American Journal of Hypertension最新文献

Background: Although high blood pressure (BP) level and variability are associated with Alzheimer's disease (AD), their relationship with cortical thickness in brain regions that are associated with AD is unclear. Furthermore, the role of 24-h BP has not been examined. We investigated the associations of office and ambulatory BP measures with cortical thickness in brain regions implicated in AD.

Methods: We performed a cross-sectional analysis of 304 participants without dementia from a population-based study with office and 24-h BP and magnetic resonance imaging data. We considered cortical thickness values derived from 10 regions throughout the frontal, parietal, and temporal lobes, and the posterior cingulate cortex that are associated with risk and progression of AD. The association between BP and cortical thickness was tested using adjusted linear regression models.

Results: The mean age was 58.1 years and 231 (76%) were women. Higher office systolic BP was associated with thinner temporal (β = -0.059; 95% confidence interval [CI], -0.112, -0.005) and posterior cingulate cortex (β = -0.095; 95% CI, -0.145, -0.045). 24-h and nighttime BP levels were associated with thinner seven regions, with β-estimates ranging from -0.103 (95% CI, -0.182, -0.012) to -0.045 (95% CI, -0.080, -0.010). A higher 24-h BP variability was associated with thinner middle frontal (β = -0.156; 95% CI, -0.282, -0.030) and middle temporal (β = -0.146; 95% CI, -0.268, -0.024) gyri, and posterior cingulate cortex (β = -0.134; 95% CI, -0.026, -0.009).

Conclusions: Increased ambulatory BP level and variability are associated with cortical thinning in regions associated with AD. Better BP evaluation with out-of-office approaches might reduce brain structural changes associated with AD.

Background: Inconsistent terminology and conceptual overlap among clinical practice guidelines, treatment protocols, and care pathways can lead to confusion in program design and implementation.

Methods: Drawing on the implementation experience of HEARTS in the Americas-the largest regional adaptation of the WHO Global HEARTS Initiative-this communication describes the characteristics, functions, and interrelationships of clinical practice guidelines, treatment protocols, and care pathways. It outlines their respective roles in development, approval, and execution to clarify their contributions to both health system organization and clinical practice.

Results: Clinical practice guidelines are composed of evidence-based recommendations grounded in rigorous scientific evaluation to support clinical decision-making. Care pathways serve as implementation tools that translate guidelines into standardized, multidisciplinary plans that organize hypertension management, facilitate task-sharing, and engage patients. Embedded within pathways, treatment protocols offer a simplified, step-by-step approach tailored to most patients, specifying a limited set of medications and dosages to ensure timely blood pressure control, reduce therapeutic inertia, and promote consistent care delivery.

Conclusions: Clarifying the distinctions and synergies among guidelines, protocols, and care pathways might enhance alignment between clinical guidance and service delivery, supporting effective implementation and scale-up of hypertension and chronic disease management programs.

Background: To examine how mid-trimester systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels, considered both independently and jointly, are associated with individual and co-occurring adverse pregnancy outcomes (APOs).

Methods: We analyzed two cohorts from northern and southern China, consisting of 78,891 singleton pregnancies. Mid-trimester (20-28 weeks' gestation) SBP and DBP were evaluated as qualitative classifications (isolated systolic, isolated diastolic, and systolic-diastolic hypertension) and quantitative measurements (levels of SBP/DBP and pulse pressure). Using two-dimensional SBP-DBP heat maps, we assessed their associations with major APOs (gestational diabetes mellitus [GDM], preterm birth, small for gestational age [SGA], postpartum hemorrhage [PPH], placental abruption [PA], and severe preeclampsia) by latent class analysis (LCA).

Results: LCA identified four latent APO classes: (1) preterm placental dysfunction, with 100% preterm birth, 26.6% SGA, 21.4% GDM and 13.2% severe preeclampsia, associated with concurrent SBP-DBP association (SBP+/DBP+); (2) term placental dysfunction, with 44.0% PPH, 34.0% PA, 25.2% severe preeclampsia and no preterm birth, associated with DBP elevation (DBP+); (3) term GDM, with 100% probability for GDM, no preterm birth and minimal other APOs, associated with SBP elevation (SBP+) and wider pulse pressure; (4) term SGA, with 100% SGA, 16.2% GDM and no preterm birth, associated with a divergent changes in SBP and DBP (SBP-/DBP+) and narrower pulse pressure.

Conclusions: Mid-trimester SBP and DBP interact in distinct patterns to influence co-occurring APO risks. This study demonstrates the independent and joint influence of BP components on risk, emphasizing the role of BP stratification in guiding pregnancy management strategies.

Background: Initial combination therapy has been recommended for patients with high blood pressure (BP). We evaluated annual trends in initial combination therapy and post-treatment BP in Kaiser Permanente Southern California, an integrated healthcare system that adopted combination therapy in 2005.

Methods: This serial cross-sectional study included patients newly initiating antihypertensive therapy from 2008 to 2024. We calculated annual age- and sex-standardized proportion of patients initiating combination therapy. Prevalence ratios (PR) of achieving post-treatment BP < 140/90 and <130/80 mm Hg between 6 and 12 months were estimated for initial combination versus monotherapy adjusting for demographic and pre-treatment BP.

Results: Among 221,384 patients, the use of initial combination therapy increased from 39% in 2008 to 45% in 2011 (p-trend=0.009), then decreased to 27% in 2024 (p-trend <0.001). The decreasing trend of initial combination therapy from 2011 to 2024 was consistent across all pre-treatment systolic BP levels: 130-139 mm Hg (33% to 20%), 140-149 mm Hg (42% to 22%), 150-159 mm Hg (49% to 29%), and ≥160 mm Hg (61% to 36%). Post-treatment BP < 140/90 mm Hg was 75% in 2011 and 66% in 2024; BP < 130/80 mm Hg was 35% in 2011 and 25% in 2024. PRs for initial combination versus monotherapy were 1.09 (95% CI 1.08, 1.10) for post-treatment BP < 140/90 mm Hg and 1.31 (95% CI 1.29, 1.33) for <130/80 mm Hg.

Conclusions: Although initial combination therapy remains associated with improved BP control, its use has declined in recent years, underscoring the importance of sustained support for guideline concordant care.

Background: Non-dipping blood pressure pattern, characterized by a blunted nocturnal decline in blood pressure, is associated with increased cardiovascular morbidity and mortality. Restless legs syndrome (RLS) has been linked to sympathetic hyperactivity and altered circadian regulation, potentially contributing to abnormal blood pressure patterns. This study aimed to evaluate the relationship between RLS and non-dipping pattern in patients undergoing ambulatory blood pressure monitoring (ABPM).

Methods: In this prospective observational study, 501 eligible participants were included after excluding those with obstructive sleep apnea syndrome, type 1 diabetes, or morbid obesity. RLS was diagnosed according to National Institutes of Health consensus criteria using clinical assessment, the International RLS Study Group scale, and the Berlin Questionnaire. A non-dipping pattern was defined as < 10% nocturnal reduction in mean systolic or diastolic blood pressure.

Results: RLS was diagnosed in 158 patients (31.5%). Compared with controls, RLS patients were more often female and had higher rates of diabetes and hyperlipidemia. Non-dipping was significantly more prevalent in the RLS group (69.0% vs 48.7%,p < 0.001), accompanied by lower systolic and diastolic BP variability (both p < 0.001). In multivariable logistic regression, independent predictors of RLS included female sex (β = 0.701, p = 0.049), hyperlipidemia (β = 0.850, p = 0.031), and non-dipping status (β  =  1.057, p < 0.001). ROC analysis demonstrated modest predictive ability (AUC = 0.601; 95% CI 0.557-0.645).

Conclusion: RLS is independently associated with a non-dipping blood pressure pattern, even after excluding major confounders. These findings suggest a shared autonomic mechanism linking RLS with impaired nocturnal blood pressure regulation and heightened cardiovascular risk.

Background: This study investigated the association and discriminative ability of six surrogate insulin resistance (IR) indices-TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, and the TG/HDL-C ratio-for hypertension (HTN) in patients with type 2 diabetes (T2D).

Methods: This cross-sectional, age- and gender-matched case-control study included 4236 patients with T2D (2167 with HTN and 2069 without) who attended a diabetes clinic between January 2014 and December 2024. Associations between surrogate IR indices and HTN were assessed using RCS and multivariable logistic regression. Discriminative ability and calibration were evaluated using ROC and calibration plots. The NRI and IDI analyses quantified the incremental value beyond a basic model.

Results: Each surrogate IR index showed a significant non-linear association with HTN. After adjusting for confounding factors, the ORs for HTN increased with higher values of each index. All indices demonstrated significant discriminative ability (AUCs > 0.690), with TyG-BMI showing the highest AUC (0.698; 95% CI: 0.664-0.733). A TyG-BMI cutoff of 144.5 identified HTN with 61% sensitivity and 71% specificity (p < 0.001). Calibration was relatively good, and the addition of surrogate IR indices to the basic model (age, gender, diabetes duration, LDL-C, HbA1c, and eGFR) significantly improved HTN identification.

Conclusions: These findings support the use of surrogate IR indices as practical tools for identifying and assessing the risk of HTN in patients with T2D and highlight the potential role of IR in the development of HTN.

Background: Hypertension (HT) constitutes a pervasive global health challenge, standing as a principal contributor to cardiovascular morbidity and mortality. Limited data are available regarding the relationship between NPAR and non-dipper hypertension. we aimed to investigate whether NPAR is independently associated with non-dipper status in newly diagnosed hypertensive patients.

Methods: Prospectively, 160 hypertensive patients were included in the study. After a 24-h ABPM assessment, the patients were divided into two groups, a dipper group and a non-dipper and 80 healthy control subjects were enrolled in the study. Baseline laboratory and echocardiographic parameters were measured and then the NPAR was calculated.

Results: Levels of WBC, NLR, hs-CRP were significantly higher in patients with non-dipper HT than dipper HT and control subjects. Echocardiographic assessments revealed that the LV wall was thicker and LV mass index were higher in the hypertensive group than the control group. NPAR levels were significantly different among the three groups (p < 0.001) and also the multivariate analysis revealed that higher NPAR and hs-CRP levels were independently associated with a non-dipping pattern. ROC analysis showed that NPAR levels higher than 22.2 can predict non-dipping status (p < 0.001).

Conclusions: Our study shows that higher NPAR levels are independently associated with non-dipper hypertension in newly diagnosed hypertensive patients. These findings emphasize the role of inflammation in the pathophysiology of circadian BP variation and suggest that NPAR may serve as a useful tool in identifying hypertensive patients at higher risk for cardiovascular complications.

Background: Remote Patient Monitoring (RPM) includes home blood pressure (BP) measurement with readings sent directly to the electronic health record (EHR). We hypothesize that RPM facilitates quicker, more frequent, more appropriate antihypertensive medication changes.

Methods: Patients with hypertension in six primary care clinics were prescribed RPM between November 2020 and August 2021 (N = 288) and matched to four control patients (N = 1152). Office and RPM BP readings and medication data over 18 months were extracted from the EHR. RPM patients were classified as baseline controlled (office and RPM <130/<80 mmHg), sustained (office and RPM ≥130 and/or ≥80), white-coat (office ≥130 and/or ≥80, RPM <130/<80) or masked hypertension (office <130/<80, RPM ≥130 and/or ≥80).

Results: RPM patients had earlier first antihypertensive medication changes, with half of RPM patients having ≥1 change by 228 days versus 530 days for controls. RPM patients had more total medication changes, with 25% of RPM patients having ≥4 (median 1; 25th-75th percentiles 0-4) changes versus ≥2 (median 1; 0-2) changes in controls. Compared to baseline sustained hypertension RPM users, white-coat hypertension users were less likely to have ≥1 medication increase (24% [N = 11] versus 53% [N = 74], p = 0.001) within 12 months. Compared to baseline-controlled RPM users, masked hypertension users were less likely to have ≥1 medication decrease (0% [N = 0] versus 44% [N = 8]; p = 0.003) within 12 months.

Conclusions: Even without additional staff dedicated to medication adjustment, RPM facilitated quicker medication changes, more total changes and differential prescribing decisions for white-coat and masked hypertension patients supporting RPM use in primary care.

Background: The efficacy and safety of lorundrostat, a selective aldosterone synthase inhibitor, in patients with uncontrolled hypertension remain unclear. This meta-analysis aimed to evaluate its effects on blood pressure and risk of hyperkalemia.

Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were systematically searched through July 2025 for randomized controlled trials comparing lorundrostat with placebo. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were estimated using a random-effects model with the Restricted Maximum Likelihood estimator. Trial Sequential Analysis (TSA) was conducted to assess the conclusiveness of safety evidence.

Results: Three RCTs including 1,060 patients were identified. Lorundrostat significantly reduced systolic blood pressure at 50 mg (MD, -9.08 mmHg; 95% CI, -13.14 to -5.03) and 100 mg (MD, -11.41 mmHg; 95% CI, -15.97 to -6.85), and diastolic blood pressure at 50 mg (MD, -3.48 mmHg; 95% CI, -5.98 to -0.98). However, lorundrostat increased the risk of hyperkalemia at 50 mg (RR, 6.56; 95% CI, 1.53-28.12; NNH=71) and 100 mg (RR, 10.37; 95% CI, 2.44-44.03; NNH=42). TSA confirmed hyperkalemia at 100 mg as the only conclusive harm signal, while other safety outcomes remained inconclusive.

Conclusions: Lorundrostat effectively lowered blood pressure but increased dose-dependent risk of hyperkalemia. These findings support its potential as a novel therapy for uncontrolled hypertension, while emphasizing the need for longer-term cardiovascular outcome trials and direct comparisons with mineralocorticoid receptor antagonists concerning efficacy and safety.