American Journal of Hypertension最新文献

Introduction: Diagnosing hypertension typically requires repeated blood pressure (BP) readings taken over multiple days, but obtaining accurate BP measurements from patients at home is known to be challenging, at least in part due to failure to accurately report those measurements. Here, we evaluate two low-cost electronic reporting strategies, text messaging and a novel image-based alternative, for acceptability and accuracy.

Methods: We developed and tested a two-stage optical character recognition (OCR) model to "read" a BP monitor display from patient-provided cellphone photographs. We then conducted a crossover trial to test the accuracy and acceptability of image-based BP reporting with having patients report BP measurements by text messaging. We compared the response rates and values obtained from photo uploads to those from text messages.

Results: The majority of the 50 respondents submitted most of the requested data. We received an average of 12/14 texted BP responses and 11.3/14 photo responses from participants. Only 4 participants sent neither text nor photo responses. In addition, our OCR model achieved 98.3% accuracy when "reading" BP values from images of sufficient quality (17.9% were rejected for quality issues), and the average BP reported by subjects did not differ between our text and image-based methods.

Conclusion: We were able to successfully "read" BP values from photos of BP monitors sent by participants. Both text messaging and photo uploads of monitor displays appear to be accurate and acceptable approaches for collecting home BP readings.

Background: Self-measured blood pressure monitoring (SMBP) is a proposed strategy to improve hypertension control, but few studies compare SMBP with automated office blood pressure (AOBP) measurements over time. Moreover, little is known about reimbursement for these services.

Methods: We describe a quality improvement initiative in our academic internal medicine practice. Patients received validated home blood pressure (BP) devices and were instructed to check their BP twice daily for seven days each month. Devices transmitted readings seamlessly via a smart phone application that averaged weekly readings. Clinicians reviewed the data and adjusted therapy if indicated. We tracked changes in SMBP, AOBP, antihypertensive medications, and reimbursement.

Results: Among 140 patients referred (mean age 57.6 years, 57.1% women, 25.7% Black), 59 completed the program. Over 6 months, the mean self-measured systolic BP decreased by 5.8 mm Hg (95% CI: -8.2 to -3.5) and the mean diastolic BP decreased by 2.8 mm Hg (95% CI: -4.2 to -1.4) and the number with BP < 130/<80 mm Hg increased by 22 percentage points (P = 0.007). However, unattended AOBP showed no change in either systolic (change: 0.1 mm Hg; P = 0.98) or diastolic (change: -0.6 mm Hg; P = 0.64) readings. Reimbursement was variable and ranged from no payment to a maximum payment of $51; when paid, the average payment was $13.81.

Conclusions: In this program, SMBP decreased over time while AOBP remained similar. Reimbursement, when received, was modest. Future work should evaluate whether using SMBP as a therapeutic target reduces cardiovascular events.

Background: We investigated the morning-to-evening changes in home blood pressure (BP) and pulse rate for demographic and clinical determinants, interrelationship, and association with BP control in treated patients with hypertension.

Methods: We performed a cross-sectional analysis in patients (≥55 years of age) with hypertension, enrolled in a China nationwide registry on home BP monitoring between 2020 and 2025. Home BP was measured three times consecutively in the morning and evening, respectively, for seven consecutive days. The change was calculated by subtracting the BP and pulse rate values in the morning from those in the evening.

Results: The 4,787 participants had a mean (±SD) age of 66.1 (±7.5) years, and included 2,366 (49.4%) men. Overall, systolic/diastolic BP decreased from 129.1/80.6 mmHg in the morning to 127.2/78.7 mmHg in the evening by a mean change of -1.9 ± 7.8/-1.8 ± 4.7 mmHg. Pulse rate, however, increased from 70.5 beats/min in the morning to 73.7 beats/min in the evening by a mean change of +3.1 ± 5.8 beats/min. Adjusted analyses showed that the changes in pulse rate were negatively associated with those in both systolic (r = -0.20, 95% CI: -0.22 to -0.17) and diastolic BP (r = -0.12, 95% CI: -0.14 to -0.09). Patients with a change in pulse rate above the median (≥3.0 beats/min) had a lower control rate of office systolic/diastolic BP (60.1% vs. 65.5%, P < 0.001) than those with a change in pulse rate below the median.

Conclusions: There were interrelated morning-to-evening changes in home BP and pulse rate, being a drop and rise, respectively.

Background: To estimate the association of degree of prematurity with arterial stiffness in young adults using augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) and pulse wave velocity (PWV).

Methods: This was a secondary cross-sectional analysis from a prospective cohort study of young adults born preterm with extremely low or very low birth weight (<1,500 g) and term-born peers with normal birth weight. Gestational age at birth was the exposure. Arterial stiffness outcome assessment was performed using radial artery tonometry (Sphygmocor) and a pressure wave transducer with an electrocardiogram (Colin). We used directed acyclic graph-informed multivariable linear regression to estimate the association of gestational age at birth on the continuous and binary scales with AIx@75 and PWV.

Results: Of the 113 participants, 110 had AIx data and 97 had PWV data for analysis. AIx@75 was 5.07% higher in the preterm group. In adjusted analysis, each one-week higher gestational age at birth was associated with lower AIx@75 among the entire cohort (-0.38% per week, 95% confidence interval -0.74, -0.02). There was no statistically significant difference in PWV between the preterm and term groups.

Conclusions: There was a higher AIx in young adults with increasing severity of prematurity amongst the entire cohort, but no difference in PWV. More studies are needed that directly assess the severity of prematurity with arterial wall stiffness and alterations in arterial wall structure to determine if they are associated with a higher risk of hypertension and cardiovascular disease long term in the premature population.

Background: Creatine kinase (CK), the enzyme that rapidly regenerates ATP for cardiovascular pressor responses, has been associated with hypertension in experimental settings and cross-sectional population studies, but the temporal relationship between CK and new-onset hypertension remains understudied.

Methods: We included 515 adults (42% men, mean age 45.6 years, SE 0.2) who participated in population studies with baseline and 10-year follow-up cardiovascular measurements. The primary outcome was the association between baseline resting plasma CK and the development of new-onset hypertension (systolic blood pressure ≥140, diastolic ≥90 mm Hg, or receiving antihypertensive drugs at 10 years, in persons without hypertension at baseline). We adjusted the outcome for cardiovascular risk factors, including sex, age, and body mass index (BMI), in multivariable logistic regression analysis.

Results: Among individuals without hypertension at baseline (n = 362), systolic/diastolic blood pressure (mean, SE), increased over 10 years by +14.2 (0.7)/+4.6 (0.8), rising from 117.1 (0.6)/76.4 (0.4) to 131.1 (0.8)/81.0 (0.5) mm Hg. Baseline CK was higher in participants with new-onset hypertension (n = 143, 40%) than in those without hypertension at follow-up, respectively 148.0 (SE 7.1) vs. 120.2 (5.1) IU/L. New-onset hypertension was independently associated with age (years), odds ratio (95% CI) 1.07 (1.03-1.11); BMI (kg/m2), 1.09 (1.03-1.15); and baseline CK, 6.05 (2.33-15.70)/logCK.

Conclusions: High CK levels precede hypertension, suggesting a causal link and a potential new target for antihypertensive therapy. CK estimations could help identify individuals for intensified blood pressure monitoring and preventive cardiovascular risk management.

Background: Large inter-ankle systolic blood pressure (IASBP) differences (≥10 or ≥15 mmHg) have been linked to cardiovascular events and mortality. This longitudinal study evaluated the association of changes in IASBP differences with incident cardiovascular events and mortality.

Methods: In the Atherosclerosis Risk in Communities study, bilateral ankle blood pressure was measured at Visit 5 and at Visit 6/7 (n = 2051; mean age 73.7 ± 4.3 years). Participants were categorized into four groups by IASBP differences: small at both visits (<10 mmHg); decreasing (≥10 mmHg at Visit 5 but <10 mmHg in Visit 6/7); increasing (<10 mmHg at Visit 5 but ≥10 mmHg in Visit 6/7); and large at both visits (≥10 mmHg). Categories were repeated using a ≥15 mmHg cutoff value. Cox proportional hazards regression models were used to calculate hazard ratios (HRs).

Results: In adjusted analyses, individuals with increasing differences (≥10 mmHg) had higher risks of heart failure (HR: 1.31; 95% confidence intervals [CI], 1.00-1.76) and stroke (HR: 1.57; 95% CI, 1.16-2.11), compared to those with small differences at both visits. Similarly, those with persistently large differences showed elevated risks of coronary heart disease (HR: 2.25; 95% CI, 1.46-3.47) and stroke (HR: 1.68; 95% CI, 1.17-2.41). Analyses using a ≥15 mmHg cutoff value demonstrated even stronger associations with all three cardiovascular events. No significant associations were observed with all-cause or cardiovascular mortality for these categories.

Conclusions: Increasing and persistently large IASBP differences are associated with elevated risk of incident cardiovascular events. Monitoring IASBP differences may help identify individuals at higher risk for adverse outcomes.