American Journal of Hypertension最新文献

Background: Large inter-ankle systolic blood pressure (IASBP) differences (≥10 or ≥15 mmHg) have been linked to cardiovascular events and mortality. This longitudinal study evaluated the association of changes in IASBP differences with incident cardiovascular events and mortality.

Methods: In the Atherosclerosis Risk in Communities study, bilateral ankle blood pressure was measured at Visit 5 and at Visit 6/7 (n = 2051; mean age 73.7 ± 4.3 years). Participants were categorized into four groups by IASBP differences: small at both visits (<10 mmHg); decreasing (≥10 mmHg at Visit 5 but <10 mmHg in Visit 6/7); increasing (<10 mmHg at Visit 5 but ≥10 mmHg in Visit 6/7); and large at both visits (≥10 mmHg). Categories were repeated using a ≥15 mmHg cutoff value. Cox proportional hazards regression models were used to calculate hazard ratios (HRs).

Results: In adjusted analyses, individuals with increasing differences (≥10 mmHg) had higher risks of heart failure (HR: 1.31; 95% confidence intervals [CI], 1.00-1.76) and stroke (HR: 1.57; 95% CI, 1.16-2.11), compared to those with small differences at both visits. Similarly, those with persistently large differences showed elevated risks of coronary heart disease (HR: 2.25; 95% CI, 1.46-3.47) and stroke (HR: 1.68; 95% CI, 1.17-2.41). Analyses using a ≥15 mmHg cutoff value demonstrated even stronger associations with all three cardiovascular events. No significant associations were observed with all-cause or cardiovascular mortality for these categories.

Conclusions: Increasing and persistently large IASBP differences are associated with elevated risk of incident cardiovascular events. Monitoring IASBP differences may help identify individuals at higher risk for adverse outcomes.

Background: Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies.

Methods: In an Italian study started in 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-h ambulatory BP (ABP) monitoring. We defined white-coat hypertension (WCH) as an average 24-h ABP < 130/80 mmHg or <125/75 mmHg. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality.

Results: Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths were 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-h ABP < 125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-h ABP < 130/80 mmHg (HR: 1.79; 95% CI, 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-h ABP < 125/75 mmHg (HR 1.37; 95% CI, 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-h ABP < 130/80 mmHg (HR 1.82; 95% CI, 1.55-3.58).

Conclusions: WCH defined by an average 24-h ABP < 125/75 mmHg identifies people at low risk of MACE and death in the long term. Even modestly above these threshold values, the risk associated with WCH increases.

Background: We aimed to explore the association between systolic blood pressure time-in-target range (SBP-TTR) and left ventricular hypertrophy (LVH).

Methods: A total of 33,818 participants of the Kailuan Study who underwent echocardiography and had participated in at least two health checkups between 2006 and 2020. The target SBP ranges are defined as 120-140 and 110-130 mmHg, respectively. SBP-TTR was calculated by linear interpolation. Poisson regression models were used to assess relative risk (RR) and 95% confidence intervals (CIs) for the associations of 120-140 and 110-130 mmHg SBP-TTR with LVH.

Results: When the SBP target range was defined as 120-140 mmHg, in multivariable-adjusted models, compared to the reference group (SBP-TTR ≤25%), LVH risk was significantly reduced in the 75% < SBP-TTR ≤ 100% group, (RR: 0.94, 95% CI: 0.89-0.99). When the SBP target range was defined as 110-130 mmHg, compared to the reference group (SBP-TTR ≤25%), there was significantly reduced in LVH risk in the 25% < SBP-TTR ≤ 50% (RR: 0.89, 95%CI: 0.83-0.94), 50%

Conclusions: With increased SBP-TTR associated with a reduced risk of LVH, demonstrating a clear dose-response relationship. Compared to an SBP-TTR range of 120-140 mmHg, maintaining SBP-TTR at 110-130 mmHg more effectively reduces LVH risk.

Background: Hypertension is undiagnosed in three-quarters of affected youth. Barriers include uncertainty about the accuracy of in-office blood pressure measurements, limited access to recommended confirmatory ambulatory blood pressure monitoring (ABPM), and low subspecialist referral completion rates. This study aimed to assess whether "point of care" ABPM, ABPM device placement within the primary care setting, could improve HTN diagnosis confirmation.

Methods: This prospective cohort study was conducted within a single urban primary care practice. "Point of care" ABPM was offered to youth 10 to 17 years of age with suspected hypertension based upon a single manual blood pressure ≥ 95th percentile. We conducted semistructured qualitative interviews with patients, parents, and primary care providers to evaluate perceptions and experiences with "point of care" ABPM, perceived barriers to device tolerability, confidence in results, and comfort with follow-up recommendations. Qualitative data were analyzed using an inductive thematic approach.

Results: "Point of care" ABPM was offered to 62 youth and accepted by 60 (97%). Qualitative interviews of patients (N = 25), parents (N = 24), and providers (N = 8) revealed that parents recognized the benefit and convenience of "point of care" ABPM and trusted the ABPM results. Parents and providers reported greater certainty in the diagnosis when they did not have to rely on in-office blood pressure assessment alone.

Conclusions: ABPM may be an acceptable approach for improved hypertension diagnosis confirmation in children and adolescents when applied within the primary care setting. Further, it may help alleviate parent and provider uncertainty about the significance of elevated in-office blood pressure.

Background: Self-measured blood pressure is an important tool for diagnosing and controlling hypertension. Current insurance coverage for home blood pressure monitors varies widely, creating potential barriers to implementation.

Methods: This observational study was conducted in a large, multisite Federally Qualified Health Center in Tucson, AZ, between 2023 and 2024. We compared prescription rates and fill rates during two 6-month periods: the final six months of grant-funded free monitor distribution (2023, n = 2,619 prescriptions, 2,357 fills) vs. the first 6 months after grant end when patients were charged approximately $35 (2024, n = 1,630 prescriptions, 974 fills). Data were extracted from the electronic health records system and analyzed using R version 4.2.3.

Results: After cost-sharing implementation, two distinct effects reduced monitor distribution: prescription fill rates decreased from 90.0% to 59.8% (30.2% reduction, 95% CI [27.8%, 32.2%]), and providers sent 38% fewer prescriptions. The combined effect of both reduced prescribing and lower fill rates resulted in 59% fewer patients receiving monitors (974 vs. 2,357).

Conclusions: In this single-center study, cost-sharing was associated with substantial reductions in both prescribing and filling of home BP monitor prescriptions.

Background: Timely blood pressure (BP) screening is not consistently performed for new mothers. Only 60% complete a 6-week postpartum visit, and even fewer are evaluated within 1 week. This timing is crucial since mortality is highest in the first 6 days. Primary care has a role to play in improving postpartum BP care. However, research has yet to fully explore primary care-driven strategies for postpartum BP screening.

Objective: This review aims to identify primary care postpartum BP screening strategies and to understand the characteristics of patients who are completing BP screenings within 1 week.

Methods: We used the PubMed and Web of Science databases to identify peer-reviewed studies published since 2010. Included studies were conducted in the United States and of English-language publications.

Results: We identified 13,452 articles and synthesized 32 studies. Of 11,270 postpartum patients, 40% (n = 4,790) identified as Black/African American race. For recruitment, 24 (75.0%) studies focused on high-risk patients, 5 (15.6%) compared high-risk to low-risk patients, and 3 (9.4%) studies recruited all patients with no restrictions. Studies often reported BP ascertainment within 1-week postpartum (53.1%; n = 17). Further, 12 (37.5%) studies incorporated both in-clinic and in-home settings for postpartum BP screening, 10 (31.2%) were in-clinic, and 10 (31.2%) were in-home.

Conclusions: We found that primary care systems are evaluating BP within 1-week postpartum, leveraging remote BP monitoring and child-wellness checks. Those strategies, however, less often included low-risk patients. Updated guidelines are needed to cover postpartum BP screening for patients with uncomplicated pregnancies and the absence of other risk factors.

Background: Protecting the kidneys by lowering systolic blood pressure (SBP) in hypertensive patients is not unequivocally settled. We tested the hypothesis that achieving lower average SBP in middle-aged and older high-risk hypertensive patients with and without type-2 diabetes mellitus through several years would clarify kidney protection.

Methods: We analyzed patients 50-80 years with no cardiovascular events during the first 6 months of drug up-titration after randomization to valsartan or amlodipine, and with 3 or more visits onwards with standardized BP measurements. Adjusted Cox analyzes compared worsened kidney function defined as a 50% rise in se-creatinine on a minimum of two occasions at least 4 weeks apart or end-stage kidney disease (ESKD) in achieved SBP quartiles and in patients who achieved SBP < 130 and 130-139 mmHg with patients whose SBP remained ≥140 mmHg.

Results: A total of 13,803 patients were investigated of whom 4,655 had DM. Patients with DM had less worsened kidney function at SBP 130-139 mmHg (HR = 0.524, 95% CIs 0.375-0.733, n = 1849, P < 0.001) and at SBP < 130 mmHg (HR = 0.538, CIs 0.316-0.915, n = 674, P = 0.022) compared with patients at ≥ 140 mmHg. They also had less ESKD at SBP 130-139 mmHg (HR = 0.442, CIs 0.196-1.000, P = 0.050) with a similar trend at SBP < 130 mmHg and in quartile analysis with only 1 ESKD in the lowest quartile. Findings in patients without DM (n = 9,148) were similar to DM.

Conclusions: In high-risk hypertensive patients aged 50-80 years, with and without DM, targeting SBP of 130-139 mmHg confers kidney protection with possible further benefit at the lower target of SBP < 130 mmHg.

Clinical trials registration: Trial Number NCT06395194, www.clinicaltrials.gov.