Journal of Clinical Hypertension最新文献

{"title":"Association of Systolic Blood Pressure Time in Target Range With Cardiovascular Events Among PRECISION Participants","authors":"Neel Agarwal,&nbsp;Julie St. John,&nbsp;Vikas Sunder,&nbsp;Ashish Sarraju,&nbsp;Luke J. Laffin","doi":"10.1111/jch.70009","DOIUrl":"https://doi.org/10.1111/jch.70009","url":null,"abstract":"<p>Blood pressure (BP) is a dynamic vital sign with variability. Novel metrics that account for BP variability and longitudinal control are gaining interest, such as time in target range (TTR) assessments. TTR is the percentage of time a patient's BP is within a desired range. We sought to determine if systolic BP TTR was associated with major adverse cardiovascular events (MACE) among participants in the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial. PRECISION was a 24 081-participant cardiovascular (CV) outcomes trial comparing celecoxib, naproxen, or ibuprofen in participants with increased CV risk. Systolic BP was in the target range if it was between 110 and 130 mm Hg. TTR was determined via traditional and Rosendaal linear interpolation (RLI) methods. Participants were categorized based on TTR achieved, &lt;25%, 25%–&lt;50%, 50%–&lt;75%, or ≥75%. Hazard ratios (HR) and Kaplan–Meier survival curves were generated. Twenty thousand four hundred and eighty-seven participants had at least four BP readings available for analysis and a median follow-up of 27.6 ± 5.4 months. The cohort had a mean baseline BP of 125.2 mm Hg and a mean systolic BP of 127.5 mm Hg when accounting for all follow-up visits. A lower risk of MACE was observed among individuals with ≥75% TTR compared with those &lt;25% using the traditional (adjusted HR 0.70, 95% CI 0.52–0.95, <i>p</i> = 0.02) and RLI method (adjusted HR 0.56, 95% CI 0.43–0.75, <i>p</i> &lt; 0.001). More systolic BP TTR is associated with a lower risk of MACE among individuals in PRECISION.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 7","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Nomogram for Predicting the Probability of Postpartum Chronic Hypertension in Women With Hypertensive Disorders of Pregnancy: A Multicenter, Cross-Sectional Study","authors":"Qing Liu,&nbsp;Minghui Gong,&nbsp;Zhuolin Su,&nbsp;Huiran Xu,&nbsp;Ziwei Zhao,&nbsp;Ying Zhang,&nbsp;Yinong Jiang,&nbsp;Wei Song","doi":"10.1111/jch.70094","DOIUrl":"https://doi.org/10.1111/jch.70094","url":null,"abstract":"<p>Women with hypertensive disorders of pregnancy (HDP) have a higher risk of developing chronic hypertension (CHT) postpartum, which can lead to increased cardiovascular events. Therefore, we aimed to develop and validate a nomogram to predict the probability of CHT in HDP women by analyzing traditional characteristics and pregnancy-related indices. A total of 688 HDP women who delivered at the three designated hospitals in China, during the period of January 2011 to June 2021, were randomly divided into 70% (<i>n</i> = 482) as the training set and the remaining 30% (<i>n</i> = 206) as the validation set. Predictors for CHT were extracted to establish a nomogram based on multivariate logistic analysis of the training set. The performance of the nomogram was evaluated by an internal validation. In total, 207 (30.1%) patients developed CHT after delivery. Maternal age, highest systolic blood pressure (SBP), highest diastolic blood pressure (DBP), peak alkaline phosphatase (ALP) levels, peak uric acid (UA) levels, and urine protein during pregnancy were independent predictors of the nomogram. Area under the curve (AUC) of the training set was 0.819 (95% CI: 0.778–0.860, <i>p</i> &lt; 0.001) and 0.800 (95% CI: 0.739–0.862, <i>p</i> &lt; 0.001) in the validation set. A good consistency between the nomogram model and standard diagnostic criteria was obtained (<i>p</i> &gt; 0.05). Decision curve analysis (DCA) also showed a net benefit in the nomogram when the risk thresholds were 10%–90%. In conclusion, we developed a novel clinical nomogram to predict CHT risk in women with HDP, which was a useful and easy tool to identify high-risk individuals and performed well on internal validation.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 7","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Blood Pressure Variability, Heart Rate, and Target Organ Damage in Resistant Hypertension Patients","authors":"Xiaoxia He,&nbsp;Xiahong Chen,&nbsp;Lingyan Chen,&nbsp;Lv Huang,&nbsp;Xianhu Luo,&nbsp;Huiwen Tan","doi":"10.1111/jch.70081","DOIUrl":"https://doi.org/10.1111/jch.70081","url":null,"abstract":"<p>Resistant hypertension (RH) is characterized by uncontrolled blood pressure (BP) despite optimal antihypertensive treatment. This study investigated the clinical characteristics and target organ damage (TOD) in patients with RH, examining their relationships with BP and heart rate variability (HRV). Among 386 hypertensive patients—including those with RH, controlled hypertension, and inadequately treated hypertension—clinical data, laboratory results, and 24-h ambulatory BP monitoring were analyzed. Patients with RH showed higher body mass index, blood glucose, serum uric acid levels, and longer hypertension duration compared to other groups. Notably, in patients with uncontrolled RH, markers of TOD such as urinary albumin-creatinine ratio and pulse wave velocity measures were significantly elevated. Multivariate regression revealed that earlier onset of hypertension, elevated serum uric acid and creatinine, and increased arterial stiffness independently predicted RH. Additionally, TOD indicators were closely correlated with 24-h systolic and diastolic BP as well as HRV parameters. Increased BP variability and arterial stiffness were identified as important factors contributing to TOD, suggesting a bidirectional relationship that may hasten disease progression. These findings emphasize that RH is strongly associated with severe TOD, particularly when BP remains uncontrolled. Effective management of both BP levels and their variability is essential to reduce TOD, and further studies are needed to clarify underlying mechanisms and improve therapeutic strategies.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Blood Flow and the Retinal Microvasculature Across the Spectrum From Normal to Failing Hearts","authors":"Jia Liu,&nbsp;Chang Chen,&nbsp;Zhongping Yu,&nbsp;Xuwei Chen,&nbsp;Zihao Chen,&nbsp;Wei Li,&nbsp;Min Ye,&nbsp;Xin He,&nbsp;Jiangui He,&nbsp;Juping Liu,&nbsp;Yugang Dong,&nbsp;Jan A. Staessen,&nbsp;Chen Liu,&nbsp;Fengjuan Yao,&nbsp;Fang-Fei Wei","doi":"10.1111/jch.70087","DOIUrl":"https://doi.org/10.1111/jch.70087","url":null,"abstract":"<p>Deficiency of the myocardial microcirculation plays a role in the pathogenesis of heart failure (HF). We aimed to investigate the association of myocardial blood flow (MBF) and the retinal microvasculature with left ventricular (LV) function and its potential mediators. In healthy controls (HCs; <i>n</i> = 48), patients with cardiovascular risk factors (CVRF; <i>n</i> = 49) and patients with compensated HF (CHF; <i>n</i> = 52), we assessed LV diastolic filling pressure (<i>E</i>/<i>e</i>′), LV ejection fraction (LVEF), and global longitudinal strain (GLS) associated with MBF and the retinal arteriole-to-venule ratio (AVR), using multivariable regression models, while considering their direct contributions to LV function and the indirect contributions running via NT-proBNP. Compared with HC, CHF had lower MBF and smaller AVR (<i>p</i> ≤ 0.002). In all participants, smaller AVR was associated with higher <i>E</i>/<i>e</i>′, lower LVEF, and lower GLS (<i>p</i> ≤ 0.010). Per 1 dB × dB/s MBF reduction, <i>E</i>/<i>e</i>′ increased by 0.09, whereas LVEF and GLS decreased by 0.46% and 0.14%, respectively (<i>p</i> &lt; 0.001). The indirect contributions running via NT-proBNP were all significant (<i>p</i> &lt; 0.001) for MBF and for AVR related to GLS (<i>p</i> = 0.044) with mediation proportions of ≥29%. Across subgroups, these associations were directionally similar but lost significance given the lower sample size. Furthermore, across the spectrum of LV function, estimates of the associations of MBF with <i>E</i>/<i>e</i>′ and AVR with GLS showed a decreasing versus increasing trend (<i>p</i> ≤ 0.034). MBF and retinal microvasculature were associated with LV function and counterbalance the impaired LV function in CHF. NT-proBNP, the natural vasodilating and natriuretic hormone, contributes close to 30% of the maintenance of LV function.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Circulating Bone Morphogenetic Protein 9 and Arterial Stiffness in Hypertensive Patients","authors":"Sijin Zhang,&nbsp;Mingjie Ma,&nbsp;Ping Li,&nbsp;Siyu Yao,&nbsp;Chi Wang,&nbsp;Xiaojian Wang,&nbsp;Kunlun He,&nbsp;Hao Xue","doi":"10.1111/jch.70086","DOIUrl":"https://doi.org/10.1111/jch.70086","url":null,"abstract":"<p>Bone morphogenetic protein 9 (BMP9) plays an important role in vascular development and stability. However, the association between circulating BMP9 levels and arterial stiffness (AS) in hypertensive patients is not yet clear. This study enrolled 305 hospitalized patients with hypertension. Brachial-ankle pulse wave velocity (baPWV) was measured, with values ≥1800 cm/s indicating AS. Clinical characteristics and laboratory parameters were collected during hospitalization. Circulating BMP9 levels were measured with an ELISA kit. Multivariable linear regression and stepwise logistic regression analysis were used to assess the relationship between BMP9 and baPWV. A nomogram was constructed to predict AS in hypertensive patients and internally validated using the bootstrap method. Among 305 patients, 97 were diagnosed with AS. Multivariable linear regression analysis revealed that BMP9 was positively correlated with baPWV in hypertensive patients (<i>β</i> = 0.471, <i>p</i> &lt; 0.001). Multivariate logistic stepwise regression analysis showed that age ≥ 60 years old, diabetes mellitus, SBP ≥ 140 mmHg, and higher BMP9 levels were the independent risk factors for hypertensive patients with AS. A nomogram combining these factors showed strong predictive performance (AUC: 0.804, 95% CI: 0.7503–0.8567). The calibration plot performed a good adaptability between prediction and observation (<i>χ</i>² = 6.60, <i>p</i> = 0.359) and the decision curve analysis (DCA) demonstrated the acceptable clinical utility. The addition of BMP9 to the traditional risk model had an incremental effect on the predictive value for AS (0.765 vs. 0.804, <i>p</i> &lt; 0.01). The elevation of BMP9 is strongly related to AS in hypertensive patients. BMP9 may be a biomarker of AS in hypertension.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Radiofrequency Renal Denervation in Taiwan Based on Clinical Evidence and Regional Event Rates","authors":"Hui-Chun Huang,&nbsp;Khoa N. Cao,&nbsp;Anne M. Ryschon,&nbsp;Kee-Wong Phay,&nbsp;Tzung-Dau Wang,&nbsp;Jan B. Pietzsch","doi":"10.1111/jch.70090","DOIUrl":"https://doi.org/10.1111/jch.70090","url":null,"abstract":"<p>Radiofrequency renal denervation (RF RDN) is recognized as an adjunct therapy for hypertension. This study evaluated the cost-effectiveness of RF RDN for the Taiwanese healthcare system using results from the SPYRAL HTN-ON MED randomized, sham-controlled trial. A decision-analytic Markov model projected clinical events, costs, and quality-adjusted life-years (QALYs) for RF RDN versus standard-of-care (SoC) in an Asian population context. Clinical event risk reductions from treatment effects on office-based systolic blood pressure (oSBP) were derived from a meta-regression study of 47 hypertension trials. SPYRAL HTN-ON MED demographics and results (oSBP reduction of 4.9 mmHg against sham) were used in the base case analysis. The incremental cost-effectiveness ratio (ICER) was assessed against a willingness-to-pay (WTP) threshold of three million Taiwan dollars (TWD) per QALY gained. Compared to SoC, RF RDN was projected to reduce clinical events, with relative risks of 0.80, 0.88, and 0.74 for stroke, myocardial infarction (MI), and heart failure (HF), respectively. The incremental costs and QALYs were 216 381 TWD and 0.25, respectively, resulting in an ICER of 850 932 TWD per QALY gained. The ICER was cost-effective across a broad range of uncertainty analyses. Model-based projections adjusted for East Asian event rates suggest RF RDN may significantly reduce events, making it a cost-effective intervention in the Taiwanese healthcare system for treating uncontrolled hypertension.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Cumulative Exposure to Triglyceride and Remnant Cholesterol With the Risk of Cardiovascular Disease in Hypertensive Patients With Target LDL-C","authors":"Shuang Guo,&nbsp;Chi Wang,&nbsp;Taoyu Hu,&nbsp;Lihua Lan,&nbsp;Zhen Ge,&nbsp;Jianxiang Huang,&nbsp;Shuohua Chen,&nbsp;Shouling Wu,&nbsp;Hao Xue","doi":"10.1111/jch.70084","DOIUrl":"https://doi.org/10.1111/jch.70084","url":null,"abstract":"<p>Hypertensive patients are at high risk of cardiovascular disease (CVD) and require intensive lipids management. Triglycerides (TG) and remnant cholesterol (RC) contribute to residual risk beyond low-density lipoprotein cholesterol (LDL-C), and cumulative exposure reflects a more comprehensive assessment. However, their impact on hypertensive patients with target LDL-C levels remains unclear. A total of 9046 hypertensive participants with target LDL-C levels who completed three health examinations (2006‒2010) were enrolled and followed until December 31, 2022. Cumulative burden was calculated as the average level multiplied by the interval between assessments. The primary outcome included a composite of CVD events (myocardial infarction [MI], ischemic stroke [IS], and hemorrhage stroke [HS]). Participants were categorized into four groups according to cumulative triglyceride (cumTG) (≥5.66 vs. &lt;5.66 [median, mmol/L]) and cumulative RC (cumRC) (≥4.20 vs. &lt;4.20 [median, mmol/L]): low cumTG and low cumRC, high cumTG and low cumRC, low cumTG and high cumRC, and high cumTG and high cumRC. Cox models were used to calculate the hazard ratio (HR) and 95% confidence intervals (CI) between the cumulative burden and CVD risk. During a median follow-up of 15.97 years, 1415 participants developed CVD. After multivariable adjustment, compared to the low cumTG/low cumRC group, CVD risk was higher in the high cumTG/high cumRC (HR 1.43, 95% CI 1.24‒1.64) and low cumTG/high cumRC groups (HR 1.24, 95% CI 1.05–1.47), but not in the high cumTG/low cumRC group (HR 1.06, 95% CI 0.89–1.25). In hypertensive patients with target LDL-C levels, high cumRC, rather than cumTG, is associated with an increased risk of CVD.</p><p><b>Trial Registration</b>: ChiCTR-TNC-11001489</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Levels of Angiotensinogen, Sex Hormones, and Hormone Therapy—The Multi-Ethnic Study of Atherosclerosis (MESA)","authors":"Karita C. F. Lidani,&nbsp;Patrick J. Trainor,&nbsp;Robert Buscaglia,&nbsp;Kristoff Foster,&nbsp;Sophia Jaramillo,&nbsp;Kirolos Michael,&nbsp;Alexander P. Landry,&nbsp;Erin D. Michos,&nbsp;Pamela Ouyang,&nbsp;Erin S. Morgan,&nbsp;Sotirios Tsimikas,&nbsp;Andrew P. DeFilippis","doi":"10.1111/jch.70083","DOIUrl":"https://doi.org/10.1111/jch.70083","url":null,"abstract":"<p>Angiotensinogen, the unique precursor of all angiotensin hormones of the renin-angiotensin-aldosterone system (RAAS), is now a potential target in a novel pharmacological approach to hypertension. Investigating the factors that influence angiotensinogen levels, including sex hormones, may have important therapeutic implications. Plasma angiotensinogen and sex hormones levels were measured in 5171 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Linear models were employed to determine the associations of angiotensinogen with sex hormones. Angiotensinogen levels were significantly higher in postmenopausal women receiving hormone therapy (HT, <i>n</i> = 760) compared to women not receiving HT (<i>n</i> = 1675) and in men (<i>n</i> = 2736). A positive association was present between angiotensinogen and estrogen levels that differed in magnitude between sexes and by HT status among postmenopausal women (women on HT: <i>r</i> = 0.44, <i>p</i> &lt; 0.0001; women not on HT: <i>r</i> = 0.09, <i>p</i> = 0.0002; and men: <i>r</i> = 0.07, <i>p</i> = 0.0003). The type of HT formulation (estrogen or estrogen/progesterone) and its duration of use did not significantly affect angiotensinogen levels. This study suggests a significant role of sex, estrogen, and HT in the pathophysiology of angiotensinogen, which is important given the development and testing of angiotensinogen-targeting therapeutics.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Accuracy of Unattended Automated Blood Pressure Measurements and Control of Blood Pressure Thresholds: A Multicenter Cross-Sectional Study","authors":"Shijie Yang,&nbsp;Zhanyang Zhou,&nbsp;Huanhuan Miao,&nbsp;Zhen Yin,&nbsp;Xiaochun Duan,&nbsp;Yuqing Zhang","doi":"10.1111/jch.70070","DOIUrl":"https://doi.org/10.1111/jch.70070","url":null,"abstract":"<p>Accurate blood pressure measurement is fundamental for the diagnosis and management of hypertension. The emergence of u-AOBP has been proposed as a potential alternative or complementary approach for assessing patients’ blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. The study involved participants recruited from October 2023 to February 2024 at three different hospitals. Participants were provided with comprehensive study information, and informed consent was obtained. Standardized, validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-h ambulatory blood pressure monitoring. The optimal cutoff values for diagnosing elevated blood pressure using u—AOBP, determined by ROC curve analysis with the awake ambulatory blood pressure threshold of 135/85 mmHg as the gold standard, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%). In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (<i>p</i> &gt; 0.05). In conclusion, unattended automated office blood pressure measurement with the optimal cut-off values for diagnosing elevated blood pressure being 130.75/83.75 mmHg, and in the population with a normal dipper circadian rhythm, the standardized u-AOBP values can be equivalent to standard office blood pressure, but the low specificity of u-AOBP may affect the accuracy of identifying nonhypertensive individuals.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Variation in Adherence to Diagnostic Guidelines in Hypertension Management in Swedish Primary Healthcare","authors":"Mikko Hellgren,&nbsp;Kristina Bengtsson Boström,&nbsp;Katarina Hedin,&nbsp;Stefan Jansson,&nbsp;Staffan Nilsson,&nbsp;Gunnar Nilsson,&nbsp;Per Wändell,&nbsp;Patrik Wennberg","doi":"10.1111/jch.70079","DOIUrl":"https://doi.org/10.1111/jch.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>High blood pressure (BP) is a frequent cause for visits to primary healthcare centers (PHCCs) in Sweden. Guidelines on methods for BP measurements for diagnosis of hypertension have recently been updated. We aimed to study adherence to diagnostic guidelines in hypertension management and evaluate whether adherence to guidelines was related to organizational or sociodemographic characteristics. Interviews with representatives from 76 randomly selected PHCCs from eight regions in Sweden were conducted. PHCCs’ use of 24-h ambulatory BP monitoring (ABPM), home BP monitoring (HBPM) and BP measurements in both arms for the diagnosis of hypertension were chosen as proxy markers for adherence to diagnostic guidelines. An adherence index was created as a composite score of these diagnostic methods. The proportion of PHCCs stating they “often use” ABPM and HBPM were 13.7% and 16.0%, respectively, and 57.3% stated they performed BP measurements in both arms. Two PHCCs did not use ABPM, HBPM or BP measurements in both arms to diagnose hypertension. None of the organizational or sociodemographic characteristics (number of listed patients, Care Need Index (CNI), geographical location, ownership, investigation primarily led by doctor/nurse, dedicated team management, special training for hypertension and local routines) were associated with the adherence index. This study shows that adherence to diagnostic guidelines vary largely between PHCCs. No organizational characteristic, not even team-based management, was associated with adherence to diagnostic guidelines. The variation raises questions about inequity healthcare and novel strategies that may be needed to improve PHCCs’ adherence to diagnostic guidelines in hypertension management. Trial Registration: ClinicalTrials.gov identifier: 263351 [www.researchweb.org]</p>\u0000 </section>\u0000 </div>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}