American Journal of Hypertension最新文献

{"title":"Response to \"reconsidering the interpretation of 'low-efficacy' antihypertensive initiation in older adults\".","authors":"Nelson Wang, Anthony Rodgers, Paul Muntner","doi":"10.1093/ajh/hpag039","DOIUrl":"https://doi.org/10.1093/ajh/hpag039","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure variability is associated with heart failure risk, elevated NT-proBNP, and elevated high-sensitivity troponin: the Multi-Ethnic Study of Atherosclerosis.","authors":"Daniel S Nuyujukian, Jin J Zhou, Juraj Koska, Shanpeng Li, Chike C Nwabuo, Alain G Bertoni, Gang Li, Peter D Reaven","doi":"10.1093/ajh/hpaf226","DOIUrl":"10.1093/ajh/hpaf226","url":null,"abstract":"<p><strong>Background: </strong>It is not well established whether blood pressure variability (BPV) is associated with risk of incident heart failure (HF) as well as with subclinical markers of HF and myocardial injury. We investigated these relationships in the Multi-Ethnic Study of Atherosclerosis (MESA).</p><p><strong>Methods: </strong>We examined the association between visit-to-visit BPV (estimated by variability independent of the mean-VIM) and HF in MESA (2000-2012), a community-based cohort study of 6814 individuals free of clinical cardiovascular disease (including HF) at baseline, using Cox models and joint longitudinal-survival models. VIM was calculated from Exams 1 to 5. Serial measurements (Exams 1 and 5) of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin-T (hs-cTnT) were used to test the early onset and directionality of the relationships by logistic regression.</p><p><strong>Results: </strong>Over a median of 9.4 years of follow-up, VIM-SBP was associated with HF in adjusted Cox models including CVD risk factors (HR = 1.33 [95% CI, 1.03-1.69]), as well as in joint longitudinal-survival models. BPV was associated with elevated Exam 5 NT-proBNP (>125 pg/mL) after multivariable adjustment (VIM-SBP: OR = 1.26 [95% CI, 1.17-1.37]; VIM-DBP: OR = 1.23 [95% CI, 1.14-1.33]) and Exam 5 elevation in hs-cTnT (for VIM-SBP, OR = 1.27).</p><p><strong>Conclusions: </strong>BPV was associated with incident HF and longitudinal increases of subclinical markers of HF and myocardial injury in a multi-ethnic community-based cohort. These data indicate that visit-to-visit BPV may contribute to the development of HF.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"696-703"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12798817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522649","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":"Tolvaptan Improves the Diurnal Blood Pressure Profile in Patients with Hypertension and Autosomal Dominant Polycystic Kidney Disease.","authors":"Masaaki Hanaoka, Hiromichi Wakui, Daisuke Kanai, Sho Kinguchi, Kengo Azushima, Toshimasa Ohnishi, Kouichi Tamura","doi":"10.1093/ajh/hpag035","DOIUrl":"https://doi.org/10.1093/ajh/hpag035","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder frequently associated with non-dipper hypertension, with tolvaptan being the only currently approved treatment. However, the effects of tolvaptan on blood pressure (BP) in patients with ADPKD and hypertension remain unclear.</p><p><strong>Methods: </strong>This retrospective study examined the effect of tolvaptan on 24-hour ambulatory BP monitoring parameters. Changes in ambulatory BP-related parameters, including annual rate of change in total kidney volume (TKV), were assessed in 23 patients with ADPKD and hypertension before and after initiating tolvaptan.</p><p><strong>Results: </strong>After initiation of tolvaptan, nocturnal systolic and diastolic BP dipping rates increased significantly, with systolic dipping rising from 9.61% to 14.0% (Δ  + 4.39%; P = .014) and diastolic dipping from 10.48% to 14.66% (Δ  + 4.18%; P = .023). The prevalence of a non-dipper BP profile decreased from 57% at baseline to 29% after treatment (P = .0339). In addition, the annual growth rate of TKV decreased from 13.6% to 1.61% (P < .0001), and the eGFR slope improved from -4.46 to - 2.26 mL/min/1.73 m2/year (P = .0431).</p><p><strong>Conclusions: </strong>Tolvaptan treatment was associated with improvements in nocturnal BP decline and diurnal BP patterns in patients with hypertension and ADPKD. In addition, a reduced rate of TKV growth and a slower decline in eGFR were observed. These findings provide further insight into the potential hemodynamic and renal effects of tolvaptan in this population.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADAM17 expression in ACEI/ARB-treated patients with hypertension was comparable to that observed in patients without hypertension.","authors":"Nora L Falcoff, Gabriela R Guman, Rolando F Seguel, Gabriela C Tabaj, Jonathan Honickman, Lucila Daroca, Myriam Nuñez, Martin Salazar, Gianfranco Parati, Mariela M Gironacci","doi":"10.1093/ajh/hpag040","DOIUrl":"https://doi.org/10.1093/ajh/hpag040","url":null,"abstract":"<p><strong>Background: </strong>ADAM17 (A disintegrin and metalloproteinase 17) contributes to angiotensin-converting enzyme (ACE) 2 shedding in response to angiotensin II-AT1 receptor signaling, potentially shifting the renin-angiotensin system toward its pressor arm. We investigated whether ACE inhibitor (ACEI) or AT1 receptor blocker (ARB) therapy modulates ADAM17 expression.</p><p><strong>Methods: </strong>ADAM17 protein expression was evaluated by immunohistochemistry in alveolar type II pneumocytes of lung parenchymal samples from untreated control patients (n = 20) and patients treated with ACEI (n = 21) or ARB (n = 17; total ACEI/ARB-treated patients = 38).</p><p><strong>Results: </strong>There were no significant differences in the proportion of ADAM17-expressing type II pneumocytes between patients without hypertension and ACEI/ARB-treated patients with hypertension (56.1 ± 4.3% vs 45.8 ± 3.1%, respectively). Similarly, no differences were observed according to smoking status (50.6 ± 4.1% in never smokers, 48.4 ± 4.0% in current smokers, and 50.8 ± 6.8% in former smokers) or sex (49.7 ± 4.2% in women vs. 49.1 ± 3.3% in men). In contrast, a significant age-related decline in the proportion of ADAM17-expressing type II pneumocytes was observed (56.2 ± 3.5% in patients <60 years vs. 43.0 ± 3.5% in patients ≥60 years; P = .005).</p><p><strong>Conclusions: </strong>These findings suggest that ACEI/ARB therapy, while targeting the pressor axis of the RAS, maintains ADAM17 expression at levels comparable to those in patients without hypertension. ACEI/ARB therapy may represent a potential strategy for the treatment of ADAM17-mediated cardiovascular, pulmonary, and inflammatory diseases.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Insurance Status and Hypertension Control Before and After the Affordable Care Act.","authors":"Brent M Egan, Jiexiang Li, Susan E Sutherland, Michael K Rakotz","doi":"10.1093/ajh/hpag036","DOIUrl":"https://doi.org/10.1093/ajh/hpag036","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure control among adults <65 years old with public, private, or no healthcare insurance after the U.S. 2010 Affordable Care Act (ACA) is unknown.</p><p><strong>Methods: </strong>National Health and Nutrition Examination Surveys were analyzed pre- (2001-2010) and post-ACA (2015-2023) on adults 20-64 years (pre-Medicare eligibility) with hypertension (systolic ≥140 or diastolic blood pressure ≥90 mmHg, or antihypertensive therapy). Relationships of blood pressure control (<140/<90 mmHg) to healthcare insurance and social determinants (race/ethnicity, low income [<200% federal poverty]) were assessed.</p><p><strong>Results: </strong>Among adults 20-64 years with hypertension pre- vs. post-ACA the uninsured (17.2% vs. 11.4%) and privately insured declined (64.3% vs. 56.0%), while the publicly insured increased (16.2% vs. 28.5%). Non-Hispanic Black and Hispanic adults comprised lower percentages of privately than publicly or uninsured adults, respectively, pre-ACA (18.9% vs. 37.3%, 42.4%) and post-ACA (24.1% vs. 38.3%, 50.3%). Low incomes were less frequent for privately than publicly or uninsured adults, respectively, pre-ACA (13.0% vs. 64.4%, 64.9%) and post-ACA (11.3% vs. 67.6%, 63.1%). Blood pressure control was not different pre-ACA for publicly and privately insured adults (54.3% vs. 50.4%, P = .064) and lower among uninsured adults (30.5%) than both insured groups with a similar pattern post-ACA (54.5% [public], 50.2% [private], 30.3% [uninsured]).</p><p><strong>Conclusions: </strong>In this U.S. population-based study, blood pressure control was not different for publicly and privately insured adults pre- and post-ACA, although lower for uninsured adults. Public healthcare insurance appeared to continue mitigating effects of adverse social determinants on blood pressure control post-ACA, despite the increase in publicly insured adults.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Informed Prioritization of Interventions for Integrating Hypertension Management into Cardiovascular-Kidney-Metabolic Care in Primary Health Care: HEARTS 2.0 Phase 3.","authors":"Pedro Ordunez, Andres Rosende, Maria Florencia Grande Ratti, Donald J DiPette, Ana Marcela Torres, Esteban Londoño, Sonia Y Angell, Mariana L Rodriguez de la Cerda, Norm R C Campbell, Libardo Rodríguez Martínez, Jeffrey Brettler, Fernando Tortosa, Vilma Irazola, Marc G Jaffe, Ariel Izcovich, Niamh Chapman, Andelys de la Rosa, Ana Claudia de Souza, Miguel Angel Diaz Aguilera, Paula Diaz Valencia, David Flood, Lourdes Jarquin, Taskeen Khan, Javier Mariani, Andrew E Moran, Carolina Neira Ojeda, Emily Ridley, Marcela Rivera, Gonzalo Rodriguez, Cesar A Romero, Santiago Torroba, Yamile Valdes Gonzalez, Natalia Vensentini, Irmgardt A Wellmann, Eric Zuniga, Ludovic Reveiz, Paul K Whelton","doi":"10.1093/ajh/hpag033","DOIUrl":"https://doi.org/10.1093/ajh/hpag033","url":null,"abstract":"<p><strong>Background: </strong>HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. This paper presents Phase 3 of HEARTS 2.0, an evidence-informed process to prioritize clinical and health-system interventions to support the operationalization of integrated cardiovascular, kidney, and metabolic (CKM) care in primary health care (PHC) and to inform the update of the HEARTS Clinical Pathway. CKM conditions frequently coexist, sharing common risk factors and pathophysiological mechanisms that exacerbate cardiovascular disease burden. Despite their overlap, clinical practice often remains siloed due to condition-specific guidelines, and its integration remains limited.</p><p><strong>Objective: </strong>To prioritize evidence-informed clinical and health-system interventions that support the operationalization of integrated CKM care within PHC and inform the update of the HEARTS Clinical Pathway.</p><p><strong>Methods: </strong>Building on previous phases of HEARTS 2.0, a multidisciplinary panel evaluated 45 candidate interventions in different areas. The selection process utilized structured evidence appraisal, Evidence-to-Decision frameworks, and a modified RAND/UCLA appropriateness method involving anonymized rating rounds.</p><p><strong>Results: </strong>A total of 38 interventions were prioritized for implementation. Although hypertension management remains the primary entry point, the resulting framework integrates early detection of diabetes and chronic kidney disease, lifestyle interventions, risk-based combination pharmacotherapy, task-sharing, and longitudinal follow-up.</p><p><strong>Conclusion: </strong>By translating dispersed guideline recommendations into implementable interventions, Phase 3 of HEARTS 2.0 provides an evidence-informed basis for advancing integrated CKM care at scale in PHC and guiding the forthcoming update of the HEARTS Clinical Pathway. The resulting framework offers a flexible, scalable approach for countries confronting similar epidemiological and health system challenges.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Hypertension and Obesity and the Risk of Incident Heart Failure: Insights from Two Prospective Cohort Studies.","authors":"Dongjie Du, Yitian Chen, Weilan Li, Zeya Li, Weihua Chen, Rongchong Huang","doi":"10.1093/ajh/hpag038","DOIUrl":"https://doi.org/10.1093/ajh/hpag038","url":null,"abstract":"<p><strong>Background: </strong>This study examined the association of hypertension and obesity with incident heart failure (HF) and the feasibility of the clinical obesity definition proposed by The Lancet Diabetes & Endocrinology Commission.</p><p><strong>Methods: </strong>Data from the UK Biobank (n = 444,754) and Tongzhou Cohort (n = 10,459) were analyzed. Hypertension was defined as physician-diagnosed hypertension, blood pressure ≥140/90 mmHg, or antihypertensive treatment. Obesity was assessed as BMI-defined obesity, central obesity, a combined \"BMI+central\" anthropometric phenotype, and clinical obesity, defined as excess adiposity with obesity-related organ dysfunction and/or functional limitation. Participants were classified into four groups: neither hypertension nor obesity, obesity only, hypertension only, and coexisting hypertension and obesity. Kaplan-Meier curves and multivariable Cox models were used to estimate HF risk, and joint effects of elevated blood pressure and pre-obesity were evaluated.</p><p><strong>Results: </strong>The two cohorts had similar mean ages: 58.15 ± 6.84 years in the UK Biobank and 59.42 ± 6.29 years in Tongzhou Cohort. Depending on the obesity definition, the prevalence of coexisting hypertension and obesity ranged from 18.0% to 25.9% in the UK Biobank and 23.1% to 37.3% in Tongzhou Cohort. Across BMI-defined obesity, central obesity, the combined \"BMI+central\" phenotype, and, in the UK Biobank, clinical obesity, coexistence of hypertension and obesity was consistently associated with the highest HF risk. Among individuals without hypertension or obesity, the combination of elevated blood pressure and pre-obesity was associated with increased risk of HF.</p><p><strong>Conclusion: </strong>Coexisting hypertension and obesity are associated with the highest HF risk across multiple adiposity definitions, and excess risk is evident even at preclinical stages.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visit-to-visit systolic blood pressure variability and risk of severe hypertensive episodes in a multicenter cohort.","authors":"Hyung Joon Joo, Youngho Seo, Soon Jun Hong, Cheol Woong Yu, Seung Yong Shin, Eung Ju Kim","doi":"10.1093/ajh/hpag034","DOIUrl":"https://doi.org/10.1093/ajh/hpag034","url":null,"abstract":"<p><strong>Background: </strong>Visit-to-visit blood pressure variability has been associated with cardiovascular outcomes; however, its role in predicting severe blood pressure (BP) elevation requiring emergency department care remains uncertain. We investigated whether long-term systolic blood pressure variability independently predicts severe BP elevation and evaluated externally validated prediction models.</p><p><strong>Methods: </strong>We analyzed electronic health records from three tertiary hospitals. After excluding patients with cardiovascular events during a 2-year monitoring window, systolic blood pressure variability, quantified by standard deviation (SD), was assessed for incident severe BP elevation (systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg at emergency department visits) during 5-year follow-up using landmark Cox models. Risk prediction models incorporating systolic blood pressure variability were developed and externally validated across institutions.</p><p><strong>Results: </strong>Among 20,090 patients, 2,128 (10.6%) developed severe BP elevation. Each 1-SD increase in systolic blood pressure variability was independently associated with severe BP elevation (adjusted hazard ratio 1.21, 95% confidence interval 1.16-1.26; P < .001), irrespective of mean blood pressure and clinical covariates. The association was consistent across major subgroups. Prediction model incorporating blood pressure variability achieved good discrimination in external validation cohorts (area under the curve 0.763 [Guro] and 0.765 [Anam]).</p><p><strong>Conclusions: </strong>Visit-to-visit blood pressure variability independently predicts severe hypertensive destabilization beyond mean blood pressure. These findings suggest that incorporating visit-to-visit blood pressure variability into clinical assessment may improve identification of patients at risk for severe hypertensive episodes.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debating coffee and hypertension: coffee may increase the risk for chronic hypertension.","authors":"Paolo Palatini","doi":"10.1093/ajh/hpag017","DOIUrl":"https://doi.org/10.1093/ajh/hpag017","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debating coffee and hypertension: coffee does not increase the risk of chronic hypertension.","authors":"Guido Grassi","doi":"10.1093/ajh/hpag028","DOIUrl":"https://doi.org/10.1093/ajh/hpag028","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}