patients with PA who are unable to opt for surgery or MRA therapy, and its clinical and biochemical success fall between those of ADX and MRAs.

Background: Systolic blood pressure (BP) is a key factor in the outcomes of patients with acute ischemic stroke (AIS) receiving endovascular thrombectomy (EVT). However, the factors that mediate the association between BP and clinical outcome are unclear.

Methods: Consecutive patients with AIS in the anterior circulation underwent continuous BP monitoring for 24 hours. The 3-month modified Rankin scale (mRS) score was defined as the clinical functional outcome. The systolic BPI indices (BPIs) were successive variation, standard deviation, variability independent of mean BP (VIM), and 24-hour mean BP. Regression analysis was used to assess the correlation between different BPIs and functional outcomes, whereas mediation analysis was employed to assess the potential mediating effects of baseline risk factors through BP on functional outcomes.

Results: A total of 140 of 292 patients (47.9%) achieved functional independence, and 87 (29.8%) experienced hemorrhagic transformation (HT). A history of stroke or hypertension and NIHSS score at onset were associated with SD and VIM (P < 0.05). BP variation (BPV) was still strongly associated with functional outcomes after adjustment for different risk factors. Mediation analysis revealed that stroke affected functional outcomes by affecting BPV, while the hypertension history affected functional prognosis by impacting the 24-hour mean BP and BPV. In addition, higher National Institute of Health stroke scale (NIHSS) scores were associated with increased BPV, whereas increased BPV was correlated with a greater proportion of unfavorable outcomes.

Conclusions: To our knowledge, this study is the first to explore the mediating effects of different BPIs on the relationships between risk factors and functional outcomes and may provide new insights and potential mechanisms for improving AIS prognosis.

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 an 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 United States, health equity in HBPM use, and HBPM use among specific populations. Finally, research gaps and future directions of HBPM are reviewed.

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 to 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 a 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 a 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: Leptin is a hormone that is secreted by the adipocytes. In the circulation, leptin levels are directly proportional to the body fat percentage. Studies have shown that higher leptin levels are associated with an increased risk of hypertension after adjusting for body mass index (BMI). Therefore, leptin has been proposed as a mediator of obesity-related hypertension. Whether leptin is associated with hypertension when controlling for body fat percentage remains unclear.

Methods: We studied 103 obese men (BMI ≥ 30.0 kg/m2). All men were healthy and were medication-free. We measured blood pressure using 24-h ambulatory blood pressure (ABP) recordings. Hypertension was defined as 24-h systolic ABP ≥ 130 mm Hg and/or 24-h diastolic ABP ≥ 80 mm Hg, and normotension was defined as 24-h ABP < 130/80 mm Hg. We measured fasting serum leptin concentrations and used dual-energy X-ray absorptiometry scanning to determine body fat percentage.

Results: Of the 103 obese men, 64 were hypertensive (24-h systolic ABP-mean ± standard deviation-137 ± 11 mg Hg and 24-h diastolic ABP 83 ± 6 mm Hg) and 40 were normotensive (24-h systolic ABP 117 ± 6 mg Hg and 24-h diastolic ABP 73 ± 4 mm Hg). The 2 groups had similar fasting serum leptin concentrations (median-interquartile range; 13.4 (5.7-36.1) µg/L vs. 13.4 (5.4-27.1) µg/L, P = 0.88) and total fat mass percentage (34.8 ± 4.5% vs. 34.0 ± 4.7%, P = 0.90).

Conclusions: Obese hypertensive men have serum leptin concentrations similar to those of obese normotensive men with comparable body fat percentage measurements. This finding does not support leptin's candidacy as a mediator of obesity-related hypertension.

Background: Hypertensive disorders of pregnancy (HDP) significantly increase the risk of adverse pregnancy outcomes (APOs). Blood pressure (BP) phenotypes, including masked hypertension (MH), white-coat hypertension (WCH), sustained hypertension (SH), and normotension, are identified through office BP (OBP) and ambulatory BP (ABP) monitoring. The proportion of BP phenotypes at different gestational age and their associations with APOs are not well understood.

Methods and results: This retrospective study included 967 women at high risk or diagnosed with HDP who underwent OBP and ABP measurement at different gestational stages [0-19+6 (n=150), 20+0-29+6 (n=221), 30+0-32+6 (n=135), 33+0-35+6 (n=185), and ≥36+0 gestational weeks (GW) (n=276)]. Women with ABP monitored at 20+0-29+6 GW had the lowest BP levels corresponding to the highest prevalence of NT. Compared to OBP, hypertension determined by ABP demonstrated stronger and more consistent associations with APOs, defined as a composite of maternal (e.g., severe preeclampsia, preterm birth) and fetal (pregnancy loss and SGA infants) outcomes. SH was consistently associated with the highest risk for APOs, with risk decreasing as gestation advanced after 20+0 GW. MH was significantly associated with APOs, particularly between 30+0-32+6 GW. WCH had no association with fetal outcomes at any gestational stage.

Conclusion: The associations between BP phenotypes and APOs differ across gestational stages. SH detected earlier in pregnancy carries the highest risks, while WCH is generally benign for fetal outcomes. These findings highlight the critical role of ABP monitoring in BP phenotyping and underscore the need for gestational-stage-specific diagnostic thresholds to enable tailored interventions and optimize APOs.

Background: Changes in retinal vessel caliber are crucial for detecting early retinopathy, a significant cause of blindness in individuals with Diabetes Mellitus type 2 (T2DM). This study aims to evaluate the changes in retinal vessel caliber and identify factors associated with these changes in recently diagnosed T2DM patients.

Methods: The study included newly diagnosed T2DM patients (within 6 months of diagnosis) who were free of antidiabetic treatment (except metformin) and matched individuals based on age and blood pressure (BP). Data collected included somatometric measurements, BP (office and 24-h), hematological data, albuminuria (via 24-h urine collections), ten-year atherosclerotic cardiovascular disease risk (ASCVD score), endothelial dysfunction (measured by Asymmetric Dimethylarginine, ADMA), retinal microvascular changes, assessed as central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) using specialized software on nonmydriatic fundus photographs.

Results: The study involved 87 T2DM patients and 90 controls, aged 57±11 years. Key findings include no significant differences in CRAE, CRVE, and AVR between T2DM patients and controls. Age (P=0.019) and nighttime systolic BP (SBP) (P=0.002) were independent predictors of AVR. CRAE was independently associated with nighttime SBP (P=0.048). CRVE was independently associated with age (P=0.016), dipping (P=0.002), and smoking (P=0.018). In normotensive subjects, AVR was significantly lower in T2DM patients (P=0.035).

Conclusions: The study concludes that increased nighttime SBP is a more critical factor than hyperglycemia in affecting retinal vascular caliber changes in newly diagnosed T2DM patients. This highlights the importance of managing nocturnal hypertension to prevent retinal damage in this patient population.