In a retrospective audit of 89 adults with spontaneous intracerebral haemorrhage (ICH) at a tertiary neuroscience centre, fewer than 60% met the National Institute for Health and Care Excellence (NICE) blood pressure (BP) target in the year before their haemorrhage, despite most carrying a known diagnosis of hypertension. Blood pressure control and antihypertensive prescribing improved after ICH, yet most survivors remained above the European Stroke Organisation (ESO) secondary-prevention target, and the first documented community BP check occurred a median of 62 days after discharge. These findings expose primary- and secondary-prevention gaps spanning the whole care pathway and lend support to a structured, protocolised uptitration pathway after discharge, combining remote BP monitoring with pharmacist- or nurse-led dose escalation.
Persistent hypertension (HTN) remains common after covered stent implantation for coarctation of the aorta (CoA). However, existing evidence is derived predominantly from surgical repair cohorts and cross-sectional echocardiography, leaving the individual trajectory of left ventricular (LV) remodeling after stenting poorly defined. We retrospectively studied 84 patients with complete persistent HTN status, and 75 patients with paired follow-up echocardiography for LV remodeling analyses. Multivariable logistic and linear regression were performed to identify factors associated with persistent HTN and follow-up LV mass index (LVMI) separately. Paired changes in LV hypertrophy (LVH) and LV geometry were assessed using McNemar and Stuart-Maxwell tests. Persistent HTN occurred in 46 of 84 patients (54.8%) at a median clinical follow-up of 9 years, and was associated with older age at repair and higher preoperative systolic blood pressure. Higher follow-up LVMI was associated with higher baseline LVMI, male sex and longer follow-up duration. At a median echocardiographic follow-up of 2 years, LVH prevalence decreased from 41.3–24.0%. This net decline masked bidirectional individual trajectories: 19 of 31 patients with baseline LVH (61.3%) no longer met LVH criteria, whereas 6 of 44 patients without baseline LVH (13.6%) developed new-onset LVH. Anatomical relief after CoA stenting therefore does not preclude ongoing myocardial burden, and patients developing new-onset LVH would not be identified by preoperative risk stratification alone. Serial echocardiographic assessment should complement long-term blood pressure surveillance, though these findings require validation in larger cohorts with standardized follow-up.
Kidney transplant recipients (KTRs) frequently exhibit abnormal ambulatory blood pressure (BP) patterns, particularly nocturnal hypertension and impaired dipping. However, morning hypertension and morning BP surge (MBPS) remain less well-characterized in this population. This analysis aims to evaluate the prevalence and phenotypes of morning hypertension and ambulatory BP monitoring (ABPM)-derived morning surge indices according to nocturnal BP status and dipping pattern in KTRs. A total of 135 KTRs who underwent 24 h ABPM (ABPMpro device) were included. Morning BP was defined as mean BP during the first two hours after awakening. MBPS was assessed using pre-awakening, sleep-through and rising surge definitions. Morning hypertension was present in 53.3% of KTRs; among those with morning hypertension, 93.1% had sustained nocturnal and morning hypertension. Elevated SBP was equally frequent during morning and nighttime periods (43.7% each), but only half of them had elevated BP during daytime. Office BP underestimated morning BP burden, with masked morning hypertension identified in 18.5%. Participants with nocturnal hypertension had lower pre-awakening systolic MBPS than those without nocturnal hypertension (8.0 ± 12.1 vs. 15.2 ± 12.8 mmHg, p = 0.014), as well as lower sleep-through systolic MBPS (15.6 ± 13.0 vs. 22.2 ± 13.9 mmHg, p = 0.037), while rising MBPS did not differ significantly. Across dipping categories, MBPS indices were consistently higher in dippers and lower in reverse dippers (pre-awakening SBP surge: dippers 24.7 ± 13.1, non-dippers 10.7 ± 9.1, and reverse-dippers 1.1 ± 11.2 mmHg; p < 0.001). Morning hypertension is common in KTRs and is driven predominantly by sustained nocturnal and morning hypertension. Blunted MBPS likely reflects persistent nocturnal BP elevation and impaired dipping status.
