American Journal of Hypertension最新文献

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.

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.