American Journal of Hypertension最新文献

{"title":"Medical Costs, Health Care Utilization, and Productivity Losses Associated with Hypertension Moderated by COVID-19 Diagnosis Among US Commercial Enrollees.","authors":"Jun Soo Lee, Yidan Xue Zhang, Yu Wang, Joohyun Park, Ashutosh Kumar, Bruce Donald, Feijun Luo, Kakoli Roy","doi":"10.1093/ajh/hpaf081","DOIUrl":"https://doi.org/10.1093/ajh/hpaf081","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a major risk factor for cardiovascular and renal diseases, significantly contributing to morbidity and mortality. The COVID-19 pandemic has heightened concerns about the impact of hypertension on severe COVID-19 outcomes.</p><p><strong>Methods: </strong>We analyzed 2020-2021 data from the MarketScan Commercial and Health and Productivity Management databases, focusing on adults aged 18-64 years with continuous employer-sponsored private insurance, excluding pregnancy or capitated plans. We compared medical costs, healthcare utilization (emergency department [ED] visits, inpatient admissions, outpatient visits, and outpatient prescription drugs), and productivity losses (sick absences, short-term disability [STD], and long-term disability [LTD]) between individuals with and without hypertension, stratified by COVID-19 diagnosis. We used multivariable regression models, including an interaction term for hypertension and COVID-19 diagnosis, to estimate differences in outcomes, adjusting for demographics and comorbidities.</p><p><strong>Results: </strong>Among 1,296,596 adults, 21% had hypertension. Those with hypertension were older, less likely female, less likely urban residents, and had more comorbidities. Excess medical costs associated with hypertension were $8,572 per patient over the two-year period (95% CI $8,182-$8,962). Patients with versus without hypertension had 0.200 (95% CI, 0.195-0.205) more ED visits, 0.081 (95% CI, 0.077-0.085) more inpatient admissions, 5.984 (95% CI, 5.892-6.075) more outpatient visits, and 20.25 (95% CI, 20.09-20.41) more prescriptions per patient over the two-year period. They also had more sick absences (1.13 days; 95% CI 0.93-1.34) and STD occurrences (3.88 days; 95% CI 3.56-4.20) per patient. Among those with hypertension, individuals with versus without COVID-19 had $3,495 (95% CI, $2,135-$4,856) higher medical costs and 2.588 (95% CI, 1.112-4.065) more STD days per patient over the two-year period.</p><p><strong>Conclusions: </strong>Hypertension was associated with higher medical costs, healthcare utilization, and productivity losses, exacerbated by COVID-19.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961462","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":"Exploring the Causal Relationships Between Anxiety, Obesity, and Hypertension: A Two-Sample Mendelian Randomization Study.","authors":"Caini Fan, Jie Wang, Baozhu Guo, Shanshan Wang, Dehui Kong, Min Liu, Ling Jiang, Ling Li, Haiying Zhao","doi":"10.1093/ajh/hpaf072","DOIUrl":"https://doi.org/10.1093/ajh/hpaf072","url":null,"abstract":"<p><strong>Background: </strong>Both anxiety and obesity have been implicated in hypertension development, with emerging evidence suggesting metabolic risk factors as potential mediators. Notably, obesity may partially mediate the link between anxiety and hypertension. However, the causal relationships among these factors remain unclear. To address this, we conducted a two-sample Mendelian randomization (MR) analysis to elucidate their causal relationship.</p><p><strong>Methods: </strong>We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from European ancestry cohorts. The inverse-variance weighted (IVW) method was used as the primary analytical approach, with sensitivity analyses and heterogeneity tests conducted to ensure robustness. Additionally, a two-step MR approach was conducted to quantify the proportion of the anxiety-hypertension association mediated through obesity-related pathways.</p><p><strong>Results: </strong>The two-sample MR analysis demonstrated significant causal effects of anxiety (OR=1.025, 95% CI 1.011-1.038; P<0.001) and obesity (OR=1.010, 95% CI 1.007-1.013; P<0.001) on hypertension risk. Bidirectional analysis revealed a unidirectional causal association between anxiety and obesity (OR=1.518, 95% CI 1.044-2.206; P=0.029), with no evidence of reverse causation from obesity to anxiety (OR=1.014, 95% CI 0.990-1.039; P=0.268). Mediation analysis estimated that 17.4% (95% CI 5.3-29.5%) of anxiety's total effect on hypertension risk was mediated through adiposity-related pathways.</p><p><strong>Conclusion: </strong>The two-sample MR analysis in this study confirmed a causal relationship between anxiety and hypertension. Obesity was found to partially mediate this association. Our causal estimates support weight management interventions as an effective psychosomatic strategy for preventing hypertension in individuals with anxiety, particularly due to the modifiable nature of obesity-related risk factors.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968217","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":"Hypertensive Pregnancy Disorders: From Mechanisms to Management.","authors":"Marcus K Robbins, Hellen Nembaware, Sautan Mandal, Anukool Bhopatkar, Azaziah Parker, Christy Chambers, Chas Brewerton, Jessica Mauroner, Krystle Hughes, Evangeline Deer, Jan M Williams, Denise C Cornelius","doi":"10.1093/ajh/hpaf080","DOIUrl":"https://doi.org/10.1093/ajh/hpaf080","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity and mortality globally, affecting up to 10% of pregnancies. As rates of obesity, chronic hypertension, and advanced maternal age continue to rise, the burden of HDP is expected to escalate. This review provides a comprehensive overview of HDP, encompassing updated classification systems, risk factors, and diagnostic approaches, including emerging biomarkers and predictive imaging tools. We highlight the complex pathophysiology involving impaired placentation, angiogenic imbalance, immune dysregulation, oxidative stress, mitochondrial dysfunction, and epigenetic modifications. Current management strategies are discussed alongside evolving therapeutic interventions, including low-dose aspirin, statins, and novel agents such as hydrogen sulfide donors and C-type natriuretic peptide. Special emphasis is placed on racial, ethnic, and socioeconomic disparities that contribute to disproportionate outcomes, particularly among Black and Indigenous women. We also explore the role of personalized medicine, predictive models, and digital health tools in transforming HDP care. By integrating mechanistic insight with public health strategies and clinical innovation, this review aims to inform multidisciplinary approaches to reduce the burden of HDP and promote equitable maternal and neonatal outcomes.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956994","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":"Kidneys Under Pressure In Ckd Patients With And Without Nocturnal Hypertension.","authors":"Peter W de Leeuw, Liffert Vogt","doi":"10.1093/ajh/hpaf079","DOIUrl":"https://doi.org/10.1093/ajh/hpaf079","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966031","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":"The Impact Of Modern Industrialized Dietary Sodium Intake On The Plasma Proteome.","authors":"Melinda Solomon, Mahyar Heydarpour, Laura C Tsai, Brooke Honzel, Jenifer Brown, Andrew J Newman, Stefanie Parisien-LaSalle, Thomas J Wang, Jin Wei, Jie Zhang, Sushrut Waikar, Anand Vaidya","doi":"10.1093/ajh/hpaf078","DOIUrl":"https://doi.org/10.1093/ajh/hpaf078","url":null,"abstract":"<p><strong>Background: </strong>High dietary sodium intake is associated with cardiovascular disease. We investigated the influence of sodium intake on the plasma proteome.</p><p><strong>Methods: </strong>Prospectively recruited normotensive participants underwent 2 controlled dietary sodium interventions to evaluate hormonal and proteomic (1,512 proteins) changes: sodium-restriction resembling ancestral hunter-gatherer intake (~10 mEq/day, ~230mg/day) and sodium-loading resembling modern industrialized intake (~200 mEq/day, ~4600mg/day). 24h urine collections were obtained after each diet. Plasma proteomic changes were assessed with correction for false-discovery.</p><p><strong>Results: </strong>Participants achieved a 24h urinary sodium excretion of 16 mEq/L when sodium-restricted and 249 mEq/L when sodium-loaded. 38 proteins displayed statistically significant changes with 15 additional proteins exhibiting notable trends that did not reach statistical significance. The most apparent changes were increases in proteins related to fibrosis and the extracellular matrix (ECM) when sodium loaded, whereas sodium restriction increased proteins related to immune/inflammatory pathways and the renin-angiotensin system (RAS)-kallikrein-kinin system (KKS)-complement pathway. NT-proBNP, FUMH (fumarate hydratase), LKHA4 (leukotriene A(4) hydrolase), COFA1 (collagen alpha-1(V) chain), COF2 (cofilin-2), BMP-4, and TGF-β RIII had the greatest increases when sodium-loaded, whereas renin, thrombin, apo A-1 (apolipoprotein A-1), FABPA (fatty-acid binding protein), and LEAP-1 (hepcidin) had the greatest increases when sodium-restricted.</p><p><strong>Conclusion: </strong>When compared to a sodium-restricted diet resembling ancestral intake, the modern industrialized dietary sodium intake increased proteins related to fibrosis and the ECM, and decreased proteins related to the RAS, KKS, immunity and inflammation. These findings in normotensive people provide an atlas of proteomic changes, and biological pathways, that may contribute to hypertension and other sodium-related disorders.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953807","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":"Commentary on \"Plasmacytoid dendritic cell content is associated with plasma aldosterone concentration in patients with primary aldosteronism\".","authors":"Georgiana Constantinescu, Nicole Bechmann","doi":"10.1093/ajh/hpaf076","DOIUrl":"https://doi.org/10.1093/ajh/hpaf076","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958420","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":"Long-term Efficacy and Safety of Unilateral Adrenal Artery Embolization in Patients with Idiopathic Hyperaldosteronism: A 24-month Cohort Study.","authors":"Guo Ji, Sen Liu, Jindong Wan, Yaqiong Zhou, Changqiang Yang, Xinquan Wang, Gaomin He, Anping Zeng, Lingling Zhang, Tao Luo, Yi Yang, Dan Wang, Kaige Feng, Jixin Hou, Peijian Wang","doi":"10.1093/ajh/hpaf077","DOIUrl":"https://doi.org/10.1093/ajh/hpaf077","url":null,"abstract":"<p><strong>Background: </strong>Adrenal artery embolization (AAE) has been shown to reduce blood pressure (BP) and correct biochemical abnormalities in patients with idiopathic hyperaldosteronism (IHA) during short-term 6-12-month follow-ups. This study aimed to evaluate the long-term efficacy and safety of unilateral AAE over a 24-month period.</p><p><strong>Methods: </strong>The prospective study included 109 IHA patients undergoing unilateral AAE, with 94 completing the 24-month follow-up. Evaluations included office, home and 24-hour ambulatory BP, biochemical markers, renal function, and cardiac function (echocardiography). Medication use and adverse events were documented.</p><p><strong>Results: </strong>At the 24-month follow-up, the office, home, and 24-hour ambulatory systolic BP values decreased by 17.3 ± 23.1, 16.4 ± 21.9, and 9.9 ± 18.6 mmHg, respectively (all P < 0.001), and the diastolic BP values decreased by 8.8 ± 16.1, 7.1 ± 15.8, and 6.4 ± 11.1 mmHg (all P < 0.001). The complete and partial clinical success rates were 14.9% and 50.0%, respectively, whereas those for biochemical success were 13.6% and 45.5%. Abnormal biochemical characteristics, including elevated plasma aldosterone levels, increased aldosterone‒renin ratios (ARRs), plasma renin suppression, and hypokalemia, were significantly improved (all P < 0.01). Improvements in cardiac remodeling and left ventricular (LV) diastolic function were observed, particularly in those with elevated LV mass index (P < 0.05). No evidence of renal impairment or long-term safety concerns was observed.</p><p><strong>Conclusion: </strong>Unilateral AAE in IHA patients promotes sustained BP reduction, biochemical correction, improved cardiac remodeling, and enhanced LV diastolic function over 24 months, with no significant long-term safety concerns.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957190","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":"Association of anxiety with discrepancies between unattended and attended office blood pressure measurement.","authors":"M Stopa, K Zięba, A Tofilska, B Bętkowska-Korpała, G Bilo, M Rajzer, A Olszanecka","doi":"10.1093/ajh/hpaf075","DOIUrl":"https://doi.org/10.1093/ajh/hpaf075","url":null,"abstract":"<p><strong>Background: </strong>Precision of blood pressure (BP) measurements is crucial in hypertension care. Conventional office measurements (OBP) are susceptible to confounding factors, including the white coat effect. An emerging alternative is unattended automated office BP measurement (UAOBP). UAOBP values are typically lower than OBP, but factors responsible for this phenomenon remain poorly understood. The study aimed to analyze factors affecting discrepancies between these methods.</p><p><strong>Methods: </strong>219 hypertensive patients completed the State-Trait Anxiety Inventory questionnaire, assessing anxiety levels. Subsequently, BP measurements were performed using two methodologies in a randomized sequence:UAOBP: After a 5-minute rest in the examination room, BP was automatically measured three times at 1-minute intervals.OBP: Following a 5-minute rest, a physician performed three automated oscillometric measurements at 1-minute intervals.</p><p><strong>Results: </strong>The BP values obtained through UAOBP were significantly lower than those in OBP: mean (SD) 124.7 (14.4) vs. 128.2 (14.2) mmHg, p<0.001 for systolic, and 73.3 (10.2) vs. 75.2 (10.6) mmHg, p<0.001 for diastolic. In the multiple regression analysis, the only factors significantly affecting the differences in systolic BP measurements were trait anxiety level (β = 0.22; p = 0.02) and the order in which the measurements were taken (β = 3.5; p = 0.01). Diastolic BP differences were only predicted by the order of measurement (β = 2.8; p < 0.001).</p><p><strong>Conclusions: </strong>UAOBP appears particularly efficient in mitigating the white coat effect in patients with high levels of anxiety. Further research is needed to investigate whether this may improve the assessment of BP-related risk in such patients.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956202","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":"The association between diabetes and hypertension time course, their cumulative co-exposure, and post-coronary artery bypass graft outcomes.","authors":"Mana Jameie, Behrad Saeedian, Mina Pashang, Nastaran Babajani, Ahmad Vakili, Fatemeh Chichagi, Sepehr Nayebi Rad, Arash Jalali, Mani K Askari, Shahab Toursavadkohi, Mushabbar Syed, Adrian V Hernandez, Soheil Mansourian, Kaveh Hosseini","doi":"10.1093/ajh/hpaf074","DOIUrl":"https://doi.org/10.1093/ajh/hpaf074","url":null,"abstract":"<p><strong>Background: </strong>The association between patient outcomes and cumulative effects of cardiovascular risk factors over time is recognized but poorly quantified. This study quantitively addressed the impact of diabetes and hypertension duration, and their combined effect, on post-coronary artery bypass grafting (CABG) outcomes.</p><p><strong>Methods: </strong>This single-center cohort study included patients who underwent coronary angiography followed by isolated CABG (n=10803, median follow-up: 111.3 months) from 2007 to 2017. Study outcomes comprised all-cause mortality and major adverse cardiocerebrovascular events (MACCE). Cox regressions were used to assess the association between risk factors' duration (<5 years, 5-10 years, ≥10 years) and study outcomes among the total cohort and stratified by the co-presence of risk factors.</p><p><strong>Results: </strong>The study population aged 65.56 ± 10.00 years (75.3% male, 40.1% diabetes, 64.1% hypertension). The risk of study outcomes increased with increasing duration of diabetes (adjusted-hazard ratio from \"0-5y\" to \"≥10y\" group for all-cause mortality: 1.37[95%CI: 1.23-1.52] to 1.91[1.69-2.16], and for MACCE: 1.23[1.14-1.34] to 1.59[1.44-1.76]). When stratified by hypertension status, the association between shorter diabetes duration and study outcomes became non-significant among non-hypertensive patients, while the association persisted for their hypertensive counterparts (reference group: non-diabetic patients). An increasing risk pattern was observed with longer hypertension duration (from 1.38[1.25-1.53] to 1.51[1.30-1.75] for all-cause mortality and 1.27[1.18-1.37] to 1.39[1.24-1.55] for MACCE). This risk enhancement was more pronounced when diabetes co-existed.</p><p><strong>Conclusion: </strong>Our results highlight the significance of risk factor exposure duration in patient risk assessment. These insights could be valuable for enhancing existing risk assessment tools and developing tailored preventive strategies.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061936","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":"Adrenal Ablation for Primary Aldosteronism: A Novel Alternative or Complement to Traditional Treatments.","authors":"Zhiming Zhu, Hao Wu, Hongbo He","doi":"10.1093/ajh/hpaf067","DOIUrl":"https://doi.org/10.1093/ajh/hpaf067","url":null,"abstract":"","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962115","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}