Blood pressure variability (BPV) is an established cardiovascular risk factor associated with target organ damage beyond mean blood pressure levels. Arterial stiffness, assessed by carotid-femoral pulse wave velocity (cfPWV), represents an early manifestation of hypertension and an independent predictor of cardiovascular events. Among short-term BPV indices, Average Real Variability (ARV) is considered a robust marker of blood pressure fluctuations. This study evaluated the relationship between ARV and arterial stiffness and identified clinically relevant ARV thresholds associated with increased cfPWV. A total of 315 adults underwent 24-h ambulatory blood pressure monitoring and cfPWV assessment. Receiver operating characteristic (ROC) analysis was performed to determine optimal systolic and diastolic ARV cut-off values for detecting increased arterial stiffness (cfPWV ≥10 m/s). Multivariable logistic regression models assessed independent associations between ARV indices and cfPWV. ROC analysis identified daytime systolic ARV ≥11.4 mmHg as the optimal threshold for predicting cfPWV ≥10 m/s (AUC 0.68; 95% CI 0.61-0.76; p < 0.001). Other significant ARV cut-offs ranged between 11.4 and 12.0 mmHg for systolic and diastolic measures. After adjustment for age, sex, and mean systolic blood pressure, daytime systolic ARV remained independently associated with cfPWV ≥10 m/s (OR 5.36 95% CI 1.70-17.04; p < 0.01). All diastolic ARV indices also retained statistical significance, with lower effect sizes (OR 2.45-3.25).Daytime systolic ARV ≥11.4 mmHg shows the strongest independent association with increased arterial stiffness, while diastolic ARV ijch70355ndices remain significant but weaker predictors. Trial Registration: The study received approval from the institutional bioethics committee. As it does not meet the criteria for a clinical trial, registration was not applicable.
Blood pressure (BP) response after renal denervation (RDN) remains heterogeneous. This study explored whether baseline neurohumoral and inflammation-related biomarkers were associated with a pronounced ambulatory BP response after RDN. This single-center post hoc analysis included 40 patients with uncontrolled essential hypertension who underwent RDN in four clinical trial programs. High response was defined as a reduction of ≥10 mmHg in 24-h ambulatory systolic blood pressure (24-h SBP) at 6 months. Baseline clinical, anatomical, procedural, and biomarker variables were compared between high- and low-response groups. Logistic regression and receiver operating characteristic analyses were performed to evaluate candidate biomarkers. RDN was associated with reductions in ambulatory BP at 24 h and 6 months. At 6 months, office SBP and diastolic blood pressure (DBP) decreased by 21.57 ± 9.90, 9.70 ± 9.94 mmHg, and 24-h ambulatory SBP and DBP decreased by 14.38 ± 13.55/9.25 ± 8.57 mmHg. BP reductions were broadly comparable across the four catheter subgroups. Baseline sex, age, ablation number, renal artery diameter and length, aldosterone did not differ between response groups. High responders had higher baseline upright plasma renin activity, 24-h urinary norepinephrine, serum neuropeptide Y, and plasma adenosine triphosphate levels. These four biomarkers were associated with high response in logistic regression, and their combined model showed high apparent discrimination. Patients with a pronounced ambulatory BP response after RDN showed a biomarker profile consistent with higher neurohumoral activation. This profile may help characterize RDN responsiveness, but validation in larger prospective cohorts is required.
ABSTRACT Cardiovascular risk factors are often undertreated in patients with dementia. Renin‐angiotensin system inhibitors (RASI) are first‐line treatments for hypertension. We examined the association between RASI and all‐cause mortality in hypertensive patients with and without dementia, comparing angiotensin‐converting enzyme inhibitors (ACEI) to angiotensin receptor blockers (ARB); and selected individual agents. This nationwide register‐based cohort study included data from Swedish national registries 2007–2018. The study included 158 176 hypertensive patients with exposure to RASI medications (21 152 RASI users and 137,024 non‐users), after excluding prevalent users. Propensity score matching was used to balance measured confounders. Cox regressions compared mortality risk among RASI users versus non‐users, ACEI users versus ARB users, and users of enalapril, ramipril, losartan, and candesartan versus other RASI users. RASI use was associated with lower all‐cause mortality (hazard ratio[HR] 0.93, 95% confidence interval[CI] 0.91–0.95, p < 0.001) in the full cohort, and among patients with dementia (HR 0.88, 95% CI 0.85–0.92). Compared to ACEI, ARB were associated with lower mortality in the full cohort (HR 0.90, 95% CI 0.85–0.96), but results were not significant in patients with dementia. The comparison of the individual drugs were consistent with class‐level findings. RASI use was associated with lower all‐cause mortality among older hypertensive patients, including those with dementia. These observational findings support continued attention to evidence‐based hypertension treatment in patients with dementia.
ABSTRACT Short‐term blood pressure variability (BPV) and circadian BP abnormalities are important cardiovascular risk predictors of mean BP levels, but their combined prognostic significance in essential hypertension remains incompletely understood. To evaluate the independent and combined prognostic value of 24‐hour BPV and circadian BP patterns for predicting major adverse cardiovascular events (MACE) in patients with essential hypertension. This retrospective cohort study included 500 adults with essential hypertension who underwent 24‐hour ambulatory BP monitoring. Short‐term BPV was assessed using the standard deviation of 24‐hour systolic BP. Circadian patterns were classified as dipper, non‐dipper, or reverse dipper based on nighttime systolic BP decline. The primary outcome was MACE, including myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox proportional hazards regression models were used to evaluate associations with outcomes. During a median follow‐up of 4.2 years, 128 patients (25.6%) experienced MACE. High BPV was associated with a significantly greater incidence of MACE than low BPV (34.2% vs. 17.1%, p < 0.001) and remained an independent predictor (adjusted HR 1.89, 95% CI 1.32–2.71, p < 0.001). Reverse dipping was also associated with increased risk. Patients with both elevated BPV and abnormal circadian patterns had the highest risk. Elevated short‐term BPV and abnormal circadian BP patterns are independent predictors of MACE in essential hypertension. Their coexistence identifies a particularly high‐risk phenotype. ABPM‐based dynamic BP assessment may improve cardiovascular risk stratification beyond mean BP levels.
ABSTRACT Renal artery variations are recognized as potential contributors to hypertension through altered renal perfusion and activation of renin–angiotensin system. However, their clinical and hemodynamic significance in children remains unclear. This retrospective study included 14 pediatric patients (0–18 years) with hypertension and renal artery variations. Demographic, laboratory, echocardiographic and ambulatory blood pressure monitoring (ABPM) data were analyzed at baseline and follow‐up. Patients were stratified according to serum renin levels (elevated vs. normal). Accessory renal arteries and early branching were identified in 78.4% and 42.8% of patients, respectively. At baseline, 38.4% of patients had left ventricular hypertrophy and most exhibited nocturnal hypertension with impaired dipping patterns. Although daytime, nighttime blood pressure (BP) SDS values tended to decrease during follow‐up; 24‐h, daytime, nighttime systolic, diastolic BP and mean arterial pressure values did not change significantly in either group. Patients with elevated renin levels showed persistently higher nocturnal BP‐SDS values and more pronounced non‐dipping patterns. In the high‐renin group, left ventricle relative wall thickness (RWT) decreased significantly from 0.41(0.36–0.43)–0.31(0.27–0.35) ( p = 0.03), whereas left ventricular mass index (LVMI) remained unchanged [33(30–40] vs. 37(34–45) g/m 2 · 7 , p = 0.56]. In the normal‐renin group, LVMI showed nonsignificant tendency to decrease [34(32–55) vs. 30(29–51) g/m 2 · 7 , p = 0.06], while the reduction in RWT did not reach statistical significance ( p = 0.12). Renal artery variations in children should not be considered purely anatomical findings. Persistent nocturnal hypertension and impaired dipping patterns, particularly in patients with elevated renin levels, may contribute to ongoing target organ damage. Although ABPM parameters remained largely unchanged during follow‐up, cardiac remodeling showed distinct patterns according to renin status.
ABSTRACT A recent study suggested an increase in male births associated with maternal preconception high blood pressure. Our objective was to examine this association. Data were obtained from the China‐US Collaborative Project for Neural Tube Defects Prevention, a large population‐based cohort study. We included 44 399 singleton pregnancy to women who were registered before pregnancy in seven counties in southern China. Blood pressure was measured during registration by trained health care workers and other health‐related information was recorded prospectively. We used log‐binomial regression to evaluate the associations between preconception blood pressure and the risk of male delivery, adjusting for potential confounders. The study size had 99% power (α = 0.05) to detect an increase of 50% over the unexposed rate of 51.94% for male delivery. The prevalence of hypertension in the preconception study population was 4.61% (2045/44 399). The prevalence of male delivery was 51.10% for the hypertension group and 51.79% for the non‐hypertension group. Compared with the non‐hypertension group, the hypertension group did not show significantly increased chance for male delivery [adjusted risk ratio (RR) = 0.99, 95% confidence interval (CI): 0.94, 1.03]. Our results do not support an association between hypertension or higher blood pressure prior to pregnancy and increased likelihood of male delivery.
ABSTRACT Hypertension, affecting nearly half of US adults, is a significant modifiable risk factor for Alzheimer's disease (AD), the fifth leading cause of death among Americans aged 65 and older. Hypertension contributes to AD through microvascular damage, reduced cerebral perfusion and neuroinflammation, leading to cognitive decline and dementia. This study examines US national trends and disparities in mortality due to comorbid AD and hypertension in older adults (≥65 years) using CDC WONDER data from 1999–2019. Age‐adjusted mortality rates (AAMRs) per 100 000 individuals and crude rates (CRs) were determined. Joinpoint regression was used to calculate Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs). A total of 372 839 deaths occurred, increasing from 4948 to 27 257 annually (1999–2019). AAMRs rose from 14.51 to 53.13, with an AAPC of 6.16%. Females (47.09) had higher AAMRs than males (33.80). Non‐Hispanic Blacks experienced the highest mortality rates (54.82), while NH Asians had the lowest (28.14); Hispanics experienced the highest AAPC (6.81). The 85+ age group bore the greatest mortality burden (AAPC: 6.84%). Most deaths (60.05%) occurred in hospice/nursing facilities. Mortality was highest in the West (AAMR: 50.28) and lowest in the Northeast (27.00). Mississippi had the highest, Massachusetts the lowest state‐level mortality burden. Non‐metropolitan areas exceeded metropolitan AAMRs (47.89 vs. 41.28). Targeted interventions are needed to counter observed trends, addressing hypertension as a key manageable risk factor for AD prevention.
ABSTRACT Female nurses face unique health challenges due to pregnancy and physiological factors, yet the association between reproductive factors and blood pressure remains debated. This cross‐sectional study surveyed 122 533 female nurses in Hebei Province using questionnaires and standardized blood pressure measurements. Data were collected on reproductive factors (menstrual status, number of abortions and deliveries), BMI, history of hypertensive disorders of pregnancy, and other potential confounders. Abortion was defined as pregnancy loss before 28 weeks of gestation, including both spontaneous miscarriage and induced termination, which are clinically and biologically distinct but were combined in this study due to data availability. Logistic regression and multifactorial analysis of variance were used to assess the associations of these reproductive factors with hypertension prevalence and blood pressure levels, respectively, including interaction terms for BMI and hypertensive disorders of pregnancy history. After adjusting for age, BMI, and other covariates, irregular menstruation (OR = 1.388, 95%CI: 1.302–1.478), menopause (OR = 1.328, 95%CI: 1.185–1.489), and having one delivery (OR = 1.215, 95%CI:1.004–1.471) were independently associated with higher odds of hypertension. Among nurses with prior hypertensive disorders of pregnancy, those with more than three abortions had significantly higher systolic (by 7.63 mmHg) and diastolic (by 6.38 mmHg) blood pressure compared to those with no abortion history. The findings indicate that reproductive factors are significantly associated with blood pressure in female nurses. We recommend regular blood pressure monitoring for nurses with irregular menstruation, menopause, or one delivery, proactive management of menstrual irregularities, and individualized reproductive counselling for those with a history of hypertensive disorders of pregnancy.
ABSTRACT This retrospective cohort study preliminarily investigated the feasibility of implementing primary aldosteronism (PA) screening without discontinuing dihydropyridine calcium channel blockers (DHP‐CCBs). We screened all patients undergoing diagnostic testing for secondary hypertension from January 2017 to May 2022 at authors’ center. For inclusion, patients must be on DHP‐CCBs monotherapy for hypertension. Aldosterone and renin concentration were measured pre‐ and post‐washout. Confirmatory tests were conducted in patients with positive screen [combination of ARR >2.5 (ng/dL)/(μIU/mL), aldosterone ≥10 ng/dL, and renin ≤8.2 μIU/mL] after washout. The final analysis included a total of 198 patients (median age: 49.5 years and 117 men). Confirmatory tests identified PA in 31 (15.7%) patients. Aldosterone‐to‐renin ratio (ARR) increased in 158 (79.8%) patients after washout. In 168 patients with a negative pre‐washout screen, 22 turned positive after washout, and 14 were diagnosed PA. Consequently, the missed diagnosis rate of PA was 45.2% (14/31) when using standard positive screen criteria before washout of DHP‐CCBs monotherapy. Exploratory analysis indicated that a pre‐washout ARR cutoff of >1.2 (ng/dL)/(μIU/mL) demonstrated 0.97 sensitivity and 0.75 specificity. In conclusions, caution is warranted when interpretating screening results from patients on DHP‐CCBs monotherapy due to the potential risk of missed diagnosis. Preliminary data suggest that ARR ≤1.2 (ng/dL)/(μIU/mL) before washout may serve as a candidate threshold for excluding PA in these patients, though this observation remains a hypothesis‐generating finding that requires further investigation.
ABSTRACT Renal sympathetic denervation (RDN) has demonstrated blood pressure–lowering efficacy in randomized trials; however, long‐term real‐world data on durability and safety beyond the first year, particularly from the Middle East, remain limited. We conducted a single‐center observational cohort study of consecutive patients with resistant hypertension undergoing RDN between February 2023 and December 2025. Baseline blood pressure was defined as the mean of three measurements obtained at separate visits. Follow‐up data were collected during routine clinical visits up to 30 months. The primary outcome was durability of blood pressure reduction. Secondary outcomes included changes in antihypertensive medications and renal safety. A total of 105 patients were included. Mean systolic blood pressure decreased from 162.1 ± 18.3 mmHg at baseline to 142.0 ± 18.9 mmHg at 12 months (−20.1 mmHg; p < 0.001), with sustained reductions observed through 30 months. Responder rates remained consistently high. Medication escalation was uncommon (6.7%), and most patients had no increase in antihypertensive burden. Renal function remained stable, with no clinically meaningful changes in creatinine or estimated glomerular filtration rate and no major procedure‐related complications. In this real‐world cohort, RDN was associated with durable blood pressure reduction over 30 months, achieved without systematic medication intensification and with preserved renal safety, supporting its effectiveness in routine clinical practice.
ABSTRACT Pheochromocytoma typically presents with sustained or paroxysmal hypertension, but initial manifestation as acute non‐ST‐segment elevation myocardial infarction (NSTEMI) is rare. Peri‐procedural hemodynamic fluctuations are often dramatic, making diagnosis and management challenging. We report a 51‐year‐old male admitted with chest tightness for 17 days. Elevated troponin and coronary angiography showing multivessel disease with total occlusion of the mid‐left anterior descending artery (LAD) led to a preliminary diagnosis of NSTEMI. During percutaneous coronary intervention, blood pressure surged to 240/130 mmHg; intravenous nitroprusside caused an instantaneous drop to 95/55 mmHg, with rapid rebound to >200 mmHg upon withdrawal, showing no clear temporal relationship with drug administration. Postoperatively, large rapid blood pressure oscillations persisted, associated with postural changes but without patient discomfort. Workup revealed markedly elevated plasma catecholamines: dopamine 77.58 pg/mL (normal 0–20), normetanephrine 1881.63 pg/mL (0–145), and norepinephrine 5,724.04 pg/mL (217–1,109). CT and PET‐CT identified a left retroperitoneal mass (59×34×44 mm, SUVmax 14.6), suggestive of pheochromocytoma. Surgical resection was performed, and histopathology with immunohistochemistry confirmed the diagnosis. Postoperatively, the patient required no antihypertensive medications and blood pressure remained stable. This case illustrates a rare pheochromocytoma presentation as secondary hypertension manifesting as acute myocardial infarction, characterized by extreme peri‐procedural hemodynamic instability during PCI and an “all‐or‐none” response to conventional antihypertensive therapy, ultimately cured by surgical resection.
ABSTRACT Health care systems have a key role in improving hypertension control in large populations, a global challenge, through the implementation of modern multicomponent programs. The impact of such programs in at‐risk minority populations, nonetheless, remains to be better characterized. Additionally, the extent to which hypertension control based on a single time‐point blood pressure (BP) measurement (LAST‐BP), the approach typically used in health system performance assessment, agrees with time‐averaged BP (AVG‐BP) has not been well studied. Leon Medical Centers (LMC), a major integrated health care system serving Medicare beneficiaries predominantly of Hispanic origin in Miami‐Dade County, Florida, implemented a hypertension control program in 2011. We conducted longitudinal data analysis evaluating hypertension control before and after program implementation, and compared annual rates derived from AVG‐BP versus LAST‐BP. During 2008–2018, the analytic sample increased from 4,710 to 21,540, mean age rose from 73.4 to 77.1 years, and the proportion of Hispanics remained stable (>98%). Adjusted odds of hypertension control were 5.7 (95% CI: 5.4–6.0) times higher after full program implementation. Improvements were comparable in women and men. Trends based on LAST‐BP paralleled those of AVG‐BP, although rates were consistently lower. Kappa agreement between AVG‐BP and LAST‐BP metrics was only fair. The LMC program was associated with a meaningful, sustained increase in hypertension control to high levels (crude rates based on AVG‐BP ∼ 90%). LAST‐BP‐based control rates underestimated those derived from AVG‐BP. Research is warranted to determine how longitudinal BP metrics can be optimally incorporated into patient care and health system performance assessment. Practical Applications : This study has two practical implications. First, it shows that a coordinated, multicomponent hypertension control program with modern core elements, including team‐based care, standardized blood pressure measurement, and promotion of guideline‐based management supported by a robust EHR system and enhanced pharmacy and transportation services, and culturally tailored patient engagement, can achieve and sustain high levels of hypertension control in the understudied population of Hispanic Medicare beneficiaries in South Florida. These findings provide a strong foundation for real‐world primary care settings, while highlighting the need for continued program refinement as the science of blood pressure (BP) control in large populations evolves. Second, the study shows that a single annual “snapshot” BP value underestimates true hypertension control compared with the average of readings obtained throughout the year. This finding supports the value of longitudinal BP metrics and highlights the need for research to determine how best to incorporate them into performance assessment.
ABSTRACT We performed a post hoc exploratory secondary analysis to investigate whether baseline circadian blood pressure (BP) pattern was associated with changes in serum uric acid (SUA) during 8‐week antihypertensive therapy. Of the 494 hypertensive patients who received amlodipine (5–10 mg) or nifedipine GITS (30–60 mg) for 8 weeks, 369 patients with available laboratory data and valid follow‐up ambulatory BP monitoring data were included in the present analysis, including 221 dippers (nocturnal systolic BP decline ≥ 10%) and 148 non‐dippers (nocturnal systolic BP decline < 10%). Analysis of covariance was used to estimate least square mean changes in SUA according to baseline dipping pattern. After 8‐week antihypertensive treatment, SUA decreased significantly in dippers (−12.4 ± 3.4 µmol/L, p = 0.0004) but not in non‐dippers (−3.3 ± 4.2 µmol/L, p = 0.44). In the repeated‐measures analysis, SUA levels decreased significantly over time ( p = 0.002), whereas no significant time‐by‐dipping interaction was observed ( p = 0.23). Baseline BP dipping pattern may be modestly associated with short‐term SUA changes during antihypertensive therapy. However, the absence of a significant time‐by‐dipping interaction suggests that these findings should be interpreted cautiously and require further confirmation.
ABSTRACT Hyperandrogenism has been linked to increased preeclampsia risk, but its independent role remains unclear due to confounding by polycystic ovary syndrome (PCOS). This retrospective cohort study investigated whether non‐PCOS hyperandrogenism is associated with hypertensive disorders of pregnancy (HDP) and adverse pregnancy outcomes in women undergoing frozen embryo transfer (FET), and whether hyperandrogenism synergizes with overweight/obesity to further increase these risks. We analyzed data from 1556 infertile women who underwent FET at Ruijin Hospital and delivered between January 2015 and December 2022. Participants were classified into four groups based on the presence of hyperandrogenism and overweight/obesity: controls ( n = 1201), hyperandrogenism only ( n = 116), overweight/obesity only ( n = 209), and both hyperandrogenism and overweight/obesity ( n = 30). Multivariable logistic regression models were used to evaluate associations with HDP and related adverse outcomes. In multivariable analyses, overweight/obesity was independently associated with an increased risk of gestational diabetes mellitus (GDM) (adjusted odds ratio [aOR] 1.62) and gestational hypertension (aOR 3.45), whereas the coexistence of overweight/obesity and hyperandrogenism was strongly associated with higher risks of preeclampsia (13.3%, aOR 7.53), preterm birth (23.3%, aOR 3.67), and cervical length shortening (CLS) (6.7%) compared to the controls. These results suggest that in women without PCOS undergoing FET, the coexistence of hyperandrogenism and overweight/obesity identifies a high‐risk hypertensive phenotype characterized by a substantially elevated risk of preeclampsia. Moreover, our findings may indicate synergistic effects of endocrine and metabolic disturbances on pregnancy‐related blood pressure dysregulation and could facilitate early risk stratification for HDP.
ABSTRACT Cognitive impairment is a major geriatric health issue with significant public health burdens. Emerging evidence suggests blood pressure variability (BPV), particularly its dynamic fluctuations, may contribute to cognitive impairment pathogenesis through cerebrovascular damage. This study aims to investigate the prospective association between BPV, and cognitive impairment based on a cohort of community‐dwelling older adults from Hong Kong. Based on a prospective cohort study with data collection of regular blood pressure (BP) measurements and health surveys in Hong Kong, participants older than 55 years were included and cognitive function was evaluated with the Montreal Cognitive Assessment. Demographic, social, and disease history information were adjusted. BPV was defined as standard deviation (SD) and categorized as high, medium, and low by a machine learning method. Logistic and quantile regression was conducted to explore the association between cognitive function and BPV. 573 participants with a mean age of 72 years, 96.2% of whom were women, with a mean follow‐up of approximately eight months and a mean of 19 BP measurements. After adjustment, higher systolic BPV was associated with an increased risk of MCI (OR: 1.16; 95% CI: 1.03–1.31), but not diastolic BPV. Participants classified as having a high level of BPV showed a 5.6‐fold risk for MCI compared with low BPV participants, especially among participants with lower cognitive levels. Higher systolic BPV was independently associated with an increased risk of MCI in older adults. Incorporating BPV assessment into routine monitoring could enhance early detection of cognitive decline in older adult populations.
ABSTRACT This retrospective study of 4143 women at Fujian Maternal and Child Health Hospital (2012–2022) investigated how maternal risk levels influence clinical characteristics and perinatal outcomes in singleton pregnancies complicated by preeclampsia. Utilizing class‐imbalance‐adjusted and random forest algorithms, participants were stratified into high‐risk (17.38%), moderate‐risk (34.08%), and low‐risk (48.54%) groups. The analysis revealed that women in the high‐risk category were diagnosed at a significantly earlier gestational age and faced higher rates of severe, early‐onset, and preterm preeclampsia compared to the other groups. Although high‐risk pregnancies were associated with increased incidences of renal impairment, hypoproteinemia, and aminotransferase abnormalities, no significant differences were observed in rates of thrombocytopenia, placental abruption, postpartum hemorrhage, or stillbirth. Regarding delivery and neonatal outcomes, the high‐risk group demonstrated markedly higher rates of Cesarean sections, fetal distress, and neonatal intensive care unit (NICU) admissions. Key drivers of these adverse outcomes included chronic hypertension, chronic kidney disease, prior fetal growth restriction (FGR), and maternal age over 40 years. Ultimately, while high‐risk status is a strong predictor of early‐onset disease and specific maternal‐neonatal complications, it does not uniformly predict all adverse fetal outcomes, suggesting that clinical management should focus heavily on the specific impacts of hypertension, renal health, and advanced maternal age.
