Journal of Hypertension

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 [≥]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.

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.

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.

1. Background: With the rising prevalence of hypertension, especially among younger populations, there is a critical need to better assess health status and predict associated complications. This study developed a biological age model ("hypertension age") for hypertensive patients to predict the risk and timing of major complications. 2. Methods: Using South Korea's NHIS-NHID data, researchers analyzed 4,535,041 hypertensive patients who underwent health examinations between 2009 and 2010. Patients were followed for an average of 12.40 years (until 2022). Principal Component Analysis (PCA) was used to develop the biological age (cBA) model. The risk and onset timing of complications were analyzed using Cox proportional hazards and multiple regression models, adjusting for variables like medication use and baseline diseases. 3. Results: A 1-standard deviation (SD) increase in the age gap?where biological age exceeds chronological age (cBA - CA)?was significantly associated with an elevated risk for all major complications in both sexes (p < 0.001). Furthermore, a 1-SD increase in this gap significantly accelerated the time to complication onset for nearly all conditions (p < 0.001), with the exception of dementia in women. The impacts of medication use, hypertension duration, and baseline comorbidities varied by specific complication. 4. Conclusions: Lowering "hypertension age" relative to chronological age can significantly reduce the risk and delay the onset of major cardiovascular and related complications. Quantifying this biological age gap serves as a powerful motivational tool for personalized health management and complication prevention in hypertensive patients.

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 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.

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.

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

Hypertension is commonly defined as a binary condition despite substantial heterogeneity in diagnosis, treatment, and blood pressure (BP) control. We propose a three-axis state model integrating diagnosis status, treatment intensity, and BP control to better characterize hypertension phenotypes. The framework generates 27 possible states that can be condensed into seven clinically meaningful groups. We applied the model to 5,129,584 Japanese adults using the National Database of Health Insurance Claims and Specific Health Checkups. Hierarchical cluster analysis, sensitivity analysis excluding patients with cardiovascular diseases other than hypertension, and validation against antihypertensive medication use were performed. Overall, 64% of participants were classified as normotensive, whereas 36% belonged to hypertension-related groups, including 11% with unrecognized hypertension and 7% with diagnosed but untreated hypertension. Agreement with data-driven hierarchical cluster analysis was substantial (weighted {kappa}=0.87). The group distribution remained largely unchanged in the sensitivity analysis, supporting the robustness of the proposed classification. Hypertension diagnosis also showed high validity, with a sensitivity of 96.5%, specificity of 91.8%, and substantial agreement with antihypertensive medication use ({kappa}=0.78). This three-axis framework provides a robust and clinically interpretable approach for characterizing hypertension phenotypes, enabling systematic identification of care gaps and supporting research, clinical decision-making, and population health 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.

Abstract Background:Patients with hypertension commonly exhibit reduced exercise capacity. Impedance cardiography (ICG) enables continuous, non-invasive assessment of exercise-derived hemodynamic parameters; however, the relative associations of different ICG-derived parameters with exercise capacity remain unclear. Methods:In this retrospective cross-sectional study, 211 patients with hypertension who completed both ICG assessment and the six-minute walk test (6MWT) were enrolled. Exercise-derived hemodynamic parameters, including maximum heart rate (HRmax), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR), were continuously measured using the PhysioFlow(R) system. Univariable and multivariable linear regression analyses were performed to evaluate the associations between ICG-derived parameters and six-minute walk distance (6MWD). HRmax tertile and subgroup analyses were subsequently conducted. Results:In the final multivariable model, age ({beta} = -2.76, 95% CI, -3.85 to -1.67, P < 0.001), male sex ({beta} = 33.50, 95% CI, 8.40-58.60; P = 0.009), and HRmax ({beta} = 1.26, 95% CI, 0.69-1.83; P < 0.001) were independently associated with 6MWD. 6MWD increased progressively across HRmax tertiles (P for trend < 0.001). The positive association between HRmax and 6MWD remained consistent across all prespecified and exploratory subgroups. Conclusions:Among multiple exercise-derived ICG hemodynamic parameters, HRmax demonstrated the strongest and most consistent independent association with exercise capacity in patients with hypertension. These findings suggest that HRmax may represent the most informative dynamic hemodynamic parameter during exercise and that combining ICG with the 6MWT may provide a simple and accessible complementary approach for evaluating exercise capacity.

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).

BackgroundYoung adult hypertension increases risk of future cardiovascular disease (CVD) but is often overlooked. We aimed to identify opportunities to reduce blood pressure (BP) among younger adults by determining the drivers of hypertension detection, treatment and control in young adults in Australia. MethodsCross-sectional analysis of adults aged 18-39 years using nationally representative 2017-18 Australian National Health Survey data. Descriptive analyses were performed to determine hypertension prevalence, detection, treatment and control by sex, health services interaction, geographical location and socioeconomic status, with subgroup analyses among those with co-existing cardiometabolic risk factors. Hypertension was defined as self-reported diagnosis, treatment, and/or measured BP[&ge;]140/90mmHg. Detection was defined as self-reported hypertension, treatment as taking [&ge;]1 antihypertensive class, and control as BP<140/90mmHg. ResultsThe survey sample (n=5,217) was representative of N=7,533,625 adults aged 18-39 years (49.9% women). Hypertension prevalence was 11.2% (95% CI: 11.1% to 11.2%). Among those with hypertension, detection was 13.5%, treatment was 6.5% and control was 4.3%. These rates were influenced by factors related to healthcare access, for example, young adults who had a recent BP check and resided in major cities had higher rates than their counterparts. ConclusionsOne in ten young Australians adult have hypertension, yet only 13.5% are detected. Differences in detection, treatment and control rates were partly explained by factors related to healthcare access. There is a need to better detect and manage high BP in young adults, potentially by developing tailored approaches that are specific to different contexts and ultimately supporting prevention of CVD in later life.

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.

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.

Ambulatory Blood Pressure Monitoring (ABPM) provides valuable insights into a patients 24-hour blood pressure (BP) patterns, offering an enhanced assessment of cardiovascular health, particularly in relation to body mass index (BMI), diabetes, and menopausal status. This method provides a more comprehensive understanding of BP dynamics compared to traditional office-based measurements, assisting healthcare professionals with devising a more accurate assessment of a patients cardiovascular risk. ABPM is increasingly growing in adoption as a service in medical practices and pharmacies due to the numerous advantages. This retrospective cohort study analyzes 24-hour ABPM data from 5618 participants to investigate the relationship between nocturnal BP fluctuations found through ABPM with BMI, diabetes, hypertension in both male and female participants. It also investigates the relationship between nocturnal BP fluctuations and menopausal status in female participants. These conditions are studied to ultimately assess whether BP fluctuations are potentially connected to an increased risk of developing chronic conditions such as cardiovascular dysfunction. The ABPM nocturnal blood-pressure fluctuations are categorized within four distinct categories: normal dipping, non-dipping, reverse dipping, and extra dipping. The findings of this study show that 44.11% of participants exhibit hypertension, with most of these participants experiencing abnormal nocturnal blood pressure patterns. Increased BMI, particularly in overweight and moderately obese categories, was significantly associated with non-dipping patterns. In addition, the relationship between menopausal status for female participants and nocturnal dipping patterns, early morning hypertension and diabetes diagnoses are assessed. These findings underscore the importance of ABPM in detecting abnormal BP patterns and their associations with key health indicators, advocating for its broader integration in clinical settings.