2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Affective exercise experiences predict physical activity behaviour in cardiac outpatients within a home-based cardiac rehabilitation programme

Home-based cardiac rehabilitation (HBCR) programmes increase exercise capacity but often face poor adherence to physical activity (PA). This study tested the structural validity of the Affective Exercise Experiences Questionnaire (AFFEXX) in a cardiac population and examined the role of the novel construct of affective exercise experiences in predicting exercise behaviour during an HBCR programme. A sample of 177 patients enrolled in a 10-month HBCR programme, completed a moderate-intensity treadmill walking test, and completed the AFFEXX questionnaire and the 7-day Physical Activity Recall at the beginning and end of the programme. Structural equation modelling confirmed the structural validity of the AFFEXX, with a good fit to the data (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.95, RMSEA = 0.08). Core affective exercise experiences, which were influenced by antecedent appraisals, significantly predicted attraction-antipathy towards exercise. Multiple regression analysis indicated that follow-up PA was significantly predicted by attraction-antipathy towards exercise (b = 0.24, p = 0.001) and baseline PA (b = 0.29, p = 0.001). The model accounted for 31% of the variance in PA. The study highlights the association between attraction towards exercise and adherence to PA in participants enrolled in an HBCR programme, emphasising the importance of this novel construct.

Population Health Management and Guideline-Concordant Care in CKD: A Secondary Analysis of Kidney Coordinated HeAlth Management Partnership

Key Points

Background

Gaps in guideline-concordant care for CKD lead to poor outcomes. The Kidney Coordinated HeAlth Management Partnership (K-CHAMP) cluster randomized trial tested the effect of a population health management intervention versus usual care on CKD progression and evidence-based care delivery in the primary care setting.

Methods

K-CHAMP included adults aged 18–85 years with eGFR<60 ml/min per 1.73 m2 and moderate-high risk of CKD progression who were not seeing a nephrologist. The multifaceted intervention included nephrology e-consult, pharmacist-led medication management, and patient education. In this post hoc analysis, we evaluate the effectiveness of K-CHAMP on guideline-concordant care processes (BP and glycemic control, annual albuminuria testing) and medication exposure days (angiotensin-converting enzyme inhibitor [ACEi]/angiotensin receptor blocker [ARB], moderate-high intensity statin, sodium-glucose cotransporter-2 inhibitor [SGLT2i], glucagon-like peptide-1 receptor agonists [GLP-1RA]). Given multiplicity of outcomes, Benjamini–Hochberg method was used to control false discovery rate.

Results

All 1596 (754 intervention, 842 usual care) enrolled patients (mean age 74±9 years, eGFR 37±8 ml/min per 1.73 m2, 928 [58%] female, 127 [8%] Black) were analyzed. After a median 17-month follow-up, intervention arm patients had significantly higher exposure days per year to SGLT2i (56 versus 32 days; relative benefit 1.72; 95% confidence interval [CI], 1.14 to 2.30) and GLP-1RA (78 versus 29 days; relative benefit 2.65; 95% CI, 1.59 to 3.71) compared with usual care in adjusted analysis. At study initiation in 2019, similar proportion of patients were prescribed SGLT2i and/or GLP-1RA in intervention and control arm (8% versus 6%, respectively; rate ratio 1.23; 95% CI, 0 to 2.99), but by 2022, prescription of these medications was significantly higher in intervention arm (44% versus 27%, respectively; rate ratio 1.63; 95% CI, 1.32 to 1.94). There was no significant difference in any process measures or exposure days to ACEi/ARB in patients with albuminuria or moderate-high intensity statin.

Conclusions

K-CHAMP was effective in accelerating implementation of SGLT2i and GLP-1RA but did not increase ACEi/ARB in patients with albuminuria or moderate-high intensity statin use or improve BP control, glycemic control, or albuminuria testing in individuals with CKD in the primary care setting.

Clinical Trial registry name and registration number:

K-CHAMP, NCT03832595.

Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults

BACKGROUND

The ability of the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator to accurately assign 10-year atherosclerotic cardiovascular disease (ASCVD) risk in older individuals, including those aged ≥80 years, is unknown. This study compares PREVENT with the 2013 Pooled Cohort Equation (PCE) calculator for predicting 10-year ASCVD risk in a large cohort of older adults.

METHODS

This was a prospective cohort study of adults without CVD from Australia and the United States aged ≥70 years (≥65 years, if US minorities). They were enrolled from 2010 to 2014 in the ASPREE trial (Aspirin in Reducing Events in the Elderly), a 5-year randomized trial of low-dose aspirin in community-dwelling older adults with posttrial observational follow-up extending to 2022. ASCVD events were adjudicated by expert panels. The discriminative ability of the 2 risk calculators was assessed by Harell C statistic following Cox regression in the 65- to 79-year age group and >80-year age group, separately. For calibration, predicted event numbers were calculated using PREVENT and PCE, scaled for the actual length of follow-up, and compared with the number of observed events in-trial and during extended follow-up.

RESULTS

Among the 15 510 participants aged 65 to 79 years (median age, 73.2 years; 56.1% women), 1084 ASCVD events occurred (median follow-up, 8.3 years); PCE predicted 3102 events while PREVENT predicted 1290 events. For the 2787 participants ≥80 years (median age, 82.6 years; 59.2% women), 355 ASCVD events occurred (median follow-up, 7.4 years); PCE predicted 1067 events while PREVENT predicted 350 events. PREVENT showed superior discriminative performance compared with PCE (PREVENT versus PCE, C statistic, 0.793 versus 0.740; P<0.001 in participants aged 65 -79 years; 0.854 versus 0.799; P<0.001 in those aged ≥80 years).

CONCLUSIONS

The PREVENT risk calculator is superior to the PCE calculator in predicting ASCVD events in older adults from the United States and Australia, including those aged ≥80 years.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583. URL: https://www.isrctn.com; Unique identifier: ISRCTN83772183.

Impact of NAFLD and Fibrosis on Adverse Cardiovascular Events in Patients With Hypertension

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity in hypertension. However, the impact of NAFLD and related fibrosis on hypertension and its control of cardiovascular disease (CVD) and mortality outcomes remains unclear.

METHODS

12 907 and 120 639 participants with hypertension were from the National Health and Nutrition Examination Survey (NHANES) and UK Biobank (UKBB), respectively. Mendelian randomization analyses explored the causal relationship among hypertension, NAFLD, and CVD. Cox regressions estimated the hazard ratios for CVD and mortality associated with NAFLD (defined by fatty liver index) and liver fibrosis (defined by fibrosis-4 index or NAFLD fibrosis score).

RESULTS

The NHANES documented 3376 deaths over a median follow-up of 8.5 years, and the UKBB documented 15 864 deaths, 4062 incident ischemic strokes, and 5314 incident myocardial infarctions over a median follow-up of 13.5 years. The hazard ratios for CVD and mortality increased in accordance with NAFLD grading (ischemic stroke, 1.16 [95% CI, 1.01-1.33]; myocardial infarction, 1.64 [95% CI, 1.44-1.86] in UKBB; and all-cause mortality, 1.29 [95% CI, 1.09-1.54] in NHANES). High-risk fibrosis increased the hazard ratios for all-cause mortality by 91% and ischemic stroke by 42% in patients with NAFLD in UKBB and for all-cause mortality by 95% in NHANES. NAFLD partially mediates the risk of hypertension for incident CVD and mortality (NHANES, 6.45% of all-cause mortality; UKBB, 5.17% of all-cause mortality; and 8.20% of myocardial infarction).

CONCLUSIONS

NAFLD and related liver fibrosis are associated with a higher risk of incident CVD and mortality in hypertensives. NAFLD and related liver fibrosis seem to partially mediate hypertension-induced CVD and mortality.

Appraisal of β-Blocker Use in Patients with Cardiovascular Disease and Chronic Obstructive Pulmonary Disease

β-blockers are a fundamental component of cardiovascular disease (CVD) management, while β2-agonists are used to treat chronic obstructive pulmonary disease (COPD). Current guidelines recommend that these conditions be treated as usual, even when they coexist. However, there have been concerns over COPD exacerbation risk with β-blockers and attenuation of the beneficial effects of β2-agonists in this comorbid population, leading to β-blocker underuse. Recent evidence suggests that β-blockers, particularly cardioselective β-blockers, do not increase COPD exacerbations, demonstrate good efficacy and safety, and improve survival in patients with COPD after first-time myocardial infarction. In atrial fibrillation with COPD, both cardioselective and nonselective β-blockers may be associated with a lower COPD exacerbation risk than calcium channel blockers, as well as improving outcomes and reducing mortality risk. In this review, we summarize the β-blocker prescribing patterns in patients with CVD and COPD; describe the reasons for β-blocker underuse in patients with CVD with COPD; collate up-to-date evidence on the effects of β-blockers on symptoms and outcomes in each of these comorbid populations; and review the current treatment guidelines for coexisting COPD and CVD to support the rational prescribing of β-blockers. Finally, we provide recommendations for future research needed to demonstrate the clinical rationale of prescribing β-blockers and to encourage the generation of more robust evidence-based guidelines for β-blockers use. Future large-scale, prospective, randomized controlled trials are needed to expand the body of evidence and better understand the effects of β-blockers in CVD with comorbid COPD.

Dietary iron intake is nonlinearly associated with the risk of diabetic retinopathy in adults with type 2 diabetes

OBJECTIVE

To elucidate the association between dietary iron intake and diabetic retinopathy (DR) in type 2 diabetes (T2D) patients.

METHODS

Participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 aged over 40 years with T2D were included. Dietary iron intake was estimated from standardised questionnaires. The presence of DR and vision-threatening DR (VTDR) was determined through retinal imaging. We used logistic regression to assess the relationship between iron intake and DR, and restricted cubic splines to reveal nonlinear links.

RESULTS

The study enrolled 1172 T2D adults. We found significant nonlinear associations between dietary iron intake and DR among females (P = 0.023), but not in males (P = 0.490). Compared with the lowest quartile of iron intake, the third quartile (13.2-18.1 mg/d) yielded significantly lower odds of developing DR (odds ratio [OR], 0.59; 95% CI, 0.39-0.90) and VTDR (OR, 0.42; 95% CI, 0.19-0.94). Stratified logistic analyses showed that medium-high iron intake was associated with lower risks of DR in females (OR, 0.44; 95% CI, 0.24-0.81), non-Hispanic Blacks (OR, 0.38; 95% CI, 0.17-0.85), and individuals with obesity (OR, 0.45; 95% CI, 0.25-0.82), high HbA1c (OR, 0.56; 95% CI, 0.34-0.93), long diabetes duration (OR, 0.40; 95% CI, 0.21-0.76) or low blood haemoglobin (OR, 0.17; 95% CI, 0.05-0.60).

CONCLUSION

Dietary iron intake was nonlinearly negatively associated with the prevalence of DR and VTDR, showing protective effect against retinopathy of medium-high iron intake in T2D patients. Such associations significantly vary by multiple factors such as age, ethnicity, obesity and glycaemic control.

Prevalence and Mortality Trends of Hypertension Subtypes Among US Adults: An Analysis of the National Health and Nutrition Examination Survey

BACKGROUND

Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality.

METHODS

This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis.

RESULTS

Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A subcohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR = 1.18, 95% CI, 1.01-1.38; HR = 1.31, 95% CI, 1.07-1.60, respectively) and all-cause mortality (HR = 1.17, 95% CI, 1.06-1.28; HR = 1.21, 95% CI, 1.08-1.37, respectively).

CONCLUSIONS

Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.

Childhood triglyceride-glucose index and pre-hypertension in adulthood: a prospective cohort study

Background

The triglyceride-glucose (TyG) index serves as a surrogate marker for insulin resistance. Multiple studies have demonstrated a positive correlation between the TyG index and blood pressure, indicating that a high TyG index is related to a greater risk of developing pre-hypertension (pre-HTN) and hypertension (HTN). However, the relationship between changes in the TyG index during childhood and pre-HTN in adulthood requires further clarification.

Methods

The present prospective study utilized data from the Bogalusa Heart Study, a long-term follow-up study. Data on triglycerides (TG), fasting glucose (Fg), and low-density lipoprotein cholesterol (LDL-C) were collected from cross-sectional examinations of participants during childhood. Blood pressure (BP) in early adulthood was categorized into normotensive and pre-HTN groups. Logistic regression was employed to evaluate the relationship between the TyG index in childhood and pre-HTN in adulthood.

Results

A total of 1,222 participants were included in the study, of whom 258 presented with pre-HTN in adulthood. Significant differences were observed in baseline TyG index, body mass index (BMI), and high-density lipoprotein cholesterol (HDL-C) between the two groups. In both unadjusted logistic regression (Odds Ratio (OR):1.8, 95% CI: 1.4, 2.5, P < 0.001) and simple adjustment (OR: 1.7, 95% CI: 1.2, 2.3, P = 0.003), childhood TyG index were significantly associated with pre-HTN in adulthood. However, this significant relationship disappeared after full adjustment (OR: 1.2, 95% CI: 0.8, 1.9, P = 0.373) which extended Model 1 by including adjustments for baseline BMI, baseline HDL-C, baseline LDL-C, smoking status, drinking status, use of antihypertensive medication and family history of HTN.Stratified analysis in Model 2 showed that gender and race significantly affected the relationship between TyG index and BP. In the male population, elevated TyG index levels increased the probability of pre-HTN, whereas no such relationship was found in female (Male: OR: 1.9, 95% CI: 1.1, 3.5, P = 0.029; Female: OR: 0.8, 95% CI: 0.4, 1.4, P = 0.447; P for interaction = 0.037). Similarly, in American Caucasians, TyG was positively associated with the risk of pre-HTN, but this relationship was not observed in African American (American Caucasian: OR: 1.7, 95% CI: 1.0, 2.9, P = 0.035; African American: OR: 0.5, 95% CI: 0.2, 1.1, P = 0.087; P for interaction = 0.007).

Conclusions

In males and Caucasians, elevated TyG index during childhood can increase the risk of pre-HTN in adulthood. Monitoring the TyG index may help in screening individuals at higher risk of pre-HTN.

Non-linear association of a novel inflammation-lipid composite marker CRP/HDL with insulin resistance and type 2 diabetes: findings from a comprehensive national cross-sectional study

BACKGROUND

Chronic low-grade inflammation and dyslipidemia are central to the development of insulin resistance (IR) and type 2 diabetes (T2D). The ratio of high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) integrates these factors, potentially serving as a novel biomarker for metabolic risk. However, the combined impact of these markers on the risks of IR and T2D has not been thoroughly examined. This study aims to elucidate the relationship between the hs-CRP/HDL-C ratio and the risks of IR and T2D.

METHODS

The cross-sectional methodology of this investigation is underpinned by data procured from the National Health and Nutrition Examination Survey (NHANES), encompassing a sample of 4,928 individuals from 2015 to 2018. The outcome variables were IR and T2D, as defined by the 2013 guidelines of the American Diabetes Association. To thoroughly investigate the association, a variety of analytical techniques were employed. These included weighted multivariate linear regression, weighted multivariate logistic regression, and restricted cubic spline (RCS) models to capture potential nonlinear associations between the hs-CRP/HDL-C ratio and outcomes. Subgroup analyses were also conducted.

RESULTS

After controlling for multiple potential confounders, the ratio correlates with an escalated likelihood of of IR (OR = 2.46, 95% CI: 1.78, 3.40) and T2D (OR = 2.45, 95% CI: 1.48, 4.05). An inverted U-shaped, nonlinear relationship was identified between the ratio and IR, while a nonlinear association was also observed for T2D. However, the non-linear correlation between this ratio and T2D is more pronounced in individuals with hypertension, female, and non-drinkers.

CONCLUSIONS

The hs-CRP/HDL-C ratio exhibits a postive correlation with IR and T2D. These findings suggest that hs-CRP/HDL-C ratio has the potential to be used as biomarker for assessing IR and T2D risk in clinical settings. These results highlight the significance of keeping the hs-CRP/HDL-C ratio within optimal ranges to promote metabolic health, particularly among high-risk groups.

Modern therapy of patients with lupus erythematosus must include appropriate management of their heightened rates of atherosclerotic cardiovascular events: a literature update

Atherosclerotic cardiovascular disease (ASCVD) remains the biggest killer of patients with lupus erythematosus (LE) and the general non-autoimmune population. In this literature update on LE and ASCVD, we focused on published work since our earlier review article, meaning from 2021 to the present, with an emphasis on cutaneous LE. Several themes emerged. First, new work shows that patients with lupus still exhibit a high burden of conventional risk factors for ASCVD events. Second, recent studies continue to implicate possible effects of lupus disease activity to worsen rates of ASCVD events beyond predictions from conventional risk factors. Third, new work on estimating the risk of future ASCVD events in patients with lupus supports arterial-wall imaging, inclusion of lupus-specific factors, estimators of ASCVD event risk that take lupus status into account and considering lupus as a diabetes equivalent or even as a diabetes-plus-smoking equivalent in this context. Technologies for arterial-wall imaging continue to improve and will likely play an increasing role in ASCVD assessment and management. Fourth, purported cardiovascular benefits from certain disease-modifying antirheumatic drugs such as antimalarials have become less clear. Fifth, earlier treatment of atherosclerosis, which is a lifelong disease, can be accomplished with diet, exercise, smoking cessation and new classes of safe and effective medications for lipid-lowering and blood pressure control. Benefits on subclinical arterial disease by imaging and on ASCVD events have been reported, supporting the concept that ASCVD is eminently manageable in this autoimmune condition. Sixth, despite the heightened risk for ASCVD events in patients with lupus, available therapeutic approaches remain unused or underused and, accordingly, event rates remain high.Raising awareness among patients and healthcare providers about ASCVD assessment and management in patients with LE is essential. Greater vigilance is needed to prevent ASCVD events in patients with lupus by addressing dyslipidaemias, hypertension, smoking, obesity and physical inactivity.

Hypertensive status redicts 30-day postoperative complications following open reduction internal fixation of distal radius fractures

BACKGROUND

The primary objective of this study was to investigate the association between preoperative hypertension and postoperative complications following open reduction internal fixation of distal radius fractures.

METHODS

All patients who underwent open reduction internal fixation (ORIF) for distal radius fractures (DRF) between 2015 and 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Postoperative complications were reported within 30 days of procedure. We identified a total of 26,138 patients, and 31.5% (n = 8,225) of patients had hypertension. Hypertension was defined as blood pressure greater than 140/90 as documented in the medical record, requiring the use of an antihypertensive medication within 30 days of the operation. Multivariate logistic regression adjusted for all significantly associated variables was used to identify postoperative complications associated with preoperative systemic hypertension.

RESULTS

Characteristics of patients significantly associated with systemic hypertension were age ≥ 65 (p < 0.001), female gender (p < 0.001), body mass index (BMI) ≥ 30 (p < 0.001), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), dependent functional status (p < 0.001), smoking (p < 0.001), non-insulin-dependent diabetes (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), congestive heart failure (p < 0.001), chronic steroid use (p < 0.001), and bleeding disorder (p < 0.001). After controlling for significantly associated variables, postoperative complications significantly associated with systemic hypertensive status were major complication (OR 1.83, 95% CI 1.10-3.05; p = 0.020), urinary tract infection (OR 2.02, 95% CI 1.04-3.90; p = 0.037), and non-home discharge (OR 3.48, 95% CI 2.95-4.10; p < 0.001).

CLINICAL RELEVANCE

Preoperative hypertension requiring medication is an independent predictor for major complication, urinary tract infection, and non-home discharge following ORIF for distal radius fractures. A better understanding of preoperative risk factors, such as a patient's hypertensive status, may aid physicians to identify patients at increased risk for postoperative complications and to better counsel patients prior to management of DRF.

Correlation between estimated glucose disposal rate and diabetic depression: a population-based study

Background

Emerging evidence has identified a correlation between depression and insulin resistance (IR). This study aims to explore the correlation between estimated glucose disposal rate (eGDR)-a noninvasive and practical measure of IR-and depression in patients with diabetes mellitus (DM).

Methods

In this cross-sectional study, the data from 3,080 adults aged 18 years old or older with DM obtained from NHANES 1999-2018 were analyzed. The correlation between eGDR and depression were examined through multivariate logistic regression, subgroup analyses, restricted cubic spline (RCS) analysis, and interaction tests. Additionally, mediation analysis was conducted to assess whether leukocytes and neutrophils could mediate the effects of eGDR on depression.

Results

Multivariate logistic regression and RCS analyses demonstrate that eGDR was negative linearly correlated with diabetic depression (OR= 0.89; 95% CI: 0.84, 0.95). Patients with DM in Q3 and Q4 of eGDR exhibited a reduced risk of 28% and 54%, respectively, in depression, compared to those in Q1. Subgroup analyses, stratified by variables such as gender, BMI, age, education level, and medical comorbidities, consistently showed a negative correlation. Mediation analysis further indicates that neutrophils and leukocytes accounted for 4.0% and 3.6% of the correlation between eGDR and depression, respectively.

Conclusions

The results of this study demonstrated a statistically significant inverse linear correlation between eGDR and the prevalence of depression in patients with DM, with leukocytes and neutrophils acting as mediating factors in this correlation.

Multimodal prediction of major adverse cardiovascular events in hypertensive patients with coronary artery disease: integrating pericoronary fat radiomics, CT-FFR, and clinicoradiological features

PURPOSE

People with both hypertension and coronary artery disease (CAD) are at a significantly increased risk of major adverse cardiovascular events (MACEs). This study aimed to develop and validate a combination model that integrates radiomics features of pericoronary adipose tissue (PCAT), CT-derived fractional flow reserve (CT-FFR), and clinicoradiological features, which improves MACE prediction within two years.

MATERIALS AND METHODS

Coronary-computed tomography angiography data were gathered from 237 patients diagnosed with hypertension and CAD. These patients were randomly categorized into training and testing cohorts at a 7:3 ratio (165:72). The least absolute shrinkage and selection operator logistic regression and linear discriminant analysis method were used to select optimal radiomics characteristics. The predictive performance of the combination model was assessed through receiver operating characteristic curve analysis and validated via calibration, decision, and clinical impact curves.

RESULTS

The results reveal that the combination model (Radiomics.

CLINICAL

Imaging) improves the discriminatory ability for predicting MACE. Its predictive efficacy is comparable to that of the Radiomics.Imaging model in both the training (0.886 vs. 0.872) and testing cohorts (0.786 vs. 0.815), but the combination model exhibits significantly improved specificity, accuracy, and precision. Decision and clinical impact curves further confirm the use of the combination prediction model in clinical practice.

CONCLUSIONS

The combination prediction model, which incorporates clinicoradiological features, CT-FFR, and radiomics features of PCAT, is a potential biomarker for predicting MACE in people with hypertension and CAD.

Analysis of Influencing Factors of Prehypertension and Its Development in Occupational Population

Objective

To determine the prevalence of prehypertension in the occupational population and the risk factors associated with the progression of hypertension.

Methods

Data were collected from 13,791 people who attended occupational health examinations in Chengdu, Deyang and Mianyang in 2019 and 2023. Descriptive statistics were used to analyze prevalence and progression rates, and logistic regression was applied to assess factors influencing the progression from prehypertension to hypertension.

Results

The prevalence of prehypertension was 53.66% in 2019 and 55.46% in 2023. Data from 2023 indicated that 14.05% of individuals with prehypertension had developed hypertension. Chi-square analysis revealed statistically significant associations between prehypertension progression and factors such as gender, age, BMI, enterprise size and exposure to occupational harmful factors. Logistic regression identified male gender, older age, higher BMI, and smaller enterprise size as significant risk factors for hypertension progression among individuals with prehypertension.

Conclusion

The prevalence of prehypertension is high among occupational populations in China, with higher susceptibility noted among men and individuals with elevated BMI. Occupational health intervention strategies should be developed to manage and prevent the progression of hypertension.

Pharmacists delivering hypertension care services: a systematic review and meta-analysis of randomized controlled trials

Background

Community-based models of care with the involvement of pharmacists and other nonphysician healthcare professionals can help improve blood pressure (BP) control. We aimed to synthesize the evidence of effectiveness of pharmacist interventions on BP among patients with hypertension.

Methods

We performed systematic searches to identify randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients (latest search, March 2024). The effect on systolic and diastolic BP change or BP control were pooled using random effects model. Subgroup analysis for the types of pharmacist interventions and healthcare settings were performed. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal.

Results

Out of 2,330 study records identified in 7 electronic databases, a total of 95 RCTs, with 31,168 participants (control 16,157, intervention 15,011), were included. The intervention was led by the pharmacist in 75% of the studies and in collaboration with other healthcare providers in 25%. Pharmacist interventions included patient education in 88%, feedback to healthcare providers in 49%, and patient reminders in 24% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.3 mmHg (95% CI: -6.3 to -4.4; I 2 = 86%) and -2.3 mmHg (95% CI: -2.9 to -1.8; I 2 = 75%), respectively. The reduction of systolic BP tended to be larger if the intervention was collaborative, conducted in outpatient clinics, based on healthcare provider education, or through healthcare provider feedback. Analyses restricted to relatively large or high-quality studies yielded similar estimates, with lower between-studies heterogeneity.

Conclusion

Pharmacist care for patients with hypertension consistently improves BP across various settings and interventions. Pharmacist care is one key element of the solution to the global burden of hypertension and cardiovascular diseases.

PROSPERO registration number

CRD42021279751.

The 2024 US Medical Eligibility Criteria for Contraceptive Use: Application to Practice in the Care of Patients With Cardiac Disease

Cardiovascular disease is the leading cause of maternal mortality in the United States, with the majority of deaths stemming from preventable causes. Contraception is one of the tools that can be utilized to prevent mortality and morbidity associated with unplanned pregnancy in patients with underlying congenital or acquired heart disease. There are a wide range of contraceptive methods available. While some methods, especially those containing estrogen, may be associated with increased risks in certain cardiac disease states, intrauterine devices, implants, and progestin-only methods may be safely used by the vast majority of patients with cardiac disease. Furthermore, intrauterine devices and implants are the most effective reversible contraceptive methods available. This review provides a summary of the US Centers for Disease Control and Prevention 2024 Medical Eligibility Criteria for Contraceptive Use as it applies to cardiac disease states. This review emphasizes the importance of contraceptive counseling and aims to familiarize the reader with the various forms of contraception available to patients, as well as the risks and benefits of each method in patients with different types of cardiac disease.

Sex-Specific Association between Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes: A Post-Hoc Analysis of the SPRINT Trial

Background

Systolic blood pressure time in target range (SBP TTR) is a novel metric for blood pressure control. Previous studies have demonstrated an inverse association between SBP TTR and risks of cardiovascular events, but sex differences have never been reported. This study aims to investigate the sex-specific differences in the relationship using data from the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods

This post hoc analysis included 8822 SPRINT participants with at least three follow-up systolic blood pressure (SBP) measurements within the first three months. SBP TTR was calculated using the Rosendaal method of linear interpolation. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Cox proportional hazards models and restricted cubic splines (RCS) were used to assess the association between SBP TTR and cardiovascular events.

Results

Women accounted for 35.3% with a mean age of 68.6 ± 9.5 years, having a higher body mass index (p = 0.007) and a lower SBP TTR compared to men (p < 0.001). In the overall population and in women, each standard deviation (SD) increase in SBP TTR was associated with a reduced risk of MACCE (adjusted hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.97; p = 0.007, and adjusted HR 0.85; 95% CI 0.74-0.99; p = 0.039, respectively) and acute decompensated heart failure (adjusted HR 0.86; 95% CI 0.73-0.99; p = 0.047, and adjusted HR 0.68; 95% CI 0.51-0.92; p = 0.011, respectively), while this was not observed in men. RCS indicated a similar trend in men only when SBP TTR exceeded 39%. Additional adjustments for mean SBP and SBP variability yielded similar outcomes.

Conclusions

The study demonstrates that in women, a higher SBP TTR is associated with a reduced risk of MACCE and acute decompensated heart failure, while in men, a similar trend is observed only when SBP TTR is higher, underscoring the necessity of considering sex differences in personalized blood pressure management strategies.

Clinical Trial Registration

NCT01206062, https://www.clinicaltrials.gov/expert-search?term=NCT01206062.

Nationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program

BACKGROUND

Primary aldosteronism, an endocrinopathy present in ≥10% to 25% of patients with hypertension, confers excess cardiovascular risk that can be mitigated with aldosterone-directed therapy. However, only 2% of eligible patients undergo guideline-recommended screening. This study aimed to bypass clinical inertia and identify people with primary aldosteronism using pragmatic, direct-to-patient testing.

METHODS

Hypertensive adults were recruited via online platforms and underwent virtual consent and local phlebotomy. Using a standardized diagnostic algorithm, laboratory results with interpretations were communicated to patients and primary care providers. Follow-up was ascertained at 6 to 12 months. The primary outcome was the frequency of a positive test for primary aldosteronism. Secondary outcomes included follow-up primary aldosteronism testing and implementation of aldosterone-targeted therapies.

RESULTS

The study population (N=694) had a mean age of 63.3±11.3 years, was 52.2% female, and hailed from 41 US states. Overall, 25.4% had a positive test for primary aldosteronism. Sleep apnea, resistant hypertension, and hypokalemia were the most common testing indications, with 55.2% of participants having ≥2 indications. Over half of participants (57%) were already under endocrinology, cardiology, or nephrology care, yet had not been tested. In longitudinal follow-up of participants with a positive result, 25.5% had additional testing and 13.7% were started on aldosterone-targeted therapy (mineralocorticoid receptor antagonist or adrenalectomy).

CONCLUSIONS

Pragmatic, direct-to-patient testing, and simplified results interpretation is a feasible, scalable method to increase primary aldosteronism diagnoses and implementation of aldosterone-targeted therapies. Given that new hypertension guidelines recommend primary aldosteronism screening in all hypertensive people, practical approaches to test, interpret, and implement results will be essential.

Urinary albumin-to-creatinine ratio for predicting risk of all-cause mortality and specific-cause mortality in patients with rheumatoid arthritis: evidence from NHANES 1999-2018

OBJECTIVE

To explore the relationship between urinary albumin-to-creatinine ratio (uACR) and all-cause/specific-cause mortality among patients with rheumatoid arthritis (RA).

METHODS

This study included 1354 RA patients in the National Health and Nutritional Examination Surveys (NHANESs) during 1999-2018. The mortality status was assessed by linkage to death certificate data reported in the National Death Index (NDI) until December 31, 2019. Cox proportional hazards models and Kaplan-Meier (K-M) analysis were used to elucidate the relationship between uACR and all-cause/specific-cause mortality. Restricted cubic spline (RCS) was used to visualize the association of uACR with all-cause mortality risk. Stratified analyses were employed to identify patients with higher mortality risk.

RESULTS

Over a median of 115 months of follow-up, 298 deaths occurred. Cox proportional hazards models indicated that RA patients with higher uACR had an increased risk of all-cause mortality, but not cardiovascular disease, kidney disease, and cancer mortality. K-M survival curves showed a significant difference (log-rank, p < 0.001) in all-cause mortality among uACR tertiles. RCS analysis revealed an L-shaped association between uACR and all-cause mortality, and patients with uACR above the threshold points (5.96 mg/g) had a 13.2% increased risk of all-cause mortality (HRs 1.132; 95% CI 1.011, 1.267) for each ln unit increase in uACR. The stratified analysis revealed consistent patterns for correlations between uACR and all-cause mortality.

CONCLUSIONS

High uACR, even in the normal range, was associated with an increased risk of all-cause mortality (not specific-cause mortality) in individuals with RA. Identifying high-risk populations using uACR assessment may contribute to target risk interventions among RA patients in the future. Key points • uACR, even within the normal range, significantly increased the hazard for all-cause mortality among RA patients. • uACR has good performance in identifying populations with different mortality risk levels in RA patients. • uACR, independent of varied well-recognized cardiovascular risk factors, is a predictor of mortality in RA patients.

Burden of Cardio-Cerebrovascular and Renal Diseases Attributable to Systolic Hypertension in France in 2021

BACKGROUND

Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France.

METHODS

For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions. Age- and sex-specific population attributable fractions were computed using the distribution of hypertension in the French population. These population attributable fractions were applied to nationwide statistics for mortality, hospitalizations, disease prevalence, years of life lost, years of life lived with disability, and disability-adjusted years of life.

RESULTS

The largest population attributable fractions were for ischemic heart disease and hemorrhagic stroke, with over 40% of cases attributable to hypertension. Overall, more than 385 000 patients were hospitalized due to hypertension, with 3.7 million hospitalizations and 6.2 million hospital days (all hospitalizations, including 3.4 million for chronic kidney disease) and including 390 000 overnight hospitalization. In 2021, more than 1.15 million individuals lived with ischemic heart disease attributable to hypertension, 1.26 million with chronic kidney diseases, and 358 033 with heart failure. Among 184 059 annual deaths from cardiovascular diseases, dementia, and chronic kidney diseases, 30% (55 280 deaths) were attributable to hypertension. Hypertension accounted for 8.5% of all deaths and 498 052 years of life lost.

CONCLUSIONS

In France, despite near-universal health coverage and free health care access, the burden attributable to hypertension remains high.

Impact of Different Low-Volume Concurrent Training Regimens on Cardiometabolic Health, Inflammation, and Fitness in Obese Metabolic Syndrome Patients

BACKGROUND/OBJECTIVES

Evidence supports the benefits of concurrent training (CT), which combines endurance and resistance exercises, for enhancing health and physical fitness. Recently, low-volume, time-efficient exercise approaches such as low-volume high-intensity interval training (LOW-HIIT), whole-body electromyostimulation (WB-EMS), and single-set resistance training (1-RT) have gained popularity for their feasibility and efficacy in improving various health outcomes. This study investigated the effects of low-volume CT, focusing on (1) whether exercise order affects cardiometabolic health, inflammation, and fitness adaptations and (2) which combination, LOW-HIIT plus WB-EMS or LOW-HIIT plus 1-RT, yields better results.

METHODS

Ninety-three obese metabolic syndrome (MetS) patients undergoing caloric restriction were randomly assigned to four groups performing the different low-volume CT protocols over 12 weeks. Outcomes included cardiometabolic, inflammatory, and fitness parameters.

RESULTS

In both combinations, no significant differences were found regarding exercise order. However, the pooled LOW-HIIT and 1-RT group achieved superior improvements in blood pressure, blood lipids, inflammation markers (CRP, hsCRP), the MetS severity score, and overall fitness compared to the LOW-HIIT and WB-EMS combination. Compared to previous studies using these modalities individually, LOW-HIIT plus 1-RT appeared to further reduce inflammation, whereas LOW-HIIT combined with WB-EMS was less effective for cardiometabolic health, potentially due to interference effects between modalities.

CONCLUSIONS

While LOW-HIIT plus WB-EMS appears to be a viable option for individuals unable to perform traditional resistance training, the findings suggest prioritizing LOW-HIIT plus 1-RT to maximize health outcomes. These findings highlight the importance of tailored exercise prescriptions and the need for further research into optimizing CT protocols for diverse populations.

Factors predicting secondary hypertension in young adults with hypertension: a retrospective study

BACKGROUND

Hypertension in young adults is often due to secondary causes, and investigating these can be resource-intensive. This study aimed to identify clinical and biochemical markers that could suggest secondary hypertension in individuals under 40 years.

MATERIALS AND METHODS

A 6-year retrospective observational cohort study included 207 young adults with hypertension who were assessed for secondary causes such as hyperthyroidism, primary aldosteronism, Cushing's syndrome, pheochromocytoma, and renovascular disease. Multivariable logistic regression was used to identify significant predictors, with a significance level set at p < 0.05.

RESULTS

Secondary hypertension was diagnosed in 7 patients (3.4%). The most common diagnoses were primary aldosteronism and hyperthyroidism. Three significant clinical and biochemical predictors were identified: female (OR 4.56, p = 0.020), systolic blood pressure > 160 mmHg at the time of diagnosis (OR 1.44, p = 0.010), and serum potassium < 3.5 mEq/L (OR 3.69, p = 0.019).

CONCLUSION

Several easy-to-obtain clinical and biochemical markers can help identify secondary hypertension in young adults. Individuals who do not have any of these predictors may have a lower likelihood of secondary hypertension; however, these markers should always be used in conjunction with a thorough clinical assessment and are not intended to serve as definitive criteria for diagnosis.

CLINICAL TRIAL NUMBER

Not applicable.

Integrated Multivariate Predictive Model of Body Composition and Lipid Profile for Cardiovascular Risk Assessment

(1) Background/Objectives: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality globally, necessitating effective risk prediction strategies. This study was aimed at developing and validating a multivariate predictive model integrating body composition and lipid profile to assess cardiovascular risk in an adult population. (2) Methods: A cross-sectional analysis of 90 participants from the general Spanish population was conducted. Participants were classified into cardiovascular risk groups (low, medium, high) based on systolic blood pressure. (3) Results: Descriptive and multinomial logistic regression analyses revealed significant associations between cardiovascular risk and specific parameters, such as visceral fat, glucose levels, and waist-to-hip ratio. Visceral adiposity emerged as a strong predictor of high cardiovascular risk, highlighting its critical role in cardiovascular health. Glucose levels were also significantly associated with increased risk, underscoring the importance of metabolic health in cardiovascular outcomes. Contrary to expectations, lipid markers like cholesterol and triglycerides did not show significant variations across risk categories, suggesting that traditional lipid profiles may not fully capture cardiovascular risk in the study group. Waist-to-hip ratio showed significant associations with cardiovascular risk transitions, particularly between low and medium risk, emphasizing the importance of fat distribution patterns. (4) Conclusions: These findings suggest that body composition, particularly visceral fat, is a crucial determinant of cardiovascular risk, necessitating more personalized risk assessment approaches that move beyond traditional lipid markers.

Impact of hypertension on liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease

Background

This study aims to evaluate the association between hypertension and the risk of fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) patients, as well as to investigate the impact of hypertension on the progression of liver fibrosis within this population.

Methods

We utilized data from the NHANES 2017 to March 2020. Multivariate logistic regression models were employed to control for sociodemographic and metabolic factors to determine the associations between hypertension, MASLD, and fibrosis.

Results

Of the total cohort (N = 5,967) 57.92% had hypertension, 38.8% had MASLD, 25.88% had both MASLD and hypertension. Patients with MASLD were more likely to have hypertension (64.24% vs. 44.80%). There was a significant association between stage I (OR1.70, 95% CI: 1.15-2.53) and stage II hypertension (OR1.98, 95% CI: 1.38-2.85) and an increased risk of SF. After adjusting for multiple confounding factors, stage I (OR1.59, 95% CI: 1.09-2.24) and stage II hypertension (OR1.48, 95% CI: 1.06-2.06) remained significantly associated with the risk of SF. Patients with both MASLD and hypertension had higher rates of SF at 14.83% and AF at 7.47%. After adjusting for sociodemographic factors, those patients still had an 8.02-fold increased risk of SF (OR8.02, 95% CI: 4.47-14.39) and a 15.13-fold increased risk of AF (OR15.13, 95% CI: 7.09-32.3). Further adjustment for metabolic factors, those patients still had a significantly higher risk of SF (OR3.07, 95% CI: 1.83-5.14) and AF (OR4.01, 95% CI: 1.48-10.89).

Conclusion

MASLD and hypertension are at risk for fibrosis, and the coexistence of the two has a more significant impact on the risk of fibrosis.

U-shaped association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality risk in obese adults: evidence from NHANES 1999-2018

Background

Obesity, often accompanied by dyslipidemia and increased cardiovascular risk, poses a significant threat to overall mortality. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has been identified as a valuable parameter for assessing dyslipidemia. The goal of the study was to elucidate the relationship between NHHR and mortality in obese populations.

Methods

Data for the study cohort were sourced from the National Health and Nutrition Examination Survey (1999-2018). The association between NHHR and mortality from all causes and cardiovascular disease was examined through multivariable Cox regression and restricted cubic splines (RCS). Segmented multivariable Cox regression and subgroup analyses were conducted when segmented effects were identified. The reliability of the results was confirmed through multiple sensitivity analyses.

Results

A total of 7,504 participants were included in the analysis. During a median follow-up of 119 months, 866 subjects died for all causes, of which 318 were related to cardiovascular diseases. A U-shaped association was found utilizing RCS analysis, with cardiovascular mortality and all-cause mortality exhibiting the lowest risk points at 3.409 and 3.369, respectively. The fully adjusted model revealed a negative relationship between the risk of cardiovascular mortality (HR = 0.68, 95% CI: 0.49-0.94) and all-cause mortality (HR = 0.82, 95% CI: 0.67-1.00) for per 1 mmol/L increase in NHHR levels below the cut-off value. On the other hand, above the cut-off point, NHHR was positively correlated with cardiovascular mortality (HR = 1.18, 95% CI: 1.02-1.36) and all-cause mortality (HR = 1.13, 95% CI: 1.01-1.28). The sensitivity results of this study were in accordance with earlier findings, and no significant interactions in NHHR levels were discovered across different subgroups.

Conclusions

In the obese adults, NHHR displayed a U-shaped relationship with cardiovascular and all-cause death. Monitoring and managing NHHR levels in obese population may help mitigate the risk of mortality.

Correlation between estimated glucose disposal rate, insulin resistance, and cardiovascular mortality among individuals with metabolic syndrome: a population-based analysis, evidence from NHANES 1999-2018

BACKGROUND

Estimated glucose disposal rate (eGDR), is an index of insulin resistance. It is intimately correlated with inflammation and endothelial dysfunction, both of which are contributory factors in the pathogenesis of cardiovascular disease (CVD) and premature mortality. This study aims to explore the correlation between eGDR and both all-cause and CVD-related mortality in adults with metabolic syndrome (MetS).

METHODS

A total of 8215 subjects with MetS screened from the National Health and Nutrition Examination Survey (NHANES) during the period from 1999 to 2018 were evaluated for the predictive value of eGDR for CVD and all-cause mortality.

RESULTS

Over a median follow-up for 8.3 years, a total of 1537 all-cause deaths (18.7%) and 467 CVD-related deaths (5.7%) were recorded. Logistic regression analyses revealed a significant inverse correlation between eGDR and the risk of having CVD (OR:0.845, 95%CI:0.807-0.884, p < 0.01). Multivariate Cox regression analysis and restricted cubic splines analysis demonstrated that eGDR is non-linearly correlated with both the mortality of CVD (HR: 0.906, 95% CI: 0.850-0.967, p = 0.003) and all-cause mortality (HR: 0.944, 95% CI: 0.912-0.977, p = 0.001), with an identified inflection point at 5.918. Further subgroup analyses indicated a more pronounced correlation between eGDR and all-cause mortality in individuals under 60 years old (HR: 0.893, 95%CI:0.823-0.970) or those with obesity (HR:0.891, 95%CI:0.839-0.946). Mediation analysis revealed that neutrophil to lymphocyte ratio mediated 8.9% of the correlation between eGDR and all-cause mortality.

CONCLUSION

This study demonstrates, for the first time, that a decrease in eGDR is associated with an increased risk of all-cause and CVD mortality in adults with MetS. The eGDR indices could serve as surrogate biomarkers for monitoring patients with MetS.

Association of retinal microvascular abnormalities with all-cause and specific-cause mortality among U.S. adults

BACKGROUND

Retinal microvascular abnormalities (RMA) reflect cumulative microvascular damage from systemic diseases and aging. However, little is known about the association between RMA and long-term survival outcomes. This study aimed to examine the relationships between RMA and the risk of all-cause and specific-cause mortality among U.S. adults.

METHODS

Individuals aged ≥ 40 years were included from the U.S. National Health and Nutrition Examination Survey, 2005-2008. RMA and its subtypes, including retinopathy, arteriovenous nicking (AVN), focal arteriolar narrowing (FAN) and Hollenhorst plaque (HP), were manually graded from retinal photographs. Associations between RMA and the risk of all-cause and cause-specific mortality were examined with Cox regression analysis.

RESULTS

This cohort study of 5775 adults included 2881 women (weighted proportion, 52.6%) and 2894 men (weighted, 47.4%), with a weighted mean (SE) age of 56.6 (0.4) years. RMA were present in 1251 participants (weighted, 17.9%), of whom 710 (weighted, 9.8%) had retinopathy, 635 (weighted, 9.3%) had AVN, 64 (weighted, 1.0%) had FAN, and 21 (weighted, 0.3%) had HP. During a median of 12.2 years (range, 0.1-15.0 years) of follow-up, 1488 deaths occurred, including 452 associated with cardiovascular disease (CVD), 341 associated with cancer, and 695 associated with other causes. After adjusting confounding factors, the presence of any RMA and retinopathy at baseline was associated with higher risk of all-cause mortality (HR, 1.26; 95%CI, 1.07-1.47; HR, 1.36; 95%CI, 1.09-1.71, respectively), CVD mortality (HR, 1.36; 95%CI, 1.06-1.73; HR, 1.53; 95%CI, 1.04-2.26, respectively) and other-cause mortality (HR, 1.33; 95%CI, 1.06-1.67; HR, 1.55; 95%CI, 1.20-2.01, respectively). Additionally, FAN was significantly associated with an increased risk of other-cause mortality (HR, 2.06; 95%CI, 1.16-3.65). Although AVN was not associated with mortality in the whole population, it was significantly related to higher risks of all-cause and CVD death in those with obesity (HR, 1.68; 95%CI, 1.12-2.52; HR, 1.96; 95%CI, 1.23-3.13, respectively).

CONCLUSIONS

This study revealed that the presence of RMA is independently associated with greater risks of all-cause, CVD and other-cause mortality in adults aged 40 years or older.

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults

BACKGROUND

Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination.

METHODS

We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained.

RESULTS

Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses.

CONCLUSIONS

In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.

Outpatient management of essential hypertension: a review based on the latest clinical guidelines

Background: Essential hypertension, a prevalent cardiovascular condition, poses a significant health burden worldwide. Based on the latest American clinical guidelines, half of adults in the United States have hypertension. Of these, only about a half are treated and about a quarter are adequately controlled for hypertension. Given its impact on morbidity and mortality, ensuring effective management of high blood pressure is crucial to reduce associated risks and improve patient outcomes.Objective: This review aims to provide a comprehensive and up-to-date summary of the latest cardiology guidelines and evidence-based research on essential hypertension, with a focus on guiding outpatient clinical practice.Methods: The review evaluates both non-pharmacological approaches and pharmacological interventions to offer clinicians practical insights. Notably, it emphasizes the importance of individualized treatment plans tailored to patients' specific risk profiles and comorbidities.Results: By consolidating the latest advancements in hypertension management, this review provides clinicians with an up-to-date reference, offering a nuanced understanding of treatment goals and strategies.Conclusion: Through the incorporation of evidence-based recommendations, healthcare practitioners can optimize patient care, mitigate potential complications, and improve overall outcomes in essential hypertension.

Association of endothelial function and limb artery indices with coronary artery stenosis severity in patients with hypertension

BACKGROUND

Hypertension is one of the major risk factors for cardiovascular events. This study aims to analyse the association of endothelial function and limb artery indices with coronary artery stenosis (CAS) severity in hypertension based on easily accessible and detailed clinical information, and to help accurately identify high-risk groups and avoid missed diagnosis and misdiagnosis.

METHODS

Admission data of 1,375 consecutive hypertensive patients complicated with suspected coronary atherosclerotic heart disease (CHD) from September 2020 to August 2021 in China-Japan Friendship Hospital were retrospectively assessed. All candidates underwent coronary angiography for screening. A total of 600 eligible patients were classified in the CHD group (n = 359) and non-CHD group (n = 241) based on their coronary angiography results. Subjects in the CHD group were further assigned to 'high stenosis' (n = 178) and 'low stenosis' (n = 181) subgroups based on the median value of Gensini score. Endothelial function and limb artery indicators, including brachial artery flow-mediated vasodilatation (FMD), ankle-brachial index (ABI) and brachial-ankle pulse velocity (baPWV), were examined and compared between subgroups. Multivariate logistic regression analysis and multiple linear regression analysis were carried out to select independent risk factors of CAS severity in hypertension. A predictive equation was conducted according to the results of multivariate logistic regression analysis to make clinical practice easier. As the receiver operating characteristic (ROC) curve had been plotted, the predictive ability of endothelial function and limb artery indicators in CAS severity in hypertension was detected by the area under the curve (AUC).

RESULTS

In patients with hypertension, the FMD (p = 0.023), ABI (p < 0.001) and baPWV (p < 0.001) of CHD patients appeared substantially different from the non-CHD patients. Furthermore, the ABI (p < 0.001) and baPWV (p = 0.032) both independently associated with CAS severity in hypertensive patients with CHD. Based on the results of multivariate logistic regression analysis with CAS severity as a dependent variable, a predictive equation of baPWV, ABI and FMD was developed: combined coefficient = Logit(p)=5.531-0.218*FMD-7.019*ABI + 0.244*baPWV. From the combined coefficients of baPWV, ABI and FMD, the largest AUC was 0.800, suggesting a powerful predictive value of CAS severity in hypertensive patients, followed by ABI (AUC = 0.747, 95%CI 0.693-0.796), baPWV (AUC = 0.704, 95%CI 0.648-0.756) and FMD (AUC = 0.588, 95%CI 0.529-0.645).

CONCLUSION

This study shows that baPWV, ABI and FMD are independent risk factors for CHD, of which, baPWV and ABI are strongly associated with CAS severity in hypertensive patients. The predictive ability of CHD in hypertensive patients may be enhanced through combining the three endothelial function and limb artery indicators. The results may help to facilitate clinical decision-making during treatment and management of coronary artery disease.

Oxidative Stress in Kidney Injury and Hypertension

Hypertension (HTN) is a major contributor to kidney damage, leading to conditions such as nephrosclerosis and hypertensive nephropathy, significant causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). HTN is also a risk factor for stroke and coronary heart disease. Oxidative stress, inflammation, and activation of the renin-angiotensin-aldosterone system (RAAS) play critical roles in causing kidney injury in HTN. Genetic and environmental factors influence the susceptibility to hypertensive renal damage, with African American populations having a higher tendency due to genetic variants. Managing blood pressure (BP) effectively with treatments targeting RAAS activation, oxidative stress, and inflammation is crucial in preventing renal damage and the progression of HTN-related CKD and ESRD. Interactions between genetic and environmental factors impacting kidney function abnormalities are central to HTN development. Animal studies indicate that genetic factors significantly influence BP regulation. Anti-natriuretic mechanisms can reset the pressure-natriuresis relationship, requiring a higher BP to excrete sodium matched to intake. Activation of intrarenal angiotensin II receptors contributes to sodium retention and high BP. In HTN, the gut microbiome can affect BP by influencing energy metabolism and inflammatory pathways. Animal models, such as the spontaneously hypertensive rat and the chronic angiotensin II infusion model, mirror human essential hypertension and highlight the significance of the kidney in HTN pathogenesis. Overproduction of reactive oxygen species (ROS) plays a crucial role in the development and progression of HTN, impacting renal function and BP regulation. Targeting specific NADPH oxidase (NOX) isoforms to inhibit ROS production and enhance antioxidant mechanisms may improve renal structure and function while lowering blood pressure. Therapies like SGLT2 inhibitors and mineralocorticoid receptor antagonists have shown promise in reducing oxidative stress, inflammation, and RAAS activity, offering renal and antihypertensive protection in managing HTN and CKD. This review emphasizes the critical role of NOX in the development and progression of HTN, focusing on its impact on renal function and BP regulation. Effective BP management and targeting oxidative stress, inflammation, and RAAS activation, is crucial in preventing renal damage and the progression of HTN-related CKD and ESRD.

Identification of Novel Proteins Mediating Causal Association Between Smoking and Essential Hypertension: A Mendelian Randomization Study

BACKGROUND

Smoking is a factor for hypertension. We aim to reveal novel plasma proteins mediating the relationship of smoking with hypertension and identify potential drug targets for hypertension on the basis of Mendelian randomization design.

METHODS AND RESULTS

Data for smoking were selected from the largest genome-wide association study meta-analysis performed by the Genome-Wide Association Study and Sequencing Consortium of Alcohol and Nicotine Use. Data for plasma proteins were selected from the deCODE Health study and the UK Biobank Pharma Proteomics Project. Data for hypertension were extracted from the FinnGen Study. Moreover, proteome-wide Mendelian randomization and colocalization analyses, 2-step Mendelian randomization, and gene function and network prediction, as well as druggability assessment were performed. We finally identified 8 proteins (ANXA4 [annexin A4], DLK1 [protein delta homolog 1], KLB [β-klotho], MMP8 [matrix metallopeptidase 8], PLAT [tissue-type plasminogen activator], POSTN [periostin], SAT2 [thialysine N-ε-acetyltransferase], and IFNLR1 [interferon λ receptor 1]) mediating association of smoking with hypertension. PLAT and IFNLR1 were identified to be involved in the complement and coagulation cascades and the Janus kinase/signal transducer and activator of transcription signaling pathway. ANXA4, KLB, MMP8, PLAT, and IFNLR1 had druggability. Moreover, IFNLR1 had strong evidence of genetic colocalization, because the posterior probability for H4 of IFNLR1 was 91.3%.

CONCLUSIONS

This study identified the 8 proteins that mediate causal association between smoking and essential hypertension. Interferon λ receptor agonist targeting IFNLR1 may open a new avenue for treating hypertension. Our discoveries provide new insights into protein pathogenesis of hypertension and to better guide hypertension prevention and treatment among smokers.

Cardiovascular, perceptual, and performance responses to single- vs. multi-chambered blood flow restriction cuffs

Introduction

This study aimed to investigate the impact of the blood flow restriction bladder type (single- [SC-BFR] vs. multi-chambered [MC-BFR]) on exercise performance, cardiovascular responses, and perceptual experiences with exercise sessions incorporating multiple sets to volitional failure in a randomized, crossover experimental design.

Methods

Twenty-seven healthy, physically active participants (age: 22.6 ± 5.7; weight: 74.3 ± 15.8 kg; height: 171.7 ± 7.7 cm; BMI: 25.0 ± 4.1 kg/m2; ∼93% reported regular resistance training within 6 months; 11 females) randomly performed exercise to failure (4× sets to failure, 20% 1RM, 1 min rest between sets) in each of three conditions: SC-BFR (using the Delfi Personalized Tourniquet Device inflated to 60% limb occlusion pressure), MC-BFR (using the B Strong Cuffs inflated to 300 mmHg according to manufacturer recommendations), and N-BFR (no BFR control).

Results

SC-BFR blunted post-exercise increases in carotid-femoral pulse wave velocity (p = 0.328) (+3.3%) whereas the other conditions showed elevations (MC-BFR +11.8% [p = 0.041], N-BFR +9.3% [p = 0.012]). Discomfort was lower in N-BFR compared to SC-BFR (p < 0.001) and MC-BFR (p = 0.035) but all displayed similar exertion (p = 0.176). Median total repetitions achieved were significantly less in SC-BFR (57 [25-75th percentile: 47-65) than MC-BFR (76 [63-91] (p = 0.043) and N-BFR [106 (97-148)] p = 0.005). Per set repetition volumes were similar on set 1 between SC-BFR (p < 0.001) and MC-BFR (p = 0.001) and were lower than N-BFR (p ≤ 0.001) whereas in sets 2-4, MC-BFR performed similar number of repetitions as N-BFR (p = 0.984-1.000).

Conclusion

Bladder design of a BFR cuff has an impact on the acute responses to exercise if applied according to recommended application guidelines, as SC-BFR impacts performance to a greater degree and mitigates post-exercise arterial stiffness responses compared to MC-BFR and N-BFR while both BFR conditions display greater levels of discomfort compared to N-BFR.

Clinical Trial Registration

NCT06276673.

Estimated glucose disposal rate is correlated with increased depression: a population-based study

BACKGROUND

Recent studies have identified a correlation between insulin resistance (IR) and depression. This study aims to explore the correlation between estimated glucose disposal rate (eGDR), a practical and noninvasive measure for assessing IR, and depression in the general population.

METHODS

In this population-based cross-sectional study, data from 28,444 adults aged 18 years old or older in the NHANES during the period from 1999 to 2018 were analyzed. The correlation between eGDR and depression was examined through multivariate logistic regression analyses, subgroup analyses, restricted cubic spline, and interaction tests. Furthermore, a mediation analysis was conducted to elucidate the role of the atherogenic index of plasma (AIP) in mediating the effect of eGDR on depression.

RESULTS

Multivariate logistic regression analysis and restricted cubic splines analysis indicated that eGDR can exhibit a linearly correlation with depression (OR = 0.913; 95% CI: 0.875, 0.953). Subjects in eGDR6-8 and eGDR > 8 groups had a decrease risk of depression as 25.4% and 41.5% than those in the eGDR < 4 group. This negative correlation was more pronounced in those with obesity. Mediation analysis indicated that AIP mediated 9.6% of the correlation between eGDR and depression.

CONCLUSIONS

eGDR was linear negatively correlated with depression, with AIP playing a mediating role. This study provides a novel perspective on the mechanism connecting IR to depression. Managing IR and monitoring AIP may contribute to alleviating depression.

Insulin Resistance-Nutritional Index: A Simple Index and Potential Predictor of Mortality Risk in Patients with Chronic Heart Failure and Type 2 Diabetes

Background

Patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM) are prone to insulin resistance and malnutrition, both of which are significant prognostic factors for CHF. However, the combined effect of the triglyceride-glucose index (TyG index) and prognostic nutritional index (PNI) on the mortality risk in patients with CHF and type 2 DM has not yet been studied.

Methods

We enrolled 3,315 patients with CHF and type 2 DM. We used a multivariate Cox regression model to assess hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk based on TyG index and PNI levels. Furthermore, we constructed a novel index, the insulin resistance-nutritional index (IRNI), defined as TyG index/Ln (PNI), and evaluated its prognostic significance.

Results

During follow-up, 1,214 deaths occurred. Participants with a high TyG index and non-high PNI had a significantly higher mortality risk compared to those with a non-high TyG index and high PNI, with an adjusted HR of 1.91 (95% CI, 1.57-2.32). The multivariate Cox regression analysis revealed HRs for all-cause and cardiovascular deaths of 1.93 (95% CI, 1.66-2.26; P < 0.001) and 2.50 (95% CI, 2.05-3.06; P < 0.001), respectively, when comparing the highest and lowest IRNI tertiles. IRNI's predictive power was stronger in groups with higher adapted Diabetes Complications Severity Index scores (P for interaction < 0.05). Additionally, adding IRNI to the baseline risk model significantly improved predictive performance, showing a greater effect compared to the TyG index or PNI.

Conclusion

IRNI, a novel and composite index reflecting insulin resistance and nutritional status, emerges as a potentially valuable prognostic marker for patients with CHF and type 2 DM.

Association of Dietary Flavonoids Intake With All-Cause and Cardiovascular Disease Mortality in Diabetic Kidney Disease: A Cohort Study From the NHANES Database

The relationship between dietary flavonoid intake and mortality in the diabetic kidney disease (DKD) population is unknown. So this study is aimed at investigating the association of total dietary flavonoid intake and their subclasses with all-cause and cardiovascular disease (CVD) mortality. Data of this cohort study were extracted from the NHANES (2007-2010 and 2017-2018). The survival status of participants was determined by linking to the National Death Index through the end of 2019. Flavonoid intake was measured using two 24-h dietary recall interviews. The Kaplan-Meier curves and weighted Cox proportional hazard regression models were used to assess the effect of dietary flavonoid intake on CVD and all-cause mortality, with adjustments for multiple covariates. A total of 1155 participants were included for analysis. After a median follow-up of 76.36 (S.E: 3.24) months, 409 participants died of all-cause mortality, of which 138 died of CVD. In the fully adjusted model, higher total dietary flavonoids intake (HR = 0.69, 95% CI: 0.52-0.92) was associated with lower all-cause mortality and subclasses of higher flavones (HR = 0.60, 95% CI: 0.35-0.85) was also with lower all-cause mortality. In subclasses of flavonoids, higher intake of both anthocyanidins (HR = 0.54, 95% CI: 0.28 to 0.87) and flavones (HR = 0.50, 95% CI: 0.28-0.87) were associated with lower odds of CVD mortality. Higher flavonoid intake was associated with a reduced risk of CVD and all-cause mortality in DKD. Higher flavonoid intake provides a potential opportunity to improve the prognosis of DKD. And future research into the mechanisms between flavonoids and mortality is needed.

The dietary inflammatory index (DII®) and human papillomavirus infection: a cross-sectional study of US women

BACKGROUND

Diet may influence susceptibility of human papillomavirus (HPV) infection by affecting inflammation and immunity. However, the association between HPV infection and the inflammatory potential of diet has not been investigated. The research aimed to examine the correlation between HPV status and the dietary inflammatory index (DII®).

METHODS

We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2003-2016 to investigate the correlation between DII and HPV status among 9,256 women aged 18-59 years. DII scores were calculated based on 24-hour dietary recall interviews. The association between HPV status and DII was analyzed using weighted logistic regression and restricted cubic spline (RCS).

RESULTS

Women with HPV infection exhibited higher DII scores than those without HPV infection. An increased likelihood of HPV infection was found to be significantly associated with higher DII scores (OR = 1.05, 95% CI: 1.01-1.09, P = 0.021), after full multivariate adjustment. Compared with the lowest tertile of DII scores, the ORs (95% CIs) for HPV infection were 1.20 (1.01, 1.42) and 1.27 (1.07, 1.51) for the second and third tertiles, respectively (P for trend = 0.006). RCS analysis showed a U-shaped relationship between DII and HPV infection, with a breakpoint identified at 0.13.

CONCLUSIONS

Our findings suggest that a pro-inflammatory diet is associated with an increased likelihood of HPV infection among women in the United States. Dietary interventions to reduce inflammation may help prevent HPV infection and related diseases.

Treatment of hypertension in the elderly: target the lowest well-tolerated blood pressure

INTRODUCTION

Antihypertensive treatment provides substantial benefits in older people. However, many challenges remain, including the ideal blood pressure (BP) target to be achieved. Because the elderly population is particularly vulnerable to adverse events, BP control should be carefully managed. Some studies have evaluated the cardiovascular effects of different BP targets in older patients, with mixed results and uncertainty about the most appropriate BP target. However, pooled analyses suggest that intensive BP lowering provides greater cardiovascular protection than less intensive strategies in elderly hypertensive patients.

AREAS COVERED

Understanding the balance between the risks and benefits of intensive BP targets and individualizing treatment is essential to ensure that older patients receive appropriate treatment to reduce the risk of cardiovascular complications. We reviewed data from clinical trials which investigated the protective effects of BP lowering drugs in elderly hypertensive patients aged ≥65 years.

EXPERT OPINION

Evidence suggests that age does not preclude an aggressive strategy for treating hypertension in elderly patients. Being 'tolerant' with one hand and 'intensive' with the other should become a universal standard in the management of elderly hypertensive patients. The lowest well-tolerated BP could be a simple and universally applicable BP target in the management of hypertensive patients, including the elderly.

Beneficial Effects of Exercise on Hypertension-Induced Cardiac Hypertrophy in Adolescents and Young Adults

PURPOSE OF REVIEW

Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy.

RECENT FINDINGS

Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.

Acute impact of autoregulation of applied blood flow restriction pressures on bilateral single-joint upper limb resistance exercise

To investigate the acute effects of 4 sets of autoregulated (AR-BFR) versus non-autoregulated (NAR-BFR) applied pressures during blood flow restriction (BFR) resistance exercise to volitional failure compared with low-load exercise without BFR. A randomized crossover design study was conducted on 32 healthy adults (20.8 ± 2.3 years; 11 females). Outcome measures were as follows: (1) arterial stiffness, (2) peak perceptual responses and likelihood to perform again, and (3) performance. Results: Post-exercise changes in central and brachial diastolic blood pressure were decreased in all groups. Post-exercise supine systolic blood pressure in no-BFR increased (mean difference (MD) = 4 ± 1 mmHg, 95% CI (1-7), p = 0.003, η2 = 0.13). Total repetitions performed and volume workload were similar between BFR conditions but less than no-BFR. AR-BFR reported significantly higher exertion (MD = 0.53 ± 0.2, 95% CI (0.04-1.0), p = 0.03, η2 = 0.19) than other conditions, and induced greater discomfort (MD = 2.50 ± 0.36, 95% CI (1.63-3.37), p < 0.001, η2 = 0.28) than no-BFR. Conclusion: Biceps curl exercise to volitional failure appears to induce negligible arterial stiffness or blood pressure changes regardless of the application of autoregulation, yet autoregulation appears to enhance the perceptual response to BFR exercise compared to NAR-BFR without impacting exercise performance.

Risk factor control and adherence to recommended Lifestyle among US hypertension patients

BACKGROUND

Although hypertension is a significant public health challenge globally, only a few studies have assessed the effectiveness of risk factor control and adherence to recommended lifestyle among United States hypertension patients.

METHODS

In this study, a detailed, stratified analysis of the 1999-2018 National Health and Nutrition Examination Survey was conducted to assess the adequacy of risk factor control and conformity to recommended lifestyle among United States patients with hypertension. Logistic regression analysis was used to identify influencing factors associated with not acheving risk factors and lifestyle targets.

RESULTS

A total of 21,770 participants (mean age, 62 ± 15 years) were enrolled in this study. About one in five (20%) participants achieved the recommended body mass index goal, 40% achieved the low-density lipoprotein cholesterol goal, and 30% achieved the recommended waist circumference. Most patients (80%) achieved the recommended smoking goal, 58% met the recommended alcohol consumption, and 19% achieved the recommended physical activity goal. Multivariate analysis demonstrated that age, gender, race, education, metabolic syndrome, and diabetes mellitus were independent predictors of not achieving risk factors and lifestyle targets.

CONCLUSIONS

Controlling risk factors and adherence to recommended lifestyles are not ideal for hypertension patients. Therefore, further research should assess how to improve the compliance rate and take targeted measures based on influencing factors for long-term prognosis.

Information and Communications Technology-Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results

BACKGROUND

Information and communications technology-based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps.

OBJECTIVE

This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC).

METHODS

Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology-based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey.

RESULTS

In the base-case analysis, compared with UC, TM was more costly (US $23,157 for TM vs US $22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US $5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97% at an incremental cost-effectiveness ratio threshold of US $26,515 (KRW 35 million) per QALY gained.

CONCLUSIONS

Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services.

Hypertensive patients with periodontitis as predictors of cardiovascular and all-cause mortality: a long-term cohort study

OBJECTIVES

The aim of this study is to examine the potential correlation between periodontitis and the risk of cardiovascular mortality and all-cause mortality in individuals diagnosed with hypertension, despite the established association between periodontitis and hypertension.

METHODS

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in 1999-2014 involving hypertensive individuals. Following the criteria proposed by Eke et al., periodontitis was classified. Survival estimates were calculated using Kaplan Meier analyses and a Kaplan Meier curve was generated. Weighted multivariate cox regression were employed to assess the association between periodontitis and all-cause mortality, as well as cardiovascular mortality.

RESULTS

Of the 21,645 individuals, 6,904 individuals were diagnosed with periodontitis. The Kaplan-Meier survival analysis revealed significantly higher rates of all-cause mortality (34.766% vs. 14.739%) and cardiovascular mortality (12.469% vs. 3.736%) in the periodontitis group compared to the non-periodontitis group. Hazard ratios (HRs) for all-cause mortality were 3.19 (95% CI 2.88-3.53) and for cardiovascular mortality were 3.80 (95% CI 3.13-4.61) in individuals with periodontitis compared to those without periodontitis.

CONCLUSION

Periodontitis is a risk factor for mortality in patient with hypertension, especially if it is moderate to severe. Improving periodontal health could lead to better outcomes for these patients.

Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations

Importance

Since 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) have recommended the pooled cohort equations (PCEs) for estimating the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). An AHA scientific advisory group recently developed the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations, which incorporated kidney measures, removed race as an input, and improved calibration in contemporary populations. PREVENT is known to produce ASCVD risk predictions that are lower than those produced by the PCEs, but the potential clinical implications have not been quantified.

Objective

To estimate the number of US adults who would experience changes in risk categorization, treatment eligibility, or clinical outcomes when applying PREVENT equations to existing ACC and AHA guidelines.

Design, Setting, and Participants

Nationally representative cross-sectional sample of 7765 US adults aged 30 to 79 years who participated in the National Health and Nutrition Examination Surveys of 2011 to March 2020, which had response rates ranging from 47% to 70%.

Main Outcomes and Measures

Differences in predicted 10-year ASCVD risk, ACC and AHA risk categorization, eligibility for statin or antihypertensive therapy, and projected occurrences of myocardial infarction or stroke.

Results

In a nationally representative sample of 7765 US adults aged 30 to 79 years (median age, 53 years; 51.3% women), it was estimated that using PREVENT equations would reclassify approximately half of US adults to lower ACC and AHA risk categories (53.0% [95% CI, 51.2%-54.8%]) and very few US adults to higher risk categories (0.41% [95% CI, 0.25%-0.62%]). The number of US adults receiving or recommended for preventive treatment would decrease by an estimated 14.3 million (95% CI, 12.6 million-15.9 million) for statin therapy and 2.62 million (95% CI, 2.02 million-3.21 million) for antihypertensive therapy. The study estimated that, over 10 years, these decreases in treatment eligibility could result in 107 000 additional occurrences of myocardial infarction or stroke. Eligibility changes would affect twice as many men as women and a greater proportion of Black adults than White adults.

Conclusion and Relevance

By assigning lower ASCVD risk predictions, application of the PREVENT equations to existing treatment thresholds could reduce eligibility for statin and antihypertensive therapy among 15.8 million US adults.

Use of electronic health records to characterize patients with uncontrolled hypertension in two large health system networks

BACKGROUND

Improving hypertension control is a public health priority. However, consistent identification of uncontrolled hypertension using computable definitions in electronic health records (EHR) across health systems remains uncertain.

METHODS

In this retrospective cohort study, we applied two computable definitions to the EHR data to identify patients with controlled and uncontrolled hypertension and to evaluate differences in characteristics, treatment, and clinical outcomes between these patient populations. We included adult patients (≥ 18 years) with hypertension (based on either ICD-10 codes of hypertension or two elevated blood pressure [BP] measurements) receiving ambulatory care within Yale-New Haven Health System (YNHHS; a large US health system) and OneFlorida Clinical Research Consortium (OneFlorida; a Clinical Research Network comprised of 16 health systems) between October 2015 and December 2018. We identified patients with controlled and uncontrolled hypertension based on either a single BP measurement from a randomly selected visit or all BP measurements recorded between hypertension identification and the randomly selected visit).

RESULTS

Overall, 253,207 and 182,827 adults at YNHHS and OneFlorida were identified as having hypertension. Of these patients, 83.1% at YNHHS and 76.8% at OneFlorida were identified using ICD-10-CM codes, whereas 16.9% and 23.2%, respectively, were identified using elevated BP measurements (≥ 140/90 mmHg). A total of 24.1% of patients at YNHHS and 21.6% at OneFlorida had both diagnosis code for hypertension and elevated blood pressure measurements. Uncontrolled hypertension was observed among 32.5% and 43.7% of patients at YNHHS and OneFlorida, respectively. Uncontrolled hypertension was disproportionately higher among Black patients when compared with White patients (38.9% versus 31.5% in YNHHS; p < 0.001; 49.7% versus 41.2% in OneFlorida; p < 0.001). Medication prescription for hypertension management was more common in patients with uncontrolled hypertension when compared with those with controlled hypertension (overall treatment rate: 39.3% versus 37.3% in YNHHS; p = 0.04; 42.2% versus 34.8% in OneFlorida; p < 0.001). Patients with controlled and uncontrolled hypertension had similar incidence rates of deaths, CVD events, and healthcare visits at 3, 6, 12, and 24 months. The two computable definitions generated consistent results.

CONCLUSIONS

While the current EHR systems are not fully optimized for disease surveillance and stratification, our findings illustrate the potential of leveraging EHR data to conduct digital population surveillance in the realm of hypertension management.

A neural perspective on the treatment of hypertension: the neurological network excitation and inhibition (E/I) imbalance in hypertension

Despite the increasing number of anti-hypertensive drugs have been developed and used in the clinical setting, persistent deficiencies persist, including issues such as lifelong dosage, combination therapy. Notwithstanding receiving the treatment under enduring these deficiencies, approximately 4 in 5 patients still fail to achieve reliable blood pressure (BP) control. The application of neuromodulation in the context of hypertension presents a pioneering strategy for addressing this condition, con-currently implying a potential central nervous mechanism underlying hypertension onset. We hypothesize that neurological networks, an essential component of maintaining appropriate neurological function, are involved in hypertension. Drawing on both peer-reviewed research and our laboratory investigations, we endeavor to investigate the underlying neural mechanisms involved in hypertension by identifying a close relationship between its onset of hypertension and an excitation and inhibition (E/I) imbalance. In addition to the involvement of excitatory glutamatergic and GABAergic inhibitory system, the pathogenesis of hypertension is also associated with Voltage-gated sodium channels (VGSCs, Nav)-mediated E/I balance. The overloading of glutamate or enhancement of glutamate receptors may be attributed to the E/I imbalance, ultimately triggering hypertension. GABA loss and GABA receptor dysfunction have also proven to be involved. Furthermore, we have identified that abnormalities in sodium channel expression and function alter neural excitability, thereby disturbing E/I balance and potentially serving as a mechanism underlying hypertension. These insights are expected to furnish potential strategies for the advancement of innovative anti-hypertensive therapies and a meaningful reference for the exploration of central nervous system (CNS) targets of anti-hypertensives.

Machine Learning-Based Hyperglycemia Prediction: Enhancing Risk Assessment in a Cohort of Undiagnosed Individuals

Background

Noncommunicable diseases continue to pose a substantial health challenge globally, with hyperglycemia serving as a prominent indicator of diabetes.

Objective

This study employed machine learning algorithms to predict hyperglycemia in a cohort of individuals who were asymptomatic and unraveled crucial predictors contributing to early risk identification.

Methods

This dataset included an extensive array of clinical and demographic data obtained from 195 adults who were asymptomatic and residing in a suburban community in Nigeria. The study conducted a thorough comparison of multiple machine learning algorithms to ascertain the most effective model for predicting hyperglycemia. Moreover, we explored feature importance to pinpoint correlates of high blood glucose levels within the cohort.

Results

Elevated blood pressure and prehypertension were recorded in 8 (4.1%) and 18 (9.2%) of the 195 participants, respectively. A total of 41 (21%) participants presented with hypertension, of which 34 (83%) were female. However, sex adjustment showed that 34 of 118 (28.8%) female participants and 7 of 77 (9%) male participants had hypertension. Age-based analysis revealed an inverse relationship between normotension and age (r=-0.88; P=.02). Conversely, hypertension increased with age (r=0.53; P=.27), peaking between 50-59 years. Of the 195 participants, isolated systolic hypertension and isolated diastolic hypertension were recorded in 16 (8.2%) and 15 (7.7%) participants, respectively, with female participants recording a higher prevalence of isolated systolic hypertension (11/16, 69%) and male participants reporting a higher prevalence of isolated diastolic hypertension (11/15, 73%). Following class rebalancing, the random forest classifier gave the best performance (accuracy score 0.89; receiver operating characteristic-area under the curve score 0.89; F1-score 0.89) of the 26 model classifiers. The feature selection model identified uric acid and age as important variables associated with hyperglycemia.

Conclusions

The random forest classifier identified significant clinical correlates associated with hyperglycemia, offering valuable insights for the early detection of diabetes and informing the design and deployment of therapeutic interventions. However, to achieve a more comprehensive understanding of each feature's contribution to blood glucose levels, modeling additional relevant clinical features in larger datasets could be beneficial.

Carotid ultrasound to identify head and neck cancer survivors with high cardiovascular risk after radiation therapy: rationale and design of a prospective, cross-sectional pilot study

Background: Radiation therapy is an integral component of treatment that can predispose to carotid artery stenosis (CAS) and increase the risk of cerebrovascular events for head and neck cancer survivors. The utility of screening for CAS with carotid ultrasound in asymptomatic head and neck cancer survivors is unclear.Methods: In this prospective, cross-sectional pilot study, 60 patients who have no evidence of cancer at least 2 years from completion of RT will undergo screening carotid ultrasound to identify patients with high risk of cardiovascular events.Results: Outcomes will include clinically significant CAS, carotid intima-media thickness, acceptability/feasibility of screening, barriers to care and preliminary data on changes to medical management because of screening. Correlative multi-omics analyses will examine biomarkers of CAS after radiation therapy.Conclusion: The results of this study will provide valuable data on the prevalence of CAS and preliminary patient-centered data that will inform the design of a future large-scale, multi-site clinical trial.Clinical Trial Registration: NCT05490875 (ClinicalTrials.gov).

Examining the Hypertension Control Cascade in Adults With Uncontrolled Hypertension in the US

Importance

Uncontrolled hypertension is a major contributor to cardiovascular disease (CVD) in the US.

Objective

To determine the prevalence of hypertension control cascade outcomes (hypertension awareness, treatment recommendations, and medication use) among individuals with uncontrolled hypertension to inform action across cascade levels.

Design, Setting, and Participants

This weighted cross-sectional study used January 2017 to March 2020 National Health and Nutrition Examination Survey (NHANES) data from noninstitutionalized adults aged 18 years or older in the US with uncontrolled hypertension. Data analysis occurred from January to February 2024.

Exposure

Calendar year of response to the NHANES survey.

Main Outcomes and Measures

Mean blood pressure (BP) was computed using up to 3 measurements. Uncontrolled hypertension was defined as systolic BP of 130 mm Hg or greater or diastolic BP of 80 mm Hg or greater, regardless of medication use. Outcomes included patient awareness of hypertension, treatment recommendations, and medication use. To estimate population totals by subgroup, the age-standardized proportion of each outcome was multiplied by the estimated number of adults with uncontrolled hypertension.

Results

The study included 3129 US adults with uncontrolled hypertension (1675 male [weighted percentage, 52.3%]; 775 aged 18 to 44 years [weighted percentage, 29.4%]; 1306 aged 45 to 64 years [weighted percentage, 41.4%]; 1048 aged 65 years or older [weighted percentage, 29.2%]), resulting in a population estimate of 100.4 million adults (weighted percentage, 83.7%) with uncontrolled hypertension. More than one-half of study participants (57.8 million adults [weighted percentage, 57.6%]) were unaware that they had hypertension, and of the 35.0 million who were aware and met criteria for antihypertensive medication, 24.8 million (weighted percentage, 70.8%) took the medication but had hypertension that remained uncontrolled. These negative outcomes in the hypertension control cascade occurred across demographic groups, with notably high prevalence among younger adults and individuals engaged in health care. Among an estimated 30.1 million adults aged 18 to 44 years with hypertension, 10.4 of 11.3 million females (weighted percentage, 91.8%) and 17.7 million of 18.8 million males (weighted percentage, 94.3%) had uncontrolled hypertension. Of the 10.4 million females, 7.2 million (weighted percentage, 68.8%) were unaware of their hypertension status, and of the 17.7 million males, 12.0 million (weighted percentage, 68.1%) were unaware. Additionally, 9.9 of 13.0 million adults with uncontrolled hypertension (weighted percentage, 75.7%) reported no health care visits in the past year and were unaware. Conversely, among 70.6 million adults with uncontrolled hypertension reporting 2 or more health care visits, approximately one-half (36.6 million [weighted percentage, 51.8%]) were unaware.

Conclusions and Relevance

In this cross-sectional study, more than 50% of adults with uncontrolled hypertension in the US were unaware of their hypertension and were untreated, and 70.8% of those who were treated had hypertension that remained uncontrolled. These findings have serious implications for the nation's overall health given the association of hypertension with increased risk for CVD.

Prognostic value of the triglyceride-glucose index for adverse cardiovascular outcomes in young adult hypertension

BACKGROUND

The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance that is involved in the progression of hypertension. This study aimed to evaluate the association of the TyG index with the risk for major cardiovascular events (MACE) in young adult hypertension.

METHODS

A total of 2,651 hypertensive patients aged 18-40 years were consecutively enrolled in this study. The TyG index was calculated as Ln [triglycerides × fasting plasma glucose/2]. The cutoff value for an elevated TyG index was determined to be 8.43 by receiver-operating characteristic curve analysis. The primary endpoint was MACE, which was a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, and end-stage renal dysfunction. The secondary endpoints were individual MACE components.

RESULTS

During the median follow-up time of 2.6 years, an elevated TyG index was associated with markedly increased risk of MACE (adjusted hazard ratio [HR] 3.440, P < 0.001) in young hypertensive adults. In subgroup analysis, the elevated TyG index predicted an even higher risk of MACE in women than men (adjusted HR 6.329 in women vs. adjusted HR 2.762 in men, P for interaction, 0.001); and in patients with grade 2 (adjusted HR 3.385) or grade 3 (adjusted HR 4.168) of hypertension than those with grade 1 (P for interaction, 0.024). Moreover, adding the elevated TyG index into a recalibrated Systematic COronary Risk Evaluation 2 model improved its ability to predict MACE.

CONCLUSIONS

An elevated TyG index is associated with a higher risk of MACE in young adult hypertension, particularly in women and those with advanced hypertension. Regular evaluation of the TyG index facilitates the identification of high-risk patients.