Clinical Hypertension最新文献

Hypertension remains a leading global health challenge. However, decades of conventional strategies have failed to achieve adequate blood pressure (BP) control rates. Given the complex pathophysiology and diverse risk factors of hypertension, the primary barriers to its effective management are an inadequate recognition of cardiovascular risk, as well as suboptimal methods for accurate, early-stage diagnosis and phenotyping. This persistent public health problem underscores an urgent need for transformative innovations of hypertension management. Digital hypertension is an emerging field that integrates advanced technologies into the management of hypertension, especially artificial intelligence (AI). Emerging technologies are providing new strategies for hypertension management, including accurate prediction and precision subtyping from large datasets, remote telemedicine support, intelligent BP monitoring, and personalized interventions. This review summarizes recent advancements and challenges in these technologies, particularly AI, offering new insights for realizing precision medicine in the era of digital hypertension.

Background: A history of preeclampsia is a significant risk factor for recurrence, especially in cases of early-onset or severe preeclampsia. Additional maternal risk factors present in the subsequent pregnancy include advanced maternal age, interval between pregnancies, and newly diagnosed chronic hypertension. However, the impact of chronic hypertension diagnosed during the previous pregnancy on recurrence risk remains underexplored.

Methods: Ninety-four women with a history of preeclampsia were followed into their subsequent pregnancies. The association of clinical parameters in their previous pregnancy and the subsequent pregnancy outcomes was analysed.

Results: Among the 94 women, 56 (60%) did not develop any current hypertensive disorders of pregnancy (HDP), while 4 (5%) developed chronic hypertension, 12 (13%) developed gestational hypertension, and 22 (24%) developed recurrent preeclampsia. Notably, among the 10 women who were diagnosed with chronic hypertension in the previous pregnancy, 80% developed recurrent HDP, compared to 36% of those without it (odds ratio [OR], 7.200; 95% confidence interval [CI], 1.538-34.71; P = 0.0133). In addition, 87% of women with recurrent hypertensive disorders had a cesarean section in their previous pregnancy, compared to 68% of those without recurrence (OR, 3.126; 95% CI, 1.077-8.279; P = 0.0356).

Conclusions: Women with preeclampsia complicated by chronic hypertension diagnosed in their previous pregnancies and those who underwent cesarean section in their previous pregnancies are at increased risk for recurrent HDP, including recurrent preeclampsia.

Background: This report utilizes the latest national data to describe the prevalence, management status, and treatment patterns of hypertension in South Korea, with a special analysis of the growing burden of hypertensive disorders of pregnancy (HDP).

Methods: Two nationwide datasets were analyzed: the Korea National Health and Nutrition Examination Survey (KNHANES, 1998-2023) and the National Health Insurance (NHI) Big Data (2002-2023). In KNHANES, hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current use of antihypertensive medication. HDP prevalence was analyzed using NHI data for childbearing women aged 15-49 years from 2005 to 2023.

Results: In 2023, an estimated 12.6 million Korean adults (29% of adults aged ≥ 20 years) had hypertension. Management indicators continued to improve, with awareness, treatment, and control rates reaching 79%, 76%, and 62%, respectively. However, among young adults aged 20-39 years, awareness and treatment rates remained below 50% despite recent substantial gains. Healthcare utilization also increased, with 11.9 million individuals receiving hypertension-related care and 8.3 million achieving continuous treatment adherence (≥ 290 days/year) in 2023. Dual therapy was the most common regimen (44%), followed by monotherapy (40%). Angiotensin receptor blockers (77%) and calcium channel blockers (62%) were the most frequently prescribed drug classes. The burden of HDP has risen markedly over time. The number of women with HDP increased from approximately 22.8 thousand in 2005 to over 30 thousand in 2023, representing a 32% increase despite a substantial decline in total births. In 2023, HDP affected 13.2% of maternity healthcare users, comprising chronic hypertension (7.2%), pregnancy-induced hypertension (4.7%), and preeclampsia/eclampsia (2.9%).

Conclusions: South Korea continues to demonstrate high performance in hypertension management at the population level, with steady improvements in awareness, treatment, and control. Nevertheless, the rising absolute number of individuals with hypertension and the substantial, accelerating increase in HDP underscore the need for strengthened public health strategies. Targeted early detection and tailored management approaches are essential to improve cardiovascular, maternal, and fetal health outcomes.

Background: The clinical implications of arterial stiffness in relation to hypertension remain unclear in patients undergoing percutaneous coronary intervention (PCI). This study aimed to determine whether the arterial stiffness index provides additional prognostic information regarding hypertension-related risks in this population.

Methods: Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV) in 3,930 PCI patients before discharge. The primary outcome was net adverse clinical events (NACE), a composite of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke) and major bleeding over 4 years. The patients were categorized into four groups based on hypertensive status and baPWV phenotype (< 1,891 vs. ≥ 1,891 cm/s).

Results: Compared to hypertensive status, the baPWV phenotype showed a stronger association with clinical outcomes. Hypertensive status and baPWV phenotype showed an additive effect on risk stratification. The highest incidence rates of clinical events were observed in the hypertensives with high baPWV, followed by the normotensives with high baPWV, hypertensives with low baPWV, and normotensives with low baPWV groups. Specifically, the 4-year incidence of NACE was 14.8%, 12.4%, 7.1%, and 6.0%, respectively, and the corresponding incidences of MACCE were 12.7%, 9.5%, 6.2%, and 5.2%, respectively. The hypertensives with high baPWV group exhibited significantly higher risks for NACE (adjusted hazard ratio [aHR], 1.556; 95% confidence interval [CI], 1.132-2.138; P = 0.006), MACCE (aHR, 1.573; 95% CI, 1.113-2.223; P = 0.010), and major bleeding (aHR, 2.023; 95% CI, 1.029-3.978; P = 0.041) compared with the normotensive with low baPWV group. Findings were consistent across subgroups for NACE without significant interactions.

Conclusions: Arterial stiffness exhibited additive prognostic implications in patients undergoing PCI. The combined use of the baPWV and hypertension phenotype may enhance post-PCI risk stratification for clinical events.

Trial registration: ClinicalTrials.gov Identifier: NCT04650529.

Background: Previous studies have demonstrated an association between left ventricular (LV) phenotypes assessed by echocardiography and clinical outcomes in patients with hypertensive heart disease (HHD). However, data evaluating LV phenotypes using cardiac magnetic resonance (CMR)-the reference standard for quantification of LV volume, mass, and function-remain limited. This study aimed to assess the prognostic value of CMR-derived LV phenotypes in patients with HHD.

Methods: We included 756 consecutive patients with hypertension who were referred for clinically indicated CMR at an academic hospital in Thailand between 2011 and 2019. Four LV phenotypes were defined using LV mass index (LVMI), LV mass-to-volume ratio, and LV end-diastolic volume index (LVEDVI). Patients were followed for major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and stroke.

Results: The mean age was 70 ± 10 years, and 47% of patients were male. At baseline, 42.3% had controlled blood pressure, 37.0% had grade 1 hypertension, and 20.7% had grade 2-3 hypertension. The mean LVEF was 70.9 ± 9.7%. Over a median follow-up of 7.1 years (interquartile range 4.1-9.2), 153 MACE occurred. Annualized MACE rates were highest in patients with eccentric hypertrophy (5.8 per 100 patient-years), followed by concentric hypertrophy (3.5), concentric remodeling (2.7), and normal geometry (1.5). After multivariable adjustment, concentric remodeling (adjusted hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.30-3.81; P = 0.004), concentric hypertrophy (adjusted HR, 2.81; 95% CI, 1.77-4.46; P < 0.001), and eccentric hypertrophy (adjusted HR, 2.40; 95% CI, 1.40-4.14; P = 0.002) remained independently associated with MACE. In addition, the combined inclusion of LVEDVI and LVMI, as well as LV phenotypes, provided incremental prognostic value beyond the baseline model (incremental χ² = 23.29, P < 0.001 and 23.60, P < 0.001, respectively).

Conclusions: CMR-based LV phenotyping was associated with prognosis in patients with HHD, with abnormal LV phenotypes demonstrating higher risks of MACE compared with normal geometry. These findings indicate that CMR may have a complementary role in risk assessment among patients with hypertension.

Background: Inflammation plays a key role in pathophysiology of hypertension; however the relevance of specific inflammatory mediators, such as C-reactive protein (CRP) is uncertain. We conducted a systematic literature review and meta-analysis to assess the associations between CRP levels and 24-hour blood pressure (BP) values in adult patients.

Methods: We performed a systematic search of PubMed/MEDLINE, Embase, Web of Science, and Scopus for human studies published between January 2013 and June 2023. We included cross-sectional and cohort studies. We excluded studies reporting clinically significant inflammation. We calculated the Pearson's correlation coefficients between 24-hour BP indices and the CRP levels weighted by the inverse of their variances.

Results: Of 716 reports identified, 20 met eligibility criteria (10,799 participants, mean age ± standard deviation [SD] 56.1 ± 9.5 years, mean ± SD 24-hour systolic BP [SBP] 132.2 ± 14.3 mmHg, and diastolic BP [DBP] 79.3 ± 9.8 mmHg). CRP ranged from 0.14 to 10.6 mg/L, median 2.66 mg/L (interquartile range, 1.13-5.13 mg/L). In the subgroup of studies where CRP levels were ≥ 3 mg/L, a significant positive association between CRP and average 24-hour SBP (r = 0.79, P < 0.001) and DBP (r = 0.83, P < 0.001) was observed. When all studies were analyzed however, there was no correlation between CRP and neither 24-hour SBP (r = 0.18, P = 0.29), nor DBP (r = 0.27, P = 0.94).

Conclusions: CRP may be an important biomarker of the relationship between inflammation and hypertension. However, the relation may not be linear throughout the entire range of CRP values.

Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42023462606.

Background: Heart failure associated with renal artery stenosis (RAS) and Pickering syndrome, characterized by recurrent flash pulmonary oedema (FPE) in the setting of bilateral RAS or unilateral stenosis in a solitary kidney, represent 2 severe forms of renovascular disease. Despite their clinical significance, the role of endovascular treatment is still debated due to inconsistent findings from randomized trials.

Methods: This study combines a case series of patients with Pickering syndrome undergoing percutaneous transluminal renal angioplasty (PTRA) with a meta-analysis evaluating the efficacy of endovascular treatment in patients with atherosclerotic RAS and heart failure. The meta-analysis included studies comparing endovascular intervention plus medical therapy against medical therapy alone.

Results: In the case series, all patients experienced significant improvement in blood pressure (BP) control, reduction in pulmonary congestion, and stabilization of renal function following PTRA. The meta-analysis demonstrated a significant reduction in systolic BP (-11.73 mmHg, 95% confidence interval, -22.97, -0.48) in patients with heart failure undergoing PTRA, while no significant benefit was observed in those without heart failure.

Conclusions: Our findings suggest that endovascular therapy is beneficial in selected patients with RAS, particularly in those with recurrent FPE or heart failure. Future research should refine patient selection criteria to improve outcomes and reconsider the role of revascularization in high-risk subgroups.

Background: Adherence to guidelines for hypertension-mediated organ damage (HMOD) assessment has not been extensively studied. We aimed to evaluate guideline adherence to HMOD assessment and to identify factors associated with this adherence.

Methods: In this prospective, multicenter observational study conducted from May 2013 to December 2022, we evaluated adherence to guideline-recommended HMOD screening among 2,070 hypertensive patients enrolled from 24 tertiary care centers in Korea. Patients were categorized as either newly treated or on treatment. The basic screening tests included urine albumin-to-creatinine ratio (UACR), electrocardiography (ECG), and glomerular filtration rate (GFR). The extended screening tests included echocardiography, carotid ultrasonography, fundoscopic examination, ankle-brachial index measurement, and brachial-ankle pulse wave velocity assessment.

Results: The overall adherence rate for basic screening was 68.4%. Compliance with GFR and ECG assessments was high (90.3% and 95.2%, respectively), whereas adherence to UACR testing was lower (72.5%). The adherence rate for basic screening was significantly lower in the on-treatment group compared with the newly treated group (57.1% vs. 79.9%). Elderly patients (≥ 60 years) exhibited the lowest adherence to basic screening. Further analyses revealed that increasing age was significantly associated with a lower likelihood of completing both basic and extended screenings.

Conclusions: Guideline-recommended HMOD screening remains underutilized in routine clinical practice, particularly among elderly patients. These findings underscore the need to improve adherence to HMOD screening.

Trial registration: ClinicalTrials.gov Identifier: NCT01861080.

Background: An elevated resting heart rate (RHR) increases the risk of chronic kidney disease (CKD), but the relationship between longitudinal patterns of RHR and the risk of CKD in hypertensive patients is unclear. We aimed to explore the association between RHR trajectories and incident CKD in hypertensive patients.

Methods: A total of 21,509 hypertensive participants from the Kailuan cohort who were free of CKD and cardiovascular disease before 2010 were included. The RHR trajectories were developed using latent mixture modeling based on examination data in 2006, 2008, and 2010. Cox proportional hazards regression models were established to evaluate the association between RHR trajectories and risk of incident CKD.

Results: We identified 4 RHR trajectories in participants with hypertension between 2006 and 2010: low-stable group (n = 2,465 [11.46%], mean RHR range, 63.33-65.06 beats/min); moderate low-stable group (n = 15,610 [72.57%], mean RHR range, 73.09-74.32 beats/min); moderate high-stable group (n = 3,158 [14.68%], mean RHR range, 84.32-85.43 beats/min,) and elevated-stable group (n = 276 [1.28%], mean RHR range, 99.63-100.74 beats/min). During an average follow-up of 7.93 years, 2,769 cases of CKD were identified. Compared with the moderate low-stable group, adjusted hazard ratios for CKD were 1.15 (95% confidence interval [CI], 1.03-1.29) for the low-stable group, 1.22 (95% CI, 1.10-1.37) for the moderate high-stable group, and 1.54 (95% CI, 1.13-2.09) for the elevated-stable group.

Conclusions: RHR trajectories were associated with the risks of CKD in patients with hypertension.

Background: There is limited evidence regarding the incidence and prognosis of apparent resistant hypertension (aRHT) in hypertensive patients. This study aimed to estimate the incidence of aRHT and assess the risk of cardiovascular and kidney complications in patients with aRHT compared to those without aRHT, using a multi-state analysis.

Methods: This retrospective cohort study utilized real-world data from hypertensive patients treated at Ramathibodi Hospital, Bangkok, Thailand, between January 2010 and June 2024. aRHT was defined as having uncontrolled blood pressure (BP), while using ≥ 3 antihypertensive medications or having controlled BP with using ≥ 4 antihypertensive medications. The outcomes of interest were cardiovascular and kidney complications including coronary artery disease (CAD), stroke, heart failure (HF), and chronic kidney disease (CKD), and all-cause mortality. A multi-state analysis was applied to estimate the risk of disease progression from hypertension without complications to aRHT, CAD, stroke, HF, CKD, and all-cause death. Kaplan-Meier estimates with a clock-reset approach were used to calculate transition probabilities for each progression. Multivariate Cox regression analysis was applied to assess the risk factors of aRHT and assess the prognosis of aRHT.

Results: Among 114,364 hypertensive patients, the incidence of aRHT was 2.61 per 100 person-years (95% confidence interval [CI], 2.56-2.65). Results from multivariate Cox regression analysis found that the independent risk factors of aRHT were increasing age, males, obesity, type 2 diabetes mellitus, dyslipidemia, and having cardiovascular and kidney complications including CAD, stroke, CKD, and HF. Regarding the prognosis of aRHT, compared to non-aRHT patients, those with aRHT had significant higher risk of CAD, CKD, HF, and all-cause mortality with hazard ratios (95% CI) of 1.80 (1.56-2.08), 1.93 (1.79-2.08), 4.24 (3.54-5.08), and 2.84 (1.89-4.27), respectively.

Conclusions: The risk of aRHT was higher in hypertensive patients with cardiovascular and kidney complications compared to those without. Patients with aRHT had a worse prognosis than hypertensive patients without aRHT, as evidenced by higher risks of CAD, CKD, HF, and all-cause death.