Journal of Clinical Hypertension最新文献

{"title":"Letter to the Editor: Influenza Vaccination and Short-Term Risk of Stroke Among Elderly Patients With Chronic Comorbidities in a Population-Based Cohort Study","authors":"Laiba Khan,&nbsp;Syeda Zuha Sami","doi":"10.1111/jch.70157","DOIUrl":"10.1111/jch.70157","url":null,"abstract":"<p>To the Editor,</p><p>We read with great interest the article “Influenza vaccination and short-term risk of stroke among elderly patients with chronic comorbidities in a population-based cohort study ”by Wang et al. [<span>1</span>]. While this study shed light on valuable clinical and stroke outcomes of influenza vaccination in a Shanghai Cohort, a few additional elements could have strengthened the article's robustness.</p><p>First, the vaccination rate in this cohort was very low (1.25%–1.55%), resulting in only 786 and 589 vaccinated participants in the 2017–2018 and 2018–2019 influenza seasons, respectively. Within these small subgroups, merely 5 and 7 stroke events occurred. Such sparse outcomes render hazard ratio estimates unstable and associated confidence intervals wide, raising concerns about the robustness of the findings [<span>2, 3</span>].</p><p>Additionally, despite the application of multivariable adjustment and propensity score matching, residual confounding is highly likely. Vaccinated participants differed significantly from their unvaccinated counterparts—they were younger, more often male, more likely to smoke or drink, more frequently hypertensive, and less often diabetic [<span>4</span>]. Furthermore, important covariates such as medication use (antiplatelets, anticoagulants, antihypertensives, statins), stroke subtype (ischemic vs. hemorrhagic), and prior influenza infection history were not available. These unmeasured factors may strongly bias effect estimates [<span>5</span>].</p><p>Thirdly, the exposure definition—vaccination at any time between August and March—does not account for temporal variation in influenza circulation and risk periods [<span>6</span>]. The use of Poisson regression as a sensitivity analysis is also problematic, as extremely low event counts may artificially inflate effect sizes. Additionally, the BMI categories applied do not align with population-specific Chinese cutoffs, which could lead to misclassification [<span>7</span>].</p><p>In light of these limitations, the impressive reduction in stroke risk reported should be interpreted with caution. While the hypothesis that influenza vaccination may confer cardiovascular protection is biologically plausible and of great clinical relevance, more definitive evidence will require larger, multicenter cohorts with longer follow-up, precise stroke classification, and comprehensive adjustment for potential confounders.</p><p>We appreciate the authors’ contribution and hope that these observations will help guide future investigations in this important area.</p><p>In conclusion, I commend the authors for their significant work and recommend that further studies consider these limitations. Doing so would help enhance the strength, consistency, and clinical applicability of the findings.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139999","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":"Parent Needs, Recommendations, and Systemic Challenges Affecting Pediatric Hypertension Detection","authors":"Abbas H. Zaidi,&nbsp;Erica Sood,&nbsp;Sarah De Ferranti,&nbsp;Samuel Gidding,&nbsp;Varsha Zadokar,&nbsp;Jonathan Miller,&nbsp;Anne Kazak","doi":"10.1111/jch.70152","DOIUrl":"10.1111/jch.70152","url":null,"abstract":"<p>Pediatric hypertension (HTN) affects 3%–5% of children in the United States, yet only 25% are diagnosed and 60% lack recommended follow-up care. Skepticism about elevated blood pressure (BP) readings and reluctance to use antihypertensive medications by parents and clinicians highlight the need for stakeholder-informed strategies to address these challenges. This study examined parents’ perceived needs, their recommended strategies to improve HTN detection, and contextual health system challenges. Parents and clinicians from 10 pediatric primary care clinics participated in semi-structured qualitative interviews. Only parents of children with documented stage 2 BP readings and a HTN diagnosis, but with gaps in care of 1 year or longer, were included. Participants were recruited from clinics in diverse communities. Thematic analysis identified major themes and recommendations guided by the Consolidated Framework for Implementation Research (CFIR). A total of 38 stakeholders participated, including 13 parents and 25 healthcare clinicians. Parents reported limited discussions in the clinic around pediatric HTN, logistical barriers related to social determinants of health, including financial burdens and insurance issues, and scheduling conflicts. Clinicians cited systemic constraints such as time limitations, staffing shortages, and insufficient resources to address social determinants of health-related needs. Parents recommended strategies, including enhanced education on pediatric HTN, flexible scheduling, telehealth, remote BP monitoring, and improved care coordination, to overcome barriers and align with systemic improvements. Parent-recommended strategies can address pediatric HTN detection challenges. However, aligning these strategies with systemic constraints is essential for effective, stakeholder-informed improvements in HTN detection.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133422","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":"Effect of Ramadan Fasting on Blood Pressure and Kidney Functions in Newly Diagnosed Hypertensive Patients: A Study in Konya, Turkey","authors":"Hüseyin Tezcan,&nbsp;Zafer Büyükterzi","doi":"10.1111/jch.70159","DOIUrl":"10.1111/jch.70159","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We sincerely thank Dr. Kalcik and colleagues for their thoughtful comments on our article, “Effect of Ramadan Fasting on Blood Pressure and Kidney Functions in Newly Diagnosed Hypertensive Patients: A Study in Konya, Turkey.” In that retrospective, single-center study of newly diagnosed hypertensive adults uniformly initiated on an ACEI/ARB plus hydrochlorothiazide regimen, we examined short-term (1-month) blood pressure trajectories and renal safety during Ramadan [&lt;span&gt;1&lt;/span&gt;]. We are encouraged that our findings—similar to end-of-month blood pressures between fasting and non-fasting groups and no deterioration in creatinine or eGFR—have prompted constructive discussion. Many of the methodological considerations raised in the letter were acknowledged in our article, and we appreciate the opportunity to expand on them in this response.&lt;/p&gt;&lt;p&gt;We agree that a retrospective, single-center design limits causal inference and generalizability. As noted in our Limitations, this was a hypothesis-generating study in which we deliberately used a uniform ACEI/ARB + hydrochlorothiazide regimen to minimize treatment heterogeneity and better isolate the effect of fasting [&lt;span&gt;1&lt;/span&gt;]. The logical next step is a prospective, multicenter investigation across diverse antihypertensive classes and populations.&lt;/p&gt;&lt;p&gt;Regarding therapy class, we intentionally restricted treatment to an ACEI/ARB plus low‑dose hydrochlorothiazide to minimize pharmacologic heterogeneity and because contemporary guidelines endorse initial two‑drug combinations pairing a renin–angiotensin system blocker with either a calcium‑channel blocker or a thiazide/thiazide‑like diuretic [&lt;span&gt;2&lt;/span&gt;]. In the Ramadan context of anticipated daytime hypohydration, this design allowed us to pragmatically assess whether the thiazide component would precipitate volume‑related adverse effects or metabolic/electrolyte derangements; in our cohort, we observed neither clinically meaningful electrolyte shifts nor renal deterioration at 1 month. Prior evidence likewise suggests that diuretic‑based regimens can be well tolerated during Ramadan with appropriate monitoring [&lt;span&gt;3&lt;/span&gt;]. We agree that regimen‑specific effects warrant confirmation in prospective multicenter studies that also include CCB‑based combinations.&lt;/p&gt;&lt;p&gt;We agree that dietary sodium and hydration are key confounders [&lt;span&gt;4&lt;/span&gt;]. As explicitly noted in our Limitations (p. 5), the retrospective design precluded reliable quantification of sodium/sugar and daily fluid intake; neither structured food-frequency questionnaires nor biochemical markers such as 24-h urinary sodium were collected [&lt;span&gt;1&lt;/span&gt;]. Accordingly, we proposed that prospective studies incorporate standardized FFQs and objective measures (e.g., 24-h urinary sodium) to better isolate the independent effect of Ramadan fasting on BP and renal outcomes.&lt;/p&gt;&lt;p&gt;We fully agree and consider this the most important shortcoming of our study t","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133381","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":"Improvements in Blood Pressure Control and the Hypertension Care Continuum Over 2 Years in Urban Haiti Amidst Civil Unrest","authors":"Miranda Metz,&nbsp;Rodney Sufra,&nbsp;Anju Ogyu,&nbsp;Vanessa Rouzier,&nbsp;Reichling St. Sauveur,&nbsp;Kelly Celestin,&nbsp;Guyrlaine Forrestal,&nbsp;Fabyola Preval,&nbsp;Mirline Jean,&nbsp;Suzanne Edwidge Marcelin,&nbsp;Auguste Sarine,&nbsp;Catherine Bennett,&nbsp;Serena Koenig,&nbsp;Kenneth Jamerson,&nbsp;Jean William Pape,&nbsp;Lily D. Yan,&nbsp;Margaret L. McNairy","doi":"10.1111/jch.70153","DOIUrl":"10.1111/jch.70153","url":null,"abstract":"<p>Hypertension (HTN) is the leading cause of death worldwide, yet only 8% of individuals have controlled blood pressure (BP) in low- and middle-income countries, with particular challenges in humanitarian crisis settings including Haiti. The Haiti Cardiovascular Disease Cohort, an observational population-based cohort in Port-au-Prince, offers a unique opportunity to evaluate the HTN Care Continuum in a setting of extreme poverty and civil unrest. From 2019 to 2021, 3005 adults were enrolled, with BP measured every 6 months and free clinical care provided. HTN was defined as SBP ≥ 140, DBP ≥ 90, or antihypertensive medication use. We assessed screening, awareness, treatment, and BP control (BP &lt; 140/90 on antihypertensives) at enrollment and 24 months. Multivariable Poisson regression identified sociodemographic factors associated with BP control. Of 3005 adults, 878 had HTN at enrollment (median age 57; 62% female; 71% earned &lt; $1/day). Among 568 hypertensive participants with 24-month follow-up, awareness increased from 67% to 95%, treatment from 40% to 71%, and BP control from 11% to 32%. Median BP decreased from 150/91 to 138/82 mmHg. Across visits, 67% had ≥ 1 controlled BP and 35% had control at more than half of visits. Younger age (18–39 vs. ≥60 years) was associated with lower BP control (PR: 0.40, 95% CI: 0.18–0.77). Substantial improvements in HTN care, including a threefold rise in BP control and a mean SBP decrease of 12 mmHg, are achievable even in settings of extreme adversity and humanitarian crises.</p><p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT03892265</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133378","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":"Efficacy and Safety of Lorundrostat in Uncontrolled Hypertension: A Systematic Review and Meta-Analysis","authors":"Allah Dad,&nbsp;Kinza Bakht,&nbsp;Haris Bin Tahir,&nbsp;Muhammad Arham,&nbsp;Anika Goel,&nbsp;Malik Maaz Ahmad,&nbsp;Soban Raza,&nbsp;Syeda Hafsa Qadri,&nbsp;Diya Rathi,&nbsp;Saad Javed,&nbsp;Syed Shah Qasim Hamdani,&nbsp;Hasnan Arshad,&nbsp;F. N. U. Abubakar,&nbsp;Muhammad Nauman Awais,&nbsp;Muhammad Abdullah Nizam","doi":"10.1111/jch.70155","DOIUrl":"10.1111/jch.70155","url":null,"abstract":"<p>This systematic review and meta-analysis evaluated the efficacy and safety of lorundrostat in adults with uncontrolled hypertension. Following PRISMA guidelines and PROSPERO registration (CRD420251088503), five databases were systematically searched through July 2025 for randomized controlled trials comparing lorundrostat with placebo in this population. The primary outcome was change in systolic blood pressure (SBP), while secondary outcomes included diastolic blood pressure, severe BP events, and adverse effects. Three RCTs comprising 1568 participants across 10 study arms were included. Lorundrostat significantly reduced 24-h ambulatory SBP (mean difference [MD]: –7.45 mmHg; 95% CI: −12.54 to −2.36; <i>p</i> = 0.0041; <i>p</i>² = 0%) and diastolic BP (MD: −3.49 mmHg; 95% CI: −5.56 to −1.41; <i>p</i> = 0.0010; <i>I</i>² = 0%). While office SBP showed a non-significant reduction in the primary analysis (MD: −13.55 mmHg; <i>p</i> = 0.077; <i>I</i>² = 94%), it became statistically significant in a sensitivity analysis (MD: −9.08 mmHg; <i>p </i>&lt; 0.0001). Lorundrostat also significantly lowered the risk of severely elevated BP events (odds ratio [OR]: 0.37; 95% CI: 0.17–0.81; <i>p</i> = 0.028). Adverse effects included an increased risk of hyperkalemia (OR: 3.22; <i>p </i>&lt; 0.001) and hyponatremia (OR: 2.16; <i>p</i> = 0.037), with no significant difference in serious adverse events between groups. In conclusion, lorundrostat demonstrates significant reductions in both ambulatory and diastolic BP in patients with uncontrolled hypertension, with a generally tolerable safety profile. Hyperkalemia and hyponatremia remain notable risks. Further long-term trials are warranted to validate its sustained efficacy and safety.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133389","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":"Universal Screening for Primary Aldosteronism in Hypertensive Patients: A 2025 Taipei Positional Paper","authors":"Liang-Yu Lin,&nbsp;Yen-Hung Lin,&nbsp;Shih-Chieh Jeff Chueh,&nbsp;Chih-Fan Yeh,&nbsp;Chih-Cheng Wu,&nbsp;Hao-Min Cheng,&nbsp;Shang-Jyh Hwang,&nbsp;Feng-Hsuan Liu,&nbsp;Jun Yang,&nbsp;Vin-Cent Wu","doi":"10.1111/jch.70102","DOIUrl":"10.1111/jch.70102","url":null,"abstract":"<p>All authors conceptualized the current manuscript; L.Y. Lin, J. Yang, and V.C. Wu drafted the manuscript; all authors thoroughly revising the manuscript critically for important intellectual content and approved the submitted manuscript.</p><p>The authors have nothing to report.</p><p>No patient enrollment.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133044","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 Triglyceride–Glucose Body Mass Index With Target Organ Damage in Essential Hypertension: A Retrospective Cohort Study","authors":"Ahmed Bashir,&nbsp;Muhammad Bashir,&nbsp;Muhammad Aman Rizwan","doi":"10.1111/jch.70158","DOIUrl":"10.1111/jch.70158","url":null,"abstract":"&lt;p&gt;To the Editor,&lt;/p&gt;&lt;p&gt;We have read the article “Association of Triglyceride–Glucose Body Mass Index with Target Organ Damage in Essential Hypertension: A Retrospective Cohort Study” by Huang et al. [&lt;span&gt;1&lt;/span&gt;] with great interest. We would like to acknowledge the author's rigorous work in this important area that will be appreciated by the readers. We agree with their final conclusion that TyG-BMI is a simple and inexpensive index that measures obesity and incorporates insulin resistance, and that having prognostic ability similar to traditional risk factor models may be helpful in identifying and monitoring children at risk for future poor health outcomes.&lt;/p&gt;&lt;p&gt;We do, however, think that a couple of additional points could potentially strengthen the conclusion of the article.&lt;/p&gt;&lt;p&gt;First, the method of a retrospective cohort study [&lt;span&gt;2&lt;/span&gt;] has inherent biases; we need to consider including selection bias and residual confounding. Although the authors describe that multivariable adjustments were made for baseline characteristics, it will be challenging to control for the dynamic nature of the baseline factors, like medication compliance, lifestyle changes, or clinical management over 23 months of follow-up. As with all unmeasured variables, they may have effects on both TyG-BMI and the progression of target organ damage, which limits conclusions of causation. Large-scale prospective studies of long duration need to validate these findings.&lt;/p&gt;&lt;p&gt;Second, even though Huang et al. [&lt;span&gt;1&lt;/span&gt;] used TyG-BMI as a surrogate measure for insulin resistance (IR), there are concerns over the generalizability and diagnostic accuracy of the measure. A recent systematic review concluded that the hyperinsulinemic-euglycemic clamp remains the gold standard of assessing IR. While the TyG index had variable performance across different populations, it lacks standardized cut-offs [&lt;span&gt;3&lt;/span&gt;]. The absence of the gold-standard assessment in the study prevents us from identifying the true diagnostic accuracy of the TyG-BMI. More importantly, a singular, simplified index may overlook the complexities and relationships between IR, hypertension, and the progression of target organ damage, which could limit its clinical utility across different groups of patients.&lt;/p&gt;&lt;p&gt;Third, metabolic markers, including fasting glucose and triglycerides, which are the fundamental elements of the TyG-BMI calculation, were assessed only once at baseline and do not necessarily reflect long-term changes or variation, which makes them more prone to misclassification risk. For example, one study that investigated the cardiovascular risk with longitudinal comparisons demonstrated that it is useful to repeat key measurements in people with high blood pressure [&lt;span&gt;4&lt;/span&gt;]. Future studies should attempt to compare various measurements in order to establish if there is any relationship between multiple parameters with the development of cardiovascular-related outcome","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133430","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":"Frequency of Antihypertensive Drug Classes and Single-Pill Combinations in Obese Patients: An 8-Year Retrospective Study","authors":"Beata Moczulska,&nbsp;Karolina Osowiecka,&nbsp;Leszek Gromadziński,&nbsp;Marta Majewska","doi":"10.1111/jch.70143","DOIUrl":"https://doi.org/10.1111/jch.70143","url":null,"abstract":"<p>Obesity is a major contributor to the development and progression of hypertension, and its coexistence significantly increases cardiovascular risk. Although numerous guidelines exist for the management of arterial hypertension, none are dedicated specifically to obese patients, despite their increasing prevalence. Since 2018, both European and Polish guidelines have recommended the use of single-pill combinations (SPCs) at every stage of treatment. This retrospective study aimed to evaluate antihypertensive treatment patterns over the past eight years among obese patients. This analysis was restricted to obese patients with hypertension to explore prescribing patterns in a subgroup with unique pathophysiological features and high cardiovascular risk, for which specific therapeutic recommendations remain limited. The study cohort was limited to obese patients hospitalized for preoperative assessment prior to planned bariatric surgery. We analyzed medical records of 233 obese hypertensive patients divided into two cohorts: those diagnosed before 2020 and those diagnosed in 2020 or later. We observed a significant increase in the use of three or more antihypertensive drugs and a rise in the prescription of beta-blockers and angiotensin receptor blockers after 2020. Despite these changes, the use of SPCs remained low: two-drug SPCs were used in 35.6% of patients, and three-drug SPCs in only 11.2%, with no significant increase in their use over time. Additionally, SGLT2 inhibitors were introduced into therapy after 2020. Our findings highlight the discrepancy between clinical guidelines and real-world prescribing habits. Improved adherence to treatment recommendations may enhance therapeutic outcomes and medication adherence in this high-risk group.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110935","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":"Improving the Generalizability and Risk Interpretation of Adolescent Hypertension Research: A Commentary on Loo et al.","authors":"Aisha Fatima,&nbsp;Mubashira Noor,&nbsp;Syeda Eraj Zehra Rizvi,&nbsp;Muhammad Hassan Saeed","doi":"10.1111/jch.70150","DOIUrl":"https://doi.org/10.1111/jch.70150","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We have read with interest the article ‘’Blood Pressure and Hypertension in Adolescents and Young Adults: Results From a Nationwide Screening Program ‘’by Loo et al. [&lt;span&gt;1&lt;/span&gt;]. The authors' investigation into the prevalence of hypertension among Asian adolescents and young adults in Singapore is a remarkable contribution to the existing literature. A noteworthy advancement which offers insights that can play a pivotal role in future studies and public health initiatives. However, several methodological and contextual considerations warrant discussion to strengthen the study's interpretation and applicability.&lt;/p&gt;&lt;p&gt;As the study focuses solely on a Singaporean male population, its findings, particularly regarding risk factors such as diet and environmental exposures, may reflect region-specific trends. Previous studies, such as that by Meher et al., emphasize the significant impact of dietary habits, salt intake, and alcohol consumption, and these factors are not addressed in the current study [&lt;span&gt;2&lt;/span&gt;]. Multicenter data collection would have enhanced the generalizability. The exclusion of females further limits generalizability, as blood pressure patterns are known to differ by sex. Including both genders would have yielded more representative and inclusive findings [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This study did not identify smoking as a significant factor in hypertension, which further contradicts the existing evidence, which suggests that smoking can increase the risk up to two to three folds [&lt;span&gt;4&lt;/span&gt;]. Although the author's explanation regarding limited smoking exposure due to age is understandable, interpretation of the findings should be made with caution as it might mislead. Future studies should focus on the potential long-term effects of smoking initiation at adolescence. Additionally, the study did not evaluate secondary causes (such as renal or endocrine conditions) relevant in the younger populations [&lt;span&gt;5&lt;/span&gt;]. These considerations would have provided a more comprehensive understanding of hypertension in this population and informed more effective prevention and treatment strategies.&lt;/p&gt;&lt;p&gt;Although the cross-sectional design provides a valuable snapshot in time, it does not evaluate the progression of blood pressure overtime. This limits further understanding of how early hypertension might later on progress into cardiovascular disease. Longitudinal follow-up is essential to understand whether early hypertension leads to adverse cardiovascular outcomes. Chen and Wang demonstrated that childhood blood pressure tracks into adulthood, underscoring the importance of longitudinal studies [&lt;span&gt;6&lt;/span&gt;]. Socioeconomic status and environmental factors, which significantly influence adolescent blood pressure, were not considered, introducing potential residual confounding. These factors are known to influence adolescent blood pressure and should be prioritized in future analyses [&lt;span&gt;7&lt;/span&gt;]. Add","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110894","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":"Amlodipine-Based Therapy and Its Effect on Time in Target Range and Long-Term Blood Pressure Variability Across Age Groups in Chinese Patients With Primary Hypertension: A Retrospective Study","authors":"Jinghan Yang,&nbsp;Shuling Chen,&nbsp;Dajun Chai,&nbsp;Feng Peng,&nbsp;Ningling Sun,&nbsp;Jinxiu Lin","doi":"10.1111/jch.70151","DOIUrl":"https://doi.org/10.1111/jch.70151","url":null,"abstract":"<p>This study aimed to compare systolic blood pressure (SBP) time in target range (TTR), long-term blood pressure (BP) variability (BPV), and BP control across age groups (18–45, 46–64, 65–79, ≥80 years) in patients with primary hypertension treated with amlodipine-based antihypertensive therapy for ≥12 months. Data were obtained from adult patients enrolled in the China Hypertension Center who received amlodipine-based antihypertensive therapy. Demographics, BP measurements, and laboratory results were recorded. Baseline characteristics, SBP TTR, long-term BPV, and BP control were compared among age groups. A total of 36 153 patients were included: 2681 in the 18–45 group, 14 300 in the 46–64 group, 15 595 in the 65–79 group, and 3577 in the ≥ 80 group. Younger and middle-aged patients demonstrated better indicator improvements. SBP TTR declined with age (82.52% ± 19.68%, 81.98% ± 20.69%, 79.10% ± 22.96%, and 78.33% ± 23.50%, respectively; <i>p</i> &lt; 0.001). BP control also declined with age (84.04%, 83.20%, 80.44%, and 79.59%, respectively; <i>p</i> &lt; 0.001). BPV increased with age, though not significantly (<i>p</i> = 0.051). During follow-up, SBP TTR and BP control improved, while BPV declined, with most changes reaching statistical significance. Across all age groups, SBP TTR remained above 78% throughout follow-up. Long-term continuous use of amlodipine is beneficial for achieving improved BP control, enhanced TTR, and reduced BPV.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110896","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}