American Journal of Hypertension最新文献

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.

Background: The rate of hypertension hospitalizations is increasing among US adults. Individuals with low socioeconomic position are more likely to have high blood pressure (BP), which may increase their risk of hypertension hospitalization and adverse post-discharge outcomes.

Methods: We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which enrolled 5,115 adults aged 18 to 30 years from 4 urban US communities in 1985-1986. Hospitalizations were identified by self-report during study exams and annual interviews, with hypertension hospitalizations determined through medical record review, through August 2020. Socioeconomic position included education, family income, having private health insurance, and neighborhood deprivation assessed at the last study visit prior to the hypertension hospitalization. Uncontrolled BP (≥140/90 mmHg) was determined at the first CARDIA study visit after hypertension hospitalization.

Results: Overall, 67 CARDIA participants were hospitalized for hypertension. The hazard ratio of hypertension hospitalization among participants who had less than high school versus high school or more education was 3.12 [95%CI: 1.78, 5.48], whose family income was <$25,000 versus ≥$25,000 was 2.43 [95%CI: 1.44, 4.11], who had no private versus private insurance was 2.58 [95%CI: 1.56, 4.28] and those in tertile 3 versus tertile 1 of neighborhood deprivation index (most versus least deprived) was 3.06 [95%CI: 1.23, 7.58]. Among 46 participants who attended a CARDIA study visit following hospital discharge, 23 (50%) had uncontrolled BP.

Conclusion: Adults with low socioeconomic position were more likely to be hospitalized for hypertension. Uncontrolled BP was common following hypertension hospitalization.

Background: Vascular aging, often defined in terms of arterial stiffness and impaired arterial hemodynamics, is an important factor associated with hypertension and CVD. Aortic stiffness, a more particular measure of arterial stiffness focusing on central hemodynamics (ie, the aorta), is an independent predictor of hypertension and CVD risk. Higher levels of physical activity are associated with lower arterial stiffness in various White populations, for peripheral and central measures of stiffness, but further investigations into Black populations are warranted. We examined the association between physical activity and aortic stiffness among participants in the Jackson Heart Study (JHS).

Methods: We analyzed data from JHS participants who completed applanation tonometry assessment as part of an ancillary study (2012-2017). 1,226 Black adults (age 59.0 ± 10.0, 60.4% female) were included for analysis. Associations were assessed using multivariable linear regression models, adjusted for age and sex and then further adjusted for other demographic and CVD-related risk factors. Physical activity was measured via self-report, and aortic stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using applanation tonometry.

Results: Higher total physical activity was associated with lower cfPWV when controlling for risk factors associated with arterial and aortic stiffness (estimated B=-0.96; 95% CI -1.59 to -0.33). When considering American Heart Association physical activity recommendations (ie, ideal activity vs not meeting recommendations), this relationship remained.

Conclusion: Higher levels of physical activity were associated with lower levels of aortic stiffness in the Jackson Heart Study.

Backgrounds: Multivitamin-multimineral (MVM) supplements have been associated with lower blood pressure (BP) in several small trials. We investigated the effects of a MVM on incident hypertension and BP in a secondary analysis of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

Methods: COSMOS is a 2X2 factorial, double-blinded RCT testing effects of cocoa extract and MVM supplementation among women aged ≥65y and men aged ≥60y. Among 8905 COSMOS participants free from hypertension, effects of MVM supplementation on incident hypertension were investigated. Hypertension diagnosis was ascertained through self-reports. Additionally, in two substudies with BP measurements (N = 529 at clinic by research staff and 994 at home by technician), we evaluated the effects on 2-year BP changes.

Results: Incident hypertension was observed in N = 1034 (22.9%) in MVM arm and N = 1039 (23.6%) in placebo arm over a median of 3.4 years (IQR: 3.0, 3.9) of follow-up, with hazard ratio (HR) 0.98 [95% CI: 0.90, 1.06]. Effects differed according to baseline diet quality, with HRs of incident hypertension 0.81 [0.70, 0.95] and 1.14 [1.01, 1.28] among participants with lower and higher Alternate Mediterranean Diet score, respectively (p-interaction = 0.001). There was no effect of MVM on 2-year changes in systolic BP (4.4mmHg in MVM; 4.5mmHg in placebo), while pronounced effects were observed for baseline normal BP (p-interaction = 0.004).

Conclusion: MVM supplementation versus placebo did not reduce hypertension incidence or lower BP overall. Exploratory analyses showed greater reduction in hypertension risk and BP changes among those with lower dietary quality and normal BP at baseline, respectively.

Clinicaltrials.gov registration: NCT02422745.

Background: The Hiroshima Registry for Evaluation and Treatment of Nocturnal and Early Morning Hypertension (Hiroshima NOCTURNE) was a prospective, multicenter study designed to determine whether elevated nighttime blood pressure (BP), assessed using a home BP monitoring (HBPM) device, can be normalized through active antihypertensive therapy in patients already receiving antihypertensive medication. In this subanalysis, we aimed to identify factors associated with failure to normalize nocturnal hypertension.

Methods: Patients with nocturnal hypertension at baseline who underwent a six-month intervention based on nighttime BP were included. Nocturnal hypertension was defined as a mean nighttime systolic BP of ≥ 120 mmHg. Treatment decisions were left to the discretion of the attending physicians.

Results: Among the 90 patients with baseline nocturnal hypertension, 42 (46.7%) failed to achieve normalization (<120 mmHg) after the intervention. In the multivariable analysis, higher baseline nighttime systolic BP (OR 1.07, 95% CI 1.001-1.15, P = 0.046) and baseline diuretic use (OR 3.99, 95% CI 1.17-13.6, P = 0.03) were significantly associated with failure to normalize nocturnal hypertension. Diabetes mellitus tended to be associated with the failure to normalize nocturnal hypertension (OR 3.01, 95% CI 0.93-9.72, P = 0.06). Participants using diuretics at baseline and those with diabetes mellitus were already receiving multiple antihypertensive medications, and additional drug classes were not often prescribed during the intervention.

Conclusions: In patients already receiving antihypertensive medication, failure to normalize nocturnal hypertension despite treatment guided by nighttime BP measurements was associated with elevated baseline nighttime BP, diuretic use, and possibly diabetes mellitus. These findings highlight the need for more individualized therapeutic approaches, particularly in patients receiving diuretics or those with diabetes mellitus.