American Journal of Hypertension最新文献

{"title":"Blood pressure Time in Target Range and Clinical Outcomes in Chronic Kidney Disease.","authors":"M Rahman, Z Chen, M Dweekat, M Wang","doi":"10.1093/ajh/hpag085","DOIUrl":"https://doi.org/10.1093/ajh/hpag085","url":null,"abstract":"<p><strong>Background: </strong>We examined the association between blood pressure (BP) time in target range and clinical outcomes in chronic kidney disease (CKD).</p><p><strong>Methods: </strong>In 1908 participants in the Chronic Renal Insufficiency Cohort study who had BP measured at each visit for the first five years of the study, BP time in target range was defined as the percentage of visits with BP < 130/80 mmHg between baseline and year 5; and categorized into three groups (<25%, 25% to 75% and >75% of visits in target). Outcomes included cardiovascular events, kidney outcomes and mortality occurring after the year 5 visit.</p><p><strong>Results: </strong>BP was in target range < 25% of visits in 430 (22.5%) participants; 909 (47.6%) participants had BP in target range 25-75% of visits, and 569 (29.8%) participants had BP in target range > 75% of visits. Participants with BP in target range at < 25% of visits had higher risks of subsequent cardiovascular events (Hazard Ratio HR 1.76, 95% Confidence Intervals 1.28-2.41), kidney outcomes (HR 2.25, 1.66-3.05), and all-cause mortality (HR 1.54, 1.21-1.97) compared with those controlled at > 75% of visits Participants with BP in target range at 25-75% of visits had higher risks of subsequent cardiovascular events (HR 1.46, 1.12-1.89), and kidney outcomes (HR 1.55, 1.21-1.98), compared with those controlled at > 75% of visits.</p><p><strong>Conclusions: </strong>Participants with CKD with lower BP time in target range over a five year period had a higher risk of subsequent renal and cardiovascular outcomes.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705411","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":"A 25-YEAR LONGITUDINAL GENDER-BASED STUDY ON LEFT VENTRICULAR GEOMETRY TRACKING IN THE GENERAL POPULATION: THE PAMELA STUDY.","authors":"Cesare Cuspidi, Rita Facchetti, Marijana Tadic, Elisa Gherbesi, Giuseppe Mancia, Guido Grassi","doi":"10.1093/ajh/hpag098","DOIUrl":"https://doi.org/10.1093/ajh/hpag098","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal findings on the relationship between sex, aging and left ventricular (LV) geometric patterns in population-based cohorts with a low prevalence of risk factors, are still scarce. We investigated this issue in the participants of the third survey of Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study in which echocardiographic data were prospectively collected over a 25-year period.</p><p><strong>Methods: </strong>420 participants who attended the initial survey (1990-1993) and two subsequent ones, 10 (2001-2003) and 25 years later (2017-2018), were included in the analysis. LV geometric patterns were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines.</p><p><strong>Results: </strong>The prevalence of LV concentric geometry (i.e. relative wall thickness ≥ 0.43) increased progressively across the three surveys in both men: 11.5 (CI: 7.8-16.7), 29.0 (CI: 23.1-35.6), 53.0% (CI: 46.1-59.8), p < 0.001 and women: 5.5 (CI: 3.1-9.3), 14.9 (CI: 10.5-19.8), 36.8% (CI: 30.7-43.4), p < 0.001. Contrary to what found for other patterns, the prevalence of concentric LV hypertrophy (LVH) showed a different sex-specific behaviour, i.e. a gradual increase in women from the first to the third survey: 1.4 (CI: 0.5-2.4), 5.0 (CI: 2.8-8.3), 13.6% (CI: 9.7-18.8), p < 0.001) and a decline from second to third survey in men: 0.5 (CI: 0.1-2.8), 9.0 (CI: 5.8-13.9), 7.5% (CI: 4.6-12.0), p < 0.05).</p><p><strong>Conclusions: </strong>Our findings show that aging is accompanied by a marked increase in concentric geometry in both sexes, and suggest that women are at higher risk of developing concentric LVH.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683117","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 and cardiovascular risk in a contemporary cohort of young adults.","authors":"Eirik Aaseth, Sigrun Halvorsen, Sverre Erik Kjeldsen, Jørgen Gravning","doi":"10.1093/ajh/hpag025","DOIUrl":"10.1093/ajh/hpag025","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that blood pressure (BP) is a stronger risk factor for cardiovascular disease (CVD) in women compared to men. However, few have rigorously investigated this association in young adults with emphasis on sex differences.</p><p><strong>Methods: </strong>In 2000, the \"Oslo Health Study\" (HUBRO), recruited 5933 individuals born in 1969 or 1970. By linkage with national health registries in Norway, we followed this cohort through 2024 with respect to CVD events. Multivariate Cox analyses were performed to assess the risk of CVD during follow-up. Sex-specific analyses were performed by interaction testing.</p><p><strong>Results: </strong>The median age at baseline was 31 years (interquartile range (IQR): 30-31), and 56% were women. The median systolic and diastolic BP was 122 (IQR 114-130) and 69 (IQR 63-75) mm Hg, respectively. After 24 years of follow-up, 158 (2.7%) CVD events had occurred. The adjusted hazard ratio (HR) (95% confidence interval) for CVD events per 10 mm Hg higher systolic and 5 mm Hg higher diastolic BP was 1.22 (1.04-1.42) and 1.20 (1.09-1.31), respectively. The HR per 10 mm Hg higher systolic BP was 1.30 (1.01-1.68) in women vs 1.15 (0.96-1.38) in men. No statistically significant sex-interaction between systolic BP and risk of CVD event was found (P = .38). The HR per 5 mm Hg higher diastolic BP was 1.20 (1.03-1.41) in women and 1.20 (1.07-1.34) in men.</p><p><strong>Conclusions: </strong>In young adults from the general population, systolic and diastolic BP were related to the risk of CVD events during long-term follow-up, with similar risk in women and men.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"1005-1012"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508907","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":"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":"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 US 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 aged 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 the 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 insured adults than for publicly insured 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 US 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 the 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":"1013-1020"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369954/pdf/","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":"OA","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":"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. 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>Conclusions: </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":"956-965"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369960/pdf/","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":"OA","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":"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 3 tertiary hospitals. After excluding patients with cardiovascular events during a 2-year monitoring window, systolic blood pressure variability, quantified by 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":"979-987"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","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":"Sodium, potassium, and calories: implications for implementing a recommended diet in adults with hypertension.","authors":"Michael G Buhnerkempe, Avani Yaganti, Stephanie Bitner, Zachary Settelmyer, Ananya Yaganti, Annah Carney, Vivek Prakash, Albert Botchway, Asad Cheema, John M Flack","doi":"10.1093/ajh/hpag021","DOIUrl":"10.1093/ajh/hpag021","url":null,"abstract":"<p><strong>Background: </strong>Achieving evidence-based dietary recommendations for sodium and potassium are key lifestyle modifications for adults with hypertension. This study aimed to investigate how dietary recommendations have been followed in US adults with hypertension over time.</p><p><strong>Methods: </strong>Cross-sectional data on adults with hypertension was pooled from 12 National Health and Nutrition Examination Surveys (1999-2023). Dietary electrolyte intake was stratified as: (1) sodium ≤2300 mg/day (recommended) or ≤1500 mg/day (ideal), and (2) potassium ≥3500 mg/day (recommended) or ≥4700 mg/day (ideal).</p><p><strong>Results: </strong>From 1999 to 2023, 29.4% (95% confidence interval: 28.6-30.1) and 20.3% (19.6-21.0) of adults with hypertension met recommended sodium and potassium intakes, respectively, with 1.3% (1.1-1.5) meeting both levels. Adults with hypertension meeting ideal intakes for sodium, potassium, and both represented 9.5% (9.1-10.0), 6.1% (5.7-6.6), and 0.03% (0.01-0.06), respectively. The proportion meeting recommended thresholds for sodium has followed a U-shape over time reaching a minimum [24.3% (21.6-26.9)] in 2011-12 before increasing to 34.5% (31.3-37.7) in 2021-23 (P < .001). The proportion meeting the recommended potassium intake, however, has declined over time [yearly prevalence ratio = 0.99 (0.98-0.99), P < .001] reaching the lowest point [15.3% (13.5-17.0)] in 2021-23. The correlations between intakes of sodium and potassium, calories and sodium, and calories and potassium were 0.62, 0.77, and 0.71, respectively.</p><p><strong>Conclusions: </strong>A low percentage of adults with hypertension met both recommended sodium and potassium intakes with higher intakes of potassium associated with high sodium and calories.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"997-1004"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497160","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":"Histamine N-methyltransferase inhibition attenuates hypertension and proximal tubule damage in Dahl SS rats fed a high salt diet.","authors":"Antara Chaudhuri, Corey E Andrews, Alena Cherezova, Denisha R Spires, Alexandra S Zamaro, Karen A Reyes Monroy, Courtney J Christopher, Adam C Jones, Ray M Wade, Guido Verbeck, Shawn R Campagna, Jessica L Faulkner, Oleg Palygin, Daria V Ilatovskaya","doi":"10.1093/ajh/hpag089","DOIUrl":"https://doi.org/10.1093/ajh/hpag089","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is one of the mechanisms of renal disease development in salt-sensitive hypertension (SS-HTN). We have previously shown that Dahl SS rats exhibit higher renal histamine levels when fed a high salt diet and reported that renal epithelium has abundant histaminergic system components. We hypothesized here that inhibition of histamine N-methyltransferase (HNMT) attenuates the development of hypertension and reduces renal damage in the Dahl SS rat.</p><p><strong>Methods: </strong>Male Dahl SS rats implanted with telemeters were administered HNMT inhibitor SKF-91488 (3.0 mg/kg/day) or vehicle s.c., while fed a 4.0% NaCl high salt diet for 21 days. Renal function and biometric parameters were assessed at endpoint; tissues were collected and subjected to IHC and Western blotting.</p><p><strong>Results: </strong>We report attenuation of hypertension in the SKF-91488 treated group at endpoint (mean arterial pressure = 132.6 ± 11.8 vs. 160.3 ± 6.5 mmHg in control, p < 0.05) and proximal tubule damage measured with KIM-1 (0.8 ± 0.1 vs. 1.7 ± 0.2% stained area fraction, p < 0.01). αSMA IHC of coronary vasculature in the SKF-91488 group demonstrated smaller vessel wall thickness relative to total diameter (p = 0.046). Renal abundance of histamine receptors 1 and 4 (p = 0.01/both) and the pan-macrophage marker CD68 (p = 0.04) were higher in the renal cortex of the SKF-91488 treated group. Urinary Cl- excretion was higher in the SKF-91488 treated rats at endpoint compared to vehicle controls (p < 0.001).</p><p><strong>Conclusions: </strong>Our study demonstrated that HNMT inhibition alleviates blood pressure and proximal tubule damage in SS-HTN, potentially through immune-related mechanisms.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534734","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":"Dependency of kidney function decline on intensive clinic blood pressure lowering in patients with high arterial stiffness: a post-hoc analysis of a randomized controlled trial.","authors":"Ying Wang, Yan Li, Ji-Guang Wang","doi":"10.1093/ajh/hpag088","DOIUrl":"https://doi.org/10.1093/ajh/hpag088","url":null,"abstract":"<p><strong>Background: </strong>Intensive blood pressure (BP) lowering increased acute kidney injury risk, despite cardiovascular benefits. We investigated the association between treatment-induced BP changes and kidney function decline, while accounting for arterial stiffness.</p><p><strong>Methods: </strong>This post‑hoc analysis included 266 patients with hypertension from a 20‑week double‑blind trial treated with calcium-channel blockers. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min·1.73 m2 or a decrease ≥30% from baseline. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV).</p><p><strong>Results: </strong>At baseline, systolic/diastolic BP (mean±SD, 153.2±9.3/91.8±9.5 mmHg) was associated positively (r = 0.20 [95% CI, 0.09 to 0.32]/0.23 [95% CI, 0.11 to 0.34]) with serum creatinine (72.1±16.2 μmol/l), and inversely (r=-0.25 [95% CI, -0.36 to -0.14]/-0.16 [95% CI, -0.28 to -0.04]) with eGFR (91.6±13.8 ml/min·1.73 m2). The associations with clinic systolic BP were weakened with higher baPWV, being observed in tertiles 1 and 2 (r ≥ 0.30 or ≤-0.27), but not tertile 3. After 20 weeks treatment, the incidence of kidney dysfunction was 0%, 4.8%, and 6.4%, respectively, in tertiles 1, 2 and 3 of baPWV (odds ratio for tertile 3 versus tertile 1, 2.23 [95% CI, 0.84-5.95]). In longitudinal analysis, the least square mean change from baseline in eGFR was -3.7 ml/min·1.73 m2 (95% CI, -4.3 to 1.1) in patients within tertile 3 of both baseline baPWV and treatment-induced clinic systolic BP changes.</p><p><strong>Conclusions: </strong>In patients with stiffer arteries, kidney function at baseline was not associated with higher BP, and its decline during follow-up was greater when clinic BP was intensively reduced.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468252","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":"Optimizing Home Blood Pressure Monitoring Protocols in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study.","authors":"Frances M Wang, Hannah Col, Fredrick Larbi Kwapong, Dhrumil Patil, Md Marufuzzaman Khan, Long Ngo, Jennifer L Cluett, Elizabeth Selvin, Lynne Wagenknecht, Timothy M Hughes, B Gwen Windham, Thomas Mosley, Pamela L Lutsey, Kimberly Ring, Arielle Valint, Mingyu Zhang, Stephen P Juraschek","doi":"10.1093/ajh/hpag080","DOIUrl":"https://doi.org/10.1093/ajh/hpag080","url":null,"abstract":"<p><strong>Background: </strong>Current clinical guidelines recommend home blood pressure monitoring (HBPM) to confirm hypertension diagnosis, guide therapy, and support long-term control. However, the optimal number of HBPM measurements needed for valid assessment is not established.</p><p><strong>Methods: </strong>At ARIC Visit 10 (2023), participants completed an eight-day HBPM protocol with morning and evening measurements and three readings per session. We evaluated the validity between the eight-day mean (reference) and streamlined protocols (fewer days, less than three readings per session, or only morning or evening measurements). In secondary analyses, we assessed the validity of these HBPM protocols relative to ambulatory BP.</p><p><strong>Results: </strong>Among 812 participants (median age 83 years, 24% Black adults, 40% male, 84% using anti-hypertensive medications), median BP varied by less than 3 mmHg across the eight-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from one to two days. By three days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mmHg of the reference for both systolic and diastolic BP. Averaging ≥2 readings per session, including both morning and evening measurements, yielded greater validity than a single reading or timepoint.</p><p><strong>Conclusions: </strong>In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each. While further studies are required to validate generalizability beyond this engaged cohort, these findings support shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417958","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}