American Journal of Hypertension最新文献

Background: Non-dipping blood pressure pattern, characterized by a blunted nocturnal decline in blood pressure, is associated with increased cardiovascular morbidity and mortality. Restless legs syndrome (RLS) has been linked to sympathetic hyperactivity and altered circadian regulation, potentially contributing to abnormal blood pressure patterns. This study aimed to evaluate the relationship between RLS and non-dipping pattern in patients undergoing ambulatory blood pressure monitoring (ABPM).

Methods: In this prospective observational study, 501 eligible participants were included after excluding those with obstructive sleep apnea syndrome, type 1 diabetes, or morbid obesity. RLS was diagnosed according to National Institutes of Health consensus criteria using clinical assessment, the International RLS Study Group scale, and the Berlin Questionnaire. A non-dipping pattern was defined as < 10% nocturnal reduction in mean systolic or diastolic blood pressure.

Results: RLS was diagnosed in 158 patients (31.5%). Compared with controls, RLS patients were more often female and had higher rates of diabetes and hyperlipidemia. Non-dipping was significantly more prevalent in the RLS group (69.0% vs 48.7%,p < 0.001), accompanied by lower systolic and diastolic BP variability (both p < 0.001). In multivariable logistic regression, independent predictors of RLS included female sex (β = 0.701, p = 0.049), hyperlipidemia (β = 0.850, p = 0.031), and non-dipping status (β  =  1.057, p < 0.001). ROC analysis demonstrated modest predictive ability (AUC = 0.601; 95% CI 0.557-0.645).

Conclusion: RLS is independently associated with a non-dipping blood pressure pattern, even after excluding major confounders. These findings suggest a shared autonomic mechanism linking RLS with impaired nocturnal blood pressure regulation and heightened cardiovascular risk.

Background: This study investigated the association and discriminative ability of six surrogate insulin resistance (IR) indices-TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, and the TG/HDL-C ratio-for hypertension (HTN) in patients with type 2 diabetes (T2D).

Methods: This cross-sectional, age- and gender-matched case-control study included 4236 patients with T2D (2167 with HTN and 2069 without) who attended a diabetes clinic between January 2014 and December 2024. Associations between surrogate IR indices and HTN were assessed using RCS and multivariable logistic regression. Discriminative ability and calibration were evaluated using ROC and calibration plots. The NRI and IDI analyses quantified the incremental value beyond a basic model.

Results: Each surrogate IR index showed a significant non-linear association with HTN. After adjusting for confounding factors, the ORs for HTN increased with higher values of each index. All indices demonstrated significant discriminative ability (AUCs > 0.690), with TyG-BMI showing the highest AUC (0.698; 95% CI: 0.664-0.733). A TyG-BMI cutoff of 144.5 identified HTN with 61% sensitivity and 71% specificity (p < 0.001). Calibration was relatively good, and the addition of surrogate IR indices to the basic model (age, gender, diabetes duration, LDL-C, HbA1c, and eGFR) significantly improved HTN identification.

Conclusions: These findings support the use of surrogate IR indices as practical tools for identifying and assessing the risk of HTN in patients with T2D and highlight the potential role of IR in the development of HTN.

Background: Hypertension (HT) constitutes a pervasive global health challenge, standing as a principal contributor to cardiovascular morbidity and mortality. Limited data are available regarding the relationship between NPAR and non-dipper hypertension. we aimed to investigate whether NPAR is independently associated with non-dipper status in newly diagnosed hypertensive patients.

Methods: Prospectively, 160 hypertensive patients were included in the study. After a 24-h ABPM assessment, the patients were divided into two groups, a dipper group and a non-dipper and 80 healthy control subjects were enrolled in the study. Baseline laboratory and echocardiographic parameters were measured and then the NPAR was calculated.

Results: Levels of WBC, NLR, hs-CRP were significantly higher in patients with non-dipper HT than dipper HT and control subjects. Echocardiographic assessments revealed that the LV wall was thicker and LV mass index were higher in the hypertensive group than the control group. NPAR levels were significantly different among the three groups (p < 0.001) and also the multivariate analysis revealed that higher NPAR and hs-CRP levels were independently associated with a non-dipping pattern. ROC analysis showed that NPAR levels higher than 22.2 can predict non-dipping status (p < 0.001).

Conclusions: Our study shows that higher NPAR levels are independently associated with non-dipper hypertension in newly diagnosed hypertensive patients. These findings emphasize the role of inflammation in the pathophysiology of circadian BP variation and suggest that NPAR may serve as a useful tool in identifying hypertensive patients at higher risk for cardiovascular complications.

Background: Remote Patient Monitoring (RPM) includes home blood pressure (BP) measurement with readings sent directly to the electronic health record (EHR). We hypothesize that RPM facilitates quicker, more frequent, more appropriate antihypertensive medication changes.

Methods: Patients with hypertension in six primary care clinics were prescribed RPM between November 2020 and August 2021 (N = 288) and matched to four control patients (N = 1152). Office and RPM BP readings and medication data over 18 months were extracted from the EHR. RPM patients were classified as baseline controlled (office and RPM <130/<80 mmHg), sustained (office and RPM ≥130 and/or ≥80), white-coat (office ≥130 and/or ≥80, RPM <130/<80) or masked hypertension (office <130/<80, RPM ≥130 and/or ≥80).

Results: RPM patients had earlier first antihypertensive medication changes, with half of RPM patients having ≥1 change by 228 days versus 530 days for controls. RPM patients had more total medication changes, with 25% of RPM patients having ≥4 (median 1; 25th-75th percentiles 0-4) changes versus ≥2 (median 1; 0-2) changes in controls. Compared to baseline sustained hypertension RPM users, white-coat hypertension users were less likely to have ≥1 medication increase (24% [N = 11] versus 53% [N = 74], p = 0.001) within 12 months. Compared to baseline-controlled RPM users, masked hypertension users were less likely to have ≥1 medication decrease (0% [N = 0] versus 44% [N = 8]; p = 0.003) within 12 months.

Conclusions: Even without additional staff dedicated to medication adjustment, RPM facilitated quicker medication changes, more total changes and differential prescribing decisions for white-coat and masked hypertension patients supporting RPM use in primary care.

Background: The efficacy and safety of lorundrostat, a selective aldosterone synthase inhibitor, in patients with uncontrolled hypertension remain unclear. This meta-analysis aimed to evaluate its effects on blood pressure and risk of hyperkalemia.

Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were systematically searched through July 2025 for randomized controlled trials comparing lorundrostat with placebo. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were estimated using a random-effects model with the Restricted Maximum Likelihood estimator. Trial Sequential Analysis (TSA) was conducted to assess the conclusiveness of safety evidence.

Results: Three RCTs including 1,060 patients were identified. Lorundrostat significantly reduced systolic blood pressure at 50 mg (MD, -9.08 mmHg; 95% CI, -13.14 to -5.03) and 100 mg (MD, -11.41 mmHg; 95% CI, -15.97 to -6.85), and diastolic blood pressure at 50 mg (MD, -3.48 mmHg; 95% CI, -5.98 to -0.98). However, lorundrostat increased the risk of hyperkalemia at 50 mg (RR, 6.56; 95% CI, 1.53-28.12; NNH=71) and 100 mg (RR, 10.37; 95% CI, 2.44-44.03; NNH=42). TSA confirmed hyperkalemia at 100 mg as the only conclusive harm signal, while other safety outcomes remained inconclusive.

Conclusions: Lorundrostat effectively lowered blood pressure but increased dose-dependent risk of hyperkalemia. These findings support its potential as a novel therapy for uncontrolled hypertension, while emphasizing the need for longer-term cardiovascular outcome trials and direct comparisons with mineralocorticoid receptor antagonists concerning efficacy and safety.

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.