American Journal of Hypertension最新文献

Background: Increased variability in central aortic systolic pressure (CASP) and pulse pressure (PP) are predictors of poor cardiovascular disease outcomes. Low-level tragus stimulation (LLTS) is a noninvasive method to reduce sympathetic tone via vagal afferent fibers. It is unknown if LLTS has a favorable effect on elevated variability in CASP and PP in patients with acute decompensated heart failure (HF) (ADHF).

Methods: Patients hospitalized for ADHF after initial stabilization (median 80 years, males 60%) were randomly assigned to active or sham group, and LLTS (20 Hz, 1 mA) was delivered using an ear clip attached to the tragus (active group) or the earlobe (sham group) for 1 hour daily over 5 days. The variability of PP and CASP was measured before and after each stimulation.

Results: Each of SD, CV, and δ in PP, CASP, radial augmentation index (rAI), %PP variation (PPV), and PP × heart rate (HR) was significantly decreased after stimulation in the active group (n = 8) (all P < 0.05), while δ in CASP was significantly increased after stimulation in the sham group (n = 8) (P < 0.05). All the changes in SD, CV, and δ in PP, CASP, rAI, %PPV, and PP × HR before and after stimulation were also significantly different between active and sham groups (all P < 0.05).

Conclusions: In this proof-of-concept study, LLTS led to a better hemodynamic profile, as evident in variability reduction in PP, CASP, and rAI. Further studies are warranted to study the long-term hemodynamic effects of LLTS on HF.Clinical trial registration: UMIN000044121.

Background: Hypertension is a leading contributor to morbidity and mortality, disproportionately affecting vulnerable populations. We examined the intersection of social vulnerability and race on blood pressure (BP) control.

Methods: We examined 76,600 patients with hypertension in Western New York State. BP control was defined according to the Healthcare Effectiveness Data and Information Set as BP<140/90 mmHg. We utilized social vulnerability index (SVI) scores based on each patient's census tract. Log-binomial regression was used to estimate the independent effects of demographic characteristics on the prevalence of uncontrolled BP. Models were adjusted for race, SVI group, age, sex, marital status, and community type. For a convenience subset of patients, we also assessed patient-reported health-related social needs.

Results: Uncontrolled BP among patients differed by race (White 27.7%; Black 41.3%) and increasing social vulnerability. The adjusted risk ratio (aRR) for uncontrolled BP in Black vs. White patients by SVI group was SVI 0-24: 1.08 (CI: 0.98-1.18); SVI 25-49: 1.30 (CI: 1.22-1.38); SVI 50-74: 1.35 (CI: 1.27-1.43); and SVI 75-100: 1.25 (CI: 1.18-1.32). Black patients reporting food insecurity had a higher prevalence of uncontrolled BP than White patients with similar food insecurity (Black 39.2%; White 28.1%). Similar disparities were seen with housing insecurity (Black 42.3%; White 29.8%); and unmet transportation needs (46.3% Black; 30.0% White).

Conclusions: The impact of increased social vulnerability was experienced disproportionately by Black patients. Among patients living in the most socially vulnerable census tracts, Black patients had 25%-35% increased risk of uncontrolled BP compared to White patients.

Background: Automated patient messages based on home blood pressure (BP) may help overcome clinician and patient inertia in hypertension treatment.

Methods: We designed and piloted an automated messaging system based on remote patient monitoring (RPM) results delivered through patients' electronic health record portal. Messages included reminders to monitor, what to do if BP is above or below goal, and positive feedback when goal BP is achieved; these were triggered via a deterministic algorithm based on reported home BPs. Seven clinicians agreed to participate in this pilot study. Patients with the most recent two office BPs ≥140/90 mmHg were eligible. Outcomes assessed after 9 months included change in home SBP, net change in antihypertensive medication, and number of automated messages. Subgroup analysis was conducted by baseline home BP.

Results: Of 285 eligible patients, 70 (25%) enrolled. Baseline mean (SD) office systolic/diastolic BP was 148(18)/81(12) mmHg. By 9 months, participants had received a mean (range) of 13 (5-44) messages and viewed 85%. Among 64 patients completing the 9-month study visit, the baseline home BP was 142(17)/84(15) mmHg, 9-month change in home SBP was -9.4 mmHg (95% CI: -1.3, -14.7). Among 13 patients with controlled baseline home BP (<130/80 mmHg), SBP change was +2.7 mmHg (-4.8, +12.3). Among 51 patients with uncontrolled baseline home BP, SBP change was -12.5 mmHg (-5.2, -16.8); 51% had antihypertensive pharmacotherapy increased.

Conclusions: Delivering automated feedback based on RPM BP results through a commercial electronic health record was feasible. Participants with sustained hypertension had large BP declines.

Background: The choice of starting antihypertensive regimen is important because most patients remain on their initial treatment, even when their blood pressure (BP) remains high. We examined the expected BP lowering efficacy of antihypertensive regimens initiated among US Medicare beneficiaries.

Methods: We analyzed data on a 20% random sample of Medicare beneficiaries aged ≥65 years with a diagnosis of hypertension. The initial regimen comprised all fills within 7 days of the first antihypertensive claim in 2023 with no fills in the previous 365 days. The primary analysis was restricted to regimens including ≥1 drug class recommended in the 2025 American Heart Association/American College of Cardiology BP guideline and secondary analysis included all antihypertensive drug classes. Expected BP-lowering efficacy for each regimen was estimated using www.bpmodel.org, a model derived from 484 double-blind placebo controlled randomized trials.

Results: Among 52,031 Medicare beneficiaries initiating antihypertensive medications, 74% received monotherapy. In total, 1,060 distinct drug combinations and 2,836 unique drug-dose permutations were filled. The top twenty-five regimens accounted for 70% of initiations and conferred an average expected systolic BP reduction of 8 mmHg and diastolic BP of 4 mmHg. When including non-guideline recommended antihypertensive regimens, the top 25 regimens were filled by 67% of patients initiating treatment, with an average expected systolic/diastolic BP reduction of 6/3 mmHg.

Conclusions: Most antihypertensive regimens initiated among US Medicare beneficiaries were low efficacy monotherapy. Initiating more effective antihypertensive therapy has the potential to improve BP control in the US.