OBJECTIVE:To investigate interindividual variability in post-exercise hypotension (PEH) and to characterise cardiovascular and autonomic differences between responders and non-responders following aerobic and isometric exercise in adults of African and South Asian descent with elevated blood pressure (BP). METHODS:Physically inactive adults of African and South Asian descent living in Suriname (18-65 years) with high-normal BP or grade I hypertension participated in a randomised controlled crossover trial. In this randomised cross-over trial, 47 adults (50.1 ± 10.8 years; 38% male) with high-normal blood pressure or grade I hypertension completed three conditions: aerobic exercise (30 min at 40-60% heart rate reserve), isometric handgrip exercise, and a non-exercise control. Ambulatory BP was assessed over 24 h. PEH was defined as the net effect: (post-exercise - pre-exercise) - (post-control - pre-control). Participants were classified as responders if daytime BP decreased ≥5 mmHg. Arterial stiffness, cardiac, and autonomic parameters were assessed. RESULTS:Following aerobic exercise, 46% of participants were classified as systolic responders compared with 28% after isometric exercise. No baseline differences were observed in demographic or clinical characteristics between responders and non-responders, suggesting that PEH variability may reflect underlying physiological rather than clinical differences. Aerobic responders demonstrated greater reductions in aortic augmentation index (-19.4% vs. -10.9%, p = 0.05), larger increases in stroke volume (+8.1 vs. -5.3 mL, p = 0.05) and cardiac output (+1.54 ± 1.89 vs. +0.58 ± 1.60 L/min, p = 0.009), and more favourable autonomic recovery. Among all variables, only the change in cardiac output was associated with PEH magnitude (r = -0.46, p = 0.006). No consistent physiological differences were observed following isometric exercise. CONCLUSION:PEH following aerobic exercise is characterised by a distinct responder phenotype associated with greater reductions in aortic augmentation index and favourable cardiac adaptations. These findings highlight substantial interindividual variability in BP responses and support the need for individualised exercise strategies in hypertension management.
BACKGROUND:In clinical practice, blood pressure (BP) is typically assessed using brachial measurements, whereas finger plethysmography is widely used in vascular physiology research. However, agreement between BP levels at the finger and more proximal sites is not straightforward because of interindividual differences in BP gradients along the arterial tree. METHODS:We investigated factors associated with the mean arterial pressure (MAP) difference between non-invasive radial artery and finger measurements in 574 normotensive and hypertensive individuals without cardiovascular disease, diabetes or antihypertensive medication. Recordings included pulse wave analysis from radial BP, plethysmographic finger BP and whole-body impedance cardiography. Radial BP signals were calibrated using oscillometric contralateral brachial artery measurements. RESULTS:Simultaneous mean radial and finger BP (systolic/diastolic) were 131/75 and 122/69 mmHg, respectively (p < .001). When examined in quartiles of the radial-finger BP gradient, the average MAP difference was -7, 4, 10 and 20 mmHg, respectively. In linear regression analysis (enter method), a greater MAP difference was significantly associated with higher radial MAP (p < .001), age (p = .001) and stroke index (p = .015); and with lower pulse wave velocity (p < .001), pulse pressure amplification (p = .002) and insulin sensitivity check index (p = .022). CONCLUSIONS:High MAP is a major factor contributing to greater BP difference between the radial and finger sites. However, the difference is also more pronounced in the presence of lower large artery stiffness, lower pulse pressure amplification, and higher stroke index, older age and greater insulin resistance.
BACKGROUND:Vasovagal syncope (VVS) without aura is characterised by a high fall risk and misdiagnosis rate. However, its hemodynamic characteristics remain unclear. METHODS:A total of 221 participants were prospectively and consecutively enrolled, including 34 patients with non-prodromal VVS, 118 patients with prodromal VVS, and 69 non-syncope controls. All participants completed the head-up tilt test (HUTT) combined with transcranial Doppler (TCD). Blood pressure, heart rate, and cerebral hemodynamic parameters were monitored dynamically during the test. Data were statistically analysed. RESULTS:The non-prodromal VVS group consisted predominantly of males (70.59% vs. 37.29%), had a higher body mass index (median 24.14 vs. 21.26 kg/m2), and was older (median 47 vs. 37 years) (all p < 0.05). The baseline cerebral blood flow velocity (CBFV) in the non-prodromal VVS group was significantly lower than that in the prodromal VVS group (55 vs. 60 cm/s, p = 0.009), and the decrease of CBFV during the tilt test preceded the change of blood pressure. During the return to the supine position after HUTT, systolic blood pressure was significantly higher in the non-prodromal VVS group than in the prodromal VVS group (p = 0.019), and the heart rate increment was greater during the drug-induced phase. CONCLUSIONS:Non-prodromal VVS, with its unique hemodynamic profile involving early cerebral hypoperfusion and impaired central compensatory mechanisms, represents a high-risk subtype associated with higher fall risk. The identified hemodynamic differences may serve as objective biomarkers for its diagnosis. This study highlights the need for tailored management strategies.
Background: High blood pressure (BP) in young adults is an underrecognised public health issue with potential long-term health consequences, including increased mortality risk. To examine the prevalence of prehypertension among US young adults and assess its association with all-cause and cardiovascular mortality. Methods: This cohort study utilised data from the National Health and Nutrition Examination Survey (NHANES) 1999-2016. Cox proportional hazards (PHs) regression models were used to estimate hazard ratios (HRs) for mortality. The Fine and Gray subdistribution hazard model was applied to account for competing risks in cardiovascular mortality. Population attributable fractions (PAFs) were calculated to assess the mortality burden associated with prehypertension and hypertension in this population. Prehypertension was defined as a systolic BP (SBP) of 120-139 mm Hg or a diastolic BP (DBP) of 80-89 mm Hg. All-cause and cardiovascular mortality were ascertained through linkage to the National Death Index (NDI) (up to 2019). Results: Among 18,271 participants (mean [SE] age, 28.6 [0.1] years; 49.6% female), the design-weighted prevalence was 23.9% for prehypertension and 14.3% for hypertension. Compared with normotensive individuals, the adjusted HRs for all-cause mortality were 1.82 (95% CI, 1.20-2.74) for prehypertension and 2.39 (95% CI, 1.50-3.81) for hypertension. The HRs for cardiovascular mortality were 1.37 (95% CI, 0.45-4.15) for prehypertension and 4.17 (95% CI, 1.51-11.51) for hypertension. The PAFs for all-cause mortality were 15.1% for individuals with prehypertension and 16.5% for those with hypertension. For cardiovascular mortality, the PAFs were 6.0% for prehypertension and 36.7% for hypertension. Conclusions: In this nationally representative cohort, prehypertension and hypertension were common among US young adults and associated with increased all-cause mortality. These findings highlight the need for early detection and management of high BP in young adults to reduce mortality risk.
OBJECTIVE:Sleep duration, a modifiable lifestyle factor, has been variably associated with blood pressure regulation, yet evidence among the oldest-old populations remains limited and inconsistent. This study aims to investigate the association between self-reported sleep duration and hypertension in a large cohort of Chinese older adults. METHODS:We analysed cross-sectional data from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 15,650 participants aged 65 years and older were included. Sleep duration was self-reported and categorised as <6 h, 6-8 h, and ≥9 h. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or a self-reported physician diagnosis. Multivariate logistic regression models were used to evaluate the associations. Restricted cubic splines were applied to model non-linearity. RESULTS:Among 15,650 participants (mean age 87.16 years, SD 11.36; 57.0% female), 7,345 (46.9%) met criteria for hypertension. In the fully adjusted model, short sleep duration (<6 h) was associated with a 1.30-fold higher odds of hypertension compared with sleeping 6-9 h (adjusted odds ratio [OR] 1.30; 95% confidence interval [CI] 1.17, 1.44). Long sleep duration (≥9 h) showed no statistically significant association after full adjustment (OR 1.04; 95% CI 0.97, 1.12). The relationship followed a non-linear J-shaped curve (p for non-linearity < 0.05). Interaction analyses revealed that the effect of short sleep duration on hypertension was more pronounced among adults with no limitations in activities of daily living (p for interaction = 0.009). CONCLUSION:Short sleep duration (<6 h) is independently associated with hypertension in Chinese older adults. These findings suggest sleep assessment may help identify older adults at hypertension risk, and support future trials on sleep hygiene for hypertension prevention.
BACKGROUND:Despite efforts to improve hypertension management, control rates remain low. Effective control depends on care competence and continuity. We describe health system competence, care continuity, user experience, and health and economic outcomes among individuals with hypertension in Uruguay. METHODS:This longitudinal study of randomly selected 200 adults aged ≥35 years with baseline blood pressure >140/90 mmHg and mobile phone access from the CESCAS 2010 cohort.. . Over eight months, participants completed baseline, six telephone follow-up, and a final surveys documenting health status, health system competence, care continuity, patient activation, user experience, and health and economic outcomes. RESULTS:Mean age was 64.9 (9.7) years; 77% reported 'Excellent/Very good' health. Overall, 79.5% knew they had hypertension and were on treatment; 42.0% of the total sample had controlled blood pressure at baseline. Only 11.5% received all guideline-recommended clinical interventions. Regardless of coverage, 60.8% usually attended a primary care facility. Although 93.5% had at least one visit in 8 months, only 48.8% of newly diagnosed participants completed the three recommended visits. In all, 57.1% received care from the same professional in the same facility. Blood pressure control was achieved by 34.4% of those with known hypertension and 19.5% of newly diagnosed participants. Only 49% reported timely appointments availability. Patient activation was 70.5%, and 68.9% reported autonomy in decision-making. CONCLUSION:The low proportion of individuals receiving continuous, competent care, particularly among those newly diagnosed, underscores the need for targeted interventions to improve care quality.
BACKGROUND:This study investigates the association between positive life orientation (PLO) and blood pressure (BP) in two Finnish cohorts of older adults born 20 years apart. METHODS:Seventy-year-old residents of Turku, Finland, were surveyed in 1990 (1920-born Turku Older Adults Study [TUVA] cohort) and in 2010 (1940-born New Turku Older Adults Study [UTUVA] cohort). PLO was derived from questionnaire items capturing life satisfaction, feeling needed, future plans, zest for life and frequency of depressive feelings and loneliness. Associations between PLO and BP were examined using analysis of variance with post hoc tests and chi-squared tests for categorical outcomes and multiple linear regression adjusted for age, gender, smoking and BMI. Analyses included 684 TUVA and 870 UTUVA participants. RESULTS:The mean PLO score was 0.86 in TUVA and 0.88 in UTUVA (p = .047 for inter-cohort difference). In TUVA, systolic BP differed across PLO tertiles (153.3 ± 20.1, 158.2 ± 21.5 and 156.3 ± 21.0 mmHg; p = .038), as did diastolic BP (84.3 ± 10.0, 87.3 ± 10.1 and 85.4 ± 9.9 mmHg; p = .005). In UTUVA, no significant BP differences were observed across tertiles (p ≥ .13). Regression analyses showed no significant associations between PLO score and systolic or diastolic BP in either cohort (p ≥ .13). In UTUVA, antihypertensive medication use differed across PLO tertiles (61.4%, 55.9% and 50.7%; p = .035). Other comparisons for hypertension prevalence and medication use were not significant (p ≥ .217) in the cohorts. CONCLUSIONS:In these two population-based cohorts, PLO had at most a minor relationship with BP, and any such association appeared attenuated in the context of widespread antihypertensive treatment in the later-born cohort.
BACKGROUND:Studies on the effect of atmospheric pollutant levels on blood pressure variability (BPV) are limited. However, the effects of atmospheric pollutant levels on blood pressure variability (BPV) in hypertensive patients remain unknown. People who are exposed to air pollutants in the short term have elevated blood pressure. The objective of this study was to explore the effects of air pollutant levels on BPV in patients with essential hypertension. METHODS:A total of 1,658 patients diagnosed with essential hypertension were included. We collected BPV indicators from the patients and pollutant data, including particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), sulphur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), and ozone 8-h mean (O3-8 h). We used the daily averages of PM2.5 and PM10, CO, NO2, SO2 from monitoring stations near the patients' homes. We constructed a distributed lag model for the median regression of the distribution, to explore the lag effect and correlation between air pollution components and BPV in patients with essential hypertension. RESULTS:For every 10-μg/m³ increase in PM2.5, the maximum lag effect on dSBPSD (day time systolic blood pressure standard deviation) and dSBPCV (daytime systolic blood pressure coefficient of variation) was observed at lag 0, while that on dDBPCV (daytime diastolic blood pressure coefficient of variation) was observed at lag 4, with increments of 1.08 (95% CI: 0.15, 2.02), 0.80 (95% CI: 0.11, 1.50), and 0.53 (95% CI: 0.04, 1.02), respectively. For every 10-μg/m³ increase in PM10, the maximum lag effect on nDBPSD (night-time diastolic blood pressure standard deviation) and nDBPCV (night-time diastolic blood pressure coefficient of variation) was observed at lag 5, with increments of 0.57 (95% CI: 0.16, 0.99) and 1.00 (95% CI: 0.19, 1.8), respectively. For every 10-μg/m³ increase in SO2, the maximum lag effect on dSBPSD and dSBPCV were observed at lag 0, with increments of 4.35 (95% CI: 1.21, 7.48) and 3.54 (95% CI: 0.87, 6.21), respectively. For every 1-g/m³ increase in CO, the maximum lag effect on dSBPCV was observed at lag 0, with increments of 1.21 (95% CI: 0.25, 2.18) . CONCLUSIONS:We observed a lag effect on BPV in patients with essential hypertension following short-term exposure to PM2.5, PM10, SO2 and CO.
BACKGROUND:Many patients pharmacologically treated for hypertension do not reach blood pressure (BP) treatment targets. In Europe, a target of BP < 130/80 mmHg has recently been recommended. Presently, the effect of combining pharmacological approaches and lifestyle changes is unclear. The Hypocaloric Mediterranean Diet or Physical Activity (MeDiPA) randomised controlled trial aims at investigating the effects of lifestyle modifications in patients with uncontrolled hypertension taking antihypertensives. Here, we present the MeDiPA design and baseline population characteristics. METHODS:We included participants with office BP ≥ 130/80 mmHg on two occasions, taking at least two antihypertensives, with body mass index (BMI) 25-40 kg/m2 and waist circumference ≥88 cm (women)/≥102 cm (men). We excluded participants with BP ≥ 160/100 mmHg, type 1 diabetes, recent cardiovascular disease or chronic kidney disease. Participants were randomised to a hypocaloric Mediterranean-style diet, increased physical activity or control, for 6 months. The main outcome is changes in 24-h ambulatory BP after 6 months. Exploratory outcomes include changes in metabolic parameters and quality of life. RESULTS:Sixty-six participants were included (56% women): 21, 22 and 23 in the diet, physical activity and control groups, respectively. Mean (standard deviation) age was 59 (8) years, 85% of participants were Norwegian and 83% had higher education. Mean BMI was 32.0 (4.5) kg/m2 and waist circumference was 106.3 (11.8) cm (women)/113.3 (8.6) cm (men). Mean BP was 137 (15)/90 (8) mmHg and 61% of participants had BP ≥ 140/90 mmHg. CONCLUSION:This trial will improve our understanding of how lifestyle modifications modulate BP in pharmacologically treated patients with uncontrolled hypertension.Trial registration NCT04155112; first submitted 2019-10-23.
Background The prevalence of untreated, uncontrolled and resistant hypertension and their specific prognosis among American adults with prediabetes remain unclear. We aimed to explore the prevalence of hypertension treatment and control and their associated risks of all-cause and cardiovascular disease (CVD) mortality among this population.Methods We analyzed data from 12,321 participants in the NHANES survey (1999-2016). Prediabetes was defined as fasting plasma glucose 5.6–7.0 mmol/L, hemoglobin A1c 5.7%–6.4%, 2-hour glucose 7.8–11.1 mmol/L, or self-reported diagnosis. Hypertension was defined as blood pressure ≥140/90 mmHg, a self-reported history of hypertension, or current antihypertensive medication use, and categorized into untreated, controlled, uncontrolled, and resistant hypertension. Cox regression assessed associations between hypertension categories and CVD and all-cause mortality.Results The study included 12,321 adults with prediabetes, representing an estimated 53.3 million individuals. Age- and sex-standardized hypertension prevalence was 43%. Among those with hypertension, 62% were receiving treatment. Among treated individuals, 66% had controlled hypertension, 26.5% had uncontrolled hypertension, and 7.5% had resistant hypertension. Mortality risk increased progressively from non-hypertensive to untreated, controlled, uncontrolled, and resistant hypertension stages. Compared to non-hypertensive individuals, hazard ratios (HRs) for CVD mortality were 1.17 (95% CI: 0.80–1.71), 1.52 (1.04–2.21), 2.03 (1.35–3.05), and 1.83 (1.07–3.13), respectively (P trend <0.001). For all-cause mortality, HRs were 1.01 (0.86–1.20), 1.05 (0.87–1.26), 1.16 (0.95–1.41), and 1.42 (1.09–1.85), respectively (P trend = 0.022).Conclusions Hypertension was highly prevalent among American adults with prediabetes, and mortality risk increased with advancing hypertension stages.
INTRODUCTION/BACKGROUND:Resistant hypertension (rHTN) is defined as uncontrolled blood pressure despite ≥3 antihypertensives, including a diuretic. While fourth-line-intensification is recommended, comparative evidence remains scattered. RESEARCH QUESTIONS/HYPOTHESIS:To evaluate the efficacy and safety of fourth-line antihypertensives in reducing clinic systolic blood pressure (SBP) in rHTN. METHODS/APPROACH:PubMed, Embase, Scopus, and Web of Science were searched (2015-2026) for randomized controlled trials (RCTs) with ≥4 weeks follow-up. Risk of bias was assessed using Cochrane RoB 2. A planned network meta-analysis was not performed because statistical inconsistency and transitivity violations rendered indirect comparisons unreliable. Therefore, pairwise meta-analyses were conducted using random-effects models, with results reported as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CIs). RESULTS/DATA:Eleven RCTs involving 3,931 adults with rHTN were included. Compared with placebo, the largest SBP reductions were observed with lorundrostat (MD -11.70 mmHg [95% CI -16.07, -7.33]) and baxdrostat 2 mg (MD -10.10 [-12.63, -7.58]). Baxdrostat 1 mg (MD -8.56 [-11.08, -6.04]) produced reductions similar to spironolactone (MD -7.95 [-10.10, -5.80]). Bisoprolol achieved a modest SBP reduction (MD -6.71 mmHg), whereas aprocitentan 12.5 mg reduced SBP by -3.80 mmHg [-6.65, -0.95]. No intervention significantly increased serious adverse events. Higher rates of any adverse events were observed with aprocitentan 25 mg (RR 1.89 [1.39, 2.57]) and doxazosin (RR 1.55 [1.09, 2.20]). CONCLUSIONS:Aldosterone-targeted therapies, including aldosterone-synthase inhibitors and spironolactone, provide clinically meaningful SBP reductions in rHTN without increasing serious adverse event risk. Future trials should clarify comparative efficacy and long-term outcomes.
