International Journal of Hypertension最新文献

Background: Hypertension (HTN) is a leading risk factor for cardiovascular (CV) and renal morbidity and mortality, yet blood pressure (BP) control remains suboptimal worldwide. Understanding management patterns, especially among patients with coexisting Type 2 diabetes mellitus (T2DM), chronic kidney diseases (CKDs), or heart failure (HF), and assessing uncontrolled HTN burden across diverse health systems are critical to inform guideline-concordant strategies to improve care.

Methods: Cross-sectional analysis includes participants with HTN, with or without comorbid T2DM, CKD, or HF enrolled in iCaReMe Global Registry across 29 countries. Demographic and clinical characteristics, antihypertensive treatment patterns, prevalence of uncontrolled HTN (defined as SBP ≥ 130 mmHg or DBP ≥ 80 mmHg), and its associated factors were assessed.

Results: Among 23,063 participants, comorbidities included T2DM (71.4%), CKD (38.2%), and HF (14.6%). Key CV risk factors were family history of CV disease (34.3%), obesity (40.5%), and dyslipidemia (51.0%). Echocardiography (available in 28.6%) revealed left ventricular hypertrophy (LVH) in 30.6% and diastolic dysfunction in 42.4%. Overall, 88.7% were prescribed antihypertensive drugs: renin-angiotensin system (RAS) blockers (76.6%), calcium channel blockers (CCBs, 42.0%), beta-blockers (41.4%), diuretics (23.7%), with a majority (62.3%) on combination regimens. Uncontrolled HTN was prevalent in 75.4%, who were younger (59.8 vs 61.8 years) and exhibited higher burden of obesity (42.5% vs 34.6%), CKD (39.3% vs 33.1%), LVH (32.9% vs 24.8%), and treated less intensively with antihypertensives (60.2% vs 88.7%) and combinations (46.2% vs 61.8%) when compared to the controlled HTN group. Multivariate analysis confirmed independent association of non-use of RAS blockers/CCB/diuretics combinations (dual/triple therapy), obesity, and comorbid CKD, with uncontrolled HTN (OR [95% CI], 2.8 [2.44-3.18]/2.3 [1.66-3.16], 1.5 [1.38-1.65], and 1.4 [1.27-1.53], respectively, p < 0.0001).

Conclusion: This study uncovers alarming rates of uncontrolled HTN in real-world settings, exacerbated by comorbid T2DM/CKD/HF, underscoring the need to identify HTN management gaps and tailor innovative strategies to mitigate CV risk. Trial Registration: ClinicalTrials.gov identifier: NCT03549754.

Obesity-related renal dysfunction is largely attributed to hemodynamic alterations and insulin resistance. Among individuals with overweight or obesity, albuminuria has been shown to be independently and inversely associated with circulating adiponectin levels in the absence of diabetes. Accordingly, this study aimed to evaluate and quantify the independent association between obesity and the risk of kidney disease, as assessed by the presence of albuminuria in the Asian Population. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive and systematic search strategy was applied across multiple electronic databases, including PubMed, ProQuest, Taylor & Francis, and Wiley, to identify relevant studies meeting the eligibility criteria. Data synthesis and statistical analyses were carried out using Review Manager (RevMan) software Version 5.4, and the methodological rigor of the included studies was independently assessed using the Newcastle-Ottawa Scale (NOS). The pooled analysis demonstrated that obesity was significantly associated with albuminuria in the general population as well as in sex-specific subgroups. Specifically, the odds of albuminuria were higher among individuals with obesity in the overall population (OR = 1.76; 95% CI: 1.09-2.83; p = 0.02, I ² = 78%), in men (OR = 1.34; 95% CI: 1.05-1.71; p = 0.02, I ² = 63%), and in women (OR = 1.16; 95% CI: 1.05-1.28; p = 0.004, I ² = 19%). Obesity was associated with albuminuria in Asian Populations.

Objective: Sleep deprivation is associated with an increased risk of hypertension (HTN), and many individuals practice weekend catch-up sleep (WCS). However, evidence of an association between WCS and HTN in adults in the United States remains limited. This study examines this relationship using a nationally representative sample.

Methods: Data from NHANES 2017-2023 (16,268 adults aged ≥ 20 years) were analyzed. The WCS was defined as weekend sleep minus weekday sleep. Multivariate logistic regression was used to adjust for sociodemographic, lifestyle, and metabolic factors. WCS was examined as a binary (> 0 vs. ≤ 0 h), continuous, and categorical (≤ 0, 0-1, 1-2, 2-3, and ≥ 3 h) variable. Subgroup analyses were exploratory and not corrected for multiple testing.

Results: In the fully adjusted models, neither the binary nor continuous WCS duration was significantly associated with HTN (p > 0.05). Among categorical analyses, only the 0-1 h WCS group showed lower odds of HTN compared with the ≤ 0 h group (OR = 0.814, 95% CI: 0.666-0.995, p = 0.033); all other WCS categories (1-2 h, 2-3 h, and ≥ 3 h) were nonsignificant. No dose-response relationship was observed. Subgroup analyses suggested potential effect modification by sex and education, but these results are hypothesis-generating given the lack of correction for multiple comparisons.

Conclusion: In this large cross-sectional study, the WCS was not robustly associated with HTN. The isolated finding of 0-1 h of WCS requires confirmation in prospective studies and should not be interpreted as evidence for a preventive or therapeutic strategy.

Hypertension (HT) is associated with vascular dysfunction, chronic low-grade inflammation, and increased arterial stiffness, all of which contribute to elevated cardiovascular risk. Lifestyle-based interventions incorporating nutritional and exercise strategies may provide complementary vascular benefits. This study investigated the effects of chicken protein hydrolysate supplementation, administered alone or combined with concurrent training (CT), on arterial stiffness, blood pressure (BP), inflammatory markers, and physical fitness in adults with HT. In this randomized controlled trial, adults with HT who completed the study were included in the analysis: control (CON, n = 12), chicken protein hydrolysate supplementation alone (PRO, n = 10; 28 g/day), and supplementation combined with CT (PRO + CT, n = 12) following the 8-week intervention. BP, brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hs-CRP), and physical fitness outcomes-including peak oxygen consumption (V̇O₂peak) and upper- and lower-body muscular endurance-were assessed at baseline and postintervention. Significant group × time interactions were observed for baPWV (p < 0.01), hs-CRP (p < 0.01), V̇O₂peak (p < 0.01), and upper- and lower-body muscular endurance (p < 0.01). Both PRO and PRO + CT demonstrated greater reductions in baPWV compared with CON (p < 0.05). Significant reductions in hs-CRP were observed in both PRO and PRO + CT groups (p < 0.01); however, only PRO + CT demonstrated a significantly greater reduction compared with CON (p < 0.05). Improvements in V̇O₂peak and muscular endurance occurred exclusively in the PRO + CT group (p < 0.01), whereas changes in BP were modest across intervention groups. Chicken protein hydrolysate supplementation, particularly when combined with CT, was associated with improvements in arterial stiffness, while the combined intervention further improved inflammatory status and physical fitness outcomes. These findings suggest a potential role for combined nutritional and exercise-based lifestyle interventions in improving vascular function in adults with HT. Trial Registration: Thai Clinical Trials Registry: TCTR20251210008.

Introduction: Childhood-onset systemic lupus erythematosus (cSLE) primarily affects children and adolescents and is a potentially life-threatening condition. In contrast to adult-onset SLE, children with cSLE tend to have a more severe and aggressive course of disease. One of the most prevalent and concerning comorbidities in SLE patients is hypertension (HTN). This study evaluates diverse aspects of HTN in pediatric patients afflicted with cSLE at a tertiary hospital.

Method: This historical study includes medical records of all patients with cSLE referred to Children's Medical Hospital for two years (2020-2022). Data were collected on various clinical features and laboratory findings and were analyzed by SPSS software.

Results: A total of 76 patients with cSLE were included, of whom 59.2% had lupus nephritis at diagnosis. Forty-one patients (53.9%) had normal blood pressure, while 35 patients (46.1%) were diagnosed with HTN. Although the mean age of the HTN group was higher than that of the non-HTN group, the difference, however, was not statistically significant (p value = 0.548). Similarly, the gender distribution between the HTN and non-HTN groups was not significantly different (p value = 0.350), suggesting that neither age nor sex is a major determinant of HTN in this population. Significant differences were observed between the HTN and non-HTN groups in hemoglobin, hematocrit, polymorphonuclear cell count, complement Component 3, creatinine, blood urea nitrogen, sodium, and calcium levels.

Conclusion: Laboratory changes associated with increased disease activity, including lower C3 levels, lower hemoglobin, and higher BUN and Cr were reported in cSLE patients with HTN. Given the high prevalence of HTN among cSLE patients, early diagnosis and treatment of HTN and renal involvement are crucial in the long-term outcomes of these patients.

Background: Hypertension is a leading modifiable contributor to cardiovascular disease. We developed and evaluated machine learning models to predict incident hypertension in Australian men using baseline survey data linked to pharmaceutical (PBS) and healthcare utilisation (MBS) administrative records from the Ten to Men cohort.

Methods: Among 13,519 men free of hypertension at baseline (2014), incident hypertension over 10 years was ascertained from PBS antihypertensive dispensing. Twenty-five baseline features spanning sociodemographic, anthropometric, lifestyle, clinical and administrative domains were used to train logistic regression, random forest, gradient boosting and XGBoost models, evaluated by five-fold cross-validation with out-of-fold prediction. Discrimination, calibration and threshold-based operating characteristics were reported with 95% confidence intervals.

Results: Incident hypertension occurred in 1310 men (9.7%). All algorithms achieved comparable discrimination (AUROC ≈ 0.77; XGBoost 0.771, 95% CI: 0.756-0.784), with no material advantage for flexible tree-based methods over regularised logistic regression. Age, administrative markers of healthcare engagement and BMI were the leading predictors, and a parsimonious six-variable model recovered almost all the discrimination of the full model. The model showed high negative predictive and low positive predictive values across decision thresholds, consistent with the 9.7% event rate. Incorporating measured blood pressure history from intervening waves increased apparent discrimination, but this gain was attributable to information contemporaneous with the outcome and is reported only as a concurrent surveillance benchmark.

Conclusions: Routinely collected survey and administrative data can identify Australian men at low risk of incident hypertension with high negative predictive value, supporting population-level risk stratification rather than individual diagnosis. Predictive performance was driven by feature availability and quality rather than algorithm choice.

Objective: Blood pressure (BP) variability provides prognostic information beyond mean BP. However, the class-specific associations of antihypertensive medications with BP variability remain uncertain, and few studies have directly contrasted home and office BP variability within the same patients while accounting for the white-coat effect.

Methods: In a multicenter prospective registry, patients with hypertension and adequate measurements (≥ 10 home and ≥ 5 office readings) were analyzed. The primary outcomes were systolic and diastolic average real variability (ARV) of home and office BP. Associations of renin-angiotensin system inhibitors, beta-blockers, dihydropyridine calcium channel blockers (DHP-CCBs), and diuretics with BP variability were estimated using inverse probability of treatment weighting (IPTW) and doubly robust models. The white-coat effect was further adjusted using both a continuous office-home mean difference and a guideline-based white-coat definition. A true-monotherapy subcohort sensitivity analysis and class-by-class interaction tests were additionally performed.

Results: Among 495 participants, home ARV differed minimally by antihypertensive class; a small beta-blocker-associated increase in home systolic BP (SBP)-ARV was attenuated with additional adjustment. In contrast, office BP ARV was higher with DHP-CCBs and diuretics, although the beta-blocker association was weakened after further adjustment. Following white-coat effect adjustment, home BP ARV remained neutral across drug classes, whereas DHP-CCB remained associated with higher office SBP-ARV and diuretics with higher office diastolic BP ARV. DHP-CCBs were also associated with a lower probability of office BP control. Home BP control rates did not differ significantly by antihypertensive class.

Conclusions: In this cross-sectional observational cohort, antihypertensive medication classes showed context-dependent associations with BP variability, which were minimal for home BP but more pronounced for office BP, partially independent of the white-coat effect. Given potential residual confounding by indication, these hypothesis-generating findings warrant prospective confirmation.

Background: Self-medication is a widespread practice among individuals with chronic conditions such as hypertension. It can lead to poor blood pressure control and an increased risk of complications. However, little is known about its prevalence and associated factors among patients with hypertension in Uganda. This study aimed to determine the prevalence and associated factors of self-medication among adults with hypertension at Masaka Regional Referral Hospital (MRRH), Central Uganda.

Methods: A cross-sectional study was conducted during August and September 2024 among patients with known hypertension aged ≥ 18 years attending the MRRH Hypertension Clinic. Systematic sampling was used to recruit participants. Data were collected using a structured questionnaire, capturing sociodemographic and clinical characteristics. We defined self-medication as the use of antihypertensive medicines by individuals to treat hypertension without a formal prescription or guidance from a healthcare professional within the last 90 days before the survey. Modified Poisson regression was used to identify factors associated with self-medication.

Results: We enrolled 192 participants, with a mean age of 58 (±14) years; 143 (75%) were female. The prevalence of self-medication with antihypertensive drugs was 47% (95% confidence interval [CI] = 40%-54%). Factors associated with self-medication were low monthly income (< 2,00,000 UGX; aPR = 2.00; 95% CI: 1.04-3.86), 20 medication gap (adjusted Prevalence Ratio [aPR] = 1.46; 95% CI: 1.01-2.11), and familial influence (aPR = 1.41; 95% CI: 1.04-1.92).

Conclusion: The prevalence of self-medication among hypertensive patients at MRRH was high. Self-medication was associated with low monthly income, medication gap, and familial pressure. The findings suggest that interventions addressing financial barriers, medication availability, and family influence warrant further evaluation as potential strategies to reduce self-medication.

End-stage renal disease (ESRD) patients are particularly susceptible to hypertension, as blood pressure (BP) dysregulation leads to increased mortality and morbidity, especially considering the heightened risk of cardiovascular complications, including myocardial infarction, stroke, and congestive heart failure. Given the lack of specific guidelines on therapies aimed at achieving adequate BP control in ESRD patients, we conducted a thorough literature review to identify relevant studies and articles exploring the associations of various therapies in ESRD patients and to provide a qualitative analysis based on these results. These include ACE inhibitors, ARBs, calcium channel blockers (CCBs), beta-blockers, diuretics, alpha-2 agonists, and direct vasodilators. ARBs are not affected by dialysis, while ACE inhibitors are dialyzable. Studies suggest that the incidence of cardiovascular events is significantly lower in ESRD patients receiving treatment compared to those without treatment. CCBs are nondialyzable and, thus, serve as a second-line treatment for BP control in ESRD patients. Limited evidence suggests that diuretic-based combination therapy may improve BP control in selected hemodialysis patients, but its effect on cardiovascular mortality remains uncertain. Beta-blockers have demonstrated a favorable profile but differ in dialyzability and cardioselectivity, making it challenging to endorse an ideal choice of drug. Direct vasodilators have been shown to reduce left ventricular hypertrophy, but further studies are needed to determine optimal dosing strategies. Clonidine, an alpha-2 agonist, lacks safety and efficacy evaluations but has been shown to reduce BP in ESRD patients.