Journal of Hypertension

ObjectiveIndividuals with hypertension may transition between different orthostatic blood pressure (BP) phenotypes within minutes. We studied the temporal patterns of orthostatic BP responses and their relationship to symptom development in older hypertensive individuals with and without frailty. Design and methodA cross-sectional study was conducted including patients aged [&ge;]60 years. BP was measured seated and at 1- and 3-minutes post-standing. Orthostatic hypotension (OH) and orthostatic hypertension (OHT) were defined in accordance with current guidelines. Orthostatic intolerance (OI) was defined as symptoms upon standing. Frailty was assessed using the Clinical Frailty Scale. Multivariable logistic regression models evaluated associations between orthostatic BP phenotypes, OI and Frailty. ResultsWe included 461 hypertensive adults (mean age: 72.5 {+/-} 7.0 years, 70% female). The prevalence of OH and OHT was 11% and 10%, respectively. About 50% of individuals with OH or OHT at minute 1 normalized their BP by minute 3, while a similar absolute number with normal BP at minute 1 developed OH or OHT by minute 3. Frail individuals exhibited a twofold higher prevalence of OH (OR 2.39, p = 0.023), and a more than threefold higher prevalence of OHT (OR 3.60, p < 0.001). In fully adjusted models, OI was associated with both systolic OH (OR 3.05, p = 0.019) and OHT (OR 2.33, p = 0.041). ConclusionsOrthostatic BP phenotypes in hypertensive older adults were dynamic, with frequent shifts between 1 and 3 minutes of standing. Frailty and OI were strongly associated not only with OH but also with OHT.

BackgroundThe ambulatory arterial stiffness index (AASI) has emerged as an ambulatory blood pressure monitoring (ABPM) measure of stiffness and is supposedly useful in younger subjects. The objective of our cross-sectional study was to evaluate the relationships between the AASI and indices of arterial stiffness in a pediatric population at risk of hypertension. MethodsThis was a cross-sectional study of children/adolescents (8-18 years) whose pulse wave velocity (PWV: carotid-to-femoral cf-PWV and heart-finger hf-PWV), augmentation index (AIx; normalized at 75 bpm: AIx75), systemic arterial stiffness (aortic pulse pressure/stroke volume, measured via pulse contour analysis) and ABPM were measured on the same day. At-risk populations were vascular remodeling (preterm birth, n=44 and chronic kidney diseases, n=7) and hyperkinetic causes (congenital central hypoventilation syndrome, n=14 and psychostimulant treatment, n=10). ResultsThe mean age of the 75 participants was 12.3 {+/-} 2.5 years (34 girls), and their mean AASI was 0.33 {+/-} 0.17. AASI did not correlate with cf-PWV, hf-PWV, AIx or systemic arterial stiffness. In contrast, the AASI significantly correlated with both systolic and diastolic BP at night (R= -0.23; p=0.048 and R= -0.33; p=0.004, respectively). Systemic arterial stiffness correlated with hf-PWV and AIx75 (R= 0.35; p=0.004 and R= -0.34; p=0.013, respectively). Based on ABPM, 15/75 (20%) participants had hypertension, and they had higher cf-PWV than participants without hypertension (5.64 {+/-} 0.70 vs 4.92 {+/-} 0.78 m/s, p=0.002) and not different AASI values (0.34 {+/-} 0.14 vs 0.32 {+/-} 0.18, p=0.756). ConclusionAASI is not a measure of arterial stiffness in childhood.

BackgroundHypertension (HTN) is a key risk-factor for cardiovascular diseases (CVDs). Blood-pressure (BP) categorizations between systolic blood pressure (SBP) of 120 and 140 remain debatable. In the current study we aim to evaluate if individuals with a baseline SBP between 130-140 mm Hg (hypertension as per AHA 2017 guidelines) have a significantly higher proportion of incident hypertension on follow-up, as compared to those with SBP between 120-130 mm Hg. MethodsSecondary data analysis was performed in a community-based cohort, instituted, and followed since 2017. Participants were aged [&ge;]30 years, residents of urban slums in Bhopal. BP was measured at or near home by Community Health Workers (CHWs). Two-year follow up was completed in 2019. We excluded participants who were on BP reduction therapy, had fewer than two out-of-office BP measurements and who could not be followed. Eligible participants were re-classified based on baseline BP in four categories: Normal (Category-A), Elevated-BP (Category-B), Variable-BP (Category-C) and reclassified HTN based on AHA-2017 (Category-D). Proportion of individuals who developed incident hypertension on follow up was primary outcome. ResultOut of 2649 records, 768 (28.9%), 647 (24.4%), 586 (22.1%), 648 (24.4%) belonged to Categories A, B, C and D respectively. Incident HTN with cut-off of 140/90 mm Hg was, 1.6%, 2.6%, 6.7%, 12% in categories A, B, C and D respectively. Incidence of incident hypertension in individuals with a baseline SBP between 130-140 mm Hg (Category D) was significantly higher as compared to those with SBP between 120-130 mm Hg (Category B). ConclusionWe conclude that biological basis for AHA-2017 definition of hypertension is relatively robust also for low income and resource-limited settings. Evidence from our longitudinal study will be useful for policy makers for harmonizing national guidelines with AHA-2017.

High blood pressure (BP) or hypertension is a significant risk factor for the global burden of cardiovascular diseases. Home blood pressure measurements (HBPM) have been recommended for hypertension diagnosis, treatment initiation and medication titration, but guidelines for the number of measurements and duration are inconsistent. This study compared the accuracy of 3 home BP measurements per day for seven days with 24-hour ambulatory BP measurements. We examined 24-hour ambulatory BP measurements (ABPM) and HBPM during-morning, afternoon, and evening each day for seven days in healthy community living volunteers. Standardized Bland-Altman scatterplots and limits of agreement (LOA) were used to assess absolute reliability and the variability of measurement biases. We used nonparametric Mann-Whitney U-tests to compare the mean (SD) of the devices. Correlations between HBPM and 24-hour ABPM measurements were statistically significant at p<0.05. The high correlation coefficient (r=0.75) was observed between the systolic BP retrieved from two devices compared to moderate correlation (r=0.46) among diastolic BP. A significant difference was found for systolic BP (P<0.05) between the HBPM and ABPM but was non-significant for diastolic BP (P>0.05). In Bland-Altman plots, the LOA between HBPM and ABPM was 0.07-26.23 mmHg for SBP and 11.24 -16.20 mmHg for DBP. The overall mean difference (bias) in SBP and DBP was 13.08 and 2.48, respectively. Our results suggest that HBPM three times per day for seven days can potentially be used where ABPM is unavailable. Further studies in a diverse group of people with hypertension are needed.

2.BackgroundWhile hypertension (HT) in pediatric patients is often secondary (SH), recent trends show a rise in primary hypertension (PH), which is associated with an increasing global prevalence of obesity. Our study aimed to assess the etiology of HT and predictors of PH in a large European cohort of children referred for HT based on office blood pressure (BP) measurements. MethodsWe performed retrospective analysis of 2008 children aged 0-18 years (12.3 {+/-} 4.9 years) diagnosed with HT. Patients were classified into white coat hypertension (WCH), PH, or SH groups based on office BP and 24-hour ambulatory BP monitoring (ABPM). Clinical, anthropometric, and biochemical data were collected to differentiate PH and SH and to identify predictors of PH. ResultsOut of 2008 patients included in the analysis, HT was confirmed in 1452 patients (556 were classified as WCH). Of 1452 patients with HT: 42.8% had PH, while 57.2% had SH, mainly secondary to renal parenchymal disease (33.2% of SH patients), post-kidney transplant HT (23.1%), aortic coarctation (15.9%) and renovascular HT (13.8%). However, PH started to be the dominant cause of HT after 13 years of age and was diagnosed in 59.1% of 13-18-year-old patients with confirmed HT. Age [&ge;] 13 years, obesity (BMI-SDS [&ge;]1.65), and serum uric acid [&ge;] 5.5 mg/dL were identified as significant PH predictors. ConclusionsOur study provides valuable insights into the current etiology of pediatric HT and highlights the role of uric acid level assessment in the diagnosis of PH in children.

BackgroundIn 2024, the European Society of Cardiology (ESC) hypertension guidelines introduced an "elevated blood pressure" category (120-139/70-89 mmHg), lowering the normal diastolic BP threshold from 85 to 70 mmHg. The implications of this change for risk stratification in primary prevention are uncertain. MethodsWe conducted a cross-sectional study of adults undergoing standardized preventive health assessments at a dedicated center in Paris, France. Office blood pressure was measured with a validated automated oscillometric device. Participants were classified using ESC/ESH{square}2018 and ESCL2024 definitions. We quantified shifts across BP categories and compared clinical, lifestyle, and biological profiles between individuals reclassified from ESCL2018 "Optimal" to ESCL2024 "Elevated" solely due to diastolic BP [&ge;]L70LmmHg with systolic BP<{square}120{square}mmHg. ResultsAmong 1,394 participants (mean age 49.9 {+/-} 12.1 years; 33.9% women), ESC 2024 classified 10.0% as non-elevated (<120/70 mmHg), 64.2% as elevated, and 25.8% as hypertensive ([&ge;]140/90 mmHg). Overall, 328 (23.5%) moved from ESC/ESH2018 "Optimal" (BP <120/80 mmHg) to ESC 2024 "Elevated" on the basis of diastolic pressure alone. Compared with individuals classified in the 2018 optimal and 2024 non-elevated subgroup (BP <120/70 mmHg), reclassified participants (systolic BP <120 and diastolic BP 70- 79 mmHg) were modestly older (45.5 vs 42.7 years; p = 0.007) but did not differ by sex, body-mass index, smoking exposure, alcohol consumption, self-rated health, cardiovascular history, or routine biomarkers. SCORE2 did not differ between these groups (p = 0.12), but increased progressively across successively higher ESC/ESH2018 categories. In line with this gradient, ESC/ESH2018 "Optimal" versus non-optimal groups differed significantly across multiple risk markers (all p < 0.05). ConclusionsIn this low-risk preventive cohort, lowering the diastolic threshold to 70 mmHg reclassified nearly one quarter of adults with previously optimal BP into the elevated BP category, without identifying a clinically distinct higher-risk phenotype. Prospective studies with adjudicated outcomes are needed to determine the utility of this threshold for primary prevention.

BackgroundHypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents. Methods244 participants (mean age 15.5{+/-}1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75th percentile), mid- (75th-90th percentile) and high-risk (>90th percentile) groups. TOI assessments included left ventricular mass, systolic and diastolic function, and vascular stiffness. The number of TOI markers for each participant was calculated. A multivariable general linear model was constructed to evaluate the association of different participant characteristics with higher numbers of TOI markers. Results47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers. ConclusionHigh SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.

BackgroundInterindividual variation in systolic blood pressure (SBP)-heart rate (HR) coupling reflects differences in autonomic and vascular regulation. The primary objective of this study was to determine whether SBP-HR synchronization identifies distinct hemodynamic phenotypes associated with demographic characteristics and blood pressure (BP) profiles in hypertensive and normotensive individuals. MethodsWe conducted a cross-sectional cohort analysis of 1,122 adults who underwent continuous 24-hour ambulatory monitoring of SBP, diastolic blood pressure (DBP), and HR in an outpatient clinical setting. Participants were classified as hypertensive or normotensive using guideline-based criteria. The primary exposure variable was SBP-HR synchronization, quantified using zero-lag cross-correlation coefficients. The primary outcomes were demographic characteristics (age, sex, stature) and BP phenotypes, including isolated systolic hypertension (ISH). Unsupervised partitioning around medoids clustering was used to identify synchronization-based phenotypes. Group comparisons were performed using Welchs ANOVA and {chi}{superscript 2} testing, with multivariable adjustment for age and sex where applicable. ResultsAll 1,122 participants were included in the final analysis (mean age 60.7 years; 52% female). Three synchronization phenotypes were identified: low, moderate, and high. Compared with the low-synchronization phenotype, the high-synchronization phenotype was younger (55.2 {+/-} 15.0 vs. 66.6 {+/-} 13.9 years), taller (170.4 {+/-} 9.4 vs. 167.4 {+/-} 10.5 cm), more frequently male (56% vs. 38%), and had lower baseline SBP (131.8 {+/-} 17.5 vs. 136.7 {+/-} 24.2 mmHg). Overall hypertension prevalence did not differ across phenotypes; however, ISH was less frequent in the high-synchronization phenotype (15.7% vs. 23.4%). Cluster assignments were robust across sensitivity analyses. ConclusionsSBP-HR synchronization identifies distinct hemodynamic phenotypes associated with age, sex, stature, and BP characteristics. Stronger synchronization reflects a physiological profile consistent with preserved autonomic-vascular integration and lower prevalence of isolated systolic hypertension, supporting its potential role in refined cardiovascular phenotyping.

BackgroundBlood pressure (BP) is known to follow a circadian rhythm with 10% to 15% lower values during the night than daytime. Non-dipping BP refers to the absence of BP dipping and has been associated with the development of target organ damage. The general goal of this study was to determine the correlates of non-dipping BP in persons with and without hypertension. MethodsThis was a cross-sectional study that recruited 98 participants at Chikankata Mission General Hospital. The outcome variable of the study was non-dipping BP, with sociodemographic and clinical explanatory variables. We used SPSS version 22 to describe and make inferences. ResultsThe median (interquartile range (IQR)) age of participants was 42 years (34.7-52) and 54.1% (53/98) had hypertension while 45.9% (45/98) were normotensive. The proportion of females was slightly higher (59.2%, n=58) than that of males (40.2%, n=40), this being similar in hypertensives but equal in normotensives. The median (IQR) age of hypertensives was higher compared to the normotensives, 46 (40-56) vs. 35 (25-41) years. The prevalence of non-dipping BP was 38.8% overall and higher among those with hypertension (54.7%) compared to the normotensive group (20%). The factors associated with non-dipping BP in the multivariate analysis were age (adjusted odds ratios (AOR) of 1.15; 95% CI: 1.05 - 1.25), spot urine sodium (AOR of 1.16; 95% CI: 0.99 - 1.36), daytime systolic blood pressure (SBP) load (AOR of 1.28; 95% CI: 1.06 - 1.55), daytime diastolic blood pressure (DBP) load (AOR of 0.77; 95% CI: 0.65 - 0.92), and nighttime DBP load (AOR of 1.10; 95% CI: 1.02, 1.18). However, this was abrogated by hypertension status albeit among normotensives only age remained significantly associated with non-dipping BP, none of the factors remained significantly associated with non-dipping BP among persons with hypertension. ConclusionThe prevalence of non-dipping BP was high, among hypertensives. This provides insights into the intricate links between BP patterns, sociodemographic and clinical characteristics but further underscores the need for mechanistic researches to further advance the understanding of mechanisms of associated characteristics.

BackgroundEarly identification of individuals at high risk for hypertension development is crucial for implementing timely preventive strategies. Metabolic indices such as the cholesterol-glucose (CHG) index, atherogenic index of plasma (AIP), and triglyceride-glucose (TyG) index have emerged as potential biomarkers for metabolic and cardiovascular disorders. However, their comparative predictive value for new-onset hypertension in prehypertensive individuals remains unclear. MethodsThis prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), including 2,859 adults with prehypertension followed from 2011 to 2015. Participants were stratified based on progression to incident hypertension. Baseline characteristics and metabolic indices were evaluated. Multivariable logistic regression models, restricted cubic spline (RCS) analyses, receiver operating characteristic (ROC) curves, and subgroup analyses were conducted to assess the associations between CHG, AIP, and TyG indices and the risk of developing hypertension. ResultsDuring the 4-year follow-up, 31.34% (896/2,859) of participants developed new-onset hypertension. All three metabolic indices were independently associated with an increased risk of hypertension after multivariable adjustment. The CHG index demonstrated the strongest association (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.45-2.66, P < 0.001), followed by the TyG index (OR: 1.31, 95% CI: 1.07-1.60, P = 0.010). RCS analysis revealed a significant nonlinear relationship between the CHG index and hypertension risk (P for nonlinear = 0.042), whereas AIP and TyG showed linear trends. ROC analysis indicated that the CHG index had the highest discriminatory ability for predicting hypertension (fully adjusted area under the curve [AUC] = 0.7010), outperforming both AIP (AUC = 0.6997) and TyG (AUC = 0.6980). Subgroup analyses showed that the association between the CHG index and incident hypertension was significantly stronger among individuals with lower educational attainment (illiterate), those aged 60-70 or [&ge;]70 years, and widowed individuals (P for interaction < 0.05). ConclusionAmong prehypertensive individuals, higher baseline levels of CHG, AIP, and TyG indices are significantly associated with an increased risk of developing hypertension. The CHG index demonstrates superior predictive performance and may serve as a valuable tool for early risk stratification and targeted intervention in clinical practice.

BackgroundWe have developed a patented method that acquires photoplethysmograms (PPG) at multiple cuff-pressure levels to estimate Blood pressure (BP). The method is referred to as plethysmometry. Validation of new methods for measuring BP involves comparison with Sphygmomanometry as standard. ObjectiveTo compare the new method of BP measurement (plethysmometry) with Sphygmomanometry guided by international protocols for validation and to evaluate diagnostic agreement for hypertension (HT). MethodsNinety-two adults underwent four video/audio-documented sphygmomanometric readings (two before and two after plethysmometry). The lowest and highest of the four estimates were taken as lower and upper limits of systolic and diastolic BP reported by sphygmomanometry. The values were averaged to get average systolic and diastolic pressures for each individual. Plethysmometry involves recording of 3 signals; cuff-pressure, and PPG from fingers of both cuffed and uncuffed arms. A brief ramp-inflation of cuff-pressure to the point at which the cuffed-arm pulse disappears provides a preliminary systolic estimate. 16 cuff-pressure steps (ranging from above the preliminary systolic estimate to 30 mmHg) were then applied, holding cuff-pressure at each level for 10 seconds. From the relationship of pulse amplitude to cuff-pressure, lower and upper limits of systolic and diastolic pressures were derived. Average systolic and diastolic pressures and average pulse pressure were calculated. Mean arterial pressure (MAP) was obtained from the relationship between cuff-pressure and cuff-pressure oscillation amplitude. The average pressures from both methods were compared as per AAMI criterion-1 and BHS grading scheme. A new scheme of BP classification with Plethysmometry was designed. Normative data was obtained from a subset of 77 individuals who did not have previous history of HT and whose sphygmomanometric pressures were below 140/90 mmHg. Based on the relationship of the systolic, diastolic, mean arterial and pulse pressures of the subject to the normative pressures, BP was classified as HT or normotension (NT). ResultsPlethysmometry gives two sets of arterial pressures, one proximal to the arm-cuff (closer to central pressures) and the other, in the arterial segment below or distal to the cuff (peripheral). Comparing average systolic and diastolic pressures between plethysmometry (central) and sphygmomanometry, bias(SD) was 1.18(6.66) mmHg(systolic) and -4.17(9.07) mmHg (diastolic); AAMI criterion-1 was met for central systolic but not for diastolic; criterion-2 was not applicable as there was only a single plethysmometric measurement per subject. BHS grading criteria also were met for central systolic but not for diastolic pressure. When HT diagnosis by plethysmometry with the new scheme (incorporating systolic, diastolic, mean arterial and pulse pressure) was compared with sphygmomanometry, sensitivity and specificity were more than 0.9. ConclusionsPlethysmometry provides objective ranges of systolic and diastolic pressures and MAP from a single recording, verifiable by traces of recorded parameters. It is equivalent to multiple sphygmomanometric measurements done under ideal conditions in terms of high diagnostic accuracy for HT as well as agreement between systolic pressures. The consistent negative diastolic bias in plethysmometry may be due to the well-documented over-estimation of diastolic pressure by sphygmomanometry. Plethysmometry is a good tool for clinic BP assessment and can detect masked hypertension.

Background: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered diagnostic threshold for hypertension, encouraging earlier treatment initiation in the U.S. compared to UK, where the National Institute for Health and Care Excellence (NICE) guideline recommends higher thresholds. No comparative study evaluating how different hypertension guidelines and physical activity are jointly associated with mortality outcomes in two countries. Aims: This study compared hypertension prevalence, treatment uptake, blood pressure (BP) levels, and mortality between the UK Biobank (UKBB) and the U.S. National Health and Nutrition Examination Survey (NHANES). We evaluated whether moderate-to-vigorous physical activity (MVPA) modifies mortality risk among different hypertension subgroups (normotensive, medicated hypertension, and unmedicated hypertension). Methods: We harmonized demographic, biomarker, lifestyle, and accelerometer data from UKBB (n=63,452) and NHANES (n=7,397). Comprehensive weighting methods were applied in both cohorts. Accelerometry data was classified using a validated two-stage machine learning Random Forest algorithm. Associations between MVPA and all-cause mortality were examined with restricted cubic spline regression and visualized using Kaplan-Meier survival curves. Results: NHANES showed a higher proportion of treated hypertension (29.9%) and lower average blood pressure (SBP/DBP: 122.2/70.7 mmHg) compared to UKBB (11.7% treated; SBP/DBP: 136.0/81.3 mmHg). Despite lower BP levels, cardiovascular mortality was higher in UKBB (10.3 per 10,000 person-years) compared to NHANES (4.0 per 10,000 person-years). In both cohorts, greater MVPA was linked to lower mortality risk, with the strongest association observed among medicated hypertensives. Notably, NHANES participants with treated hypertension and low MVPA (<10.7 minutes/day) experienced a steeper survival decline, falling to 74% by year 8, compared to 91% in normotensives and 79% in untreated hypertensives. Conclusion: Despite higher treatment prevalence and lower average BP levels in NHANES, mortality remained higher compared with UKBB, suggesting that differences in mortality patterns may relate to broader cardiometabolic profiles and PA patterns beyond pharmacological management alone. Across both cohorts, higher levels of MVPA were associated with lower all-cause mortality, with the strongest associations were observed among individuals with medicated hypertension.

BackgroundHigh body mass index (BMI) is an important contributor to higher blood pressure (BP) levels and its deleterious consequences. However, the strength of this association may be context-specific and differ across time due to increases in medication use or secular changes in body composition. Thus, we utilised two independent data sources to investigate if associations between BMI and systolic BP (SBP) in Britain changed from 1989-2018. MethodsWe used 23 repeated cross-sectional datasets--the Health Survey for England (HSE) at [&ge;]25 years (1994-2018; N=126,742); and three British birth cohorts (born 1946, 1958, and 1970) with outcomes available at 43-46 years (N=18,657). Anthropometry and BP were measured using standard protocols. We used linear and quantile regression to investigate cross-sectional associations between BMI and SBP. ResultsIn HSE, associations were weaker in subsequent years, and this trend was most pronounced amongst older adults--after accounting for sex, treatment and education, the mean difference in SBP per 1 kg/m2 increase in BMI amongst adults [&ge;]55 years was 0.75mmHg (95% CI: 0.60, 0.90) in 1994, 0.66mmHg (0.46, 0.85) in 2003, and 0.53mmHg (0.35, 0.71) in 2018. In cohorts, BMI and SBP associations were of similar magnitude in 1958 and 1970 cohorts and weaker in the 1946 cohort. Quantile regression analyses suggested that associations between BMI and SBP were present both below and above the hypertension threshold. ConclusionThe consequences of BMI may differ across time and by age --associations between BMI and SBP appear to have weakened in recent decades, particularly in older ages. Thus, at older ages, this weakening strength of association may partly offset the public health impacts of increases in obesity prevalence. However, BMI remains positively associated with SBP in all adult age groups, highlighting the potential adverse consequences of the ongoing obesity epidemic.

BackgroundThe circadian rhythm of blood pressure is a fundamental aspect of cardiovascular physiology in healthy individuals. Beyond nocturnal hypertension, a blunted or impaired BP circadian variation is linked to heightened target organ damage and elevated cardiovascular disease risk. This includes alterations in cardiac structure and function, atherosclerotic cardiovascular disease, dementia and heart failure. MethodsA retrospective cohort study involving 1600 participants enrolled between 2021 and 2023 identified 847 as dippers and 753 as non-dippers based on 24-hour ambulatory blood pressure monitoring. Echocardiographic evaluations were performed to assess cardiac structure and function. ResultsNon-dipping individuals displayed more signs of adverse cardiac remodeling, including a higher rate of eccentric hypertrophy (1.73 vs. 0.47%), increased left ventricular mass index in both men (75.82 vs. 70.10 g/m2) and women (65.44 vs. 63.92 g/m2), left ventricular internal diameter in diastole (4.38 vs. 4.23 cm), and left ventricular posterior wall thickness (0.82 vs. 0.81 cm). Additionally, non-dipping participants exhibited impaired ventricular relaxation, with higher E/e ratios medially (9.45 vs. 8.86) and laterally (7.61 vs. 7.23) and rates of type 1 diastolic dysfunction (9.31 vs. 4.49%). These differences persisted when analysing only participants with hypertension. ConclusionsOur study highlights the substantial impact of non-dipping blood pressure patterns on cardiac structure and function. It suggests that non-dipping blood pressure patterns may serve as an independent predictor of adverse cardiac remodelling, irrespective of hypertension diagnosis. These results underscore the necessity of devising monitoring strategies and implementing targeted interventions to address the cardiovascular risks associated with non-dipping BP profile. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/24307846v1_ufig1.gif" ALT="Figure 1"> View larger version (43K): org.highwire.dtl.DTLVardef@eb1c13org.highwire.dtl.DTLVardef@1806063org.highwire.dtl.DTLVardef@138273aorg.highwire.dtl.DTLVardef@19789e1_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundSalt sensitivity of blood pressure (SSBP) amplifies cardiovascular risk in hypertension. Although we previously found that SSBP was more prevalent in people with HIV (PWH) compared to the HIV-uninfected, yet its determinants in PWH remain understudied in sub-Saharan Africa. In this study, we hypothesized that chronic inflammation and cardiometabolic disturbances would be uniquely associated with SSBP in Zambian adults with and without HIV. MethodsWe performed a cross-sectional SSBP assessment in 366 adults (269 PWH, 97 without HIV [PWTH]). We also performed echocardiography, carotid ultrasonography, flow-mediated dilation, lipid profiles, renal function, inflammatory markers, taste perception, and 24-hour dietary recalls. SSBP was defined as a [&ge;]10mmHg mean arterial pressure increase between high-salt and low-salt intervention. Multivariate logistic regression models were used to identify independent correlates of SSBP in the overall population (adjusted for age, sex, and HIV status) and separately in PWH and PWTH (adjusted for age and sex). ResultsIn the overall population multivariate analysis, hypertension (AOR=12.28), IPROS (AOR=5.70), peripheral artery disease (AOR=2.63), left ventricular hypertrophy (AOR=2.31), and higher cardiovascular risk scores were independently associated with SSBP. PWH were older (49 {+/-} 12 vs. 44 {+/-} 17 years, p= 0.015) and exhibited lower BMI (25.04 vs. 26.44 kg/m{superscript 2}, p=0.045) and waist circumference (83.79 vs. 87.76 cm, p= 0.037) than PWTH. PWH demonstrated elevated salt-taste recognition thresholds (0.467 vs. 0.233 g/0.5L, p= 0.0014) and dysregulated metabolic/inflammatory profiles, including higher triglycerides, d-dimer, high-sensitivity C-reactive protein (hs-CRP), IL-6, and hormonal profile including renin, aldosterone, angiotensin II, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (p< 0.05). Hypertension strongly predicted SSBP in both groups in univariate (PWH: OR = 13.08, 95% CI 6.62-25.81; PWTH: OR = 28.33, 95% CI 7.69-104.35, p<0.001) and multivariate analysis (PWH: AOR = 10.27, 95% CI 5.02-21.00; PWTH: AOR = 24.68, 95% CI 5.45-111.73, P<0.0001). In multivariate analysis, an immediate pressor response to oral salt (IPROS) was independently associated with SSBP in PWH (AOR = 19.90, 95% CI 6.61-59.91) and PWTH (AOR = 18.49, 95% CI 2.14-159.28). In a comprehensive multivariate model, larger waist circumference was associated with reduced odds of SSBP (AOR=0.94 per cm, p=0.016), while greater left ventricular posterior wall thickness was associated with increased odds (AOR=21.44, p=0.027) among PWH. Left ventricular mass index, atherosclerotic cardiovascular disease (ASCVD) risk and plasma creatinine were additional correlates in PWH (p< 0.01) but not in PWTH. In PWTH, atrial natriuretic peptide (AOR=1.00, 95% CI 1.00-1.00, p=0.021) and peripheral artery disease (AOR= 5.39, 95% CI 1.20-24.06, p=0.027) were the only unique factors associated with SSBP compared to PWH. ConclusionSSBP in this Zambian cohort is associated with a complex interplay of traditional and HIV-specific factors. The strong independent association of IPROS with SSBP across all analyses supports its potential utility as a clinical screening tool. The distinct correlates in PWH, particularly the prominent role of cardiac structural changes and the unexpected association with marital status, highlight the need for HIV-specific approaches to salt sensitivity assessment and management.

ObjectivesHispanic/Latino adults have a high prevalence of uncontrolled hypertension predisposing them to CVD. We hypothesize that sleep apnea severity is associated with uncontrolled blood pressure (BP) and resistant hypertension in Hispanic/Latino adults. MethodsThis was a cross-sectional study of 2,849 Hispanic Community Health Study/Study of Latinos participants with hypertension (i.e., systolic BP [&ge;]130 mm Hg, or diastolic BP [&ge;]80 mm Hg or self-reported antihypertensive medication use) who were taking at least one class of antihypertensive medication. Participants were categorized as having controlled (BP < 130/80 mmHg among those on hypertension treatment), uncontrolled (BP [&ge;] 130/80 mmHg using one or two classes of antihypertensive medications), or resistant hypertension (BP [&ge;] 130/80 mmHg while on [&ge;] 3 classes of antihypertensive medications or the use of [&ge;] 4 classes of antihypertensive medications regardless of BP control). Sleep apnea was classified based on the respiratory event index (REI; events/h) as mild (REI [&ge;] 5 and < 15), moderate-to-severe (REI [&ge;] 15), or no sleep apnea (REI < 5). ResultsIn multinomial logistic regression, moderate-to-severe sleep apnea (vs. no sleep apnea) was associated with higher odds of resistant hypertension (Odds Ratio [OR], 2.15; 95% CI, 1.36-3.39 at 4% desaturation and OR 1.68; 95% CI, 1.05-2.67 at 3% desaturation). Neither mild nor moderate-to-severe sleep apnea was associated with uncontrolled hypertension. ConclusionAmong diverse Hispanic/Latino persons, moderate-to-severe but not mild sleep apnea was associated with resistant hypertension. Identification and management of sleep apnea in this population may improve BP control and subsequently prevent adverse cardiovascular outcomes.

Background and purpose: Excessive sitting and genetic liability to obesity are associated with risk of obesity and hypertension, two significant risk factors for cardiovascular disease. This study aimed to investigate the interactive effects of genetic liability to obesity and excessive sitting on prevalence of hypertension. Methods: Obesity genetic liability was estimated in unrelated individuals of European ancestry (n=208,594) using previously identified genetic variants and their effect sizes for adiposity related traits. Hypertension was defined as systolic blood pressure ? 140 mmHg, diastolic blood pressure ? 90 mmHg, or the use of anti-hypertensive medications. Logistic regression was used to examine the association between obesity genetic liability and across different levels of self-reported sitting time. Results: excessive sitting and increased genetic liability were independently associated with higher odds of hypertension. The greatest odds of hypertension was observed in participants with high sitting time combined with increased genetic liability to obesity (OR=1.29; 95% CI = 1.25, 1.33, P <2 x10-16) compared to individuals with low genetic liability and low sitting time. Interaction analysis identified that in individuals with excessive sitting, the effect of genetic liability of waist circumference on hypertension was greater compared to individuals with low sitting time (P interaction=0.03). Conclusion: Combined excessive sitting and high genetic susceptibility to obesity is associated with greatest odds of hypertension. These findings highlight the importance of lifestyle in offsetting risk imposed by genetic factors.

BackgroundGuidelines recommend restrictive antihypertensive treatment (AHT) in hypertensive frail older adults, as intensive AHT is assumed to cause cerebral hypoperfusion and orthostatic hypotension (OH). However, studies directly examining these assumptions in older, frail individuals are lacking. MethodsFourteen frail hypertensive patients (six females; age 80.3{+/-}5.2 years; Clinical Frailty Scale 4-7; unattended SBP [&ge;]150 mmHg) underwent measurements before and after a median of 7-weeks AHT (SBP target [&le;]140 mmHg). Transcranial Doppler measurements of middle cerebral artery velocity (MCAv), reflecting changes in cerebral blood flow (CBF), were combined with finger plethysmography recording of continuous BP. Transfer function analysis assessed cerebral autoregulation (CA). ANCOVA analyzed AHT-induced changes in CBF and CA, and evaluated non-inferiority of the relative change in CBF (margin: -10%; covariates: pre-AHT values and AHT-induced relative mean BP change). McNemar-tests analyzed whether the prevalence of (initial) OH, assessed by sit/supine-to-stand challenges, increased with AHT. ResultsUnattended mean arterial pressure decreased by 15 mmHg following AHT. Ten (71%) participants had good quality TCD assessments. Non-inferiority was confirmed for the relative change in MCAv (95%CI -2.7, 30.4). CA was normal and remained unchanged following AHT (P>0.05). None of the 14 participants had an increase in the prevalence of OH or initial OH (P[&ge;]0.655). ConclusionsWe found that AHT in frail, older patients does not reduce CBF, is not associated with impaired CA, and does not increase (initial) OH prevalence. These observations may open doors for more intensive AHT targets upon individualized evaluation and monitoring of hypertensive frail patients. Clinical Trial RegistrationClinicalTrials.gov (NCT05529147) and EudraCT (2022-001283-10).

BackgroundBlood pressure (BP) is routinely measured during healthcare visits. A standardized measurement is essential to ensure accurate values, particularly in outpatient settings, where patient preparation, environment, and technique can significantly influence results. MethodsA quasi-experimental study was conducted in adult outpatients. Demographic, anthropometric, and clinical data were collected through interviews and physical examination. BP was measured using a validated automated oscillometric device under four non-randomized predefined sequences. The standardized method followed international guideline recommendations, whereas the other three incorporated common errors observed in clinical practice (unsupported body position on the examination table, patient speaking, or legs crossed). Systolic and diastolic BP values were compared using the Friedman test and paired Wilcoxon tests with Holm adjustment. Effect sizes were expressed as median paired differences with interquartile ranges. Analyses were performed using R and Stata. ResultsA total of 295 participants were included (61% women; median age 56 years), with hypertension as the most frequent comorbidity (33%). Significant differences were observed across the four measurement models (p < 0.001). Compared with the standardized method, systolic BP was higher by +8 mmHg (M2), +2.5 mmHg (M3), and +4 mmHg (M4), while diastolic BP increased by +7 mmHg, +2 mmHg, and +2 mmHg, respectively. Clinically relevant differences (|{Delta}| [&ge;] 5 mmHg) occurred in up to 81% of systolic and 79% of diastolic measurements with M2. ConclusionsNon-adherence to guideline-recommended BP measurement protocols leads to BP overestimation and misclassification of hypertension status, which may affect therapeutic decision-making and the use of pharmacological treatments.

Genetic predisposition is a risk factor for office hypertension. We tested whether genetic background could identify individuals with ambulatory daytime hypertension in a sample of white Europeans from Liechtenstein. We evaluated two measures of predisposition to hypertension: family history and polygenic risk scores (PRS). Our analytic sample contained 1444 participants aged 25 to 41. Of the participants, 12% had office hypertension, while 37% had out-of-office hypertension. The correlation between blood pressure PRS and family history of hypertension was low (R2 = 4.96x10-3), but both were strongly associated with ambulatory blood pressure (2.2 mmHg per 1 SD increase [95% CI: 1.6, 2.7] & 2.4 mmHg increase with positive family history [95% CI: 1.3, 3.4], respectively). The PRS provides incremental improvement in predicting ambulatory systolic blood pressure beyond a validated blood pressure prediction score ({Delta}AIC = - 33), whereas family history does not ({Delta}AIC = 1). However, the difference in performance between a baseline prediction algorithm for identifying ambulatory systolic daytime hypertension (positive likelihood ratio of 6.87 [95% CI: 5.56, 8.49]; negative likelihood ratio of 0.45 [95% CI: 0.39, 0.51]) and the same model with PRS integrated (positive likelihood ratio of 7.69 [95% CI: 6.18, 9.57]; negative likelihood ratio of 0.43 [95% CI: 0.37, 0.49]) was modest. In conclusion, in a white European sample from Liechtenstein, PRS and family history are distinct constructs that are associated with increased clinical and ambulatory blood pressure. Unlike family history, polygenic risk scores provide incremental information in the identification of individuals with ambulatory hypertension. However, these gains are modest and warrant further development to improve predictive utility at the point-of-care.