American Journal of Hypertension最新文献

Background: Time in target range (TTR) of systolic blood pressure (SBP) is a concept characterizing the extent of blood pressure (BP) control. We aimed to compare the risk of all-cause mortality and cardiovascular diseases (CVDs) in participants with >50% time of their SBP within different target ranges.

Methods: A total of 40,914 participants who had complete BP data and were free of CVDs or cancer were included. Four SBP records over 6 years were used to calculate TTR and mean levels of covariates. The death and CVD events were recorded via reviewing medical records and death certificates.

Results: During a median follow-up period of 8.78 (interquartile range: 8.50-9.05) and 7.76 (interquartile range: 7.46-8.04) years, we identified 2,398 death cases and 1,995 incident CVDs, respectively. Participants who had >50%TTR >150mmHg had a higher risk of all-cause mortality (hazard ratio (HR):1.67, 95% confidence interval (CI): 1.16, 2.41) than those with >50% TTR <120mmHg. The corresponding HR was 2.06 (95%CI: 1.37,3.10) for incident CVDs. The increased risk of all-cause mortality and CVD events persisted when we adjusted the covariates measured at the 2012 visit or excluded coalminers, the hypotensive participants, the incident cases occurring the first 2 years or who used BP lowering drugs.

Conclusions: Our study suggested that >50% TTR in a high target range of SBP significantly predicted the occurrence of all-cause mortality and CVDs.

Background: Disruption of ambulatory healthcare in New York City (NYC) during the COVID-19 pandemic was common, but the impact on the cardiometabolic health of vulnerable patient groups is unknown. Therefore, we estimated the effect of total care disruption (TCD) on blood pressure (BP) control among older NYC residents with hypertension and at least one other chronic condition, and examined whether neighborhood poverty moderated this impact.

Methods: From the INSIGHT Clinical Research Network, we identified NYC residents ≥50 years of age with hypertension and at least one other chronic condition. TCD was defined as no ambulatory or telehealth visit during the pandemic. We contrasted the change in prevalence of controlled BP (BP <140/90) before and after the pandemic among those with and without TCD via an inverse probability weighted (IPW) difference-in-difference regression model.

Results: Among 212,673 eligible individuals, mean age was 69.5 years (SD: 10.2 years) and 15.1% experienced TCD. BP control declined from 52.4% to 45.9% among those with TCD and from 53.6% to 48.9% among those without TCD. After IPW adjustment, a larger decline in BP control was noted among those with TCD (adjusted difference-in-difference = 1.13 percentage points (95% CI 0.32-1.94, p-value=0.0058)). There was no consistent difference in the relationship between TCD and post-pandemic BP control across neighborhood poverty levels.

Conclusion: COVID-19-related TCD was associated with a modest decline in BP control among older adults with hypertension in NYC; this was not moderated by neighborhood poverty level.

Background: Pulmonary arterial hypertension (PAH) is a kind of pulmonary vascular lesion characterized by vasoconstriction and reshaping of small pulmonary arteries, ultimately resulting in increased pulmonary artery pressure and pulmonary vascular resistance, and eventually leading to right ventricular failure and death. This study was aimed to construct a platelet-derived growth factor BB (PDGF-BB)-induced rat pulmonary artery smooth muscle cells (PASMCs) model and conduct a combined transcriptomic and metabolomic analysis to identify proliferation-related targets, thereby enhancing understanding of the pathogenesis underlying PAH.

Methods: Rat PASMCs were isolated and cultured in the presence or absence of PDGF-BB for 24 hours. Cells were collected for transcriptomics and metabolomics investigations.

Results: A total of 1288 differentially expressed genes (572 up-regulated and 716 down-regulated) were identified in PDGF-BB-treated rat PASMCs compared to control cells. Subsequently, Gene ontology (GO) enrichment analysis revealed that 791 enriched GO terms were significantly enriched in PDGF-BB treated cells. Similarly, 294 differential metabolic pathways were enriched in PDGF-BB treated cells according to Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, Gene Set Enrichment Analysis (GSEA) were performed on the differentially expressed genes (DEGs). It turned out that 7219 gene sets were more enriched in PDGF-BB treated cells. In addition, a total of 28 secondary differential metabolites were identified in PDGF-BB-treated rat PASMCs compared to control cells (p-value < 0.05 and VIP > 1).

Conclusions: We speculate that Mylk, Pla2g4a, Gucy1b1, Adcy8, Adcy4, Gucy1a2, Col3a1, and Plcb4 are potential targets for the treatment of PAH.

Background: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends ambulatory BP monitoring (ABPM) for diagnosing masked hypertension among adults not taking antihypertensive medication with borderline office BP (i.e., office systolic BP [SBP] 120 to <130 mmHg or diastolic BP [DBP] 75 to <80 mmHg).

Methods: Using data from the Improving the Detection of Hypertension Study, sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for a positive and negative test of having borderline office BP (i.e. office SBP 120 to <130 mmHg or DBP 75 to <80 mmHg) for diagnosing masked hypertension (i.e. mean awake SBP ≥130 mmHg or mean awake DBP ≥80 mmHg) were determined among 263 participants who had a mean office SBP <130 mmHg and mean DBP <80 mmHg. Likelihood ratios for a positive test >10, 5 to 10, and <5 were considered strong, moderate, and weak, respectively. Likelihood ratios for a negative test <0.1, 0.1 to 0.2, and >0.2 were considered strong, moderate, and weak, respectively.

Results: Among the 263 participants, mean±SD age was 39.2±12.8 years, 62.4% were female, 38.4% had borderline office BP, and 26.2% had masked hypertension. SN, SP, PPV, and NPV were 0.754, 0.747, 0.515, and 0.895, respectively. The likelihood ratios for a positive and negative test were 2.984 (weak) and 0.330 (weak), respectively.

Conclusions: The use of borderline office BP thresholds recommended in the 2017 ACC/AHA BP guideline did not sufficiently rule in or rule out masked hypertension.

Background: Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality.

Methods: This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis.

Results: Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A sub-cohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR 1.18, 95% CI 1.01-1.38; HR 1.31, 95% CI 1.07-1.60, respectively) and all-cause mortality (HR 1.17, 95% CI 1.06-1.28; HR 1.21, 95% CI 1.08-1.37, respectively).

Conclusions: Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.

Background: More than one in three adults with hypertension in the United States are unaware of their condition, highlighting the importance of large-scale screening campaigns. Currently, the identification of hypertension is largely limited to medical settings. To help overcome this barrier, we developed a novel high-throughput screening protocol that measures blood pressure (BP) while patients remain seated in an automobile ("car-BP"). The aim of this study was to provide an initial assessment of the accuracy of car-BP.

Methods: Three BP readings were determined in a clinic exam room before and after three BP readings were taken while patients were seated in a parked car outside (n=100 participants). The same validated device model (Omron HEM-907XL) and BP measurement methods adhering to guidelines were used in both scenarios. The average of all 6 clinic readings was compared to the average of the 3 car-BP readings in each individual.

Results: Mean clinic and car-BP readings were 120.9 ± 16.2/78.0 ± 9.9 and 118.9 ± 15.2/76.0 ± 10.0 mm Hg, respectively. The paired mean and absolute mean differences in systolic BP levels between methods were -1.92 mm Hg (95% confidence interval (CI) -3.2 to -0.7 mm Hg) and 4.8 mm Hg (95%CI 3.8 to 5.6 mm Hg), respectively. A total of 85% of participants had both systolic and diastolic BP levels ≤10 mm Hg different between measurement scenarios (meeting the a priori determined study primary outcome).

Conclusions: Car-BP represents an innovative and accessible approach for potential large-scale hypertension screening campaigns.

Background: Hypertension (HT) is the most prevalent risk factor for cardiovascular disease (CVD) worldwide. Despite being a highly heritable trait, the underlying mechanisms of HT remain elusive due to its complex genetic architecture. Discovering disease-associated proteins with causal genetic evidence offers a potential strategy for identifying therapeutic targets for HT.

Methods: We analyzed the plasma proteome of 4,657 plasma proteins from 7,213 European American (EA) participants in the ARIC study. Genome-wide association study (GWAS) data for HT were sourced from FinnGen R10, which includes 102,864 cases and 289,117 controls. Cis-Mendelian randomization (MR) was conducted to assess the causal effect of circulating proteins on the risk of HT. A multiverse sensitivity analysis was performed to evaluate the robustness of these causal relationships. Colocalization analysis was conducted to determine whether these features share the same associated single nucleotide polymorphisms (SNPs). The causal effects of HT-associated proteins were then validated using cis-protein quantitative trait loci (Cis-pQTL) genetic instruments from the deCODE database.

Results: Among 1,788 proteins, genetically predicted levels of 18 plasma proteins were associated with HT in the discovery stage. Seven of these proteins showed strong support for colocalization. After replication, only ERAP1 and ACVRL1 were validated as therapeutic candidates for HT, demonstrating a negative correlation with the risk of HT.

Conclusions: By combining cis-MR analysis with colocalization analysis, we identified ERAP1 and ACVRL1 as potential targets for interventions in the primary prevention of HT, with ERAP1 emerging as a particularly promising drug target after further validation.

Background: The association with cardiovascular disease (CVD) is stronger for mean systolic blood pressure (SBP) estimated using ambulatory blood pressure monitoring (ABPM) vs. office measurements. Determining whether this is due to ABPM providing more measurement reliability or greater ecological validity can inform its use.

Methods: We estimated the association of mean SBP based on 2 office measurements and 2, 5, 10, and 20 measurements on ABPM with incident CVD in the Jackson Heart Study (n = 773). Hazard ratios (HRs) for CVD were estimated per standard deviation higher mean SBP. CVD events were defined by incident fatal or non-fatal stroke, non-fatal myocardial infarction, or fatal coronary heart disease.

Results: There were 80 CVD events over a median of 15 years. The adjusted HRs for incident CVD were 1.03 (95% CI: 0.90-1.19) for mean office SBP and 1.30 (95% CI: 1.12-1.50), 1.34 (95% CI: 1.15-1.56), 1.36 (95% CI: 1.17-1.59), and 1.38 (95% CI: 1.17-1.63) for mean SBP using the first 2, 5, 10, and 20 ABPM readings. The difference in the HRs for incident CVD ranged from 0.26 (95% CI: 0.07-0.46) to 0.35 (95% CI: 0.15-0.54) when comparing mean office SBP vs. 2, 5, 10, or 20 sequential ABPM readings. The association with incident CVD was also stronger for mean SBP based on 2, 5, 10, and 20 randomly selected ABPM readings vs. 2 office readings.

Conclusions: Mean SBP based on 2 ABPM readings vs. 2 office measurements had a stronger association with CVD events. The increase in the strength of the association with more ABPM readings was small.