American Journal of Hypertension最新文献

{"title":"Intensive Blood Pressure Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cardiovascular and Microvascular Outcomes.","authors":"Asma Mousavi, Shayan Shojaei, Amir Parsa Abhari, Seyed Alireza Mirhosseini, Rasoul Ebrahimi, Erta Rajabi, Mashood Ahmad Farooqi, Amirali Azizpour, Shiva Armani Moghadam, Toshiki Kuno, Anil Harrison, Wilbert Aronow, Abdul Waheed, Rosy Thachil, Kaveh Hosseini","doi":"10.1093/ajh/hpaf140","DOIUrl":"https://doi.org/10.1093/ajh/hpaf140","url":null,"abstract":"<p><strong>Background: </strong>The optimal blood pressure (BP) target for adults with type 2 diabetes (T2DM) remains a topic of debate. This systematic review and meta-analysis aimed to investigate the efficacy of intensive BP control strategies compared to standard or less intensive approaches in adults with T2DM.</p><p><strong>Method: </strong>We comprehensively searched databases for studies comparing intensive versus less intensive BP targets in individuals with T2DM. In this study, the group with the most intensive target was compared to the group with the least intensive target. Also, studies were analyzed based on current guideline recommendations. Outcomes of interest included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, heart failure, retinopathy, neuropathy, nephropathy, and end-stage renal disease. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>The meta-analysis included 21 studies (16 RCTs) with 290,907 participants (mean age 61.84 years, 55.03% male). Guideline-based analyses showed comparable clinical outcomes between groups with no significant differences. However, the most intensive targets vs. the least intensive targets revealed that the intensive BP control group experienced a significantly lower risk of MACE (RR=0.75, 0.58; 0.98), non-fatal myocardial infarction (RR=0.61, 0.41; 0.91), non-fatal stroke (RR=0.60, 0.39; 0.92), and total stroke (RR=0.61, 0.39; 0.95). Other outcomes were similar between groups. Subgroup analysis of RCTs mirrored the overall findings.</p><p><strong>Conclusion: </strong>In adults with T2DM, intensive BP control reduces the risk of cardiovascular events, such as MACE, stroke, and MI. Additionally, it demonstrates comparable diabetes-related complications to less intensive or standard controls.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726491","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":"Renal Denervation to Treat Hypertension: A Clinical State-of-the-Art Review.","authors":"Andrew S P Sharp, Naomi D L Fisher","doi":"10.1093/ajh/hpaf134","DOIUrl":"https://doi.org/10.1093/ajh/hpaf134","url":null,"abstract":"<p><p>Hypertension represents the leading risk factor for death globally, affecting one in two adults. Despite dozens of inexpensive medications and lifestyle changes that effectively lower blood pressure, hypertension control rates remain poor. Renal denervation (RDN) is a procedural therapy indicated as an adjunctive treatment for high blood pressure. FDA approval in late 2023 followed the publication of a series of rigorous, second-generation, randomized clinical trials that demonstrated safety and efficacy of the procedure. Two catheters employing radiofrequency (Spyral) and ultrasound (Paradise) are currently approved to ablate renal sympathetic nerves. In randomized sham-controlled trials, RDN lowered blood pressure in patients with mild-to-moderate and true resistant hypertension, and in patients both on and off anti-hypertensive medication. When evaluating patients for RDN, shared decision-making is a critical element, which should include potential benefits and that a minority may not respond to the therapy. There is only one constant predictor of magnitude of response: magnitude of baseline SBP, which is one reason why guidelines recommend prioritization of patients with resistant hypertension, together with patients whose BP cannot be effectively managed with medication. Before referring patients to a trained interventionalist, it is important to optimize medical therapy and adherence, and confirm uncontrolled hypertension out-of-office. Patients should be screened for primary aldosteronism and for other secondary causes of hypertension if clinically indicated, though sleep apnea is not a contraindication to RDN. A team approach is advised, with hypertension specialists and interventionalists collaborating. Data from global registries will augment our knowledge and guide future implementation.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697380","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":"Prognostic Impact of Different Definitions of White-Coat Hypertension.","authors":"Paolo Verdecchia, Stefano Coiro, Claudia Bartolini, Adolfo Aita, Claudia Borgioni, Salvatore Repaci, Chiara Dembech, Massimo Guerrieri, Nicola Sacchi, Sergio Bistoni, Mario Trottini, Fabio Angeli","doi":"10.1093/ajh/hpaf136","DOIUrl":"https://doi.org/10.1093/ajh/hpaf136","url":null,"abstract":"<p><strong>Background: </strong>Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies.</p><p><strong>Methods: </strong>In an Italian study started in year 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-hour ambulatory BP (ABP) monitoring. We defined WCH as an average 24-hour ABP <130/80 mmHg or <125/75 mmHg. Primary outcome was a composite of major adverse cardiovascular events (MACE), and all-cause mortality.</p><p><strong>Results: </strong>Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-hour ABP <125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-hour ABP <130/80 mmHg (HR: 1.79; 95% CI: 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-hour ABP <125/75 mmHg (HR 1.37; 95% CI 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-hour ABP <130/80 mmHg (HR 1.82; 95% CI 1.55-3.58).</p><p><strong>Conclusions: </strong>WCH defined by an average 24-hour ABP <125/75 mmHg identifies people at low risk of MACE and death in the long-term. Even modestly above these threshold values, the risk associated with WCH increases.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697379","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":"Longitudinal Associations between Changes in Inter-Ankle SBP Difference and Cardiovascular Events and Mortality in the ARIC Study.","authors":"Daniela Charry, Jing Xu, Michelle L Meyer, Anna Kucharska-Newton, Kunihiro Matsushita, Kenneth R Butler, Timothy M Hughes, Hirofumi Tanaka","doi":"10.1093/ajh/hpaf133","DOIUrl":"https://doi.org/10.1093/ajh/hpaf133","url":null,"abstract":"<p><strong>Background: </strong>Large inter-ankle systolic blood pressure (IASBP) differences (≥10 or ≥15 mmHg) have been linked to cardiovascular events and mortality. This longitudinal study evaluated the association of changes in IASBP differences with incident cardiovascular events and mortality.</p><p><strong>Methods: </strong>In the Atherosclerosis Risk in Communities study, bilateral ankle blood pressure was measured at Visit 5 and at Visit 6/7 (n = 2051; mean age 73.7 ± 4.3 years). Participants were categorized into four groups by IASBP differences: small at both visits (<10 mmHg); decreasing (≥10 mmHg at Visit 5 but <10 mmHg in Visit 6/7); increasing (<10 mmHg at Visit 5 but ≥10 mmHg in Visit 6/7); and large at both visits (≥10 mmHg). Categories were repeated using a ≥15 mmHg cutoff value. Cox proportional hazards regression models were used to calculate hazard ratios (HRs).</p><p><strong>Results: </strong>In adjusted analyses, individuals with increasing differences (≥10 mmHg) had higher risks of heart failure (HR: 1.31; 95% confidence intervals [CI], 1.00-1.76) and stroke (HR: 1.57; 95% CI, 1.16-2.11), compared to those with small differences at both visits. Similarly, those with persistently large differences showed elevated risks of coronary heart disease (HR: 2.25; 95% CI, 1.46-3.47) and stroke (HR: 1.68; 95% CI, 1.17-2.41). Analyses using a ≥15 mmHg cutoff value demonstrated even stronger associations with all three cardiovascular events. No significant associations were observed with all-cause or cardiovascular mortality for these categories.</p><p><strong>Conclusions: </strong>Increasing and persistently large IASBP differences are associated with elevated risk of incident cardiovascular events. Monitoring IASBP differences may help identify individuals at higher risk for adverse outcomes.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688642","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":"Interrelationship between the morning-to-evening changes in home blood pressure and pulse rate.","authors":"Jia-Bo Zhu, Qian-Hui Guo, Yi Zhou, Wen-Yuan-Yue Wang, Yuan-Yuan Kang, Xiao-Fei Ye, Xin-Yu Wang, Ming-Xuan Li, Yan Li, Ji-Guang Wang","doi":"10.1093/ajh/hpaf137","DOIUrl":"https://doi.org/10.1093/ajh/hpaf137","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the morning-to-evening changes in home blood pressure (BP) and pulse rate for demographic and clinical determinants, interrelationship and association with BP control in treated patients with hypertension.</p><p><strong>Method: </strong>We performed cross-sectional analysis in patients (≥55 years of age) with hypertension, enrolled in a China nationwide registry on home BP monitoring between 2020 and 2025. Home BP was measured three times consecutively in the morning and evening, respectively, for seven consecutive days. The change was calculated by subtracting the BP and pulse rate values in the morning from that in the evening.</p><p><strong>Result: </strong>The 4787 participants had a mean (±SD) age of 66.1 (±7.5) years, and included 2366 (49.4%) men. Overall, systolic/diastolic BP decreased from 129.1/80.6 mmHg in the morning to 127.2/78.7 mmHg in the evening by a mean change of -1.9±7.8/-1.8±4.7 mmHg. Pulse rate, however, increased from 70.5 beats/min in the morning to 73.7 beats/min in the evening by a mean change of +3.1±5.8 beats/min. Adjusted analyses showed that the changes in pulse rate were negatively associated with that in both systolic (r=-0.20, 95% CI: -0.22 to -0.17) and diastolic BP (r=-0.12, 95%CI: -0.14 to -0.09). Patients with a change in pulse rate above the median (≥3.0 beats/min) had a lower control rate of office systolic/diastolic BP (60.1% vs. 65.5%, P<0.001) than those with a change in pulse rate below the median.</p><p><strong>Conclusion: </strong>There were interrelated morning-to-evening changes in home BP and pulse rate, being a drop and rise, respectively.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688641","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":"Correlates of Nocturnal Hypertension in a Real-World Cohort.","authors":"Neil Zhang, Tzu Yu Huang, Sanket Dhruva, Susan Cheng, Joseph E Ebinger","doi":"10.1093/ajh/hpaf135","DOIUrl":"https://doi.org/10.1093/ajh/hpaf135","url":null,"abstract":"<p><strong>Background: </strong>Nocturnal hypertension (NH) is associated with adverse cardiovascular outcomes beyond and even independent of daytime hypertension (DH). Although cohort studies have evaluated correlates of NH, there is comparably less data available from real-world clinical practice and for population subsets that tend to be underrepresented in cohort studies.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients who underwent ABPM testing at a large U.S. academic medical center from January 1, 2013 to December 31, 2023. We used multivariable-adjusted logistic regression to assess DH as a correlate of NH, covariates related to the co-occurrence of DH and NH, and correlates of isolated NH.</p><p><strong>Results: </strong>Of 1566 patients, 812 (51.9%) had DH, 1125 (71.8%) had NH, and 363 (23.2%) had isolated NH. A total of 762 (48.7%) patients had co-occurring daytime and NH. In multivariable analysis, significant correlates of NH included DH, male sex, age, Black race, and Hispanic ethnicity. By comparison, significant correlates of co-occurrent DH and NH included male sex, age, Asian race, Black race, and renal disease; coronary artery disease was inversely associated with this co-occurrence. Among all covariates, only CAD was associated with isolated NH.</p><p><strong>Conclusions: </strong>Our real-world study results highlight the generally under-recognized prominence of isolated NH, as well as the presence of NH among Hispanic and Asian-American populations. Further prospective investigations are needed to evaluate whether broader ABPM screening for NH is needed across all populations at risk, including but not limited to persons with more easily identified DH.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688640","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":"Arterial Stiffness and Central Hemodynamics in South Asian, African American and White Adolescents and Young Adults-The Charisma Study.","authors":"A Kelly, A Arputhan, B S Zemel, S S Gidding, R R Townsend, S N Magge","doi":"10.1093/ajh/hpaf138","DOIUrl":"https://doi.org/10.1093/ajh/hpaf138","url":null,"abstract":"<p><strong>Background: </strong>Compared to individuals of European or African ancestry, individuals of South Asian (SA) ancestry have greater cardiovascular disease (CVD) risk. We aimed to compare arterial stiffness and central hemodynamics, surrogates of CVD, in adolescents and young adults (AYA) of SA, White, and African American (AA) ancestry with overweight or obesity.</p><p><strong>Methods: </strong>Pulse wave velocity (PWV) and pulse wave analysis (PWA metrics: Pulse Pressure Amplification [PPA]; Augmentation Index-adjusted to heart rate [HR] of 75 [Aix75]) were performed in a cross-sectional study of 40 (18M/22F) SA, 45 (16M/29F) AA, and 44 (21M/24F) White AYA (age 12-21y) of comparable age, sex, and BMI. Between group comparisons of PWV, PPA, and AIx-75 were tested using linear regression models adjusted for covariates (BMI, mean arterial pressure [MAP], sex, age), as appropriate.</p><p><strong>Results: </strong>As expected, BMI (kg/m2) did not differ (SA: 27.1, AA: 28.4, White: 27.4). Mean PWV (m/sec) did not differ in SA (5.5), AA (5.1), and White (5.5). The typical relationship of BMI with PWV was absent in SA. PPA was lower in SA (1.45, p=0.001) and AA (1.48, p=0.014) vs White (1.56). Aix75 was higher in SA (108, p=0.004) but not in AA (105, p=0.12) vs White (101).</p><p><strong>Conclusions: </strong>Although their PWV did not differ, SA AYA had lower PPA and higher Aix75 compared to White counterparts. As lower PPA associates with higher likelihood of future CV events, these findings could reflect an early CVD predisposition in SA and underscore the potential value of PWA in studies of emerging adults, a life stage in which interventions may mitigate CVD risk.Graphical Abstract.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688639","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":"Impact of Cost-sharing on Self-Measured Blood Pressure (SMBP): Cost and Prescription Abandonment for Home BP Monitors in a large FQHC.","authors":"Lisa F Soltani, Daniel J Smith, Erin L Dougherty, Grace K Parker","doi":"10.1093/ajh/hpaf124","DOIUrl":"https://doi.org/10.1093/ajh/hpaf124","url":null,"abstract":"<p><strong>Background: </strong>Self-measured blood pressure (SMBP) is an important tool for diagnosing and controlling hypertension. Current insurance coverage for home blood pressure monitors varies widely, creating potential barriers to implementation.</p><p><strong>Methods: </strong>This observational study was conducted in a large, multisite FQHC in Tucson, AZ between 2023 and 2024. We compared prescription rates and fill rates during two six-month periods: the final six months of grant-funded free monitor distribution (2023, n=2,619 prescriptions, 2,357 fills) versus the first six months after grant end when patients were charged approximately $35 (2024, n=1,630 prescriptions, 974 fills). Data were extracted from the electronic health records system and analyzed using R version 4.2.3.</p><p><strong>Results: </strong>After cost-sharing implementation, two distinct effects reduced monitor distribution: prescription fill rates decreased from 90.0% to 59.8% (30.2% reduction, 95% CI [27.8%, 32.2%]), and providers sent 38% fewer prescriptions. The combined effect of both reduced prescribing and lower fill rates resulted in 59% fewer patients receiving monitors (974 vs 2,357).</p><p><strong>Conclusions: </strong>In this single-center study, cost-sharing was associated with substantial reductions in both prescribing and filling of home BP monitor prescriptions.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673753","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":"Trends in Hypertension Prevalence, Awareness, Treatment, and Control Among US Young Adults, 2003-2023.","authors":"Rui Tang, Jaejin An, Brandon K Bellows, Andrew E Moran, Yiyi Zhang","doi":"10.1093/ajh/hpaf044","DOIUrl":"10.1093/ajh/hpaf044","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated recent trends in hypertension prevalence and management among US young adults, and assessed disparities by age, sex, or race and ethnicity, as well as potential factors contributing to the age-related disparities.</p><p><strong>Methods: </strong>Data from 51,291 adults aged ≥18 years in the National Health and Nutrition Examination Survey 2003-2004 to 2021-2023 were analyzed. Stage 1 or 2 hypertension was defined as systolic/diastolic blood pressure (BP) ≥130/80 mmHg or antihypertensive medication use. Hypertension awareness and treatment were based on self-report.</p><p><strong>Results: </strong>In 2021-2023, 21.3% (20.4 million) young adults aged 18-39 years had stage 1 or 2 hypertension, of whom only 28.3% were aware of their condition and 5.6% achieved BP control to <130/80 mm Hg. While hypertension prevalence among young adults remained stable from 2003-2004 to 2021-2023, awareness and control declined after 2013-2014, though no apparent change in control rates was observed between 2017-2020 and 2021-2023. Compared to adults aged ≥40 years, young adults had lower rates of awareness, treatment, and control, with lower rates of having a routine place for healthcare explaining 7%-16% of the gaps. Disparities in hypertension awareness, treatment, and control were greatest among young adult men, non-Hispanic Black, and Hispanic individuals compared with other sex and racial and ethnic subgroups.</p><p><strong>Conclusions: </strong>In 2021-2023, one in five US young adults had hypertension, yet awareness and control have declined since 2013-2014 and remain low.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"551-559"},"PeriodicalIF":3.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741868","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":"A Transformer-Based Framework for Counterfactual Estimation of Antihypertensive Treatment Effect on COVID-19 Infection Risk - A Proof-of-Concept Study.","authors":"Tran Q B Tran, Stefanie Lip, Honghan Wu, Shyam Visweswaran, Jill P Pell, Sandosh Padmanabhan","doi":"10.1093/ajh/hpaf055","DOIUrl":"10.1093/ajh/hpaf055","url":null,"abstract":"<p><strong>Background: </strong>Transformer-based neural networks excel in modelling high-dimensional, time-series data with complex dependencies. This proof-of-concept study applies a transformer-X-learner framework to estimate treatment effects using real-world data, using antihypertensive drug exposure and COVID-19 risk as an exemplar.</p><p><strong>Methods: </strong>We conducted a case-control study of 303,220 NHS Greater Glasgow and Clyde patients aged ≥ 40 years during the first two COVID-19 pandemic waves. Using a transformer-X-learner framework that incorporated temporal patterns in medication usage and comorbidities, we controlled for confounding effects and estimated individual and average treatment effects ACEIs, beta-blockers (BBs), calcium channel blockers (CCBs), thiazides (THZs), and statins on 180-day SARS-CoV-2 infection risk.</p><p><strong>Results: </strong>The transformer-X-learner framework outperformed traditional approaches, achieving an F1 score of 0.82 and area under the precision-recall curve (AUPRC) of 0.78. ACEIs showed a negligible overall impact on COVID-19 risk (ATE: 0.97%±5.5), while BBs (-8.3%±7.3%) and CCBs (-9.7%±8.1%) were protective. Statins (3.5%±6.1%) and THZs (4.3%±10.8%) showed slight increases in risk. Treatment effects were consistent across age, gender, and socioeconomic categories.</p><p><strong>Conclusions: </strong>ACEIs do not substantially increase the risk of COVID-19 infection while the protective effects of BBs and CCBs warrant further investigation. This study highlights the potential of transformer-based causal inference models as a powerful tool for evaluating treatment safety and efficacy in complex healthcare scenarios.</p>","PeriodicalId":7578,"journal":{"name":"American Journal of Hypertension","volume":" ","pages":"595-604"},"PeriodicalIF":3.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957995","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}