American Journal of Hypertension最新文献

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.

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: 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.

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.