Journal of Clinical Hypertension最新文献

{"title":"Impact of Systolic Blood Pressure Trajectories and Variability on Unexplained Early Neurological Deterioration Post-Endovascular Treatment in Acute Ischemic Stroke Patients.","authors":"Xuxuan Gao, Qiheng Wu, Yu Ma, Yueran Ren, Jiaying Chen, Xiaofei Lin, Lianghao Ye, Wei Song, Jiajia Zhu, Jia Yin","doi":"10.1111/jch.14970","DOIUrl":"10.1111/jch.14970","url":null,"abstract":"<p><p>Early neurological deterioration (END) following endovascular treatment (EVT) in acute ischemic stroke (AIS) patients is associated with poor long-term outcomes. Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24 h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24 h post-EVT. Unexplained END was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale score 24 h after EVT without any identifiable cause. Two distinct SBP trajectories-high and low-were identified within 24 h post-EVT. The high-trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR] = 3.28, p < 0.01). SBPV alone was an independent risk factor for unexplained END (OR = 1.11, p < 0.05). Moreover, patients with both higher mean SBP and increased SBPV had a markedly greater risk of unexplained END (OR = 13.79, p < 0.05). Notably, the harmful threshold for SBPV was lower during nighttime compared to daytime. These findings suggest that increased SBPV, particularly when combined with elevated mean SBP, significantly heightens the risk of unexplained END post-EVT. Therefore, comprehensive post-EVT blood pressure management should address both absolute BP levels and BPV, with particular emphasis on nighttime monitoring, to optimize early neurological recovery.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"27 1","pages":"e14970"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015349","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":"Renal Denervation: New Evidence Supporting Long-Term Efficacy, Alternative Access Routes, and Cost-Effectiveness","authors":"Tzung-Dau Wang","doi":"10.1111/jch.14945","DOIUrl":"10.1111/jch.14945","url":null,"abstract":"&lt;p&gt;The treatment landscape for uncontrolled and resistant hypertension continues to evolve, with renal denervation (RDN) emerging as an increasingly validated third pillar of therapeutic options, in addition to lifestyle modification and pharmacological therapy [&lt;span&gt;1, 2&lt;/span&gt;]. Three recent studies published in this issue provide important new insights into the long-term efficacy, procedural innovations, and economic value of RDN, while highlighting areas requiring further investigation.&lt;/p&gt;&lt;p&gt;Brouwers et al. provide valuable 10-year follow-up data on RDN in real-world practice, demonstrating sustained blood pressure reductions and favorable safety outcomes [&lt;span&gt;3&lt;/span&gt;]. Their findings show significant reductions in both office (approximately 20 mm Hg) and ambulatory (approximately 15 mm Hg) systolic blood pressure measurements maintained up to 10 years post-procedure, without significant changes in antihypertensive medication numbers. The study highlights an important evolution in RDN technology—the transition from first to second-generation devices. The authors found that controlled blood pressure at 1 year was more frequently achieved with the second-generation device (78% vs. 13%), associated with more ablation spots, including branch renal artery ablation [&lt;span&gt;3&lt;/span&gt;]. This finding lends evidence that technological improvements and more comprehensive denervation approaches may enhance therapeutic success.&lt;/p&gt;&lt;p&gt;Zuo et al. introduce an important procedural innovation by demonstrating the feasibility and comparable efficacy of upper extremity access (UEA)—either transradial or transbrachial—compared to traditional transfemoral access (TFA) for RDN [&lt;span&gt;4&lt;/span&gt;]. This alternative approach addresses TFA's limitation in accessing renal arteries in patients with unfavorable vascular anatomy. About 30% of patients had vascular morphology better suited to UEA, highlighting this technical advance's clinical relevance.&lt;/p&gt;&lt;p&gt;Kario et al. provide the first comprehensive cost-effectiveness analysis of RDN in an Asian healthcare setting [&lt;span&gt;5&lt;/span&gt;]. Their finding that RDN is cost-effective in the Japanese healthcare system, with an incremental cost-effectiveness ratio well below the willingness-to-pay threshold, adds important economic validation to the growing clinical evidence.&lt;/p&gt;&lt;p&gt;Each study reveals important limitations that should inform future research. The long-term follow-up data's relatively small sample size and single-center experience may limit broader generalizability. Selection bias may explain why patients treated with second-generation devices showed better early hypertension control, yet systolic blood pressure reductions at 5–10 years (from first-generation devices) were similar to those at 2–4 years (from both generations) [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Although Zuo's investigation of alternative access routes represents an important technical advance, the retrospective design and non-randomized allocation introduce pote","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1528-1530"},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14945","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711789","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":"Obesity, aldosterone excess, and mineralocorticoid receptor activation: Parallel or intersected circumstances?","authors":"Houry Puzantian PhD, FAHA,&nbsp;Raymond Townsend PhD, FAHA,&nbsp;Shweta Bansal MBBS, FASN","doi":"10.1111/jch.14898","DOIUrl":"10.1111/jch.14898","url":null,"abstract":"<p>The obesity pandemic, with its associated comorbidities of hypertension and diabetes, constitutes a global public health issue. Importantly, there is an increasing prevalence of aldosterone excess related to obesity and resultant poor health outcomes. Nevertheless, the association between aldosterone and obesity still needs to be clarified. In this review, the authors discuss the role of white adipose tissue in linking obesity, aldosterone excess, and hypertension. The consequences of aldosterone excess in obesity are presented as genomic, non-genomic, and non-epithelial effects. Moreover, the authors emphasize the value of interference with aldosterone pathophysiology (as with mineralocorticoid antagonists) in obesity, thus reducing the adverse clinical impact of aldosterone in myocardial infarction, heart failure, kidney dysfunction, and associated mortality.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1384-1390"},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14898","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711814","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":"Catheter-Based Renal Denervation for Resistant Arterial Hypertension: 10-Year Real-World Follow-Up Data","authors":"Sofie Brouwers,&nbsp;Giulia Botti,&nbsp;Matthias Verbesselt,&nbsp;Lucio Addeo,&nbsp;Marta Belmonte,&nbsp;Kostas Bermpeis,&nbsp;Dario Tino Bertolone,&nbsp;Chiara Valeriano,&nbsp;Michele Mattia Viscusi,&nbsp;Eric Wyffels","doi":"10.1111/jch.14931","DOIUrl":"10.1111/jch.14931","url":null,"abstract":"<p>This analysis of real-world data examines the efficacy, safety, and long-term outcomes of renal denervation in hypertensive patients for up to 10 years. Sixty-five consecutive patients underwent renal denervation (RDN) (single operator) for uncontrolled resistant hypertension. Efficacy was defined as the interindividual change of office (OBPM) and ambulatory blood pressure monitoring (ABPM) at 1, 6, 12 months, 2–4 and 5–10 years after RDN. Medication changes, renal function, and device generation disparities were analyzed. Of these patients, 42 received RDN with a first-generation device, while 23 underwent the procedure with a second-generation device. Baseline demographics included a predominantly male cohort (57.6%) with an average age of 60.3 years. The mean number of medications at baseline was 4.3. OBPM at baseline was 169.0/87.4 mmHg, and ABPM at baseline was 153.4/88.4 mmHg. Post-procedure, significant reductions in systolic blood pressure (SBP) were observed in both OBPM and ABPM at 1 month (OBPM 147.9/82.8 mmHg; ABPM 141.3/83.0 mmHg [SBP, <i>p</i> &lt; 0.001]), sustained up to 10 years (OBPM 153.1/84.3 mmHg; ABPM 138/80.1 mmHg [SBP, <i>p</i> &lt; 0.001]). After 1 year around half of patients had a controlled OBPM and 24 h ABPM &lt; 135/85 mmHg, which was associated with a higher number of ablation spots (31.5±14.8 vs. 15.5 ± 6.5, <i>p</i> = 0.002) and occurred more often when treated with a second-generation device (2 [12.5%] vs. 7 [77.8%], <i>p</i> = 0.002). Renal function displayed a minor physiological decline over 5–10 years. No major complication occurred. Renal denervation demonstrated sustained significant reductions in systolic OBPM and ABPM up to 10 years post-procedure. Controlled blood pressure at 1 year was associated with a higher number of mean ablated spots and the use of a second-generation device. The procedure exhibited a favorable safety profile, indicating its viability in managing hypertension without significant renal function compromise.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1521-1527"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676516","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":"Selecting Transfemoral Access or Upper Extremity Access for Renal Denervation Based on Vascular Morphology: Long-term Results","authors":"Yujie Zuo,&nbsp;Hui Dong,&nbsp;Hongwu Li,&nbsp;Wentao Ma,&nbsp;Yubao Zou,&nbsp;Xiongjing Jiang","doi":"10.1111/jch.14937","DOIUrl":"10.1111/jch.14937","url":null,"abstract":"<p>To evaluate the long-term efficacy and safety of transfemoral access (TFA) versus upper extremity access (UEA) for renal denervation (RDN) based on vascular morphology. This study retrospectively enrolled patients with resistant hypertension who underwent RDN treatment via TFA and UEA (brachial, radial, and ulnar artery) at the Fuwai Hospital between February 2012 and November 2019. Follow-up was conducted at 6 months, 1 year, and 3 years after RDN, and the last visit was June 2023. A total of 85 patients were enrolled, 58 (68.2%) of them were treated via TFA, and 27 patients (31.8%) via UEA. The fluoroscopy time was less in the TFA group (12.2 ± 5.7 min vs. 15.2 ± 7.2 min; <i>p</i> = 0.038). The procedure time (TFA group: 40.8 ± 14.9 min vs. UEA group: 38.6 ± 11.6 min; <i>p</i> = 0.506), contrast volume (TFA group: 78.2 ± 25.9 mL vs. UEA group: 91.9 ± 39.7 mL; <i>p</i> = 0.061) were similar between two groups, without procedure-related complications. Fifty-eight participants completed the last visit with a 3–12 year of follow-up (9.5 ± 1.3 years). Compared with baseline, there were no significant differences in the change of office systolic blood pressure (−12.6 ± 21.6 mmHg vs. −13.1 ± 22.8 mmHg; <i>p</i> = 0.933), 24-h mean systolic blood pressure (−11.9 ± 14.2 mmHg vs. −11.3 ± 15.3 mmHg; <i>p</i> = 0.899), the number of antihypertensive drugs, and renal function between two groups. There were three adverse events in the TFA group (3 of 58 patients, 5.2%) versus one (1 of 27 patients, 3.7%) in the UEA group, without a significant difference between the two groups. The study showed RDN via UEA was feasible using a special-designed catheter, particularly in patients with illegal vascular morphology via TFA.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1513-1520"},"PeriodicalIF":2.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649451","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":"Alcohol Consumption in Adolescence on Early-Adulthood Hypertension or Prehypertension","authors":"Lisa Hayibor,&nbsp;Jianrong Zhang","doi":"10.1111/jch.14928","DOIUrl":"10.1111/jch.14928","url":null,"abstract":"&lt;p&gt;The authors were pleased to read the recent study on the association between alcohol consumption in adolescence and early-adulthood hypertension or prehypertension in 1556 adolescent participants in China [&lt;span&gt;1&lt;/span&gt;]. Building on the findings from our previous work involving 5114 adolescents in the United States [&lt;span&gt;2&lt;/span&gt;], this new study reinforces the impact of heavy alcohol consumption on hypertension or prehypertension. Specifically, the study identified associations of hypertension or prehypertension with alcohol consumption: (1) equal to or over two times per week and (2) more than 96 mL per week. Additionally, the study found an association between hypertension or prehypertension and the intake of two or more types of alcohol (beer, wine, and liquor) [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Methodologically, the study adopted a novel approach by applying the restricted cubic spline model. Particularly when alcohol intake exceeded 25 mL per week, the model demonstrated a dose-response relationship, showing an increasing risk of hypertension or prehypertension as alcohol consumption increased [&lt;span&gt;1&lt;/span&gt;]. For males, the effect size—hazard ratio (HR)—remained above 1, suggesting a higher risk of health concerns regardless of the amount of alcohol consumed. Unfortunately, we could not find the effect size (HR) and the 95% confidence interval for the dose-response relationship derived from the restricted cubic spline model.&lt;/p&gt;&lt;p&gt;Statistically, we are curious as to why the Cox regression model was chosen to analyze the associations between alcohol consumption and health concerns rather than logistic regression, which is more commonly used when dealing with a binary outcome such as hypertension or prehypertension. Of note, the Cox regression model is typically applied to time-to-event scenarios; however, an important bias that needs to be addressed in such analyses is lead time bias. In the study, lead time bias could suggest that adolescent participants who consumed alcohol may have had a period of time that was not accounted for when analyzing the time to the development of hypertension or prehypertension in the Cox regression model. We point this out because, given the baseline comparison of age, the drinking group was significantly older than the non-drinking group (16 vs. 14 years old; &lt;i&gt;p&lt;/i&gt; &lt; 0.005) [&lt;span&gt;1&lt;/span&gt;]. To address this bias, researchers might need to examine and compare the follow-up periods between the groups. Even though nonsignificant findings may be found for the follow-up periods, the nondrinking group may not have reached the comparative age to develop hypertension/prehypertension as they were younger. This issue could also arise when using logistic regression. In addition to adjusting the statistical model for age, we wonder if propensity score matching could improve the validity of the analysis by matching baseline characteristics, including age, between the comparison groups.&lt;/p&gt;&lt;p&gt;This study makes important ","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1533-1534"},"PeriodicalIF":2.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14928","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640172","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":"Multiple Treatment Strategies of Accessory Renal Artery Related Hypertension: Report of Two Cases and Literature Review","authors":"Lin Wang,&nbsp;Yiyun Xie,&nbsp;Deqiang Kong,&nbsp;Kang Li,&nbsp;Zhichao Lai,&nbsp;Jiang Shao,&nbsp;Rong Zeng,&nbsp;Xiao Di,&nbsp;Leng Ni,&nbsp;Yuehong Zheng,&nbsp;Bao Liu","doi":"10.1111/jch.14916","DOIUrl":"10.1111/jch.14916","url":null,"abstract":"<p>Renovascular hypertension (RVH) is a primary cause of secondary hypertension, primarily driven by the activation of the renin–angiotensin–aldosterone system activation. Recently, growing studies suggested accessory renal artery (ARA) might also contribute to RVH. However, the treatment of ARA-related hypertension and whether to take interventional treatment lack consensus. Herein, we report two cases of ARA-related hypertension in our hospital. Imaging studies of both patients showed ARA stenosis. One patient had ARA occlusion well-compensated through tortuous collateral branches, achieving normal blood pressure by medical treatment alone. The other patient had ARA stenosis coexisted with main renal artery stenosis, and revascularization of both arteries led to a significant postoperative reduction in blood pressure. A literature review was conducted to summarize overall treatment strategies for ARA-related hypertension and clarify the relationship between ARA and hypertension. Recent research supported an association between ARA and hypertension. While medical therapy remains the first-line treatment for ARA-related hypertension, interventional procedures should be considered for patients whose blood pressure remains uncontrolled despite conservative management.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1449-1456"},"PeriodicalIF":2.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640175","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":"Age Differences in the Correlation Between the Cardiometabolic Index and Chronic Kidney Disease Risk in Adults With Hypertension","authors":"Yu Tao,&nbsp;Tao Wang,&nbsp;Wei Zhou,&nbsp;Lingjuan Zhu,&nbsp;Chao Yu,&nbsp;Huihui Bao,&nbsp;Juxiang Li,&nbsp;Xiaoshu Cheng","doi":"10.1111/jch.14917","DOIUrl":"10.1111/jch.14917","url":null,"abstract":"<p>Literature on the association between the cardiometabolic index (CMI) and chronic kidney disease (CKD) risk is limited, especially in hypertensive populations. The objective of the present investigation was to assess the relationship between the CMI and CKD risk in a hypertensive population. The current cross-sectional study included a total of 13 717 individuals with hypertension. The calculation of the CMI was based on the waist-to-height ratio and the triglyceride-to-high-density lipoprotein cholesterol ratio. The definition of CKD was based on an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m². The prevalence of CKD was found to be 4.24% in younger adults (aged &lt; 65 years) and 14.93% in the elderly (aged ≥ 65 years). The results of the multivariate regression analysis indicated that in the elderly group, the CMI was positively associated with CKD risk (odd ratio [OR] 1.29; 95% confidence interval [CI]: 1.14, 1.46), while no significant relationship was observed in the younger group (OR 1.04, 95% CI: 0.85, 1.27). Furthermore, subgroup analyses did not identify any potential factors that could modify the relationship between the CMI and CKD risk (all <i>p</i> for interaction &gt; 0.05). Among adults with hypertension, there was an independent and positive correlation between the CMI and CKD risk in the elderly, whereas such a correlation was not observed in younger adults.</p><p><b>Trial Registration</b>: ClinicalTrials.gov identifier: ChiCTR1800017274 [China Hypertension Registry Study]</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1457-1465"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Radiofrequency Renal Denervation for Uncontrolled Hypertension in Japan","authors":"Kazuomi Kario MD, PhD,&nbsp;Khoa N. Cao MBBS, MS, MPH,&nbsp;Yuji Tanaka MSc,&nbsp;Anne M. Ryschon MA,&nbsp;Jan B. Pietzsch PhD","doi":"10.1111/jch.14922","DOIUrl":"10.1111/jch.14922","url":null,"abstract":"<p>Radiofrequency renal denervation (RF RDN) is a novel therapy for uncontrolled hypertension. In the recent sham-controlled SPYRAL HTN-ON MED study, office-based systolic blood pressure (oSBP) and nighttime BP were reduced significantly. This study examined the cost-effectiveness of RF RDN in the context of the Japanese healthcare system based on this latest clinical evidence.</p><p>Clinical events, costs, and quality-adjusted life-years (QALYs) were projected using a decision-analytic Markov model adjusted to Japanese incidence data. Risk reduction in clinical events from changes in oSBP was calculated based on a published meta-regression of 47 trials of intentional hypertension treatment. Demographics and results from the SPYRAL HTN-ON MED trial (oSBP effect size −4.9 mmHg vs. sham) were utilized in the base case analysis. Additional scenarios were explored including the potential added benefit of improved night-time control. Costs were sourced from claims data and published literature. The incremental cost-effectiveness ratio (ICER) was evaluated against a cost-effectiveness threshold of ¥5 000 000 per QALY gained.</p><p>RF RDN was projected to reduce clinical events (10-year relative risks: 0.80 for stroke, 0.88 for myocardial infarction, and 0.75 for heart failure). Over lifetime, RF RDN added 0.36 QALYs at the incremental cost of ¥923 723, resulting in an ICER of ¥2 565 236 per QALY gained. Under the assumption of added night-time benefit, the ICER decreased to ¥2 155 895 per QALY. Cost-effectiveness findings were robust across all tested scenarios.</p><p>The findings of this model-based analysis suggest that RF RDN can provide meaningful clinical event reductions and is a cost-effective treatment option in the Japanese healthcare system.</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1502-1512"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584861","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":"Improvement of Care Cascade for Hypertension and Diabetes in Rural China: Protocol for an Implementation Study","authors":"Xuejun Yin,&nbsp;Zhenzhong Wang,&nbsp;Jingsong Yang,&nbsp;Jia Li,&nbsp;Shasha Han,&nbsp;Wenshuai Feng,&nbsp;Qinglan Liu,&nbsp;Ning Li,&nbsp;Lihui Zhang,&nbsp;Jiawen Ke,&nbsp;Xiaoxia Wei,&nbsp;Juan Zhang,&nbsp;Nizal Sarrafzadegan,&nbsp;Ruitai Shao","doi":"10.1111/jch.14918","DOIUrl":"10.1111/jch.14918","url":null,"abstract":"<p>The management of hypertension and diabetes poses significant challenges to China's healthcare system, necessitating seamless patient progression through screening, diagnosis, management, and control. Utilizing the care cascade model, this study aims to systematically identify patient drop-offs and devise strategies to address healthcare delivery bottlenecks for hypertension and diabetes in rural China. This study consists of three phases. In Phase 1, qualitative interviews are conducted to explore healthcare experiences and identify determinants across the care cascade. Phase 2 involves systematically assessing barriers identified in Phase 1 and collaborating with local stakeholders using intervention mapping and co-design to generate interventions and implementation strategies. Phase 3 is a cluster randomized controlled trial involving 48 villages, randomly assigned in a 1:1 ratio, to compare changes in hypertension and diabetes care. Intervention villages will implement interventions developed in Phase 2 for 1 year, while control villages will continue with usual care. Primary outcomes include between-group differences in achieving blood pressure and glycemic targets, along with service and implementation outcomes. This study aims to identify the stage with the largest patient retention gap in the care cascade and develop intervention strategies through participatory co-design with practitioners, emphasizing feasible, low-cost approaches. The pragmatic cluster RCT will assess strategy effectiveness, offering valuable insights for practical interventions to enhance hypertension and diabetes care in rural settings, potentially shaping impactful programs and improving healthcare outcomes.</p><p><b>Trial Registration</b>: ClinicalTrials.gov. identifier: NCT06141278</p>","PeriodicalId":50237,"journal":{"name":"Journal of Clinical Hypertension","volume":"26 12","pages":"1466-1478"},"PeriodicalIF":2.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.14918","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570024","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}