American Journal of Hypertension最新文献

Background: Obstructive sleep apnea (OSA) is a risk factor for hypertension and some evidence suggests this risk may not be mitigated with positive airway pressure. Low-intensity statin therapy can modestly reduce blood pressure (BP). In this exploratory analysis, we examined if six months of high-intensity statin therapy could lower resting or ambulatory BP in patients with OSA.

Methods: 39 patients with OSA (13F, age = 49 ± 9yrs, body mass index = 32.9 ± 4.2kg/m2, apnea-hypopnea index = 22.2 ± 12.4 events/hr) were randomized to high-intensity atorvastatin or placebo. BP was assessed using seated, "office" measurements and in 20-minute intervals over 24 consecutive hours at three timepoints (baseline, three- and six-months post-randomization). Participants maintained a diary denoting sleep and wake times for analysis. Changes (Δ) in BP from baseline were assessed and adjusted for adherence to participants' intervention (atorvastatin or placebo) as well as to their treatment for OSA (yes or no).

Results: There were no between-group differences in baseline BP variables (p = 0.09-0.96). At three months, the changes in resting (p = 0.74-0.87), 24hr mean (p = 0.54-0.96), daytime (p = 0.70-0.96), nor nighttime (p = 0.74-0.96) BP did not differ between groups. Similarly, the changes in resting (p = 0.23-0.92), 24hr mean (p = 0.51-0.82), daytime (p = 0.17-0.78), and nighttime (p = 0.51-1.00) BP did not differ between groups following six months of their respective intervention.

Conclusions: Our data suggest that high-intensity atorvastatin does not lower resting or ambulatory BP in patients with OSA relative to a placebo. Thus, it does not appear that atorvastatin is a viable adjunct intervention for BP reduction in patients with OSA.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03308578.

Background: The prognostic significance of blood pressure (BP) changes during exercise remains unclear. This study investigated the association between exercise-related BP and long-term mortality.

Methods: We analyzed 19,110 individuals (mean age 57.9 years, 61.9% men) who underwent clinically indicated treadmill exercise testing. The recordings of BP throughout the test were obtained, and maximal and recovery changes in systolic BP (ΔSBPmax and ΔSBPrec) were calculated. Mortality and cardiovascular(CV) death were obtained via linkage to the National Death Registry.

Results: During a mean follow-up of 4.4 ± 2.6 years, there were 649 deaths and 134 CV death. Higher resting SBP, recovery SBP, maximal exercise SBP, peak heart rate, ΔSBPmax, and ΔSBPrec were inversely associated with CV and all-cause mortality. In contrast, a drop in recovery SBP below resting levels was associated with higher mortality. After multivariable adjustment for age, sex, lipid profiles, diabetes, use of antihypertensive agents, resting SBP, and metabolic equivalents, both ΔSBPmax and ΔSBPrec remained independently predictive. Specifically, for per 1-SD increase, ΔSBPmax was associated with a hazard ratio (HR) of 0.80 (95% CI: 0.67-0.97) for CV death and 0.88 (95% CI: 0.80-0.96) for all-cause death. Similarly, ΔSBPrec was associated with an HR of 0.75 (95% CI: 0.62-0.90) for CV death and 0.85 (95% CI: 0.77-0.93) for all-cause death.

Conclusions: Greater SBP increases during exercise and recovery were associated with lower CV and all-cause mortality, while a drop in recovery SBP identified elevated risk. Exercise BP responses may serve as simple, clinically relevant prognostic markers.

Background: The mechanism of hypertension associated with erythropoietin stimulating agents (ESA) in chronic kidney disease (CKD) is complex and remains poorly understood.

Methods: Here, anemic hypertensive patients with CKD and well controlled or mildly elevated blood pressure (BP) as confirmed by 24-hour ambulatory BP monitoring were randomly assigned to either a waitlisted group or darbepoetin in a 1:1 ratio stratified by stages of albuminuria. The primary end point was the change in 24-hour diastolic ambulatory BP from baseline to 12 weeks.

Results: We screened 1699 patients and randomized 27 patients of the planned 160. Mean age (SD) was 75 (8) years, mean hemoglobin 9.4 (0.6) g/dL, mean clinic BP 124.4 (19.5)/57.2 (11.4) mmHg and was similar between groups. At 12 weeks there was 1.7 g/dL (95% CI 0.9 to 2.5 g/dL) difference in hemoglobin between waitlisted and immediate start group. Within group change in diastolic 24-hour ambulatory BP in the waitlisted group was -1.91 mmHg and the immediate start group was +1.07 mmHg. The difference in the changes was 2.98 mmHg (95% CI -1.36 to 7.31), p = 0.18. Comparing systolic BP, endothelial function, and UACR in the waitlisted and immediate start groups showed no significant differences between groups. However, within the waitlisted group UACR increased 35% from baseline (95% CI 11 to 82%) with darbepoetin exposure. Cardiovascular and atherothrombotic serious adverse events were more frequent during darbepoetin exposure.

Conclusions: Among anemic CKD patients with reasonably controlled hypertension, exposure to darbepoetin did not change 24-hour ambulatory BP or endothelial function. However, increases in albuminuria and serious adverse events during exposure to darbepoetin is a cause for concern and requires larger studies to affirm or refute these observations.

Background: Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) are key measurements in cardiovascular assessment. A recent invasive study by our group found that SAP averages twice DAP at the radial and femoral levels. Whether this relationship applies to the brachial artery and central aorta remains unknown.

Methods: Guided by two systematic reviews, we conducted a secondary data analysis of studies that simultaneously reported high-fidelity invasive brachial and aortic pressures in adults undergoing cardiac catheterization. Allowing a ± 2.5% measurement error in SAP and DAP, we defined an acceptable SAP/DAP ratio range of 1.90 to 2.10.

Results: Seven studies were included (n = 268; 69% male; mean age 62 years). The weighted mean brachial SAP/DAP ratio was 1.98 (141.6/71.6 mmHg) across the cohort and aligned with our hypothesis in six studies (n = 256; 95% of the population). The one study that did not support the hypothesis was a letter-format publication with a small sample size (n = 12). The hypothesis regarding the aortic SAP/DAP ratio was largely unsupported, being rejected in six studies (n = 232) and in the pooled data (1.89 = 134.7/71.4).

Conclusion: This preliminary analysis shows that brachial SAP averages twice DAP within a minimal margin of measurement error. These findings highlight a potentially important hemodynamic feature of the brachial artery-and, more generally, of peripheral large arteries, in contrast to the aorta. However, broader validation is needed to assess the clinical relevance of these results beyond the predominantly older male cohort referred for catheterization, and the physiological basis of this pattern also warrants further investigation.

Background: Despite various blood pressure (BP) measurement methods being available, many people report never or infrequently having their BP measured. There is a gap between clinical guidelines and the implementation of BP monitoring. To bridge that gap, we interviewed community members to understand their practices and perceptions regarding various measurement methods.

Methods: Australian adults who participated in a home BP measurement study were purposively sampled for semi-structured interviews (2023-2024).

Results: Participants (n = 29) were middle-aged (mean 61 ± 12.8 years, 55% female), and most (79%) had diagnosed hypertension. All participants had real-world experience with both clinic and home BP measurements; 15 with 24-hour ambulatory monitoring (24h ABPM); 10 with kiosks; and three used cuffless BP devices. Participants described clinic BP as routine and highly valued direct feedback from doctors. Participants valued home BP due to convenience and the number of measurements they could take. Most participants reported no issues with 24h ABPM, although three experienced severe discomfort or dislike. Concerns about measurement accuracy and privacy were raised by four participants regarding kiosk BP, as devices were sometimes non-standardized and located in open areas. Most participants expressed interest in cuffless BP devices but had limited experience using them.

Conclusions: We have identified barriers associated with clinic, 24-hour ABPM, HBPM, and kiosk BP that need to be addressed to enhance consumer satisfaction and increase monitoring rates, highlighting the need for a coordinated approach involving key health organizations and healthcare professionals.

Background: Hypertension (HT) is one of the most common causes of myocardial dysfunction. Although early detection of myocardial impairment remains challenging, left ventricular global longitudinal strain (LV-GLS) is a sensitive echocardiographic parameter that can identify subclinical myocardial damage. However, its application is limited in routine clinical settings. R-wave peak time (RWPT) is a simple and widely available electrocardiographic parameter that may reflect intramyocardial conduction delay and early structural remodeling. This study aimed to investigate the association between RWPT and LV-GLS in patients with HT.

Methods: This prospective study included 403 patients with a confirmed diagnosis of HT. All participants underwent transthoracic echocardiography and 12-lead surface ECG. LV-GLS was assessed using speckle-tracking echocardiography. ECG images were digitized and analyzed using ImageJ software, and RWPT was defined as the interval from the onset of the QRS complex to the peak of the R-wave.

Results: Patients were divided into two groups according to their LV-GLS value of -15.9%, which is defined as the cutoff value of myocardial impairment. Patients with a lower LV-GLS had significantly longer RWPT and QRS durations. In multivariate analysis, RWPT was found to be an independent predictor of impaired LV-GLS (OR: 1.085; 95% CI: 1.056-1.114; P < 0.001). ROC analysis demonstrated an AUC of 0.715 (95% CI: 0.665-0.765; P < 0.001) with a sensitivity of 64.9% and a specificity of 67.7% at a cutoff value of 45.5 ms.

Conclusions: RWPT may serve as a practical, accessible, and sensitive electrocardiographic marker for detecting subclinical myocardial dysfunction in patients with HT.

Background: Hydrochlorothiazide and chlorthalidone have been cornerstones of hypertension management for decades. Given the historical debate about their comparative effectiveness and cardiovascular outcomes, as well as recent clinical trial evidence, we studied prescription trends to assess the association of prescribing patterns with evolving knowledge.

Methods: We analyzed prescriptions of hydrochlorothiazide and chlorthalidone from January 2019 to December 2024 using IQVIA's National Prescription Audit (NPA). Interrupted Time Series (ITS) analysis assessed inflections in prescribing practice around the December 2022 Diuretic Comparison Project (DCP) findings and the August 2020 hydrochlorothiazide US Food and Drug Administration (FDA) non-melanoma skin cancer warning.

Results: On average, 3,734,790 hydrochlorothiazide and 543,402 chlorthalidone prescriptions were dispensed, a 7:1 ratio. A drop of 503,367 hydrochlorothiazide prescriptions (14%; 95% CI: -673,109 to -333,624) was observed in the first month after the FDA's warning, and the pre-warning 43,913 (95% CI: 31,701 to 56,125) monthly increase reversed to a monthly decline of 13,546 (95% CI: -16,137 to -10,954) prescriptions post-warning. After the DCP report, a slowdown of 2,738 (95% CI: -4,472 to -1,004) monthly prescriptions for chlorthalidone was seen, reducing the rate of monthly increase from 3,602 (95% CI: 1916 to 5289) to 864 (95% CI: 431 to 1298). Monthly hydrochlorothiazide prescriptions declined to -20,124 (95% CI: -26285 to -13962) post DCP report.

Conclusion: The FDA warning and DCP report were associated with a decline in hydrochlorothiazide and chlorthalidone prescriptions, while the DCP report slowed chlorthalidone prescribing.