Journal of Clinical Hypertension最新文献

{"title":"Trends and Disparities in Heart Failure Mortality Among Hypertensive Older Adults in the United States: A 22-Year Retrospective Study","authors":"Ahmed Raza,&nbsp;Manal Kaleem,&nbsp;Muhammad Aliyan Ahmed Shaikh,&nbsp;Fatima Mansoor,&nbsp;Muhammad Ansab,&nbsp;Mustafa Turkmani,&nbsp;Ubaid Khan","doi":"10.1111/jch.70064","DOIUrl":"https://doi.org/10.1111/jch.70064","url":null,"abstract":"<p>Hypertension (HTN) is a significant risk factor for heart failure (HF), and both significantly contribute to cardiovascular mortality. This study aims to examine trends and disparities in HF-related mortality among hypertensive older adults (≥65 years) in the United States from 1999 to 2020. Centers for Disease Control and Prevention—Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database data were analyzed, focusing on HTN as the underlying cause and HF as the contributing cause of death. Age-adjusted mortality rates (AAMRs) and crude rates were stratified by gender, race/ethnicity, age groups, urban–rural status, and geographic regions. The Joinpoint regression program was used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). A total of 259 079 HF-related deaths occurred among hypertensive older adults, with an overall AAMR increase from 11.27 in 1999 to 41.05 in 2020, indicating a clear upward trend (AAPC: 5.51%). Females had higher AAMRs (28.57) than males (25.56); however, males showed a steeper rise in mortality (AAPC: 6.15% vs. 5.23%). Non-Hispanic Blacks had the highest AAMR (43.99), while NH Whites exhibited the most significant increase (AAPC: 5.92%). Mortality rates were highest in the West (AAMR: 34.57) and lowest in the Northeast (21.44). Non-metropolitan areas had a higher AAMR than metropolitan areas (30.69 vs. 26.52). These findings emphasize the necessity for targeted interventions to diminish disparities and tackle increasing mortality rates in vulnerable populations, especially among women, NH Blacks, individuals in the West, and those living in non-metropolitan areas.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930464","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":"Gender and Age Differentials in Prevalence and Pattern of Nine Chronic Diseases Among Older Adults in India: An Analysis Based on Longitudinal Ageing Study in India","authors":"Mrigesh Bhatia,&nbsp;Laxmi Kant Dwivedi,&nbsp;Priti Maurya,&nbsp;Sameer Dawoodi,&nbsp;Waquar Ahmed,&nbsp;Somnath Jana,&nbsp;Priyanka Dixit","doi":"10.1111/jch.70069","DOIUrl":"https://doi.org/10.1111/jch.70069","url":null,"abstract":"<p>Non-communicable diseases (NCDs) account for a major portion of morbidity and mortality worldwide, with older persons being especially vulnerable due to age-related health concerns. The burden of chronic diseases among India's aging population is understudied, particularly in terms of gender and age differences. The study utilized data from the Longitudinal Ageing Study in India (LASI), wave 1 (2017–18), comprising a sample of 66,606 older adults aged 45 years and above. We performed a Mmultivariable logistic regression analysis to examine the age-gender differences in the prevalence and patterns of nine chronic diseases, namely hypertension, diabetes, cancer, chronic heart disease, stroke, psychiatric disorders, chronic lung disease, bone and joint diseases, and high cholesterol among older adults after adjusting for various socio-demographic and lifestyle factors. Compared to male respondents, female older respondents were less likely to have diabetes and stroke (in the 45–59 and 60–69 years age groups), chronic lung diseases (in the 45–59 years age group), and chronic heart diseases (in the 60–69 years age group). Conversely, in the 70 years and above age group, older female respondents had higher odds of having hypertension and bone and joint diseases compared to male respondents. The current study revealed significant gender and age-related differences in the prevalence and odds of all the nine selected diseases even adjusted for potential confounding factors. The findings highlight how urgently age- and gender-specific treatments are needed to reduce inequities in chronic diseases, boost positive health outcomes, and improve the quality of life for India's aging populations.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930501","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":"Causal Effects Between Blood Pressure Variability and Alzheimer's Disease: A Two-Sample Mendelian Randomization Study","authors":"Pingping Jia,&nbsp;Ziyu Hao,&nbsp;Karen Yiu,&nbsp;Kelvin Tsoi","doi":"10.1111/jch.70066","DOIUrl":"https://doi.org/10.1111/jch.70066","url":null,"abstract":"<p>Alzheimer's disease (AD), an escalating global public health concern, demonstrates complex pathogenesis involving both genetic predisposition and vascular components. Blood pressure variability (BPV) has been implicated in neurodegenerative diseases, but its causal relationship with AD remains unclear. This study aims to explore the causal relationship between BPV and AD by applying Mendelian randomization (MR) to genome-wide association study (GWAS) summary data. Genetic instruments were selected from BPV GWAS based on UK Biobank data, ensuring relevance and significance(<i>p</i> &lt; 5 × 10⁻⁶). Genetic estimates on exposure were obtained from three databases: The The International Genomic of Alzheimer's Project (IGAP); Maternal family history of AD from UK Biobank (MFH-UKBB), and Paternal family history of AD from UK Biobank (PFH-UKBB). Proxy SNPs were manually selected if SNPs were not available in the exposure GWAS. Data harmonization was performed to ensure consistency in effect and reference alleles. Three MR statistical methods were employed to assess causal effects, including inverse variance weighting (IVW) with random or fixed effect, MR-Egger regression, and the Weighted Median Method. Sensitivity analyses to evaluate robustness were also employed. Six SNPs associated with systolic BPV and six SNPs associated with diastolic BPV were included. Significant causal effects of SBPV on AD were found on the PFH-UKBB dataset in all four methods. The odds ratios for AD per 10-unit increment in SBPV were 1.028, 1.015, and 1.015 for MR-Egger, IVW-MR, and weighted median, respectively. In contrast, only IVW methods found significant results for DBPV in the MFH-UKBB dataset. SBPV is a possible causal risk factor for AD, while the evidence for DBPV needs further study. BPV control should be an important treatment target in preventing dementia.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930386","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":"Uric Acid Serves as a Risk Factor or Marker for Developing Hypertension According to Both Conventional and Novel Definitions: An Association or Causation!","authors":"Ugur Canpolat","doi":"10.1111/jch.70063","DOIUrl":"https://doi.org/10.1111/jch.70063","url":null,"abstract":"&lt;p&gt;In the current study, Liu et al. [&lt;span&gt;1&lt;/span&gt;] assessed the relationship between serum uric acid (SUA) levels and incident hypertension at different blood pressure (BP) cut-off levels (140/90 and 130/80 mmHg) according to recent studies and guidelines. The study involved 26 973 participants from the Taiwan Biobank (TWB), who were followed for a median of 4 years. The association of hyperuricemia and sex with incident hypertension was significant for both traditional (140/90 mmHg) and new (130/80 mmHg) definitions. They also reported a significant interaction between hyperuricemia and sex. Although confounding factors in the prediction of incident hypertension (both for traditional and new definitions) were adjusted in the analyses, patients with incident hypertension revealed a higher rate of SUA-associated several comorbidities.&lt;/p&gt;&lt;p&gt;Hypertension is known as one of the major cardiovascular disease risk factors. It has both modifiable and non-modifiable pathophysiological mechanisms. Therefore, preventing and controlling hypertension by modifying underlying mechanisms is essential for public health [&lt;span&gt;2&lt;/span&gt;]. Hyperuricemia is a well-known mediator for the development of cardiovascular diseases, including hypertension, by driving inflammation and oxidative stress [&lt;span&gt;3-5&lt;/span&gt;]. Both genetic and environmental factors influence the complex pathogenesis of hyperuricemia and its link to hypertension [&lt;span&gt;6&lt;/span&gt;]. The SUA level of &gt;7.0 mg/dL in males and &gt;6.0 mg/dL in females is defined as hyperuricemia [&lt;span&gt;7&lt;/span&gt;]. Uric acid deposition-mediated endothelial dysfunction and vascular injury typically occur at SUA levels that exceed 6.5 mg/dL. However, this threshold is significantly higher than those reported in studies linking it to hypertension and cardiovascular disease [&lt;span&gt;6&lt;/span&gt;]. Moreover, uric acid is a metabolic end product that fluctuates due to modifiable (diet, medications, etc.) and non-modifiable (genetics, age, etc.) factors. Therefore, it is unreasonable to establish a causal relationship between SUA levels and cardiovascular diseases, including hypertension, based on a single SUA measurement. Although most studies used baseline single SUA levels, it is essential to consider the temporal trends of this fluctuating variable. Kuwabara et al. [&lt;span&gt;8&lt;/span&gt;] demonstrated that hyperuricemia in asymptomatic male and female subjects without cardiac and metabolic comorbidities is an independent risk factor for hypertension within 5 years. In another study, Salim et al. [&lt;span&gt;9&lt;/span&gt;] also reported a significant association between hyperuricemia and sex with incident hypertension using different BP cut-offs (≥140/90 and ≥130/80 mmHg). Although the confounding factors or comorbidities have been adjusted before linking the SUA levels or hyperuricemia with incident hypertension in all those studies, they do not prove a direct causal relationship. Thus, there is a debate about hyperuricemia as either a causati","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930462","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":"Photoplethysmography-Derived Arterial Stiffness Index Delivered Greater Cardiovascular Prevention Value to Non-Elderly: A Retrospective Cohort Study Based on UK Biobank","authors":"Hongyu Chen,&nbsp;Fangfang Fan,&nbsp;Ziliang Ye,&nbsp;Zhe Liang,&nbsp;Xianhui Qin,&nbsp;Yan Zhang","doi":"10.1111/jch.70058","DOIUrl":"https://doi.org/10.1111/jch.70058","url":null,"abstract":"<p>Photoplethysmography-derived arterial stiffness index (ASI) has been proven to be associated with various cardiovascular diseases. The present study aims to determine whether the predictive value of ASI varies between elderly and non-elderly and whether ASI improves the discrimination and reclassification ability of the updated Systematic Coronary Risk Evaluation (SCORE2) in different age groups. This retrospective study included UK Biobank participants with ASI recordings. Multivariable Cox proportional hazard models were used to estimate the associations between ASI and major adverse cardiovascular events (MACE) in different age groups. The difference in C-statistic, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI) were calculated to test the predictive performance of ASI beyond SCORE2 in the elderly and non-elderly. A total of 127 045 participants were included in the primary analysis. During a median of 11.7 years, 2606 (10.7%) and 4408 (4.3%) MACE were identified in the elderly and non-elderly, respectively. The non-elderly exhibited a greater extent of increased risk for MACE with higher ASI (HR, 1.314 [1.280–1.350] vs. HR, 1.066 [1.026–1.107]). Furthermore, the IDI and continuous NRI of ASI beyond SCORE2 for MACE were more than two times higher for non-elderly individuals than their elderly counterparts (IDI, 0.0481% [0.0182%–0.0953%] vs. IDI, 0.0010% [−0.0052% to 0.0295%]; NRI, 8.76% [6.83% to 10.60%] vs. NRI, 3.27% [−3.92% to 5.97%]). Our findings suggested that ASI should primarily be utilized for primary cardiovascular prevention in individuals below 65.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930383","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":"Relationship Between the Drop Rate of Standing Blood Pressure and Major Adverse Cardiovascular Events","authors":"Wenqin Cai,&nbsp;Yuexian Yao,&nbsp;Suli Zheng,&nbsp;Wanting Chen,&nbsp;Lingxin Bao,&nbsp;Jinzi Su,&nbsp;Li Luo,&nbsp;Liangdi Xie","doi":"10.1111/jch.70061","DOIUrl":"https://doi.org/10.1111/jch.70061","url":null,"abstract":"&lt;p&gt;Orthostatic hypotension (OH) is defined as a decrease of ≥20 mm Hg systolic blood pressure (SBP) or ≥10 mm Hg diastolic blood pressure (DBP) within 3 min after standing. OH was associated with an increased risk of major adverse cardiovascular events (MACEs) and mortality. As an indicator reflecting the characteristics of orthostatic blood pressure (BP) changes, there is currently no research available on the relationship between the orthostatic BP drop rate and MACEs or mortality. A total of 448 hospitalized patients (mean age 62.07 ± 12.15 years, 35.49% female) completed the follow-up. The median follow-up duration was 5.09 years (0.29–6.13 years). Ninety-two patients (20.54%) developed OH, 12 patients died (2.68%), and 21 patients developed MACEs (4.69%), including 8 cases of non-fatal acute myocardial infarction (MI), 3 cases of non-fatal stroke, and 10 cases died of cardiovascular disease and stroke. Patients were categorized into the BP&lt;sub&gt;drop_rate_high&lt;/sub&gt; group (defined as SBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;annotation&gt;$ ge $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 15% and/or DBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;annotation&gt;$ ge $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 5% within 3 min after standing) and the BP&lt;sub&gt;drop_rate_normal&lt;/sub&gt; group (defined as SBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mrow&gt;\u0000 &lt;mspace&gt;&lt;/mspace&gt;\u0000 &lt;mo&gt;&lt;&lt;/mo&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;annotation&gt;$ &lt; $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 15% and DBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;&lt;&lt;/mo&gt;\u0000 &lt;annotation&gt;$ &lt; $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 5% within 3 min after standing). The Chi-square test and Kaplan-Meier survival analysis indicated that the BP&lt;sub&gt;drop_rate_high&lt;/sub&gt; group had a higher risk of MACEs and mortality than the BP&lt;sub&gt;drop_rate_normal&lt;/sub&gt; group (all &lt;i&gt;p&lt;/i&gt; &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;&lt;&lt;/mo&gt;\u0000 &lt;annotation&gt;$ &lt; $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 0.05). The Receiver Operating Characteristic (ROC) analysis demonstrated SBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;annotation&gt;$ ge $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 15% and/or DBP drop rate &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mo&gt;≥&lt;/mo&gt;\u0000 &lt;annotation&gt;$ ge $&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; 5% within 3 min after standing has high diagnostic accuracy for OH, with an area under the curve (AUC) of 0.918.Cox regression analysis revealed that the cumulative survival rate of the BP&lt;sub&gt;drop_rate_normal&lt;/sub&gt; group was significantly higher ","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930463","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":"Thiazide-Associated Hyponatremia: A Retrospective Cohort Study Comparing Hydrochlorothiazide Versus Indapamide Versus Chlorthalidone","authors":"Josef Klhůfek,&nbsp;Martin Vodička,&nbsp;Petr Ponížil,&nbsp;Ilja Ryšavý,&nbsp;Petr Fojtík,&nbsp;Vladimír Kojecký,&nbsp;Tomáš Šálek","doi":"10.1111/jch.70060","DOIUrl":"https://doi.org/10.1111/jch.70060","url":null,"abstract":"<p>Hyponatremia is a crucial complication of therapy with thiazide diuretics. This study compares the epidemiological and biochemical profiles and hospital course of patients using hydrochlorothiazide (HCTZ), indapamide (INDA), and chlorthalidone (CTD) admitted with thiazide-associated hyponatremia (TAH). Data were obtained retrospectively from the hospital's digital registries. The epidemiological and biochemical parameters between the HCTZ, INDA, and CTD groups were compared. The correlation between dose and biochemical parameters in each group was performed. The thiazide groups without diuretic co-medication were compared (HCTZ vs. INDA), and the correlation between dose and biochemical parameters in each group was examined. A comparison of the HCTZ (<i>n</i> = 135), INDA (<i>n</i> = 125), and CTD (<i>n</i> = 27) groups identified differences in serum potassium (s-K; <i>p</i> = 0.03). The hyponatremia correction rate was slower in the CTD group at 96 h after admission (<i>p</i> &lt; 0.001). After the exclusion of diuretic co-medication, the HCTZ group (<i>n</i> = 64/135) showed a higher prevalence of ARBs, s-K (both <i>p</i> &lt; 0.001), and a lower median (IQR) equipotent dose (12.5 (o) mg vs. 2.5 (1.2) mg), prevalence of ACE-I (<i>p</i> &lt; 0.001), and eGFR (<i>p</i> = 0.03), when compared to the INDA group (<i>n</i> = 109/125). In conclusion, except for s-K, we observed no significant difference in biochemical and epidemiological profiles between HCTZ, INDA, and CTD. After excluding the influence of other diuretics, we observed higher s-K in the HCTZ group compared to the INDA group, potentially explained by the lower equipotent dose of HCTZ. The CTD group showed a statistically significant trend of slower hyponatremia correction.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930384","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":"Impact of Variability in Blood Pressure and Heart Rate on Beta-Blocker Adherence","authors":"Yan Li,&nbsp;Jia-Yin Sun,&nbsp;Qian-Yun Guo,&nbsp;Hong-Ya Han,&nbsp;De-An Jia,&nbsp;Zhi-Ming Zhou,&nbsp;Zhi-Jian Wang,&nbsp;Ying-Xin Zhao,&nbsp;Yu-Jie Zhou,&nbsp;Shi-Wei Yang","doi":"10.1111/jch.70065","DOIUrl":"https://doi.org/10.1111/jch.70065","url":null,"abstract":"<p>Adherence to antihypertensive medications is essential for blood pressure (BP) control, influencing long-term outcomes in hypertensive patients. This study examines the association between visit-to-visit variability in BP and heart rate (HR) and its effect on adherence to beta-blocker therapy among outpatients. Conducted across 160 hospitals in China from January 1, 2011, to December 31, 2011, this study included 9225 hypertensive outpatients prescribed metoprolol succinate. BP and HR variability were assessed over three visits (baseline, 1-month, and 2-month follow-up) using standard deviation (SD) and mean-independent parameters. Nonadherence was defined as medication discontinuation or treatment regimen changes by the 2-month follow-up. Among the 9037 patients analyzed, the mean age was 58.85 years (±12.54), and 52.9% were male. Visit-to-visit variability in the rate–pressure product (RPP; SBP×HR) was a significant predictor of nonadherence, with an odds ratio (OR) of 1.26 (95% confidence interval [CI]: 1.04–1.53, <i>p</i> &lt; 0.05) for the top-decile SD of RPP, independent of mean RPP. Variability in diastolic blood pressure (DBP) and pulse pressure (PP) were also associated with nonadherence, with ORs of 1.65 (95% CI: 1.35–2.00, <i>p</i> &lt; 0.001) for DBP and 1.66 (95% CI: 1.39–1.99, <i>p</i> &lt; 0.001) for PP, independent of their mean values. Patients with fluctuations in PP or HR had a higher risk of nonadherence compared to those with consistent reductions in these measures. Visit-to-visit variability in RPP, DBP, and PP is a significant predictor of nonadherence to beta-blockers, regardless of mean levels. Addressing this variability is critical for improving adherence to antihypertensive treatments and optimizing patient outcomes.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930348","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 Screenings for Hypertension, Diabetes, and High Cholesterol With All-Cause and Cardiovascular Mortality: Evidence From a Cohort Study","authors":"Jiayue Zhang,&nbsp;Shuting Wang,&nbsp;Ying Huang,&nbsp;Wenxiao Zheng,&nbsp;Ying Xiao,&nbsp;Zuyao Yang","doi":"10.1111/jch.70053","DOIUrl":"https://doi.org/10.1111/jch.70053","url":null,"abstract":"<p>Screenings for hypertension, diabetes, and high cholesterol are widely conducted in routine clinical practice for cardiovascular disease (CVD) prevention. However, few studies have investigated whether these screenings could eventually lead to lower risks of hard outcomes such as mortality. This cohort study aimed to examine directly the association of screenings for hypertension, diabetes, and high cholesterol with all-cause and cardiovascular mortality and whether the association, if existent, varied with important characteristics. A nationally representative sample of 86 587 US adults without the three conditions and CVD at baseline were recruited. The history of screenings for the three conditions was elicited by a series of questions in the surveys. All-cause and cardiovascular mortality were ascertained by linkage to National Death Index records through December 31, 2019. The association of screenings with mortality was investigated by multivariable Cox regression analysis and expressed as hazard ratio (HR) with 95% confidence interval (CI), adjusting for major risk factors of CVD and mortality. The “1 screening,” “2 screenings,” “3 screenings,” and “any screening” (combining the above three) groups were compared with the “no screening” group separately. During a median follow-up of 51 months (4.3 years), 1783 participants died and 366 of them were attributed to CVD. After adjusting for all covariates, no statistically significant association was found between “any screening” and all-cause mortality (HR = 1.08, 95% CI 0.92–1.26) or cardiovascular mortality (HR = 1.06, 95% CI 0.76–1.47). The results were consistent across various subgroups. The associations of “1 screening,” “2 screenings,” and “3 screenings” respectively with all-cause and cardiovascular mortality were not statistically significant either (HRs ranging from 0.65 to 1.40). Overall, in this population of US general adults, there was no evidence that screening for hypertension, diabetes, and high cholesterol could lead to lower all-cause or cardiovascular mortality.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909123","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":"Aerobic, Resistance, and Isometric Exercise to Reduce Blood Pressure Variability: A Network Meta-Analysis of 15 Clinical Trials","authors":"Ziyu Hao,&nbsp;Joshua Tran,&nbsp;Amy Lam,&nbsp;Karen Yiu,&nbsp;Kelvin Tsoi","doi":"10.1111/jch.70050","DOIUrl":"https://doi.org/10.1111/jch.70050","url":null,"abstract":"<p>Elevated blood pressure variability (BPV) is an emerging independent risk factor for increased cardiovascular diseases (CVD). Many studies are exploring the impacts of regular physical exercise on reducing BPV. This study aimed to investigate whether exercise can be an intervention to control for the short-term and long-term BPV. A literature search was conducted on MEDLINE, Embase, and PsycINFO on February 10, 2025. The clinical trials and other observational studies that investigated the effects of exercise on systolic and diastolic BPV were included. There were no limitations on age, blood pressure (BP) category, or the use of antihypertensive medication. Mean differences and standard deviations (SDs) of the BPV measurements were extracted to derive standardized mean differences (SMD) with a 95% confidence interval (CI). The heterogeneity was assessed by <i>I</i>^2, and random-effect models were performed. Our search identified 8359 studies, of which 25 studies reported BPV outcomes. Fifteen clinical trials compared the short-term BPV among participants with or without exercise. Exercise interventions can significantly reduce both systolic BPV (SMD [95% CI] = −0.37[−0.61 to −0.12]) and diastolic BPV (−0.48 [−0.72 to −0.23]). The benefits are stronger for those with hypertension. Different types of exercise were compared in the network meta-analyses, and aerobic exercise showed more benefits than other types of exercise to improve BPV, especially on the diastolic BPV when it was compared with no exercise (−2.52 [−4.05 to −0.99]). No evidence was observed for the long-term BPV. Exercise interventions effectively reduce the variability of both systolic and diastolic blood pressure (DBP). Aerobic exercise is shown to be more effective in reducing diastolic BPV versus no exercise.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909221","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}