American Journal of Hypertension最新文献_第8页

Implementation of a Self-Measured Blood Pressure Pilot Program in an Academic Internal Medicine Practice. 在学术内科实践中实施自我测量血压试点计划。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf219

Jennifer L Cluett, Rosemary Farahmand, Laken Barkowski, Marc Cohen, Jonathan Li, Ruthie Olowoyeye, Michael Rakotz, Neha Sachdev, Kristine Sullivan, Katherine Tighe Miller, Stavros Tsipas, Gregory Wozniak, Stephen P Juraschek

{"title":"Implementation of a Self-Measured Blood Pressure Pilot Program in an Academic Internal Medicine Practice.","authors":"Jennifer L Cluett, Rosemary Farahmand, Laken Barkowski, Marc Cohen, Jonathan Li, Ruthie Olowoyeye, Michael Rakotz, Neha Sachdev, Kristine Sullivan, Katherine Tighe Miller, Stavros Tsipas, Gregory Wozniak, Stephen P Juraschek","doi":"10.1093/ajh/hpaf219","DOIUrl":"10.1093/ajh/hpaf219","url":null,"abstract":"Background: Self-measured blood pressure (SMBP) monitoring is a proposed strategy to improve hypertension control, but few studies compare SMBP with automated office blood pressure (AOBP) measurements over time. Moreover, little is known about reimbursement for these services.Methods: We describe a quality improvement initiative in our academic internal medicine practice. Patients received validated home blood pressure (BP) devices and were instructed to check their BP twice daily for 7 days each month. Devices transmitted readings seamlessly via a smartphone application that averaged weekly readings. Clinicians reviewed the data and adjusted therapy if indicated. We tracked changes in SMBP, AOBP, antihypertensive medications, and reimbursement.Results: Among 140 patients referred (mean age 57.6 years, 57.1% women, 25.7% Black), 59 completed the program. Over 6 months, the mean self-measured systolic BP decreased by 5.8 mm Hg (95% CI: -8.2 to -3.5) and the mean diastolic BP decreased by 2.8 mm Hg (95% CI: -4.2 to -1.4) and the number with BP <130/<80 mm Hg increased by 22 percentage points (P = 0.007). However, unattended AOBP showed no change in either systolic (change: 0.1 mm Hg; P = 0.98) or diastolic (change: -0.6 mm Hg; P = 0.64) readings. Reimbursement was variable and ranged from no payment to a maximum payment of $51; when paid, the average payment was $13.81.Conclusions: In this program, SMBP decreased over time while AOBP remained similar. Reimbursement, when received, was modest. Future work should evaluate whether using SMBP as a therapeutic target reduces cardiovascular events.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"661-669"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145547652","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}

引用次数: 0

Linking Inflammation to Nondipper Hypertension: Diagnostic Utility of Neutrophil Percentage-to-Albumin Ratio. 将炎症与非斗型高血压联系起来：中性粒细胞百分比与白蛋白比率的诊断效用。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf245

Görkem Yıldız, Hasan Ata Bolayır

{"title":"Linking Inflammation to Nondipper Hypertension: Diagnostic Utility of Neutrophil Percentage-to-Albumin Ratio.","authors":"Görkem Yıldız, Hasan Ata Bolayır","doi":"10.1093/ajh/hpaf245","DOIUrl":"10.1093/ajh/hpaf245","url":null,"abstract":"Background: Hypertension (HT) constitutes a pervasive global health challenge, standing as a principal contributor to cardiovascular morbidity and mortality. Limited data are available regarding the relationship between neutrophil percentage-to-albumin ratio (NPAR) and nondipper HT. we aimed to investigate whether NPAR is independently associated with nondipper status in newly diagnosed hypertensive patients.Methods: Prospectively, 160 hypertensive patients were included in the study. After a 24-h ABP monitoring assessment, the patients were divided into 2 groups, a dipper group and a nondipper group, and 80 healthy control subjects were enrolled in the study. Baseline laboratory and echocardiographic parameters were measured and then the NPAR was calculated.Results: Levels of white blood cell, neutrophil-to-lymphocyte ratio, and high-sensitivity C-reactive protein (hs-CRP) were significantly higher in patients with nondipper HT than dipper HT and control subjects. Echocardiographic assessments revealed that the left ventricular (LV) wall was thicker and LV mass index was higher in the hypertensive group than the control group. NPAR levels were significantly different among the 3 groups (P < .001) and also the multivariate analysis revealed that higher NPAR and hs-CRP levels were independently associated with a nondipping pattern. Receiver operating characteristic analysis showed that NPAR levels higher than 22.2 can predict nondipping status (P < .001).Conclusions: Our study shows that higher NPAR levels are independently associated with nondipper HT in newly diagnosed hypertensive patients. These findings emphasize the role of inflammation in the pathophysiology of circadian BP variation and suggest that NPAR may serve as a useful tool in identifying hypertensive patients at higher risk for cardiovascular complications.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"677-683"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809057","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}

引用次数: 0

Association of Dialysis Shift with Morning Surge in Blood Pressure and Dipping Pattern. 透析换班与晨间血压升高和血压下降模式的关系。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf218

Marieta P Theodorakopoulou, Fotini Iatridi, Artemios G Karagiannidis, Areti Georgiou, Sofia Manti, Antonios Karpetas, Panagiota Anyfanti, Eleni Gavriilaki, Pantelis Sarafidis

{"title":"Association of Dialysis Shift with Morning Surge in Blood Pressure and Dipping Pattern.","authors":"Marieta P Theodorakopoulou, Fotini Iatridi, Artemios G Karagiannidis, Areti Georgiou, Sofia Manti, Antonios Karpetas, Panagiota Anyfanti, Eleni Gavriilaki, Pantelis Sarafidis","doi":"10.1093/ajh/hpaf218","DOIUrl":"10.1093/ajh/hpaf218","url":null,"abstract":"Background: Blood pressure (BP) presents a diurnal pattern with a nocturnal decrease and an increase in early morning. Evidence suggests that an exaggerated morning BP surge is associated with higher cardiovascular risk. This is the first study evaluating the association between dialysis timing and morning BP surge in hemodialysis.Methods: One hundred thirteen patients dialyzed on the morning shift were age- and sex-matched in a 1:1 ratio with 113 patients dialyzed on the midday/evening shifts. All patients underwent 48-hour ambulatory BP monitoring. Morning BP surge at the first and second days of the recording was calculated using three definitions: pre-awakening, sleep-trough, and rising morning BP surge.Results: The two groups were similar in terms of age, BMI, and comorbidities. Morning shift patients presented higher mean sleep-through SBP/DBP surges (SBP: 18.71 ± 13.11 vs 14.22 ± 10.25 mmHg, P = .005; DBP: 12.05 ± 8.04 vs 9.46 ± 8.53 mmHg, P = .020) and higher mean pre-awakening SBP/DBP surges (SBP: 12.05 ± 8.04 vs 9.46 ± 8.53 mmHg, P = .020; DBP: 10.16 ± 9.56 vs 6.53 ± 10.78 mmHg, P = .008). No between-groups differences were observed in mean rising SBP surge. During the first 24-hour period, morning shift patients showed higher pre-awakening SBP/DBP surges (SBP: 9.85 ± 11.15 vs 6.22 ± 11.77 mmHg, P = .018) and, during the second 24-hour period, higher sleep-through SBP/DBP surges (SBP: 20.02 ± 18.17 vs 12.79 ± 12.91 mmHg, P = .001; DBP: 12.49 ± 10.76 vs 9.64 ± 10.53, P = .046). Dipping patterns did not differ between groups.Conclusions: Patients dialyzed on the morning shift exhibited significantly higher morning BP surge compared to the other two shifts. Future studies should confirm these observations and examine the need for individualizing the choice of dialysis shift for patients with specific circadian BP profiles.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"716-722"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480700","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}

引用次数: 0

GLP-1 Receptor Agonists and Blood Pressure: A State-of-the-Art Review of Mechanisms, Evidence, and Clinical Implications. GLP-1受体激动剂和血压：机制、证据和临床意义的最新综述。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf205

Areesha Moiz, Tetiana Zolotarova, Kristian B Filion, Mark J Eisenberg

{"title":"GLP-1 Receptor Agonists and Blood Pressure: A State-of-the-Art Review of Mechanisms, Evidence, and Clinical Implications.","authors":"Areesha Moiz, Tetiana Zolotarova, Kristian B Filion, Mark J Eisenberg","doi":"10.1093/ajh/hpaf205","DOIUrl":"10.1093/ajh/hpaf205","url":null,"abstract":"Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for the treatment of type 2 diabetes and, more recently, for weight management among individuals without diabetes.Aim: This review synthesizes the current evidence on the mechanisms by which GLP-1 RAs affect BP, their clinical effects across populations, and the implications for patient care. We discuss subpopulations who may benefit from their BP-lowering effects, identify limitations in the existing evidence, and explore future directions for research.Results: Beyond their metabolic effects, growing evidence suggests that GLP-1 RAs produce modest reductions in BP, typically 2-5 mm Hg systolic, across diverse populations with diabetes, obesity, or at high cardiovascular risk. These reductions appear to be driven primarily by weight loss, with additional contributions from potential weight-independent mechanisms such as natriuresis, improved endothelial function, and attenuation of vascular inflammation. Although smaller in magnitude than those achieved with traditional antihypertensive drugs, the BP-lowering effects of GLP-1 RAs can translate into meaningful cardiovascular risk reduction at the population level and provide additive BP benefit when used alongside conventional therapies. Among individuals with hypertension, GLP-1 RAs are generally well tolerated, although small increases in heart rate and potential interactions with volume-regulating medications may warrant clinical attention.Conclusion: As newer GLP-based therapies continue to emerge, a clearer understanding of their effects on BP may inform more integrated approaches to cardiometabolic care.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"611-622"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342711","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}

引用次数: 0

Global burden of heart failure attributable to hypertensive heart disease: a 30-year population-based analysis using Global Burden of Disease 2021 data. 高血压心脏病导致心力衰竭的全球负担：基于GBD 2021数据的30年人群分析

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf232

Yun Huang, Lili Ma, Yuyu Zhang, Weibo Rong, Ronghui Zhang, Chongbo Fang, Rixiang Wang, Hua Zhou

{"title":"Global burden of heart failure attributable to hypertensive heart disease: a 30-year population-based analysis using Global Burden of Disease 2021 data.","authors":"Yun Huang, Lili Ma, Yuyu Zhang, Weibo Rong, Ronghui Zhang, Chongbo Fang, Rixiang Wang, Hua Zhou","doi":"10.1093/ajh/hpaf232","DOIUrl":"10.1093/ajh/hpaf232","url":null,"abstract":"Background: Hypertensive heart disease is a major cause of heart failure (HF); this study evaluates the global burden and trends of HF attributable to hypertensive heart disease from 1990 to 2021.Methods: We collected detailed information on prevalence, years lived with disability of HF attributable to hypertensive heart disease from the Global Burden of Disease study 2021 across 204 countries and territories. Numbers, age-standardized rates, and average annual percent change of HF attributable to hypertensive heart disease prevalence and years lived with disability were compared by age, sex, and socio-demographic index.Results: In 1990 and 2021, hypertensive heart disease-related HF affected more than 4.6 million and 13 million individuals globally, demonstrating an age-standardized prevalence rate of 125.4 [95% uncertainty interval (UI), 99.0 to 158.0] and 148.3 per 100,000 (95% UI, 117.3-186.3) and an age-standardized years lived with disability rate of 11.2 (95% UI, 7.2-15.7) and 13.2 (95% UI, 8.4-19.1) per 100,000, respectively. Notably, from 1990 to 2021, the global age-standardized prevalence and years lived with disability rates increased consistently, with an average annual percent change of 0.53 (95% CI, 0.52-0.54) and 0.54 (95% CI, 0.53-0.55), respectively.Conclusions: The global burden of HF attributable to hypertensive heart disease has risen.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"704-715"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666495","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}

引用次数: 0

Role of Transitional %B Cells in Mediating the Effect of Phosphatidylinositol (16:0_18:1) on Aortic Dissection. 过渡性B细胞介导磷脂酰肌醇在主动脉夹层中的作用

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf223

Likang Ma, Lele Tang, Lei Jin, Jiakang Li, Haoyu Li, Liangwan Chen, Zhihuang Qiu

{"title":"Role of Transitional %B Cells in Mediating the Effect of Phosphatidylinositol (16:0_18:1) on Aortic Dissection.","authors":"Likang Ma, Lele Tang, Lei Jin, Jiakang Li, Haoyu Li, Liangwan Chen, Zhihuang Qiu","doi":"10.1093/ajh/hpaf223","DOIUrl":"10.1093/ajh/hpaf223","url":null,"abstract":"Background: This study investigates the causal associations between specific plasma lipids, immune cells, and aortic dissection (AD) pathogenesis, and explores immune cells as mediators in this relationship.Methods: This study used two-sample Mendelian Randomization (MR) to examine causal links between plasma lipids, immune cells, and AD. SNPs served as instrumental variables, selected based on GWAS data with significance (P < 1e-5). AD outcomes were sourced from FinnGen, while data on 179 plasma lipids and 731 immune cells came from GWAS. IVW was the main analysis method, with sensitivity tests for heterogeneity and pleiotropy. Mediation MR assessed immune cells as mediators in the liposome-AD pathway, with mediation ratios calculated to quantify their effects. Analyses were conducted in R using the \"Two Sample MR\" package.Results: MR analysis identified eight plasma lipids with significant causal associations with AD. Of these, three plasma lipids, including Phosphatidylinositol (16:0_18:1), increased AD risk (OR: 1.61 [1.22 to 2.12], P = .0007), while five others showed protective effects. Analysis revealed 38 immune cell types with causal links to AD, 22 as risk factors and 16 as protective factors. Transitional %B cells mediated 7.9% of the effect between Phosphatidylinositol (16:0_18:1) and AD.Conclusions: This study used MR to identify plasma lipids linked to AD, with Phosphatidylinositol (16:0_18:1) showing the strongest effect. While some immune cells (eg, Transitional %B cells) were associated with AD, their mediating role was limited and requires further validation. Future AD prevention should focus on lipid regulation while considering potential immune involvement.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"670-676"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476697","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}

引用次数: 0

Home Blood Pressure Monitoring in Routine Care-Factors Associated with Enrollment and Blood Pressures Recorded in the Veterans Health Administration. 日常护理中的家庭血压监测-与退伍军人健康管理局登记和血压记录相关的因素。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf216

Bethany C Birkelo, Adam Kaplan, Andrea Cutting, Brent Taylor, Karen L Margolis, Marwah Abdalla, Daichi Shimbo, Paul Muntner, Nayanjot Kaur Rai, David Nelson, Areef Ishani, Paul Drawz

{"title":"Home Blood Pressure Monitoring in Routine Care-Factors Associated with Enrollment and Blood Pressures Recorded in the Veterans Health Administration.","authors":"Bethany C Birkelo, Adam Kaplan, Andrea Cutting, Brent Taylor, Karen L Margolis, Marwah Abdalla, Daichi Shimbo, Paul Muntner, Nayanjot Kaur Rai, David Nelson, Areef Ishani, Paul Drawz","doi":"10.1093/ajh/hpaf216","DOIUrl":"10.1093/ajh/hpaf216","url":null,"abstract":"Background: Out-of-office blood pressure (BP) monitoring is recommended for hypertension management. Home BP monitoring (HBPM), which involves patients measuring their BP and transmitting readings to their provider, remains underutilized. We sought to understand how HBPM is utilized in routine clinical care and factors associated with enrollment in a national HBPM program.Methods: We conducted a retrospective study of Veterans with uncontrolled BP (systolic BP > 140mmHg) in the Veterans Health Administration (VHA) from 2013 to 2019. We identified patient-, provider-, and systems-level factors associated with enrollment in the HBPM program and with duration of monitoring and number of BPs transmitted.Results: Among 1,759,851 Veterans meeting eligibility criteria, 63,361 (3.6%) were enrolled in HBPM. Black race, Hispanic ethnicity, and higher systolic BP at the eligible primary care visit were associated with higher likelihood of enrollment. Older age and living in an area with lower socioeconomic status were associated with lower likelihood of enrollment. Non-physician providers, providers with higher percent of patients with controlled BP, and providers at VA medical center main campuses were more likely to enroll patients in the HBPM program. The average number of BPs transmitted in the first 4 weeks of monitoring was 25.0; the median duration of HBPM was 192 days. Older age was associated with transmission of more BP measurements and longer duration of HBPM.Conclusion: HBPM is underutilized in eligible VHA patients. Older age was associated with lower likelihood of enrollment but greater number of transmitted BPs. Interventions to improve HBPM utilization could focus on provider and facility factors.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"648-660"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375500","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}

引用次数: 0

Blood pressure variability is associated with heart failure risk, elevated NT-proBNP, and elevated high-sensitivity troponin: the Multi-Ethnic Study of Atherosclerosis. 血压变异性与心力衰竭风险、NT-proBNP升高和高敏感性肌钙蛋白升高有关：动脉粥样硬化的多种族研究（MESA）。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-05-01 DOI: 10.1093/ajh/hpaf226

Daniel S Nuyujukian, Jin J Zhou, Juraj Koska, Shanpeng Li, Chike C Nwabuo, Alain G Bertoni, Gang Li, Peter D Reaven

{"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":"Background: 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).Methods: 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.Results: 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).Conclusions: 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.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"696-703"},"PeriodicalIF":2.9,"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}

引用次数: 0

Is It Time to Retire Aldosterone Suppression Testing? 是时候取消原发性醛固酮增多症的确证试验了吗？

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-04-01 DOI: 10.1093/ajh/hpaf163

Gregory A Kline, Alexander A Leung, Dennis Orton, James MacFarlane, Mark Gurnell

{"title":"Is It Time to Retire Aldosterone Suppression Testing?","authors":"Gregory A Kline, Alexander A Leung, Dennis Orton, James MacFarlane, Mark Gurnell","doi":"10.1093/ajh/hpaf163","DOIUrl":"10.1093/ajh/hpaf163","url":null,"abstract":"Primary aldosteronism (PA) is the most common endocrine hypertension. For decades, PA diagnosis has required proving nonsuppressibility of aldosterone following maneuvers modulating the renin-angiotensin-aldosterone pathway. This includes oral salt suppression, intravenous saline suppression, captopril suppression, and others. Grounded in rational first principles from pathophysiologic considerations and small, early pathophysiologic studies following Conn's initial PA description, such testing has been widely recommended. However, a modern understanding of PA pathophysiology and critical appraisal of diagnostic test studies suggest that traditional suppression testing is not suited to diagnosis or disease definition. There are four main problems recently raised regarding aldosterone suppression testing: (i) PA is now known to exist along a continuous biochemical spectrum and it is scientifically impossible to draw a single, diagnostic threshold within this continuum. (ii) Aldosterone assay uncertainty is sufficiently large to yield contradictory final diagnoses when applied to a threshold during suppression testing. (iii) The pathophysiology of PA is multifactorial with multiple mechanisms not necessarily relevant to salt and volume loading tests. (iv) Finally, meta-analysis of suppression testing studies demonstrated extensive biases and confounders, which have overestimated the diagnostic value. A recent prospective, blinded study of saline suppression for PA diagnosis defined by medical or surgical response to PA-targeted therapy showed no discrimination according to nadir aldosterone level. Given the clinical value of a PA diagnosis and the high prevalence of the disease, modern evidence suggests that aldosterone suppression testing should now be retired from the diagnostic pathway; new ways of approaching the definition of PA are provided to spur further discussion.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"473-481"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939141","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}

引用次数: 0

Brachial Systolic Pressure Averages Twice Diastolic: Evidence From Invasive High-Fidelity Pressure Recordings. 臂膀收缩压平均为舒张压的两倍：来自有创高保真压力记录的证据。

IF 2.9 3区医学

American Journal of Hypertension Pub Date : 2026-04-01 DOI: 10.1093/ajh/hpaf199

Denis Chemla, Mathieu Jozwiak, Olfa Hamzaoui, Pierre Attal, Jean-Louis Teboul

{"title":"Brachial Systolic Pressure Averages Twice Diastolic: Evidence From Invasive High-Fidelity Pressure Recordings.","authors":"Denis Chemla, Mathieu Jozwiak, Olfa Hamzaoui, Pierre Attal, Jean-Louis Teboul","doi":"10.1093/ajh/hpaf199","DOIUrl":"10.1093/ajh/hpaf199","url":null,"abstract":"Background: Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) are key measurements in cardiovascular assessment. A recent invasive study by our group found that SAP averages twice DAP at the radial and femoral levels. Whether this relationship applies to the brachial artery and central aorta remains unknown.Methods: Guided by 2 systematic reviews, we conducted a secondary data analysis of studies that simultaneously reported high-fidelity invasive brachial and aortic pressures in adults undergoing cardiac catheterization. Allowing a ± 2.5% measurement error in SAP and DAP, we defined an acceptable SAP/DAP ratio range of 1.90 to 2.10.Results: Seven studies were included (n = 268; 69% male; mean age of 62 years). The weighted mean brachial SAP/DAP ratio was 1.98 (141.6/71.6 mmHg) across the cohort and aligned with our hypothesis in 6 studies (n = 256; 95% of the population). The one study that did not support the hypothesis was a letter-format publication with a small sample size (n = 12). The hypothesis regarding the aortic SAP/DAP ratio was largely unsupported, being rejected in 6 studies (n = 232) and in the pooled data (1.89 = 134.7/71.4).Conclusion: This preliminary analysis shows that brachial SAP averages twice DAP within a minimal margin of measurement error. These findings highlight a potentially important hemodynamic feature of the brachial artery-and, more generally, of peripheral large arteries, in contrast to the aorta. However, broader validation is needed to assess the clinical relevance of these results beyond the predominantly older male cohort referred for catheterization, and the physiological basis of this pattern also warrants further investigation.","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"500-504"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224659","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}

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