American Journal of Hypertension最新文献

Background: Remote hypertension management programs have emerged as potential solutions to improve poor rates of blood pressure (BP) control. The Continual Versus Occasional Blood Pressure (COOL-BP) Study investigated the feasibility and efficacy of using a cuffless wrist BP monitor in a remote hypertension (HTN) program.

Methods: COOL-BP was a prospective single-arm study within a larger HTN management program at Mass General Brigham (MGB). Participants had uncontrolled HTN, were already engaged in the MGB Remote Hypertension Program, and used a smartphone. The study involved patients wearing the Aktiia cuffless wrist BP monitor and performing traditional home BP monitoring (HBPM). The primary endpoint was the correlation of BP measurements between devices. Secondary endpoints included concordance between HBPM and cuffless pressures following a medication titration, and patient satisfaction with the cuffless device.

Results: We enrolled 38 patients, of whom 25 provided BP data on overlapping dates with both devices. There was moderate correlation between average non-simultaneous daytime BPs within the same time periods (r=0.57, 95% CI: 0.39-0.71 for systolic BP [p<0.001]; r=0.64, 95% CI: 0.48-0.76, for diastolic BP [p<0.001]). The concordance of systolic BP changes detected by the two devices post-medication titration was 87.5%. Most patients (91%) preferred the cuffless device, citing ease of use and convenience.

Conclusion: Cuffless BP devices demonstrate promise in enhancing patient compliance and effectiveness in HTN management. Their integration into clinical practice could offer a more patient-friendly and reliable approach to BP monitoring, though more research is needed to establish their utility in large populations.

Background: Leptin is a hormone which 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-hour ambulatory blood pressure (ABP) recordings. Hypertension was defined as 24-hour systolic ABP ≥130 mm Hg and/or 24-hour diastolic ABP ≥80 mm Hg, and normotension was defined as 24-hour 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-hour systolic ABP (mean ± standard deviation) 137±11 mg Hg and 24-hour diastolic ABP 83±6 mm Hg) and 40 were normotensive (24-hour systolic ABP 117±6 mg Hg and 24-hour 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 versus 13.4 (5.4-27.1) µg/L, P=0.88) and total fat mass percentage (34.8±4.5% versus 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: 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-hour), hematological data, albuminuria (via 24-hour 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 non-mydriatic 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.

Background: Clinical inertia is common when blood pressure (BP) is high in the office. Little is known about the extent of clinical inertia after ambulatory BP monitoring (ABPM).

Methods: This was an electronic health record-based retrospective cohort study of patients with high office BP (≥140/90 mmHg) referred for ABPM at a medical center in New York City between 2016 and 2020. Diagnostic inertia was defined as clinicians not newly diagnosing or treating hypertension in patients with high ABPM (i.e., mean awake BP ≥135/85 mmHg). Therapeutic inertia was defined as clinicians not intensifying treatment for patients with established hypertension after high ABPM. Multilevel modeling was used to assess patient and clinician characteristics associated with inertia.

Results: Among 329 patients without prior hypertension, 144 (44%) had high awake BP, and of these, diagnostic inertia occurred in 45 of 144 (31%). Among 239 patients taking antihypertensive medication, 141 (59%) had high awake BP, and of these, therapeutic inertia occurred in 73 of 141 (52%). In multilevel models, male gender (OR 2.81, 95%CI 1.11 - 7.08), lower awake SBP (OR 0.73 per 5 mmHg increase, 95%CI 0.53 - 1.00), and specialist vs primary care clinician type (OR 4.57, 95%CI 1.78 - 11.75) were associated with increased diagnostic inertia. Increasing age (OR 1.16 per 5-year increase, 95%CI 1.00 - 1.28) and lower awake SBP (OR 0.82 per 5 mmHg increase, 95%CI 0.66 - 0.95) were associated with increased therapeutic inertia.

Conclusions: Diagnostic and therapeutic inertia were common after ABPM, particularly when awake SBP was near the threshold.

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 blood pressure 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 (SV), standard deviation (SD), variability independent of mean blood pressure (VIM) and 24-hour mean BP. Regression analysis was used to assess the correlation between different BPIs and functional outcome, whereas mediation analysis was employed to assess the potential mediating effects of baseline risk factors through BP on functional outcome.

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 outcome after adjustment for different risk factors. Mediation analysis revealed that stroke affected functional outcome by affecting BPV, while the hypertension history affected functional prognosis by impacting the 24-hour mean BP and BPV. In addition, higher NIHSS scores were associated with increased BPV, whereas increased BPV was correlated with a greater proportion of unfavorable outcome.

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 outcome and may provide new insights and potential mechanisms for improving AIS prognosis.

Background: Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; difference between central and peripheral PP) as an independent predictor of mortality.

Methods: We analyzed systolic (SBP), diastolic (DBP), mean arterial BP (MAP), PP and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3316 patients referred for coronary angiography.

Results: All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mmHg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%).After adjusting for age, sex, BMI, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mmHg increase linked to a 4% reduction in all-cause and 6% reduction in CV mortality.

Conclusions: Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.

Background: Hypertension and cancer are both increasing with age. Recently, the new concept of "Onco-Hypertension" has been proposed to address the mutual risks posed by hypertension and cancer and to provide comprehensive care for patients with these two conditions in an aging society.

Methods: In this review, we provide an overview of the current status and future perspective of the "Onco-Hypertension," including our research findings.

Results: Hypertension and cancer share common risk factors and may be interrelated in pathogenesis: Hypertension is involved in the development of certain cancers, and cancer survivors have a higher incidence of hypertension. With recent advances in cancer therapy, the number of cancer survivors has increased. Cancer survivors not only have a higher risk of incident hypertension but also an increased risk of future cardiovascular events, highlighting the growing importance of comprehensive care.

Conclusions: There exists a diverse array of epidemiological and pathophysiological relationships between hypertension and cancer. It is imperative to move the emerging scientific field of "Onco-Hypertension" forward through relentless research efforts.

Background: This study aimed to investigate whether higher cardiorespiratory fitness (CRF) can modify the trend of age-related rise in arterial stiffness in individuals with and without hypertension (HTN) or diabetes.

Methods: The study included 4,935 participants who underwent maximal cardiopulmonary exercise testing with respiratory gas analysis in a health screening program. CRF was directly measured using peak oxygen uptake during the cardiopulmonary exercise test, while arterial stiffness was evaluated using brachial-ankle pulse wave velocity (baPWV).

Results: Participants with high CRF levels had significantly lower baPWV compared with those with low CRF levels, regardless of HTN or diabetes status (P < 0.05). The trend of baPWV increased with age, but the rate of age-related increase in baPWV was lower in individuals with moderate-to-high CRF levels compared with those with low CRF levels, regardless of HTN or diabetes status. Joint association analysis indicated that the trend of age-related increase in baPWV was the lowest in fit individuals without HTN or diabetes compared with unfit individuals with HTN or diabetes (P < 0.01). However, the trend of age-related increase in baPWV was not attenuated in fit with HTN or diabetes compared with unfit with HTN or diabetes.

Conclusions: These findings suggest that higher CRF levels may mitigate the trend of age-related rise in arterial stiffness in individuals with and without HTN or diabetes. However, this attenuating trend appears more pronounced in individuals without HTN or diabetes.