American Journal of Hypertension最新文献

Background: Hypertension, a major contributor to cardiovascular mortality, requires multimodal monitoring and management strategies for optimal blood pressure (BP) control. Patients are turning toward mobile health (mHealth) applications to manage hypertension which vary widely in design and regulation. This study examines the landscape of hypertension mHealth applications on Apple's App Store and Google's Play Store and qualitatively evaluates their functionality and security features from patient and clinician perspectives.

Methods: Publicly available applications were identified using keyword "hypertension" on the Apple App Store and Google Play Store or in a recent meta-analysis that met specific review criteria. Applications with <1,000 reviews (Apple Store) or < 10,000 reviews (Google Play Store) were excluded to capture the top 5% of applications with high public use. Of > 700 applications, 43 underwent full application screening and eighteen were reviewed for general information, storage, revenue models, security, patient/clinician interfaces, and associated research. Discrepancies were resolved through consensus and available manufacturer confirmation.

Results: Clinician interfaces were largely absent, with limited EMR integration and alert systems. Revenue models ranged from free to subscription-based. Security and data privacy policies varied with applications lacking clear opt-out options for data collection. Patient interfaces offered BP tracking and reminders, and accessibility features. Sentiment analysis showed an overall positive view of frequently reviewed Google Play Store applications.

Conclusions: Current mHealth applications lack several features for optimal hypertension monitoring and management. Based on the range of qualitative application features assessed, we formulate a framework for developing an ideal mHealth application for optimal hypertension management.

Background: Malnutrition may negatively influence cardiovascular outcomes. We investigated the association between geriatric nutritional risk index (GNRI) and ambulatory blood pressure in elderly patients with hypertension.

Methods: Our study included 235 elderly hypertensive patients with malnutrition (GNRI ≤98）and 391 patients with normal nutrition (GNRI>98). All patients underwent ambulatory blood pressure monitoring and assessment of nutritional status including total protein, prealbumin and serum albumin.

Results: Patients with malnutrition, compared with normal nutrition, were older, had a significantly (p ≤ 0.05) higher serum creatinine, and lower body weight, estimated glomerular filtration rate, serum low density lipoprotein cholesterol, serum total protein, prealbumin, and albumin, body mass index and GNRI (p ≤ 0.01). After multivariable adjustment, malnourished patients had significantly higher 24-h, daytime and nighttime systolic blood pressure (p ≤ 0.001). Lower GNRI was independently associated with higher 24-h, daytime and nighttime systolic blood pressure after adjustment for confounding factors (p＜0.05).

Conclusions: Elderly hypertensive patients with malnutrition had higher systolic blood pressure than those with normal nutrition. GNRI was associated with 24-h, daytime and nighttime systolic blood pressure.

Background: This study (1) validates the accuracy of the photoplethysmography-based Microlife cuffless upper-arm wearable blood pressure (BP) monitor according to the AAMI/ESH/ISO 81060-2:2018/Amd 1:2020 standard; (2) investigates the device's performance across age groups and skin tone; and (3) evaluates the advantages of cuffless BP monitoring in terms of estimation variability, required time, and stability.

Methods: A total of 120 participants aged ≥20 years were recruited from the general population, ensuring the representation of diverse age and skin tone groups. The device was calibrated against a clinically validated mercury sphygmomanometer. Sequential same-arm BP estimation were performed. Accuracy was analyzed according to the ISO criteria, and further subgroup analysis was conducted to compare results between participants aged ≥65 years and <65 years, as well as between participants with lighter and darker skin tones (classified according to the Fitzpatrick system). Additionally, estimation stability and variability were evaluated using three averaged BP estimations.

Results: The results demonstrated that the Microlife device met the AAMI/ESH/ISO accuracy criteria. Subgroup analysis revealed consistent accuracy across age and skin tone groups, with slight differences warranting further exploration. Notably, the cuffless design enabled faster estimations with reduced variation between the three averaged readings, showcasing its potential for home BP monitoring and frequent self-assessments.

Conclusions: These findings support the clinical potential of photoplethysmography-based cuffless BP monitoring in diverse adult populations, particularly for facilitating rapid and stable BP estimations in elderly individuals and users with varying skin tones. Further large-scale studies are warranted to corroborate and build upon these observations.

Background: Differences in clinician fidelity with hypertension quality improvement (QI) interventions may influence blood pressure (BP) control.

Methods: This analysis included data from 35, 115 patients with 89, 230 clinical encounters during a calendar year conducted by 87 physicians, 7 advanced practice nurses and 173 residents to examine the association of fidelity measures with QI interventions and BP control for a clinician-patient panel. BP control (BP < 140/90 mmHg) was based on vital signs at last clinic visit. The QI program fidelity measures included 1) documented automated office BP (AOBP) to confirm initial elevated BP, 2) 30-day follow-up visits when clinic BP is uncontrolled, 3) appropriate escalation of medications during visits with uncontrolled BP, and 4) use of combination BP-lowering medications. Linear mixed-effects models were used to examine the association of QI program fidelity measure quartiles with patient panel BP control, while adjusting for patient panel characteristics.

Results: The mean patient age was 63.2 years (SD 12.8), 45.1% were men; race/ethnicity was Non-Hispanic (NH) White in 60.5%, NH Black in 20.3%, and Hispanic in 14.0%. Average patient panel BP control rate was 69.1%. After adjustment, the highest AOBP and 30-day follow-up visit quartiles were associated with a 15.1% (95% CI 8.9%, 21.4%) and 12.3% (95% CI 6.8%, 17.7%) higher percentage of clinician-patient panels with controlled BP compared to the lowest quartile. No association was noted with other fidelity measures and BP control.

Conclusion: Increasing fidelity with hypertension QI interventions may help clinicians improve BP control rates within their patient panel.

Background: Using brachial blood pressure (BP) as a surrogate for central BP when calculating carotid arterial stiffness (CAS) has not been studied in older adults.

Methods: Veterans (n = 180) age 60+ were recruited from Madison VA Hospital. Resting supine brachial and central BP (estimated from radial artery waveforms, Atcor Medical) were obtained. Right common carotid diameters were measured using ultrasound (Philips CX50, L12-3 transducer) after a transverse sweep to identify plaque presence to optimize longitudinal angle of approach free of plaque. CAS (Peterson's elastic modulus [PEM], Young's elastic modulus [YEM]) and distensibility coefficient (DC) were calculated using brachial and central BP. Differences in CAS were compared using paired Wilcoxon tests. Linear regression models evaluated associations with cardiovascular risk factors.

Results: Participants were 70.4 (7.7) years old and 27.8% were female. Average brachial systolic BP was significantly higher than central (132.3 [18.6] mm Hg vs. 123.8 [17.7] mm Hg P < .001). Compared to brachial BP, using central BP to calculate stiffness measures resulted in significantly lower YEM and PEM and significantly higher DC (PEM: 480.6 [209.5] mm Hg vs. 378.3 [178.4] mm Hg; YEM: 2220.2 [926.6] mm Hg vs. 1746.9 [785.4] mm Hg; DC: 2.4 [1.0] × 10-3 mm Hg-1 vs. 3.1 [1.1] × 10-3 mm Hg-1; all P < .001). Absence of hypertension was associated with smaller differences in PEM (β = -26.02, SE = 12.37, P = .04), while older age was associated with greater differences in DC when calculated using brachial vs. central BP (β  = 2.09 × 10-5, SE = 0.67 × 10-5, P = .002).

Conclusions: Brachial and central BP differ in older adults and result in significant differences in calculated CAS and distensibility. Brachial BP overestimates CAS, especially in hypertensive adults.

Over one-third of Canadians with hypertension do not achieve recommended blood pressure (BP) targets despite availability of effective treatments. Renal sympathetic nerve denervation (RDN) is a recently approved, minimally invasive treatment for hypertension being offered in multiple Canadian centers. How best to implement this procedure in contemporary Canadian clinical practice remains unclear. Herein, we provide a Canadian hypertension specialist viewpoint on use of RDN in Canada. We review the rationale for, and evidence supporting, the use of RDN and discuss, using two clinical cases, its potential therapeutic role. We note that RDN has effectively lowered BP in multiple, sham-controlled, randomized clinical trials and has a favourable safety profile. Economic modeling estimates that it is cost-effective in the Canadian context. Conversely, the BP lowering effect is relatively modest; no well-established method to pre-identify responders exists; cardiovascular endpoint data supporting use of RDN are lacking; and no clear funding model is currently in place in Canada. Accordingly, we suggest that use of RDN be reserved for willing patients with severely elevated BP despite the use of first-line conventional therapies who have had secondary causes excluded. Examples include patients with resistant hypertension or moderate or severe hypertension and multiple drug intolerance syndrome. In view of its recent approval and known operator-dependency, RDN should be offered solely through programmatic, multidisciplinary collaboration between hypertension specialists and experienced interventionalists using a shared decision-making approach with the patient. Funding deployment should target such programs and sites should carefully monitor their outcomes to confirm comparability to the published literature.

The World Health Organization (WHO) estimates that the number of people living with hypertension (blood pressure (BP) of ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.28 billion. Elevated BP is associated with increased risks of stroke, coronary artery disease (CAD), heart failure (HF), and chronic kidney disease (CKD). Resistant hypertension (RH) is defined as office BP ≥ 140/90 mmHg despite treatment with three classes of antihypertensive agents (including a diuretic) at maximally tolerated doses, or the need for four or more agents regardless of BP level. Device-based antihypertensive therapies primarily target autonomic nervous system through techniques, such as renal denervation, carotid baroreceptor activation, and carotid body ablation. This review outlines the pathophysiological basis of selected interventions, critically evaluates existing clinical evidence, and highlights future directions for their development and integration into clinical practice.

Background: Hypertensive heart disease is a major cause of heart failure (HF), this study evaluate the global burden and trends of HF attributable to hypertensive heart disease from 1990 to 2021.

Methods: We collected detailed information on prevalence, years lived with disability of HF attributable to hypertensive heart disease from the Global Burden of Disease study 2021 across 204 countries and territories. Numbers, age-standardized rates and average annual percent change of HF attributable to hypertensive heart disease prevalence and years lived with disability were compared by age, sex, and socio-demographic index.

Results: In 1990 and 2021, hypertensive heart disease related HF affected more than 4.6 million and 13 million individuals globally, demonstrating an age-standardized prevalence rate of 125.4 [95% uncertainty Interval (UI) 99.0 to 158.0] and 148.3 per 100,000 (95% UI 117.3 to 186.3) and an age-standardized years lived with disability rate of 11.2 (95% UI 7.2 to 15.7) and 13.2 (95% UI 8.4 to 19.1) per 100,000, respectively. Notably, from 1990 to 2021, the global age-standardized prevalence and years lived with disability rates increased consistently, with an average annual percent change of 0.53 (95% CI 0.52 to 0.54) and 0.54 (95% CI 0.53 to 0.55), respectively.

Conclusions: The global burden of HF attributable to hypertensive heart disease has risen.