Journal of clinical hypertension (Greenwich, Conn.)最新文献

Uncontrolled hypertension is a leading cause of preventable cardiovascular mortality. Although self-measured blood pressure (SMBP) monitoring is recommended by evidence-based guidelines, adoption remains uneven in safety-net health systems. We conducted a cross-sectional analysis in an urban safety-net health system to assess factors associated with documented SMBP adoption. Using electronic health record (EHR) data from patients included in a safety-net health system's hypertension registry, we defined documented SMBP adoption as documentation of at least one patient-reported value in the EHR. We evaluated factors associated with documented SMBP adoption using sequential multivariable logistic regression and hierarchical modeling to estimate patient-, provider-, and clinic-level variation. We analyzed 15 937 patients cared for by 283 providers across 12 clinics. Twenty-six percent (4186) of patients had documented SMBP adoption. In the full model, patients aged 75 years and older [vs. 18-34 years old] (aOR 2.37, 95% CI 1.62-3.55) and those with an activated patient portal (aOR 1.36, 95% CI 1.25-1.49) were more likely to have documented SMBP adoption, while patients experiencing homelessness (aOR 0.72, 95% CI 0.60-0.87) were less likely. Substantial variation in documented SMBP adoption was observed across clinics. In the hierarchical model, 75% of the variance in documented SMBP adoption was attributable to patient-level factors, 19% to clinics, and 6% to providers. Given that nearly one-quarter of the variation in documented SMBP adoption was attributable to nonpatient factors, clinic- and provider-level workflows may be modifiable targets to improve equitable uptake and documentation of SMBP monitoring in safety-net health systems.

Health literacy and hypertension control are more limited in rural U.S. residents relative to metropolitan counterparts. Contemporary hypertension guidelines advocate for health education and home blood pressure monitoring (HBPM) to advance hypertension management. We conducted a preliminary assessment of the effect of health literacy on utilization of a virtual coaching agent, a computerized animation to converse with patient users, to promote HBPM. We recruited individuals from primary care practices in rural Pennsylvania; measured health literacy with the Brief Health Literacy Screen (BRIEF) and the Newest Vital Sign (NVS); and monitored virtual coach interactions and frequency of HBPM for 26 weeks. Participants (n = 59; age 58 ± 15 years, 59% female, 71% < bachelor's degree) had 1.03 ± 1.05 agent interactions and 5.4 ± 3.6 HBPM sessions/week over 1487 total participant-weeks. Virtual coach use was associated with greater odds of achieving the target HBPM frequency of 4 readings per week (Odds Ratio [OR] per interaction, 1.10 [95% Confidence Interval [CI]: 1.01-1.20]). This association was moderated by health literacy as measured by the BRIEF (interaction p = 0.01); with a greater magnitude among those with limited/marginal literacy (OR 1.31 per interaction, 95% CI: 1.10-1.57). NVS did not significantly moderate the association (interaction p = 0.12). In this preliminary cohort, use of a virtual coach was associated with higher adherence to HBPM in individuals with limited health literacy as measured by the BRIEF. Our results suggest that the frequency of virtual coach interactions is strongly associated with improvement in HBPM adherence among individuals with limited health literacy compared with those with adequate health literacy. Clinical Trial Registration: NCT05546931.

Oral diseases and masticatory dysfunction are more prevalent in hypertensive patients and may hinder blood pressure (BP) control during pharmacological treatment. However, the effect of the oral function on cardiovascular outcomes in patients with poorly controlled hypertension remains unclear. A total of 5 484 middle-aged and older hypertensive patients receiving antihypertensive medications without prior cardiovascular diseases (CVD) (mean age: 67.5 ± 8.0 years) were followed to investigate incident CVD. Cox proportional hazards models were used to examine associations between the baseline oral status (number of remaining teeth and denture use) and the risk of developing CVD, stratified by BP control status. Poorly controlled BP was defined as systolic BP (SBP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg. Over a mean follow-up period of 9.9 ± 2.7 years, 567 individuals (10.3%) experienced CVD events. In the poorly controlled BP group, tooth loss and non-use of dentures were significantly associated with an increased risk of CVD; the hazard ratios (95% confidence intervals) were 1.79 (1.28-2.48) for 10-19 teeth, 1.37 (0.97-1.94) for 1-9 teeth with denture use, 1.56 (1.13-2.17) for no teeth with denture use, and 2.17 (1.30-3.64) for 0-9 teeth with non-use of dentures, compared with ≥20 teeth. This association differed significantly between the poorly controlled and well-controlled BP groups (P for interaction = 0.016). In conclusion, tooth loss and non-use of dentures are associated with a higher risk of CVD among adults with poorly controlled hypertension, suggesting that BP control status under treatment modifies this association.

Carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) are widely used indicators of arterial stiffness, with cfPWV considered the gold standard and baPWV increasingly applied in Asian populations. In this community-based cohort from Beijing, we compared the associations of cfPWV and baPWV with the risk of new-onset cardiovascular events. A total of 5723 residents from the Shougang community with available cfPWV and baPWV measurements from the 2018 follow-up survey were included. CfPWV was measured using Pulsepen and baPWV using the Omron BP-203RPE III device. Cardiovascular events, defined as a composite outcome of cardiovascular death, first-ever myocardial infarction, or stroke, were identified from national and municipal registries through December 31, 2021. Over a median follow-up of 3.15 years, 173 cardiovascular events occurred. Both cfPWV and baPWV were associated with incident cardiovascular events in Kaplan-Meier analyses. However, in multivariable Cox regression models adjusting for traditional cardiovascular risk factors, cfPWV showed a nonsignificant trend (p = 0.072), while baPWV remained significantly associated with new-onset events (p < 0.001). These findings indicate that in this community-based population, baPWV, but not cfPWV, demonstrates a robust association with cardiovascular risk, suggesting that baPWV may serve as a more practical and effective tool for routine cardiovascular risk assessment in Asian populations.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is recommended for pre-heart failure (pre-HF) screening. However, universal NT-proBNP testing is infeasible and inefficient. We analyzed data from 4642 U.S. adults with hypertension in NHANES 1999-2004. Heart stress, a biomarker-defined pre-HF state, was defined using age-specific NT-proBNP cutoffs. Multivariable logistic regression was used to identify factors associated with prevalent heart stress, and a point-based score was constructed. Model discrimination and calibration were internally validated using 1000 bootstrapped samples. Heart stress was present in 31% of individuals with hypertension. Factors associated with heart stress included older age, current smoking, prior coronary heart disease/myocardial infarction, higher systolic blood pressure, lower diastolic blood pressure, and reduced estimated glomerular filtration rate. The derivation model showed acceptable discrimination (AUC 0.71; 95% CI 0.70-0.73) and good calibration. An optimal cutoff of 6 points was identified using the Youden index and was internally validated (AUC 0.71; 95% CI 0.69-0.74). Model performance was consistent across race/ethnicity and body mass index subgroups, with relatively lower discrimination in females than in males (AUC 0.66 vs. 0.78). When stratified by a predicted heart stress probability threshold of 50%, individuals in the higher-probability group had higher cumulative risk of all-cause (hazard ratio 3.90; 95% CI 3.55-4.29) and cardiovascular mortality (hazard ratio 5.18; 95% CI 4.44-6.04) than those in the lower-probability group. These findings suggest that a simple model using readily obtainable clinical variables can help identify individuals with hypertension who are likely to have prevalent heart stress, offering a practical strategy to guide selective NT-proBNP testing.

This prespecified, exploratory, body mass index (BMI)-stratified analysis of the randomized, open-label EXCITE-HT study examined whether esaxerenone elicits a blood pressure (BP)-lowering effect similar to trichlormethiazide in Japanese patients with uncontrolled essential hypertension. Patients received either esaxerenone or trichlormethiazide for 12 weeks and were grouped by baseline BMI: <25 kg/m² (low) or ≥25 kg/m² (high). The primary endpoint was change in morning home systolic/diastolic BP (SBP/DBP). Among 585 patients, 157 and 135 with low BMI received esaxerenone and trichlormethiazide, respectively; in the high BMI subgroup, 138 and 155 patients received esaxerenone or trichlormethiazide. The least squares mean between-group differences (esaxerenone-trichlormethiazide) were -2.1 mmHg (95% confidence interval [-4.1, -0.1])/-0.1 mmHg (-1.2, 1.0) and -2.0 mmHg (-4.0, -0.1)/-1.0 mmHg (-2.2, 0.2) for SBP/DBP in the low and high BMI subgroups, respectively. Bedtime home and office BP showed comparable tendencies. The incidence of serum potassium <3.5 mEq/L was more common with trichlormethiazide, whereas serum potassium ≥5.5 mEq/L occurred more frequently with esaxerenone; serum potassium never reached ≥6.0 mEq/L in any subgroup. Both drugs showed transient, modest decreases in creatinine-based estimated glomerular filtration rate that stabilized by Week 12. These exploratory findings, consistent with the primary study results, suggest that esaxerenone provides effective and well-tolerated BP control regardless of baseline BMI and may lower early-morning SBP to a greater extent than trichlormethiazide.

The triglyceride glucose-body mass index (TyG-BMI) has emerged as a unique indicator of insulin resistance (IR). This study aimed to investigate the relationship between the TyG-BMI and arterial stiffness among 18,312 participants from Hebei General Hospital in China. The TyG-BMI was calculated based on serum triglycerides, fasting plasma glucose, and BMI, while arterial stiffness was estimated using the estimated pulse wave velocity (ePWV) derived from age and mean blood pressure. Multivariate regression analysis revealed that ePWV levels were significantly higher in the two highest TyG-BMI quartiles (Q3 and Q4) compared with the lowest quartile (Q1). Subgroup analysis demonstrated a consistent positive link between the TyG-BMI index and arterial stiffness (all P-interaction >0.05). Furthermore, ROC curve analysis and non-linear testing indicated that the risk of arterial stiffness remained relatively stable until the TyG-BMI reached approximately 175, after which it rose sharply (P for non-linearity <0.001). These findings suggest that the TyG-BMI index is independently and positively associated with arterial stiffness, serving as a reliable and cost-effective surrogate marker for identifying individuals at high risk in clinical settings.

This study aimed to describe joint longitudinal patterns of SBP and modified Life's Essential 8 (LE8) and to further investigate their associations with risks of gastrointestinal cancer and all-cause mortality in the Kailuan Study. Since systolic blood pressure (SBP) was used to assess the dual-trajectories, modified LE8 score was calculated as the average of 7 component score after excluding blood pressure. A group-based dual-trajectories model was used to characterize joint longitudinal patterns of SBP and modified LE8 using data from 2006/2007 to 2014/2015 survey. Multivariable Cox proportional hazards regression models were used to assess associations of dual-trajectories patterns with risks of gastrointestinal cancer and all-cause mortality (hazard ratio, HR and 95% confidence interval, 95% CI). A total of 48,596 participants were included in the current analysis, and five dual-trajectories groups were identified. Compared with group 3, group 2 had the highest risk of gastrointestinal cancer (HR, 1.64; 95% CI, 1.17-2.29), followed by group 4 and group 5, whereas group 1 had the lowest risk of gastrointestinal cancer (HR, 1.09; 95% CI, 0.78-1.51). Similar results were observed for associations between dual-trajectories of SBP and modified LE8 and all-cause mortality. This study found joint longitudinal patterns of SBP and modified LE8 and revealed their associations with the risks of gastrointestinal cancer and all-cause mortality. The findings suggest that individuals with lower modified LE8 scores had higher risks of gastrointestinal cancer and all-cause mortality even at similar SBP levels, underscoring the importance of comprehensive cardiovascular health for risk stratification and prevention.

Adrenal venous sampling (AVS) is the gold standard for identifying aldosterone-producing adenoma and bilateral adrenal hyperplasia. This study reports the success rate of AVS and the distribution characteristics of the right adrenal vein orifice (RAVO). The data of 166 patients with primary hyperaldosteronism who underwent AVS in Fuwai Central China Cardiovascular Hospital were retrospectively reviewed. A single experienced cardiologist with 8 years of experience in cardiovascular intervention performed AVS on the included patients and separately drew 3 mL of blood from each adrenal vein and inferior vena cava. Successful catheterization was confirmed by cortisol ratio (the ratio of the cortisol concentration of each adrenal vein to that of the peripheral vein), and the distribution characteristics of the RAVO were recorded. The success rates of right and left blood samplings were 91.0% and 94.6%, respectively. The success rate of bilateral blood samplings was 86.1%. The success of right blood samplings was higher in patients with a higher body mass index (p = 0.03). The 151 patients whose right blood samplings were successful were divided into five groups according to RAVO location. In 130 (86.1%) of the 151 patients, the RAVO was located at a level ranging from the upper segment of T11 to the lower segment of T12. Age and serum creatinine levels showed statistical significance among the five groups (p = 0.001). These findings provide a practical anatomical roadmap for operators, suggesting that focusing the initial search for the RAVO between T11 and T12, especially in younger and heavier patients, could improve cannulation efficiency and success rates.