American Journal of Hypertension最新文献

Background: Studying the association between blood pressure (BP) trajectories during young adulthood and subsequent cardiovascular disease (CVD) risk can provide insights into how long-term BP patterns in early-life influence the development of CVD later in life.

Methods: We pooled data from 2 US cohorts (Coronary Artery Risk Development in Young Adults, Framingham Heart Study). We used latent growth curve models to identify distinct BP trajectory groups between ages 18 and 39 years. We then used Cox proportional hazards models to assess the associations between BP trajectories and CVD events (composite of coronary heart disease [CHD], stroke, and heart failure [HF]) after age 40 years.

Results: We included 6,579 participants and identified 4 distinct systolic BP (SBP) trajectory groups during young adulthood. During a median follow-up of 18.2 years after age 40 years, 213 CHD, 139 stroke, 120 HF, and 400 composite CVD events occurred. Individuals in an elevated-increasing vs. low-stable SBP trajectory during young adulthood were associated with a higher risk of CVD after adjusting for traditional CVD risk factors, with hazard ratios (95% confidence interval) of 3.25 (1.63, 6.46) for CHD, 3.92 (1.63, 9.43) for stroke, 8.30 (2.97, 23.17) for HF, and 3.91 (2.38, 6.41) for composite CVD outcomes. Adding BP trajectory to BP at baseline improved model discrimination for all outcomes (changes in Harrell's C-index 0.0084-0.0192).

Conclusions: An elevated-increasing BP trajectory during young adulthood is associated with a higher risk of CVD later in life, highlighting the importance of maintaining a low-stable BP trajectory throughout the young adulthood period for prevention of CVD in later life.

Background: Increased aortic blood pressure (BP) and arterial stiffness are associated with higher cardiovascular risk in hemodialysis. Previous works showed that lower dialysate sodium is associated with lower brachial-BP; data on aortic-BP and arterial stiffness are limited. This study aimed to investigate the effects of different dialysate sodium concentrations on 72-hour aortic-BP and arterial stiffness parameters in hemodialysis patients.

Methods: This analysis is part of a prospective, non-randomized interventional study. Twenty-five hemodialysis patients underwent a set of 3 periods of different dialysate sodium concentrations; 6 sessions with dialysate sodium of 137 mEq/l, followed consecutively by 6 sessions with 139 mEq/l and, finally, 6 sessions with 141 mEq/l. At the start of the sixth hemodialysis session on each sodium concentration, 72-hour ABPM (Mobil-O-Graph) was performed to evaluate aortic-BP and arterial stiffness indices during the overall 72-hour, different 24-hour, daytime, and nighttime periods.

Results: Mean 72-hour aortic systolic blood pressure (SBP)/diastolic blood pressure (DBP) were higher with increasing dialysate sodium concentrations (137 mEq/l: 114.2 ± 15.3/77.0 ± 11.8 mm Hg vs. 139 mEq/l: 115.4 ± 17.3/77.9 ± 14.0 mm Hg vs. 141 mEq/l: 120.5 ± 18.4/80.5 ± 14.7 mm Hg, P = 0.002/P = 0.057, respectively). Wave-reflection parameters (AIx, AIx(75), AP) were not significantly different between the 3 dialysate sodium concentrations. Ambulatory pulse wave velocity (PWV) was significantly higher with increasing dialysate sodium concentrations (137 mEq/l: 8.5 ± 1.7 m/s vs. 139 mEq/l: 8.6 ± 1.6 m/s vs. 141 mEq/l: 8.8 ± 1.6 m/s, P < 0.001). In generalized linear mixed models including 72-hour brachial SBP as a random covariate, the adjusted marginal means of 72-hour PWV were not significantly different between groups.

Conclusions: This study showed that higher dialysate sodium concentrations are associated with significant increases in ambulatory aortic BP and PWV. These findings further support the need for modification of dialysate sodium concentration in hemodialysis.

Background: Exaggerated blood pressure response (EBPR) to exercise stress testing (EST) may be a marker of future hypertension and carry valuable information for the prediction of cardiovascular events. We sought to evaluate the clinical and resting EST parameters associated with an increased likelihood of EBPR.

Methods: The records of 14,073 patients (mean age: 55 ± 11 years) without known cardiovascular disease who underwent a treadmill EST were analyzed.

Results: The overall prevalence of arterial hypertension was 44%. A considerable proportion (24%) of patients exhibited EBPR. Multivariate analysis of the entire study population showed that middle-aged individuals (40-60 years old), resting systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg, known arterial hypertension, current cigarette smoking, and family history of premature coronary artery disease are all independent risk factors for EBPR (all P < 0.001). Although the presence of arterial hypertension increased the likelihood of EBPR in the analysis of the entire population, the relevant association in subjects above 60 years old is statistically nonsignificant (P = 0.120). Notably, the pre-test systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg level increased significantly the likelihood of manifesting EBPR in all age categories (<40, 40-60, and >60 years old) independent of hypertension presence and in all hypertensive patients independently of antihypertensive treatment intake (all P < 0.001).

Conclusions: Considering the diagnostic and prognostic utility of EBPR during treadmill EST the clinical and resting hemodynamic parameters that increase the likelihood of EBPR are targets for interventions and preventive measures to modify lifestyle risk behaviors and reduce hypertension and cardiovascular risk factors in the early stages.

Background: The use of correctly sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff.

Methods: This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large (>34 to ≤44 cm), and extra-large (XL) (>44 cm).

Results: Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles.

Conclusion: Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Background: The non-exercise estimated cardiorespiratory fitness (eCRF) has been recognized as an important predictor of mortality among the general population. This study sought to evaluate the relationship between eCRF and mortality from all causes, cardiovascular disease (CVD), and cancer in hypertensive adults.

Methods: We included 27,437 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) III and 10 NHANES cycles from 1999 to 2018. Multivariate Cox proportional hazard models were used to assess the hazard ratios and 95% confidence intervals (CIs) of eCRF for mortality.

Results: A total of 8,023 deaths were recorded throughout a median 8.6-year follow-up, including 2,338 from CVD, and 1,761 from cancer. The eCRF with per 1 metabolic equivalent increase was linked to decreased risk of all-cause (adjusted HR 0.78, 95% CI: 0.75-0.81) and CVD mortality (adjusted HR 0.79, 95% CI: 0.74-0.84), rather than cancer mortality (adjusted HR 0.94, 95% CI: 0.86-1.03). Moreover, a stronger protective effect of eCRF was observed for females (HR 0.66 (95% CI: 0.62-0.72) versus HR 0.78 (95% CI: 0.73-0.83), Pinteraction < 0.001 for all-cause mortality; HR 0.70 (95% CI: 0.61-0.80;) versus HR 0.82 (95% CI: 0.73-0.92), Pinteraction = 0.026 for CVD mortality) compared with males. Findings did not significantly differ in subgroup analyses and sensitivity analyses.

Conclusions: Among adults with hypertension, eCRF was inversely related to all-cause and CVD mortality, but not cancer mortality. A significant interaction effect existed between sex and eCRF. Further studies are needed to verify this association in different populations.

Background: Blood pressure (BP) is routinely measured and recorded at healthcare visits, but high BP (HBP) measurements are not always discussed in clinical notes. Our objective was to identify patient- and visit-level factors associated with discussion of HBP measurements in clinical notes, among patients without prior diagnosis of hypertension.

Methods: Data from 2016-2022 for all patients with any BP record of 140/90 mmHg or greater were obtained from University of Iowa Hospitals and Clinics electronic medical records. Patients with any prior hypertension diagnosis were excluded. We used a multi-level regression model to evaluate differences in the rates of discussing HBP. The model included varying intercepts for visit specialty and non-varying slopes and intercepts for patient- and visit-level features.

Results: The final sample included 278,766 outpatient visits for 27,423 patients, of which 61,739 visits had HBP. Only 31% of visits with HBP had associated clinical notes with discussion of HBP. Even in primary-care-related clinics, HBP measurements were discussed in only 70% of visits. Factors associated with decreased odds of HBP being discussed in clinical notes included fever (OR: 0.46; 95%CI: 0.24-0.86) or external injury or pain (0.84; 0.79-0.90), and larger number of comorbidities (6+: 0.27; 0.22-0.32). Discussion of HBP in clinical notes was more likely among visits of patients with prior visits where HBP was discussed in clinical notes (12.36; 11.75-13.01).

Conclusions: We found that discussion of HBP is relatively uncommon. Increasing discussion of hypertension in clinical notes could decrease hypertension-related diagnostic inertia.