Journal of Clinical Hypertension最新文献

{"title":"Comparison of Cardiovascular Outcomes Between Chlorthalidone and Hydrochlorothiazide in Hypertensive Patients","authors":"Subin Lim,&nbsp;Ju Hyeon Kim,&nbsp;Seungmi Oh,&nbsp;Soon Jun Hong,&nbsp;Cheol Woong Yu,&nbsp;Hyung Joon Joo,&nbsp;Yong Hyun Kim,&nbsp;Eung Ju Kim","doi":"10.1111/jch.70000","DOIUrl":"https://doi.org/10.1111/jch.70000","url":null,"abstract":"<p>Chlorthalidone (CLTD) and hydrochlorothiazide (HCTZ) are widely used thiazide diuretics for hypertension management. This study aimed to evaluate and compare the cardiovascular outcomes of patients treated with CLTD versus HCTZ. This multicenter, retrospective cohort study utilized data from the Korea University Medical Center, derived from electronic health records. A total of 14 257 hypertensive patients treated with either CLTD (<i>n</i> = 1920) or HCTZ (<i>n</i> = 12 337) were identified. Patients were matched 1:1 using propensity scores, resulting in 1606 patients in each treatment group. Demographic and clinical characteristics, incidence of major adverse cardiovascular events (MACE), and safety profiles were analyzed. Baseline characteristics after propensity score matching were well balanced between the two groups. The average age was 61.8 ± 14.6 years for CLTD users, with 59.3% being male. The 3-year MACE occurred in 1.2% of the CLTD group compared with 1.4% of the HCTZ group (hazard ratio 0.91, <i>p</i> = 0.77). For secondary outcomes, cardiovascular mortality was 0.2% in both groups (<i>p</i> = 0.92). Myocardial infarction occurred in 0.3% of CLTD users and 0.4% of HCTZ users (<i>p</i> = 0.65). The incidence of hypokalemia was 19.2% in the CLTD group versus 16.7% in the HCTZ group (<i>p</i> = 0.07). In conclusion, in hypertensive patients, CLTD and HCTZ showed comparable cardiovascular outcomes and safety profiles.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424300","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":"Cardiac Baroreflex Is Preserved After the Recovery From COVID-19 Men and Women","authors":"Roberto Souza,&nbsp;Beatriz Divino,&nbsp;Helena N. M. Rocha,&nbsp;Jocemir R. Lugon,&nbsp;Natalia G. Rocha,&nbsp;Antonio C. L. Nobrega,&nbsp;Eliza Prodel","doi":"10.1111/jch.70006","DOIUrl":"https://doi.org/10.1111/jch.70006","url":null,"abstract":"<p>We sought to investigate whether mild COVID-19 impairs cardiac baroreflex sensitivity (cBRS), using the modified Oxford protocol, in young healthy men and women 12–14 weeks after recovering from the infection. Participants were distributed into two groups: Non-COVID-19 group (NCG: men <i>n</i> = 6 [30 ± 3years; 26 ± 1 kg/m²] and women <i>n</i> = 5 [25 ± 1 years; 25 ± 1 kg/m²]) and recovered from COVID-19 group (RCG: men <i>n</i> = 6 [29 ± 3 years; 25 ± 1 kg/m²] and women <i>n</i> = 10 [32 ± 4 years; 22 ± 1 kg/m²]), the RCG tested positive (RT-PCR) 12 to 14 weeks before the protocol. Beat-to-beat finger blood pressure (BP) and heart rate (HR) were measured during a bolus of sodium nitroprusside (SNP) and phenylephrine (PHE), in a control condition and during cold pressor test (CPT) and moderate dynamic handgrip exercise (GRIP). Resting systolic BP was higher in the RCG (135 ± 14 mmHg vs. 122 ± 12 mmHg, <i>p</i> = 0.01). Both CPT and GRIP maneuvers increased HR and BP; the bolus of SNP diminished BP and evoked a reflex-mediated increase in HR; PHE increased BP, resulting in a reflex-mediated decrease in HR. Of note, cBRS for decrease or increase of BP did not differ between groups under the studied conditions: control (SNP, <i>p</i> = 0.39; PHE, <i>p</i> = 0.50); CPT (SNP, <i>p</i> = 0.09; PHE: <i>p</i> = 0.82); and GRIP (SNP, <i>p</i> = 0.35; PHE, <i>p</i> = 0.53). In conclusion, mild COVID-19 did not seem to impair cBRS in healthy young men and women 12–14 weeks after recovering from the infection.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424299","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":"Predictive Value of an Early Diagnosis of Orthostatic Hypotension on Cardiovascular Events","authors":"Fosca Quarti-Trevano,&nbsp;Cesare Cuspidi,&nbsp;Guido Grassi","doi":"10.1111/jch.70018","DOIUrl":"https://doi.org/10.1111/jch.70018","url":null,"abstract":"&lt;p&gt;A large number of prospective studies carried out during the past 20 years, some of them included in a recent meta-analysis, have conclusively shown that clinically overt orthostatic hypotension represents a pathological condition associated with an increase in fatal and non-fatal cardiovascular events and in all-cause mortality [&lt;span&gt;1-8&lt;/span&gt;]. Whether and to what extent this is the case in the advanced full manifest clinical condition only or it is also detectable in the initial clinical phases of the disease is much less clearly defined, however.&lt;/p&gt;&lt;p&gt;In the present issue of the &lt;i&gt;Journal&lt;/i&gt;, a group of Chinese investigators reports the results of a retrospective study [&lt;span&gt;9&lt;/span&gt;] aimed at investigating the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, angina pectoris, heart failure, or atrial fibrillation in patients aged more than 50 years with a diagnosis of an initial orthostatic hypotensive condition and followed, on average, for more than 5 years. Early diagnosis was founded on the detection of a transient decrease in systolic blood pressure of magnitude greater than 40 mmHg and/or in diastolic blood pressure greater than 20 mmHg within 15 s of active standing, with a blood pressure recovery between 15 s and 3 min of standing [&lt;span&gt;10&lt;/span&gt;]. A group of patients with a full-blown orthostatic hypotensive disease served as a control to compare the data collected in the patients displaying the initial stage of the clinical condition. Results show that not only sustained but also initial orthostatic hypotension increases the risk of cardiovascular events, the mortality risk is, however, augmented in the advanced clinical condition only.&lt;/p&gt;&lt;p&gt;Several intriguing findings of the study deserve to be mentioned and discussed. First, the study makes the diagnosis of orthostatic hypotension on the basis of the blood pressure responses to standing detected during the initial 15 s of the maneuver. Does this approach guarantee an accurate and careful assessment of the disease? Based on current guidelines [&lt;span&gt;10&lt;/span&gt;], the approach seems accurate enough, given the notion that the circulatory responses characterizing the first 15 s of the maneuver are more likely to detect the blood pressure drop in this very initial time period. To assess such short-lasting blood pressure changes appropriately, the Authors correctly have made use of the continuous non-invasive arterial blood pressure monitoring device, which allows to properly detect short-lasting blood pressure changes occurring in this temporal window of very short duration. Another issue, which is important from a methodological but also a diagnostic viewpoint, refers to the within-subject variability of the hemodynamic responses to standing [&lt;span&gt;11, 12&lt;/span&gt;]. In other words, should the diagnosis of the condition be based only on a single evaluation or should it be based on the average of the responses repea","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424302","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 Hyperuricemia on Incident Hypertension When Hypertension Definition Changes From 140/90 to 130/80 mmHg in a Large Taiwanese Population Follow-Up Study","authors":"Yi-Hsueh Liu,&nbsp;Wei-Yu Su,&nbsp;Chih-Yi Lin,&nbsp;Chun-Chi Tsai,&nbsp;Ho-Ming Su,&nbsp;Szu-Chia Chen","doi":"10.1111/jch.70013","DOIUrl":"https://doi.org/10.1111/jch.70013","url":null,"abstract":"<p>A lower blood pressure threshold (≥130/80 mmHg) to define hypertension has been proposed in several hypertension guidelines. This study assessed the relationship between hyperuricemia and incident hypertension, examining serum uric acid (SUA) cut-offs using both traditional and new definitions in a large Taiwanese cohort. This observational cohort study enrolled 26 973 participants from the Taiwan Biobank (TWB), followed for a median of 4 years. Regarding traditional definition (140/90 mmHg), hyperuricemia (odds ratio [OR], 1.297), quartile 3 of SUA (OR, 1.211), quartile 4 of SUA (OR, 1.495), and high SUA (OR, 1.127) were significantly associated with incident hypertension in males, and hyperuricemia (OR, 1.198), quartile 4 of SUA (OR, 1.359), and high SUA (OR, 1.099) were significantly associated with incident hypertension in females. As for new definition (130/80 mmHg), hyperuricemia (OR, 1.376), quartile 3 of SUA (OR, 1.229), quartile 4 of SUA (OR, 1.554), and high SUA (OR, 1.139) were associated with incident hypertension in males, and hyperuricemia (OR, 1.249), quartile 3 of SUA (OR, 1.253), quartile 4 of SUA (OR, 1.429), and high SUA (OR, 1.096) were associated with incident hypertension in females. The interaction between hyperuricemia and sex on incident hypertension was significant for both traditional (140/90, <i>p</i> &lt; 0.001) and new (130/80, <i>p</i> = 0.001) definitions. Hyperuricemia was significantly associated with incident hypertension under both traditional and new definitions. A significant interaction between hyperuricemia and sex was noted, although the differences were not so great.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362628","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":"High Heart Rate and Hypertension: Two Intertwined Cardiovascular Risk Factors","authors":"Paolo Palatini","doi":"10.1111/jch.70010","DOIUrl":"https://doi.org/10.1111/jch.70010","url":null,"abstract":"&lt;p&gt;A large number of studies have shown that high heart rate (HR) is correlated with many risk factors for atherosclerosis and cardiovascular events, including high blood pressure, dyslipidemia, hyperinsulinemia, hyperglycemia, and obesity [&lt;span&gt;1-3&lt;/span&gt;]. These associations have been observed in general populations as well as in patients with hypertension, diabetes, coronary artery disease, and heart failure, indicating that measurement of HR should be an important component of cardiovascular risk assessment. Although many prospective studies performed in general populations showed significant associations between the baseline office HR and subsequent blood pressure or hypertension, in only a few studies did the predictive power of HR remain significant after controlling for the baseline blood pressure level [&lt;span&gt;4, 5&lt;/span&gt;]. Furthermore, the confounding effect of physical fitness was considered only in the CARDIA study [&lt;span&gt;6&lt;/span&gt;] in the United States, in people aged 18 to 30 years. These results were later confirmed by the Kailuan prospective study [&lt;span&gt;7&lt;/span&gt;], which included a large number of participants aged 38 to 54 years, and by a prospective cohort study carried out in rural China in 39- to 59-year-old subjects [&lt;span&gt;8&lt;/span&gt;]. Finally, in a meta-analysis of 9 cohort studies encompassing 79 399 individuals, Shen et al. found a linear dose–response association between HR and incident hypertension in adults [&lt;span&gt;9&lt;/span&gt;]. All these studies were carried out in young or middle-aged people while little information was available for older individuals.&lt;/p&gt;&lt;p&gt;This knowledge gap was addressed by Lou and colleagues in an article published in this issue of Journal of Clinical Hypertension [&lt;span&gt;10&lt;/span&gt;]. These investigators showed that high HR was associated with an increased risk of developing hypertension also in older individuals, with a 6% increase in risk for every 10 beats/min increment in HR. This association may explain at least in part the higher risk of mortality found in elderly subjects with fast HR [&lt;span&gt;11&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;As hypothesized by Lou and colleagues, a heightened sympathetic activity may explain why subjects with high HR tend to develop sustained hypertension in later years [&lt;span&gt;10&lt;/span&gt;]. A high sympathetic activity causes an increase in cardiac output, peripheral vascular resistance, and sodium reabsorption in the kidney, which leads to an&lt;/p&gt;&lt;p&gt;Elevation of blood pressure [&lt;span&gt;12&lt;/span&gt;]. However, whether tachycardia in these individuals reflects a temporary reaction to the medical environment or is the consequence of a stable sympathetic activation is still a matter of debate. Results of the HARVEST Study showed that in most subjects with elevated HR at the initial visit, HR tends to return to normal values after baseline assessment, and that these subjects are not at increased risk of future hypertension [&lt;span&gt;5&lt;/span&gt;]. This suggests that a transient increase in sympathetic activity on a ba","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362627","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":"Correspondence on \"Optimizing ChatGPT's Performance in Hypertension Care\"","authors":"Amaan Rais Shah","doi":"10.1111/jch.70001","DOIUrl":"10.1111/jch.70001","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;I would like to discuss the article “Enhancing clinical decision-making: Optimizing ChatGPT's performance in hypertension care.” [&lt;span&gt;1&lt;/span&gt;] The article outlines a number of ways in which AI models such as ChatGPT can be used in healthcare, such as using it as a tool for research and evidence synthesis, especially in cases of hypertension. In a similar light, another study by Kusunose et al. [&lt;span&gt;2&lt;/span&gt;] also showed that ChatGPT accurately answered clinical questions on the Japanese Society of Hypertension guidelines, making it a valuable tool for clinicians in hypertension management.&lt;/p&gt;&lt;p&gt;ChatGPT can be used to facilitate research synthesis by its ability to rapidly gather, summarize, and analyze vast quantities of medical literature. Current biomedical text summarization systems achieve good performance using hybrid methods combining computational linguistics, machine learning, and statistical approaches [&lt;span&gt;3&lt;/span&gt;]. ChatGPT can drastically cut down on the amount of time required for evidence-based decision-making by condensing clinical trials and meta-analyses into brief summaries, freeing up physicians to concentrate more on patient care. ChatGPT's adaptability in integrating updates from trusted medical sources, such as PubMed or the European Society of Cardiology guidelines, enables healthcare providers to have access to the most recent evidence.&lt;/p&gt;&lt;p&gt;But there still are certain difficulties. The quality of the underlying training data and real-time updates is very important in the reliability of the synthesized outputs. The tool's efficacy can be increased by including a feedback loop that would allow users to verify and improve these summaries, making it a more reliable partner in clinical decision-making [&lt;span&gt;4&lt;/span&gt;]. Implementing such a feedback loop for continuous improvement would involve creating a user feedback mechanism where clinicians can rate the accuracy, relevance, and clarity of ChatGPT's outputs. This feedback can then be stored in a database for systematic analysis, identifying recurring patterns of errors or areas for improvement. A set-up can be made where clinicians can mark responses as “accurate,” “incomplete,” or “misleading,” for instance, enabling algorithm developers to improve algorithms using aggregate data. Another tactic is to incorporate reinforcement learning from human feedback (RLHF) [&lt;span&gt;5&lt;/span&gt;], which retrains the model iteratively for improved performance using this carefully selected feedback. Such procedures are essential for preserving confidence and enhancing decision-support tools.&lt;/p&gt;&lt;p&gt;Future directions could focus on creating a specialized AI-driven platform for evidence synthesis. Such a platform could integrate ChatGPT with predictive analytics, providing not just a summary of findings but also actionable insights for hypertension management. Furthermore, data privacy and ethical aspects must also be taken into consideration when using AI in such s","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060933","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":"Epicardial Adipose Tissue and Left Ventricular Hypertrophy in Hypertensive Patients With Preserved Ejection Fraction: A Multicenter Retrospective Cohort Study","authors":"Runze Zhu,&nbsp;Wenxian Wang,&nbsp;Yan Gao,&nbsp;Junchuan Liu,&nbsp;Bowen Li,&nbsp;Rongxue Shan,&nbsp;Runjie Xue,&nbsp;Xianshun Yuan,&nbsp;Xi-Ming Wang","doi":"10.1111/jch.70003","DOIUrl":"10.1111/jch.70003","url":null,"abstract":"<p>This study aimed to investigate the correlation of the increased volume index of epicardial adipose tissue (EAT) and left ventricular hypertrophy (LVH) in patients with Hypertension (HTN). A total of 209 HTN patients and 50 healthy controls, who underwent cardiovascular magnetic resonance (CMR) at two medical centers in China between June 2015 and October 2024, were enrolled for this study. Postprocessing and imaging analysis were conducted and EAT measurements were performed. Restricted cubic splines (RCS) were used to explore the potential relationship with LVH. Binary logistic regression models and mediation analyses were employed to evaluate the association between EAT volume and CMR parameters as well as LVH. Hypertensive patients with LVH exhibited larger indexed EAT volumes, more pronounced diffuse fibrosis, and reduced left ventricular strain compared to hypertensive patients without LVH (all <i>p</i> &lt; 0.001), with results remaining stable after adjusting for confounding factors. The variables that were significant in the univariate regression were included in the multivariate logistic regression model, indicating that indexed EAT volume (<i>p</i> = 0.001), extracellular volume (ECV) (<i>p</i> = 0.012), and global longitudinal strain (GLS) (<i>p</i> = 0.024) were independently associated with LVH. These associations remained stable after adjusting for confounding factors. Mediation analysis further revealed that the relationship between increased EAT volume and LVH was mediated by ECV, native T1, GLS, global circumferential strain (GCS), and global radial strain (GRS) (<i>p</i> &lt; 0.05). These findings imply that EAT is independently linked to LVH in hypertensive patients. The association between EAT and LVH in hypertensive patients may be mediated by myocardial fibrosis or dysfunction.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060941","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":"Elevated Platelet-to-Lymphocyte Ratio as a Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Individuals","authors":"Rui Xu,&nbsp;Ling Chen,&nbsp;Changshun Yan,&nbsp;Hong Xu,&nbsp;Guiqiu Cao","doi":"10.1111/jch.14980","DOIUrl":"10.1111/jch.14980","url":null,"abstract":"<p>The platelet-to-lymphocyte ratio (PLR) has been proposed as a promising inflammatory biomarker, with potential implications for cardiovascular prognosis. However, its association with mortality outcomes in hypertensive individuals is not fully elucidated. This investigation sought to clarify the linkage between PLR and both overall and cardiovascular mortality in hypertensive individuals. Data from 15 483 hypertensive adults in the NHANES (2005–2018) were analyzed. Mortality data, including all-cause and cardiovascular deaths, were sourced from the National Death Index (NDI) up to December 31, 2019. The linkage between PLR and mortality risk was depicted using restricted cubic spline (RCS) models. Cox proportional hazards regression models assessed the independent association of PLR with mortality risk, with adjustments incrementally applied: Model 1 without adjustments; Model 2 adjusted for age and sex; Model 3 adjusted further for age, gender, race, marital status, diabetes, alcohol intake, smoking status, body mass index (BMI), history of cardiovascular disease (CVD), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG), and creatinine (CR). Over a median follow-up of 79 months, there were 2820 all-cause deaths and 758 cardiovascular deaths. The multivariate Cox analysis showed that those in the highest PLR quartile had significantly elevated risks of all-cause mortality (Model 1: HR = 1.28, 95% CI 1.16–1.42, <i>p </i>&lt; 0.001; Model 2: HR = 1.14, 95% CI 1.03–1.26, <i>p</i> = 0.014; Model 3: HR = 1.16, 95% CI 1.05–1.29, <i>p</i> = 0.004)and cardiovascular mortality (Model 1: HR = 1.59, 95% CI 1.30–1.94, <i>p</i> &lt; 0.001; Model 2: HR = 1.38, 95% CI 1.13–1.68, <i>p</i> = 0.001; Model 3: HR = 1.47, 95% CI 1.20–1.80, <i>p</i> &lt; 0.001). The study reveals a U-shaped relationship between PLR and all-cause mortality, alongside a linear association with cardiovascular mortality. A PLR threshold of 118.83 has been identified as indicative of an adverse prognosis for all-cause mortality. Elevated PLR independently predicts heightened risks of both all-cause and cardiovascular mortality among hypertensive patients.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060937","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 Pulse Prssure Index With Mortality in Patients With Hypertension: Results From NHANES 1999–2018","authors":"Hongjin Jin,&nbsp;Shusheng Fang,&nbsp;Shuo An,&nbsp;Yanchun Ding","doi":"10.1111/jch.70004","DOIUrl":"10.1111/jch.70004","url":null,"abstract":"<p>Vascular compliance is an important predictor of cardiovascular disease and mortality. Pulse pressure index (PPI) is a reliable indicator for evaluating vascular compliance. However, the association between PPI, all-cause mortality (ACM), and cardiovascular mortality (CVM) in patients with hypertension is still unclear. In this study, we aimed to investigate the association of PPI with ACM and CVM in patients with hypertension. Kaplan–Meier survival curves, Cox proportional hazards regression models, restricted cubic splines, and subgroup and interaction analyses were used to investigate the association of PPI with ACM and CVM. U-shaped associations were observed between PPI and both ACM and CVM, and the inflection points for ACM and CVM were at PPI values of 0.327 and 0.363, respectively. Time-dependent receiver operating characteristic curves indicated that PPI showed good predictive value for both ACM and CVM occurrence at 1, 3, 5, and 10 years, and its predictive value was higher than PP for ACM and CVM at 5 and 10 years. These results showed that PPI can be used to identify patients with hypertension who are at a high risk of mortality and can guide more aggressive anti-hypertensive treatment strategies. Moreover, these findings demonstrate that PPI is a superior vascular compliance indicator than PP.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060770","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":"Gestational Age at Delivery Is an Independent Predictor of Neonatal Outcome for Maternal HELLP Syndrome","authors":"Yan Shi,&nbsp;Xiaoli Yang,&nbsp;Chengqin Wang,&nbsp;Luosong Zhuoga,&nbsp;Dongmei Xu","doi":"10.1111/jch.70007","DOIUrl":"10.1111/jch.70007","url":null,"abstract":"<p>Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a severe complication of preeclampsia (PE), with a higher incidence rate in people living at high altitudes, such as Tibet area. Maternal HELLP syndrome is associated with an elevated neonatal mortality rate. The purpose of this study was to investigate the predicting factors for neonatal outcomes with maternal HELLP syndrome. We collected 49 PE with HELLP cases and stratified them into the Survival Group (<i>n</i> = 28) and Death Group (<i>n</i> = 21) based on the neonatal outcomes. We compared the basic characteristics and laboratory indicators using the Student's <i>t</i>-test or the Mann–Whitney <i>U</i> test, followed by univariate and multivariate logistic regression analysis to detect the independent predicting factors for neonatal outcomes. Subsequently, we performed the receiver operating characteristics (ROC) analysis to predict the prognostic power of the variables with a cutoff value. The results indicated that levels of neutrophil-to-lymphocyte ratio (NLR), serum creatinine (Scr), lactic dehydrogenase (LDH), and brain natriuretic peptide (BNP) were significantly elevated, while gestational age (GA) at delivery and alkaline phosphatase (AP) level was significantly decreased in the Death Group. The multivariate regression analysis indicated that only GA at delivery was able to predict the neonatal outcome. The cutoff value was 32.6 weeks on the ROC curve, with both 85.7% sensitivity and 85.7% specificity (AUC: 0.927, 95% CI: 0.856–0.998, <i>p</i> &lt; 0.001). Thus, it was concluded that GA at delivery less than 32.6 weeks was an independent predictor of neonatal death for maternal HELLP syndrome.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060976","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}