American Journal of Hypertension最新文献

Background: Visceral obesity, insulin resistance, and glycolipid abnormalities are associated with an increased risk of hypertension (HTN). The study aimed to explore the correlation between novel triglyceride- and triglyceride-glucose-derived obesity indices associated with these hypertension risk factors, and the prevalence of HTN among nonobese adults.

Methods: We extracted data from 12,717 nonobese adults from the National Health and Nutrition Examination Survey between 1999 and 2020 and calculated triglyceride-derived obesity indices (lipid accumulation product (LAP), visceral adiposity index (VAI), and cardiometabolic index (CMI)), triglyceride-glucose-derived obesity indices (triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-waist-to-height ratio (TyG-WHtR)) and traditional anthropometric indices. Logistic regression, curve fitting and subgroup analyses were employed to investigate the associations between these novel obesity indices and HTN prevalence. Receiver operating characteristic curve analysis was performed to assess the predictive accuracy of all the above obesity parameters.

Results: After weighted analysis of the data, the results of this study represented approximately 119.00 million nonobese US adults. The prevalence of HTN was 49.74% (men 53.45%). The multivariate logistic regression analysis revealed that LAP, VAI, CMI, TyG-BMI, TyG-WC and TyG-WHtR were significantly associated with HTN. Smoothed curve-fitting analysis revealed that the LAP, VAI and CMI correlated nonlinearly with HTN. The area under the curve for HTN was greater for all novel obesity indices compared to commonly used traditional anthropometric parameters such as BMI, WC, and WHtR.

Conclusions: LAP, VAI, CMI, TyG-BMI, TyG-WC, and TyG-WHtR were significantly associated with HTN and demonstrated potentially better predictive capability than commonly used traditional anthropometric measures.

Background: Hypertension (HTN) predisposes individuals to arterial stiffness (AS) and dysfunction of the left atrial (LA) and left ventricular (LV). AS, characterized by increased pulse wave velocity (PWV) may impair LA phasic function. This study investigates the associations of brachial-ankle PWV and the left atrioventricular coupling index (LACI) as well as LA phasic function in hypertensive patients, and to evaluate the predictive value for LA dysfunction.

Methods: A prospective cohort of 150 patients with essential hypertension was enrolled. Patients were stratified into Group I (baPWV < 1600 cm/s, n = 75) and Group II (baPWV ≥ 1600 cm/s, n = 75) based on the median baPWV. Intergroup comparisons were performed. Correlations were assessed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of baPWV.

Results: Compared with Group I, Group II exhibited reduced LAEFtotal, LAEFpass, εs, and εe (all P < 0.05). LACI was significantly higher in Group II (P < 0.05). After adjusting for cardiovascular risk factors, multivariate linear regression analysis revealed that baPWV remained independently associated with LAVImin, LACI, εs, and εe. baPWV integration with conventional risk factors significantly improved predictive performance. The AUC increased from 0.709 to 0.845 for LACI, from 0.681 to 0.892 for LAVImin, from 0.672 to 0.881 for εs, and from 0.685 to 0.919 for εe.

Conclusion: Hypertension-mediated AS exhibits concurrent abnormalities in LA-arterial and LA-LV-arterial coupling. Integrating baPWV into conventional risk stratification models enhances the predictive value for preclinical cardiac target organ damage in hypertension.

Background: Compared to individuals of European or African ancestry, individuals of South Asian (SA) ancestry have greater cardiovascular disease (CVD) risk. We aimed to compare arterial stiffness and central hemodynamics, surrogates of CVD, in adolescents and young adults (AYA) of SA, White, and African American (AA) ancestry with overweight or obesity.

Methods: Pulse wave velocity (PWV) and pulse wave analysis (PWA metrics: Pulse Pressure Amplification [PPA]; Augmentation Index adjusted to heart rate of 75 [Aix75]) were performed in a cross-sectional study of 40 (18M/22F) SA, 45 (16M/29F) AA, and 44 (21M/24F) White AYA (age 12-21 years) of comparable age, sex, and BMI. Between-group comparisons of PWV, PPA, and AIx-75 were tested using linear regression models adjusted for covariates (BMI, mean arterial pressure, sex, age), as appropriate.

Results: As expected, BMI (kg/m2) did not differ (SA: 27.1, AA: 28.4, White: 27.4). Mean PWV (m/s) did not differ in SA (5.5), AA (5.1), and White (5.5). The typical relationship of BMI with PWV was absent in SA. PPA was lower in SA (1.45, P = 0.001) and AA (1.48, P = 0.014) vs. White (1.56). Aix75 was higher in SA (108, P = 0.004) but not in AA (105, P = 0.12) vs. White (101).

Conclusions: Although their PWV did not differ, SA AYA had lower PPA and higher Aix75 compared to White counterparts. As lower PPA associates with higher likelihood of future CV events, these findings could reflect an early CVD predisposition in SA and underscore the potential value of pulse waveform analysis in studies of emerging adults, a life stage in which interventions may mitigate CVD risk.

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.