Our study investigates the temporality of factors that modulate the risk for developing hypertension (HTN) among patients with obstructive sleep apnea (OSA) without preexisting HTN at baseline. Our cohort consisted of OSA cases (based on International Classification of Diseases, 9th/10th Revision) with 20 common comorbidities selected using a previously validated electronic health record (EHR)-based algorithm. We constructed a survival model to estimate time-to-first HTN diagnosis (among patients with OSA without preexisting HTN). Our survival model included those comorbidities along with sex, body mass index, race, and age. We also performed a validation of the date of diagnosis of OSA and HTN identified from our algorithm by utilizing chart reviews in 400 randomly chosen EHR-defined cases. Among 53,035 OSA cases diagnosed between 2012 and 2021, 31,741 cases (59.8%) were without preexisting HTN at the date of OSA diagnosis and thus met our inclusion criteria. Within our survival cohort, 15,830 OSA cases (50.1%) did not develop HTN. Cardiovascular conditions (including atrial fibrillation, coronary atherosclerosis, hypercholesterolemia, diabetes), tobacco use, anemia, osteoarthrosis, and gastroesophageal reflux disease were observed to increase risk of incident HTN. Allergic rhinitis, fatigue, joint pain, and vitamin D deficiency did not increase risk of incident HTN. Chart review demonstrated diagnoses of OSA and HTN were documented in notes a median of 38 days and 738 days, respectively, prior to being coded in the EHR. In a large EHR sample, we identified conditions that are associated with increased risk of incident HTN among patients diagnosed with OSA. These findings may help guide counseling efforts among patients newly diagnosed with OSA regarding factors that may modulate risk for developing HTN.

This cross-sectional study investigated the multi-stage and phenotype-specific association between urine-estimated salt intake and hypertension (HTN) in the Tehran Lipid and Glucose Study. Adult participants (n = 1,782, mean age of 43.0 ± 13.7 years and 46.0% were men) were recruited (2015-2017) for 24-hour urine (24hU)-estimated salt intake and blood pressure (BP) measurements. Multivariable-adjusted multinomial logistic regression was used to estimate the association between 24hU-estimated salt intake (quintile categories and per each 1 g increment over recommended level) and HTN stages (Pre-HTN, stage 1 [S1-HTN], and stage 2 [S2-HTN]) and HTN phenotypes (isolated systolic HTN [ISH], isolated diastolic HTN [IDH], and systolic-diastolic HTN [SDH]). The prevalence of Pre-HTN, S1- and S2-HTN was 5.7%, 29.3%, and 9.1%, respectively. The prevalence of ISH, IDH, and SDH was 2.5%, 27.9%, and 8.0%, respectively. 24hU-estimated salt intake > 10.9 vs. < 6.7 g/day was associated with an elevated probability of Pre-HTN and S1-HTN, IDH, and SDH by 2.50, 1.65, 1.74, and 2.03-fold, respectively. Every 1 g-increment of salt intake over 5 g/day was associated with an increased chance of having Pre-HTN, S1-HTN, and IDH by 15%, 8%, and 8%, respectively. The contribution of high salt intake to the development of HTN might be more pronounced during the initial stages of BP elevation, potentially impacting diastolic BP to a greater extent than systolic BP.

The aim of this study was to determine the association between low density lipoprotein cholesterol (LDL-C) and risks of stroke and mortality in the hypertensive patients with high risk of atherosclerotic cardiovascular disease (ASCVD). A total of 19,507 hypertensive patients with high risk of ASCVD from the Kailuan cohort study were included in the present study. Patients were categorized into 5 groups by the levels of LDL-C: < 1.40 mmol/L (55 mg/dL), 1.40-1.79 mmol/L (55-69 mg/dL), 1.80-2.59 mmol/L (70-99 mg/dL), 2.60-3.39 mmol/L (100-130 mg/dL), and ≥ 3.40 mmol/L (131 mg/dL). The primary outcomes of this study included hemorrhagic stroke (HS), ischemic stroke (IS), and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HS, IS, and all-cause mortality among hypertensive patients with high risk of ASCVD across LDL-C groups. During a median follow-up of 15.81 years, 3,055 cases of stroke (including 500 cases of HS and 2,555 cases of IS) and 5,340 cases of all-cause mortality were documented. Patients with LDL-C < 1.40 mmol/L had the highest incidences of HS and all-cause mortality among the 5 LDL-C groups. After adjusting for potential confounders, the HRs of HS, IS, and all-cause mortality were 1.34 (95% CI, 1.01-1.80), 1.08 (95% CI, 0.94-1.24), and 1.10 (95% CI, 1.01-1.21) for patients with LDL-C < 1.40 mmol/L compared with those with LDL-C 1.80-2.59 mmol/L. Similar results were generated across LDL-C groups with several sensitivity analyses. LDL-C < 1.40 mmol/L was associated with increased risk of HS and all-cause mortality in hypertensive patients with high-risk of ASCVD.

While blood viscosity is recognized as a contributing factor in cerebrovascular disease pathophysiology, the specific role of diastolic blood viscosity (DBV) in functional outcomes after acute ischemic stroke (AIS) remains unclear. This study investigates the relationship between admission DBV levels and 3-month functional outcomes in patients with AIS. We analyzed 413 AIS patients admitted within 7 days of symptom onset. We utilized a scanning capillary-tube viscometer to measure whole blood viscosity and categorized DBV into three groups based on established norms. Multivariable logistic regression was employed to assess the association between DBV levels and 3-month outcomes, as determined by the modified Rankin Scale (mRS). The cohort had a mean age of 70.0 ± 13.2 years and 59.6% were male. Patients with high DBV tended to be younger, predominantly male, with higher body mass index, and more likely to be smokers. These individuals also exhibited higher levels of hemoglobin, low-density lipoprotein, and fasting blood sugar. Despite similar stroke etiology and initial severity, high DBV was significantly associated with poor 3-month outcomes (mRS 3-6; adjusted odds ratio 2.899; 95% confidence interval, 1.119-7.514). Elevated DBV on admission is linked to worse functional outcome three months after AIS. These findings highlight the importance of incorporating DBV assessments into AIS prognosis and suggest a potential avenue for therapeutic intervention targeting blood rheology to improve cerebral microcirculation and stroke recovery.

In order to ascertain the impact of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure (BP), a systematic review and meta-analysis of randomized controlled trials were carried out. DASH is advised for lowering BP. Scopus databases were searched from the beginning of 2024. A total of 579 articles from 2019 to 2023 from PubMed: 15, Scopus: 164 and Crossref: 400. There were 8 articles included in the meta-analysis. Systolic BP (1.29 mmHg to 4.6 mmHg, 95% CI, -2.17, -0.41; P < 0.005) and diastolic BP (0.76 mmHg to 1.1 mmHg, 95% CI, -1.39, -0.13; P < 0.005) were found to be significantly reduced by the DASH diet, while total cholesterol concentrations (5.2 mmol/L; P < 0.005), low-density lipoprotein (8.2 mmol/L; P = 0.03), and high-density lipoprotein increased by 8.2% (P < 0.005) were lowered by 0.9 points. When followed consistently, the DASH diet can reduce BP's systolic and diastolic readings. PROSPERO Identifier: CRD42023494005.

Cuffless blood pressure (BP) measurement devices integrated into smartwatches have gained prominence, yet limited studies provide the feasibility and preciseness of daily BP monitoring. Here, we evaluated the trackability of daily BP variance and the precision of the calibration process. We collected the data from 896 participants, reporting 35,592 BP values, and body composition analysis data measured by the Samsung Galaxy Watch 6 device. Participants were instructed to measure BP daily, in the morning (5 AM-9 AM) and evening (6 PM-10 PM) for 2 weeks, with initial calibration and re-calibration after the first week. Body composition data, obtained using the Galaxy Watch's bioelectrical impedance analysis sensor, was measured voluntarily during the campaign without specific time constraints. With BP readings collected using smartwatches, morning and evening BP values showed a significant difference, higher in the evening by 1.42 ± 5.25 mmHg (P < 0.05). Basal metabolic rate, skeletal muscle mass, total body water, morning systolic BP, morning pulse pressure, and morning heart rate were significantly associated with higher difference in morning-evening BP. The calibration stability was assessed by the difference in average BP before and after calibration, showing a substantial pre-post calibration BP difference by 4.64 ± 4.73 mmHg of systolic BP and 3.66 ± 3.62 mmHg of diastolic BP. In conclusion, watch-based devices may not detect clinical-level BP variability, and substantial extent of pre-post calibration error has to be solved for their utility in regular real-life BP monitoring.

The combined impact of achieving target systolic blood pressure (SBP) and blood pressure variability (BPV) on long-term clinical outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the combined effect of SBP target achievement and BPV on the risk of cardiovascular events in patients undergoing PCI. Consecutive patients who underwent PCI between 2012 and 2016 were included. Patients were classified into four groups based on average follow-up SBP (< 130 or ≥ 130 mmHg) and BPV (categorized as low or high, using the median of the standard deviation of SBP during follow-up). The primary outcome was net adverse clinical events (NACE; defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) for up to 5 years. Among 2,845 patients, 787 (27.7%) experienced NACE during a median follow-up of 5.43 years. Patients with high BPV had a significantly increased risk of long-term clinical outcomes, regardless of whether the target SBP was achieved. Additionally, patients with SBP ≥ 130 mmHg and high BPV had a significantly higher risk of 5-year major adverse cardiac and cerebrovascular events (adjusted hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.067-1.688; P = 0.012) and NACE (adjusted HR, 1.262; 95% CI, 1.036-1.537; P = 0.021) than those with SBP < 130 mmHg and low BPV. The combined impact of SBP target achievement and BPV was significantly associated with the risk of long-term adverse outcomes in patients who underwent PCI. These findings underscore the importance of achieving target SBP while recognizing that patients with high BPV represent a high-risk group requiring focused monitoring and management to mitigate cardiovascular events. ClinicalTrials.gov Identifier: NCT05935397.

Poor adherence to antihypertensive medication remains a significant barrier to blood pressure control in young patients. The objective of this study was to identify factors associated with antihypertensive medication adherence among young adults with hypertension. From the Korean National Health Insurance Service database, we included 141,132 participants aged 20 to 39 years (80.4% male), without cardiovascular disease, who initiated antihypertensive medication between 2013 and 2018. Participants were categorized as exhibiting good adherence (proportion of days covered [PDC] ≥ 0.8) or poor adherence (PDC < 0.8) to antihypertensive medication during the first year of treatment. We investigated the associations of demographic, lifestyle, and clinical factors with good medication adherence based on logistic regression analysis. Only 43.3% (n = 61,107) of young adults with hypertension showed good adherence to antihypertensive medication. Male sex, older age, higher income, urban residence, non-smoking, and higher physical activity were associated with good medication adherence. Initial combination therapy, especially with single-pill combination (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), was associated with good adherence. Among patients under monotherapy, initial use of renin-angiotensin blockers (OR, 5.24; 95% CI, 4.47-6.15) or calcium-channel blockers (OR, 4.07; 95% CI, 3.47-4.78) was associated with better adherence than initial diuretics. Although antihypertensive medication adherence is generally poor among young adults, we identified potential demographic and clinical factors associated with good adherence to antihypertensive treatment. Initial use of a single-pill combination may promote adherence in young patients, and its long-term clinical outcomes warrant further investigation.

Although the association between C-reactive protein (CRP) and hypertension has been acknowledged, the associations between parental high-sensitive CRP (hs-CRP) levels and offspring hypertension remain unexplored. To investigate the relationship between parental and offspring hs-CRP levels, as well as the association between parental hs-CRP levels and offspring hypertension. We included 6,848 father-offspring and 1,588 mother-offspring pairs from the Kailuan study. Time-weighted average hs-CRP (TWA-CRP) was calculated by cumulative hs-CRP/Timestart-end. Hypertension were defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. The generalized estimating equation model was used to explored the relationship between parental TWA-CRP and offspring TWA-CRP, and the association between parental TWA-CRP and offspring hypertension. The Cox proportional hazard model was applied to examine the relationship between offspring TWA-CRP and hypertension risk. The regression coefficient and 95% confidence intervals (CIs) for offspring TWA-CRP were 0.50 (0.38-0.62) in father-offspring pairs and 0.53 (0.29-0.76) in mother-offspring pairs with high parental TWA-CRP. The odds ratios (ORs) and 95% CIs for offspring hypertension were 1.30 (1.11-1.52) in father-offspring pairs and 1.32 (0.95-1.84) in mother-offspring pairs with high parental TWA-CRP. When both parent and offspring had a high TWA-CRP, the ORs (95% CIs) for offspring hypertension were 1.92 (1.43-2.56) in father-offspring pairs and 2.44 (1.35-4.35) in mother-offspring pairs. The hazard ratios and 95% CIs for offspring hypertension were 1.43 (1.15-1.76) in father-offspring pairs and 2.48 (1.18-5.22) in mother-offspring pairs with high offspring TWA-CRP. Parental high TWA-CRP may increase the risk of offspring hypertension. Chinese Clinical Trial Registry Identifier: ChiCTR2000029767.

This report provides an overview of hypertension prevalence, management, and trends in South Korea. The analysis is based on data from Korean adults aged 20 and older, using the 1998-2022 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002-2022 National Health Insurance (NHI) Big Data. An estimated 30% of Korean adults (13 million) have hypertension, including 7.2 million men, 5.8 million women, and 5.8 million aged 65 or older. Overall awareness, treatment, and control rates were 77%, 74%, and 59%, respectively, showing a tendency to increase with advancing age. Medical utilization for hypertension has steadily increased, with 11.5 million patients accessing medical services, 10.9 million receiving antihypertensive prescriptions, and 8.1 million undergoing continuous treatment in 2022. Prescription patterns reveal monotherapy (40%), dual therapy (44%), and combination therapy with three or more drugs (16%). The most commonly prescribed antihypertensive medications include angiotensin receptor blockers (76%), calcium channel blockers (62%), diuretics (23%), and beta-blockers (15%). Among young adults aged 20-39 with hypertension, 59.2% do not utilize healthcare services, and 84.9% are non-adherent to treatment. Awareness (36%), treatment (35%), and control rates (33%) in this group are notably lower than all age groups of above 40, with treatment continuity rates at 24% for individuals in their 20s and 40% for those in their 30s. While South Korea has achieved relatively high rates of hypertension management compared to many countries, further efforts are needed to reduce hypertension prevalence and improve awareness and treatment adherence, particularly among younger adults.