BACKGROUND: The prevalence of untreated, uncontrolled and resistant hypertension and their specific prognosis among American adults with prediabetes remain unclear. We aimed to explore the prevalence of hypertension trea...BACKGROUND: The prevalence of untreated, uncontrolled and resistant hypertension and their specific prognosis among American adults with prediabetes remain unclear. We aimed to explore the prevalence of hypertension treatment and control and their associated risks of all-cause and cardiovascular disease (CVD) mortality among this population. METHODS: We analyzed data from 12,321 participants in the NHANES survey (1999-2016). Prediabetes was defined as fasting plasma glucose 5.6-7.0 mmol/L, hemoglobin A1c 5.7%-6.4%, 2-hour glucose 7.8-11.1 mmol/L, or self-reported diagnosis. Hypertension was defined as blood pressure ≥140/90 mmHg, a self-reported history of hypertension, or current antihypertensive medication use, and categorized into untreated, controlled, uncontrolled, and resistant hypertension. Cox regression assessed associations between hypertension categories and CVD and all-cause mortality. RESULTS: The study included 12,321 adults with prediabetes, representing an estimated 53.3 million individuals. Age- and sex-standardized hypertension prevalence was 43%. Among those with hypertension, 62% were receiving treatment. Among treated individuals, 66% had controlled hypertension, 26.5% had uncontrolled hypertension, and 7.5% had resistant hypertension. Mortality risk increased progressively from non-hypertensive to untreated, controlled, uncontrolled, and resistant hypertension stages. Compared to non-hypertensive individuals, hazard ratios (HRs) for CVD mortality were 1.17 (95% CI: 0.80-1.71), 1.52 (1.04-2.21), 2.03 (1.35-3.05), and 1.83 (1.07-3.13), respectively (P trend <0.001). For all-cause mortality, HRs were 1.01 (0.86-1.20), 1.05 (0.87-1.26), 1.16 (0.95-1.41), and 1.42 (1.09-1.85), respectively (P trend = 0.022). CONCLUSIONS: Hypertension was highly prevalent among American adults with prediabetes, and mortality risk increased with advancing hypertension stages.
INTRODUCTION/BACKGROUND: Resistant hypertension (rHTN) is defined as uncontrolled blood pressure despite ≥3 antihypertensives, including a diuretic. While fourth-line intensification is recommended, comparative evidence...INTRODUCTION/BACKGROUND: Resistant hypertension (rHTN) is defined as uncontrolled blood pressure despite ≥3 antihypertensives, including a diuretic. While fourth-line intensification is recommended, comparative evidence remains scattered. RESEARCH QUESTIONS/HYPOTHESIS: This meta-analysis evaluates the efficacy and safety of fourth-line antihypertensives in reducing clinic systolic blood pressure (SBP) in rHTN. METHODS/APPROACH: A literature search across PubMed, Embase, Scopus, and Web of Science (2015-2026) identified eligible randomized controlled trials (RCTs) of ≥4 weeks duration. Risk of bias was assessed using Cochrane RoB 2. An initially planned network meta-analysis was deemed unreliable due to statistical inconsistencies and transitivity violations across the evidence base. Consequently, data were analyzed via pairwise meta-analysis using R software (version 4.5.1) to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI). RESULTS/DATA: Eleven RCTs involving 3,931 adults with rHTN were included. Pairwise comparisons against placebo showed that aldosterone targeted therapies produced the largest reductions in SBP, with lorundrostat (MD -11.70 mmHg [95% CI -16.07, -7.33]) and baxdrostat 2 mg (MD -10.10 [-12.63, -7.58]) showing comparable effects, while baxdrostat 1 mg (MD -8.56 [-11.08 to -6.04]) demonstrated reductions similar in magnitude to spironolactone (MD -7.95 [-10.10, -5.80]). β-blockers, including bisoprolol (MD = -6.71 mm Hg), also demonstrated modest SBP reductions, while aprocitentan 12.5 mg reduced SBP by -3.80 mmHg [-6.65, -0.95]. No intervention significantly increased serious adverse events versus placebo. Significant increases in any adverse events were observed with aprocitentan 25 mg (RR 1.89 [1.39, 2.57]) and doxazosin (RR 1.55 [1.09, 2.20]). CONCLUSIONS: Fourth-line agents targeting the aldosterone pathway, including aldosterone synthase inhibitors and spironolactone, provide clinically significant SBP reductions in rHTN without increasing serious adverse event risk. Due to transitivity violations across trials, indirect comparative rankings remain invalid. Future trials are required to establish efficacy and assess outcomes.
BACKGROUND: Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor associated with inflammation, endothelial dysfunction, oxidative stress, and arterial stiffness. Although elevated Lp(a) levels are linked t...BACKGROUND: Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor associated with inflammation, endothelial dysfunction, oxidative stress, and arterial stiffness. Although elevated Lp(a) levels are linked to cardiovascular disease, their association with left ventricular (LV) geometric remodelling in hypertension remains incompletely understood. This study aimed to evaluate the relationship between serum Lp(a) levels and LV geometry in non-diabetic patients with essential hypertension. METHODS: This cross-sectional observational study included 110 non-diabetic patients with essential hypertension. Patients were classified into low Lp(a) (<50 mg/dL, n=70) and elevated Lp(a) (≥50 mg/dL, n=40) groups. Comprehensive transthoracic echocardiography was performed to assess LV mass index (LVMI), relative wall thickness, and LV geometric patterns. Correlation and multivariate regression analyses were used to determine the independent association between Lp(a) levels and LV remodelling parameters. RESULTS: Patients with elevated Lp(a) levels had significantly higher LVMI compared with those with lower levels (139.6±28.5 vs. 117.6±24.2 g/m², p<0.001). Concentric LV hypertrophy was more prevalent in the elevated Lp(a) group (55.0% vs. 20.0%, p=0.001). Serum Lp(a) levels were positively correlated with LVMI (r=0.357, p<0.001) and remained independently associated with LVMI after adjustment for clinical confounders (β=0.363, p<0.001). Elevated Lp(a) levels were also independently associated with increased odds of concentric LV hypertrophy. CONCLUSIONS: Elevated serum Lp(a) levels are independently associated with adverse LV geometric remodelling and concentric hypertrophy in non-diabetic patients with essential hypertension. Measurement of Lp(a) may provide additional information for cardiovascular risk stratification and early identification of hypertensive patients at risk for target organ damage.
BACKGROUND: The global demographic shift has highlighted the co-occurrence of hypertension (HTN) and physical frailty, both of which severely impact the health outcomes and quality of life of middle-aged and older adults...BACKGROUND: The global demographic shift has highlighted the co-occurrence of hypertension (HTN) and physical frailty, both of which severely impact the health outcomes and quality of life of middle-aged and older adults. This relationship remains underexplored in India's rapidly ageing population. METHODS: We conducted a cross-sectional analysis using data from the Longitudinal Ageing Study in India (Wave 1), comprising a nationally representative sample of 66,606 participants. Physical frailty was assessed using a modified Fried phenotype. Multivariable logistic regression and the Karlson-Holm-Breen method were utilised to evaluate associations and quantify the mediating effect of additional comorbidities. RESULTS: The weighted prevalence of physical frailty among participants with HTN was 19.26% (95% CI: 18.43, 20.11). Multivariable analysis revealed that advanced age, lack of education, non-working status, underweight BMI, and presence of additional comorbidities were significantly associated with higher odds of frailty in HTN patients. Mediation analysis showed that additional comorbidities accounted for 21.31% of the total effect of HTN on frailty for all HTN cases, and 38.36% for previously diagnosed cases. CONCLUSION: Treating HTN in isolation might be insufficient for addressing functional decline. Healthcare policies and clinical practices must adopt comprehensive geriatric assessments that target patients' entire comorbid profiles, while prioritising interventions that address the modifiable risk factors.
BACKGROUND: Validation of the accuracy of the Omron HEM-790XT1 automatic oscillometric upper-arm blood pressure (BP) monitor in the general adults according to the international AAMI/ESH/ISO (ISO 81060-2:2018 + AMD1:2020...BACKGROUND: Validation of the accuracy of the Omron HEM-790XT1 automatic oscillometric upper-arm blood pressure (BP) monitor in the general adults according to the international AAMI/ESH/ISO (ISO 81060-2:2018 + AMD1:2020) standard. METHODS: Eligible adult participants meeting the protocol-specific criteria for age, gender, BP range and arm circumference distribution were recruited. The BP was measured by two trained observers using the same-arm sequential method. The test device measured BP during the inflation phase and was compared with readings from a standard mercury sphygmomanometer. The test device was used with its standard cuff, validated for an arm circumference range of 22-32 cm. RESULTS: A total of 85 participants were included in the final analysis after excluding 2 participants. The average age was 35 ± 13.7 years, with males accounting for 35.29% and females for 64.71%. According to Criterion 1 (all individual paired readings), the mean difference ± standard deviation (SD) between the test and reference device was -1.09 ± 4.94 mmHg for systolic blood pressure (SBP) and -2.49 ± 4.97 mmHg for diastolic blood pressure (DBP), meeting the requirement of ≤5 ± 8 mmHg. According to Criterion 2 (average per participant), the mean difference ± SD between the test and reference device was -1.09 ± 3.81 mmHg for SBP and -2.49 ± 4.12 mmHg for DBP. Both the SDs for SBP and DBP were below the derived thresholds of 6.86 and 6.47 mmHg, respectively. The Omron HEM-790XT1 automatic oscillometric BP monitor demonstrated satisfactory consistency with the mercury sphygmomanometer in both SBP and DBP measurements. CONCLUSIONS: The Omron HEM-790XT1 automatic oscillometric upper-arm BP monitor satisfied all validation criteria of the AAMI/ESH/ISO (ISO 81060-2:2018 + AMD1:2020) standard and can be recommended for accurate BP measurement in adults within the validated arm circumference range.
To investigate the differences in management practices for hospitalised hypertensive patients between cardiovascular specialists and non-specialists, identify key determinants affecting the quality of blood pressure (BP)...To investigate the differences in management practices for hospitalised hypertensive patients between cardiovascular specialists and non-specialists, identify key determinants affecting the quality of blood pressure (BP) control, and offer evidence-based recommendations to support the standardisation of hypertension management protocols. A retrospective analysis was conducted on the medical records of 500 inpatients with essential hypertension at Zhejiang Provincial People's Hospital in January 2022. BP control rates, drug adjustments and monitoring practices were compared between specialist and non-specialist treatment groups. Statistical analyses were performed using SPSS version 25.0, with variance analysis for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression was used to identify independent predictors of BP control at discharge. At admission, the overall BP control rate was 36.2%, with no significant difference between the non-specialist and specialist groups (37.5% . 34.0%, > 0.05). At discharge, the specialist group demonstrated a significantly higher BP control rate than the non-specialist group (72.9% . 63.0%, < 0.05). The specialist group also showed significantly higher rates of drug adjustment (72.9% 20.2%), combination therapy (84.0% . 49.8%), and completeness of discharge instructions (90.4% 28.5%) compared to the non-specialist group (all < 0.01). In multivariable logistic regression, specialist care remained independently associated with achieving target BP (aOR = 1.755, 95% CI: 1.129-2.728, = 0.012), while diabetes, stroke/transient ischaemic attack (TIA), chronic kidney disease (CKD) and higher hypertension grade were identified as independent risk factors for poor BP control. Cardiovascular specialists achieved significantly better BP control through more frequent drug adjustments and optimised combination therapy regimens. Non-specialists exhibited deficiencies in monitoring, medication regimen optimisation and follow-up management. It is recommended to enhance standardised training for non-specialists in hypertension management to improve overall hypertension prevention and control.
BACKGROUND: Hypertension remains a leading modifiable cardiovascular risk factor, yet blood pressure (BP) control in France and across Europe remains suboptimal. Although poor patient adherence is frequently cited, physi...BACKGROUND: Hypertension remains a leading modifiable cardiovascular risk factor, yet blood pressure (BP) control in France and across Europe remains suboptimal. Although poor patient adherence is frequently cited, physician-related factors, particularly therapeutic inertia, may also contribute substantially. In this national survey, we assessed whether French general practitioners (GPs) have updated their perceptions of BP targets and treatment thresholds in the context of evolving European recommendations. METHODS: Between May 2023 and December 2024, a structured questionnaire was administered by telephone to a representative sample of 503 French GPs. The findings were compared with those of a similar survey conducted in 2010 (SHARE study) in order to evaluate temporal changes in physicians' perceptions and clinical attitudes toward hypertension management. RESULTS: Most respondents perceived current BP targets as overly stringent and estimated that most of their patients were adequately controlled. The reported BP thresholds for satisfaction (136/85 mmHg), concern (148/93 mmHg), and therapeutic intervention (166/101 mmHg) were strikingly similar to those observed in 2010, suggesting limited evolution in clinical perceptions despite increasingly stringent guideline recommendations. Younger physicians more frequently prioritized home BP monitoring and adopted lower treatment thresholds, whereas older GPs more commonly preferred office-based measurements and tolerated higher BP levels. CONCLUSIONS: The limited evolution in GPs' perceptions over time suggests persistent therapeutic inertia in hypertension management. Targeted strategies to improve adherence to guideline-recommended BP control in this setting appear warranted.
INTRODUCTION: In adrenal venous sampling (AVS) for patients with primary aldosteronism (PA), apparent bilateral aldosterone suppression (ABAS) is occasionally experienced, but the underlying causes remain poorly understo...INTRODUCTION: In adrenal venous sampling (AVS) for patients with primary aldosteronism (PA), apparent bilateral aldosterone suppression (ABAS) is occasionally experienced, but the underlying causes remain poorly understood. CASE PRESENTATION: A 40-year-old Chinese man with a right adrenal adenoma presented with hypertension and refractory hypokalaemia. Initial AVS revealed no evidence of unilateral aldosterone excess and demonstrated ABAS. Six months later, repeat AVS was performed, during which two distinct venographic patterns-a 'triangular pattern' and a 'delta pattern'-were observed in the right adrenal vein depending on catheter position. Samples obtained from the main adrenal vein trunk suggested a right-sided source of aldosterone hypersecretion. The patient subsequently underwent right adrenalectomy and achieved both clinical and biochemical remission. Immunohistochemical staining for CYP11B2 confirmed an aldosterone-producing adenoma in the resected nodule. CONCLUSION: This case highlights a potential pitfall of superselective AVS and demonstrates that different venographic patterns of the right adrenal vein may result from varying catheter positions, which can critically influence diagnostic interpretation.
PURPOSE: This study aims to explore the association between the angiotensin II type 1 receptor (AT1R) A1166C gene polymorphism and susceptibility to essential hypertension (EH) within the Chinese population. MATERIALS AN...PURPOSE: This study aims to explore the association between the angiotensin II type 1 receptor (AT1R) A1166C gene polymorphism and susceptibility to essential hypertension (EH) within the Chinese population. MATERIALS AND METHODS: Relevant literature published domestically and internationally was systematically retrieved from database inception to 31 December 2024. A total of 17 eligible studies involving 9,213 patients with EH and 4,494 healthy controls were included. Meta-analysis, subgroup analysis (by ethnicity and region), sensitivity analysis and publication bias assessment were performed. RESULTS: Meta-analysis showed that the / genotype (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.07-1.69, = 0.01) and allele (OR = 1.44, 95% CI: 1.14-1.82, = 0.002) were modestly associated with an increased EH risk. Subgroup analysis revealed significant associations in the Han (/: OR = 1.56; allele: OR = 1.58) and Yi (/: OR = 1.80; allele: OR = 1.84) populations, as well as a significant association between the allele and EH in northern/northwestern regions (OR = 1.37, = 0.04). However, these subgroup findings should be interpreted cautiously. Funnel plots indicated low publication bias. CONCLUSION: The AT1R A1166C polymorphism may modestly contribute to EH susceptibility in the Chinese population, with ethnic and regional factors partly influencing this association. Large-scale prospective studies with more balanced subgroup representations and standardised blood pressure assessment methods are needed to validate these findings.
BACKGROUND: In individuals with type 2 diabetes and hypertension, weight loss may reduce antihypertensive treatment needs, but effects on blood pressure variability and nocturnal dipping are unclear. We investigated chan...BACKGROUND: In individuals with type 2 diabetes and hypertension, weight loss may reduce antihypertensive treatment needs, but effects on blood pressure variability and nocturnal dipping are unclear. We investigated changes in antihypertensive treatment and ambulatory blood pressure following a weight-loss intervention in adults with overweight and type 2 diabetes. METHODS: This single-arm intervention trial included 32 participants with type 2 diabetes undergoing a dietary weight-loss intervention. Antihypertensive medications were discontinued at intervention start and reintroduced if blood pressure increased. Changes in antihypertensive treatment, ambulatory blood pressure, and office blood pressure were assessed from baseline to 12 months. RESULTS: Mean (SD) age was 61 ± 6 years and baseline weight 102 ± 16 kg. Mean weight loss at 12 months was 11.6 ± 6.0 kg. The median number of antihypertensive medications decreased from 2 to 1 ( = 0.004), and antihypertensive treatment use from 88% to 59%. Office and ambulatory blood pressure, including nocturnal dipping, remained largely unchanged. Daytime and night-time heart rate, and night-time systolic blood pressure variability decreased (all < 0.05). CONCLUSIONS: In adults with overweight and type 2 diabetes, office and ambulatory blood pressure remained stable after weight loss, despite a reduction in antihypertensive treatment.
BACKGROUND: Blood flow restriction training (BFRT) is used to enhance low-load exercise, but vascular effects remain uncertain. We compared BFRT with matched non-BFRT exercise on endothelial function, arterial stiffness,...BACKGROUND: Blood flow restriction training (BFRT) is used to enhance low-load exercise, but vascular effects remain uncertain. We compared BFRT with matched non-BFRT exercise on endothelial function, arterial stiffness, and vascular structure. METHODS: This PRISMA 2020 review was preregistered (PROSPERO CRD420251118357). PubMed, Web of Science, Cochrane Library, and Chinese National Knowledge Infrastructure were searched on October 2, 2025, with systematic snowballing. Randomized parallel-group, crossover, or within-subject controlled trials were pooled using random-effects models (three-level or conventional) to estimate Hedges' g; subgroup/meta-regression examined moderators; RoB2, PEDro, and GRADE assessed study quality. RESULTS: Thirty-five trials (n = 764) were included. Overall, BFRT showed no advantage for flow-mediated dilation (FMD; k = 30; g = -0.10) or pulse wave velocity (PWV; k = 32; g = -0.04); pooled effects were also non-significant for blood flow, AIx, CAVI, arterial diameter, and ankle-brachial index. Effects depended on protocol: resistance BFRT improved FMD (g = 0.56), whereas handgrip (g = -0.85) and some interval/aerobic BFRT reduced FMD; interventions <4 weeks decreased FMD (g = -0.69). Low-load BFRT reduced PWV versus high-load resistance training (g = -0.76). Age positively moderated FMD responses; certainty ranged from very low to moderate. CONCLUSIONS: Evidence does not support a generalized vascular benefit of BFRT. Low-load resistance BFR may be most favorable, while small-muscle and moderate-to-high-intensity protocols warrant caution. Larger trials, especially in women and clinical populations, are needed.
BACKGROUND: Left ventricular hypertrophy (LVH) is a critical complication of hypertension that correlates with increased morbimortality. Its pathophysiology is complex and multifaceted likely involving various players th...BACKGROUND: Left ventricular hypertrophy (LVH) is a critical complication of hypertension that correlates with increased morbimortality. Its pathophysiology is complex and multifaceted likely involving various players that are still to be determined, particularly those with proinflammatory and profibrotic effects. Complement C1q/tumour necrosis factor-related protein 1 (CTRP1) is an antihypotensive adipokine that has recently been linked to adverse cardiometabolic changes and may contribute to the development of LVH. OBJECTIVE: To explore the relationship between CTRP1 and LVH in patients with essential hypertension. METHODS: A total of 360 patients with mild-to-moderate essential hypertension were enrolled from Ruijin Hospital between December 2015 and November 2017. Participants were divided into two groups: those with hypertension alone ( = 183) and those with hypertension complicated by LVH ( = 177). Plasma levels of CTRP1, adiponectin, and interleukin-6 (IL-6) were measured using enzyme-linked immunosorbent assay (ELISA). The left ventricular mass index (LVMI) was calculated from echocardiographic measurements. Patients were further stratified by sex and by CTRP1 tertiles for subgroup analysis. RESULTS: Patients with hypertension and LVH showed significantly higher levels of CTRP1, IL-6, and LVMI compared to those with hypertension alone. In contrast, adiponectin levels were significantly lower in the LVH group. CTRP1 levels were positively correlated with LVMI in both males and females. Furthermore, patients in the highest CTRP1 tertile exhibited progressively elevated SBP, DBP, CRP, IL-6, and LVMI. Multivariate logistic regression analysis identified CTRP1, IL-6, and adiponectin as independent factors associated with LVH. CONCLUSION: CTRP1 is independently associated with left ventricular hypertrophy in patients with essential hypertension, demonstrating a dose-response relationship with cardiac hypertrophy and inflammatory markers.