Hypertension In Adults Research Articles

The association between weekend warrior physical activity pattern and albuminuria in hypertensive patients

BackgroundAlbuminuria, a critical and sensitive indicator of vascular injury, has been linked to early kidney damage in patients with hypertension. High-quality physical activity (PA) may reduce urinary albumin excretion. Yet, the connection between PA patterns and albuminuria is still not well understood.MethodsAlbuminuria was identified as urinary albumin/creatinine ratio (ACR) > 30 mg/g. PA was assessed by a series of self-report questionnaires and grouped into inactive PA, insufficient PA, weekend warriors (WWs), and regular PA. Logistic regression was conducted to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) to explore the relationship between PA pattern and albuminuria among hypertensive adults. Subgroup and sensitivity analyses were conducted to verify the robustness of the results.ResultsThis research included 12,961 hypertensive adults (mean age: 54.31 ± 0.24 years), including 6,060 (46.76%) females and 6,901 (53.24%) males. Of them, 2,239 (17.27%) were identified with albuminuria, and 10,722 (82.73%) were without albuminuria. Logistic regression showed that WWs had a 47% lower risk of albuminuria (OR = 0.53,95%CI:0.35–0.80), and regular PA had a 32% decreased risk of albuminuria (OR = 0.68,95%CI:0.56–0.82). However, there were no differences between WWs and regular PA in reducing albuminuria among hypertensive adults. Subgroup analyses showed that these inverse associations of WWs and regular PA with albuminuria were found in hypertensive adults without diabetes.ConclusionsCompared with inactive PA, both WWs and regular PA could confer the equivalent benefits on reducing albuminuria among hypertensive adults. These findings highlight the beneficial effect of PA on albuminuria and provide a proven method for those hypertensive adults with a busy lifestyle.

Higher blood pressure targets for hypertension in older adults.

Higher blood pressure targets for hypertension in older adults.

Associations between phenotypes of childhood and adolescent obesity and incident hypertension in young adulthood.

We investigated whether empirically derived childhood obesity phenotypes were differentially associated with risk of hypertension in young adulthood, and whether these associations differed by sex. Data came from 11,404 participants in the Growing Up Today Study, a prospective cohort study in the US established in 1996. We used a childhood obesity phenotype variable that was previously empirically derived using latent class analysis. The childhood obesity phenotypes included an early puberty phenotype (females only), a mothers with obesity phenotype, a high weight concerns phenotype, and a mixed phenotype. Participants without overweight or obesity in childhood or adolescence were the reference group. We then used logistic regression models with generalized estimating equations to examine associations of childhood obesity phenotypes with incident hypertension between ages 20-35 years. All analyses were stratified by sex. Among females, participants in all of the empirically derived childhood obesity phenotypes were more likely than their peers without childhood overweight/obesity to develop hypertension in young adulthood (early puberty subtype odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.75, 3.62; mothers with obesity (MO) subtype OR = 2.98; 95% CI = 1.93, 4.59; high weight concerns (WC) subtype OR = 2.33; 95% CI = 1.65, 3.28; mixed subtype OR = 1.66; 95% CI = 1.25, 2.20). Among males, the childhood obesity phenotypes were associated with a higher risk of developing hypertension, although males in the MO (OR = 2.65; 95% CI = 1.82, 3.87) and WC phenotypes (OR = 3.52; 95% CI = 2.38, 5.20) had a greater risk of developing hypertension than the mixed subtype (OR = 1.51; 95% CI = 1.23, 1.86) (p = 0.004). Risk for incident hypertension in young adulthood varied by childhood obesity phenotypes, as well as by biological sex. If replicated, these results may suggest that increased surveillance of specific childhood obesity phenotypes might help in targeting those at highest risk for hypertension.

Sodium, Potassium Intake, and Sleep Duration Linked to Hypertension in Adults 40-60 in East Jakarta

Hypertension is a non-communicable disease with an increasing prevalence in Indonesia, often referred to as a silent killer due to its asymptomatic nature until serious complications like stroke or kidney failure occur. This study aims to analyze the relationship between sodium intake, potassium intake, and sleep duration with hypertension among middle-aged individuals (40-60 years) in Kramat Jati Subdistrict, East Jakarta. A cross-sectional design was used, involving 97 purposively selected respondents. Data on sodium and potassium intake were collected using a 24-hour food recall method, sleep duration through structured interviews, and hypertension status through blood pressure measurements. Data were analyzed using Chi-Square and Fisher’s Exact Test. The results showed no significant relationship between sodium intake and hypertension (p = 0.218), although 75% of respondents consumed excessive sodium. Conversely, potassium intake had a significant relationship with hypertension (p = 0.047), with 71% of respondents with sufficient potassium intake being non-hypertensive. Sleep duration also showed a significant association with hypertension (p = 0.032), as respondents with less than six hours of sleep had higher blood pressure. This study concludes the importance of maintaining dietary balance by increasing potassium intake, reducing sodium, and ensuring adequate sleep duration to prevent hypertension. Public education on healthy lifestyles is recommended to lower hypertension risk in urban middle-aged populations.

Quantity and variety of food groups consumption and the risk of hypertension in adults: a prospective cohort study.

The prospective association of dietary diversity and different food groups with the risk of hypertension in the general Chinese adults has not been evaluated. We aimed to evaluate the relationship of variety and quantity of 12 major food groups with new-onset hypertension in the Chinese adults. A total of 11,118 adults from the China Health and Nutrition Survey (CHNS) were included. The study outcome was new-onset hypertension, defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg or diagnosed hypertension by physician or under antihypertensive treatment during the follow-up. During a median follow-up period of 6.0 years, 3867 participants occurred new-onset hypertension. There was a L-shaped relationship of dietary variety score with new-onset hypertension (P for nonlinearity < 0.001). Compared with those in the quartile 1 of dietary variety score, participants in the quartile 2-4 were associated with a significantly lower risk of hypertension (HR, 0.64; 95% CI: 0.59, 0.69). In addition, there were U-shaped associations of dairy products, vegetables, aquatic products, nuts, red meat, whole grains, refined grains, processed meat, and poultry intake with new-onset hypertension, and L-shaped associations of fruits, legumes, and eggs intake with new-onset hypertension (all P for nonlinearity < 0.001). In conclusion, there was an inverse association of dietary variety score with new-onset hypertension in the Chinese adults. Furthermore, there was a negative association between different food group intake and new-onset hypertension when food group intake was relatively low; however, the risk of hypertension increased or plateaued when the intake exceeded a certain threshold.

The Psychological and Cognitive Landscape of Adult Idiopathic Intracranial Hypertension: A Scoping Review.

Idiopathic intracranial hypertension (IIH) is a chronic headache disorder with increasing prevalence. Although characterized by raised intracranial pressure causing papilledema with a risk of visual impairment, psychological symptoms such as depression, anxiety, and cognitive impairment are frequently seen but are understudied and under-reported. Together, these can negatively affect quality of life. These were explored through a systematic PRISMA scoping review. OVID, EMBASE, Cochrane, and PubMed databases were searched in April 2023, limited to those in English and published during January 2000-March 2023. PROSPERO ID CRD42023399410. From 454 identified studies, 24 relevant articles were identified from a range of countries including the United Kingdom, the United States, Israel, Egypt, Canada, Germany, and Brazil. Data on study design, participants, tests performed, and outcomes were collated. There is a considerable burden of psychiatric, affective, and cognitive conditions, as well as impaired quality of life, in adult patients with IIH. Notably, these were independently correlated with the presence of headache in a number of studies and with obesity in others. Aside from optimizing symptom control, including reducing the severity of headaches and protecting visual function, clinicians should be mindful of the biopsychosocial difficulties and potential cognitive impairments patients with IIH face. Assistance may be required with managing concurrent depression and anxiety, as well as optimizing cognitive function. Incorporating neuropsychological assessment and individualized management strategies may be beneficial at the point of diagnosis and throughout the illness.

Prevalence and associated factors of uncontrolled blood pressure among hypertensive patients in a rural population of Salem, Tamil Nadu

ABSTRACT Introduction: Hypertension, a significant risk factor for cardiovascular diseases, is a prevalent public health concern globally. It imposes a substantial burden on healthcare systems, particularly in low and middle-income countries like India. Despite the availability of effective treatments, hypertension remains poorly controlled leading to increased morbidity and mortality. Rural areas often face unique challenges in managing hypertension due to limited healthcare access and awareness. Objectives: The study aimed to estimate the prevalence of uncontrolled hypertension and to identify associated factors among hypertensive patients in rural Salem. Materials and Methods: A hospital-based cross-sectional study was conducted at the Rural Health Training Centre over six months. A total of 382 hypertensive adults aged 18 years and above were included. Data on sociodemographic characteristics, lifestyle factors and clinical profiles were collected using a pretested semistructured questionnaire. Clinical measurements included blood pressure, BMI, and laboratory investigations. Statistical analysis included Chi-square tests and logistic regression to determine factors associated with uncontrolled hypertension. Results: The study revealed a high prevalence of uncontrolled hypertension (62%) among rural hypertensive patients. Factors significantly associated with uncontrolled hypertension included older age (&gt;60 years) (odds ratio [OR] = 2.3, P = 0.027), obesity (OR = 2.7, P = 0.001), employment (OR = 1.5, P = 0.048), diabetes (OR = 2.6, P = 0.036), alcohol consumption (OR = 2.8, P &lt; 0.001), and lack of physical activity (OR = 3.2, P = 0.034). Compliance to treatment was associated with better blood pressure control (P = 0.002) with noncompliant patients having 1.23 times higher odds of uncontrolled hypertension. Conclusion: The study emphasizes the urgent need for tailored interventions addressing lifestyle modifications, patient education, adherence to treatment regimens, and improved healthcare access to enhance hypertension management. These efforts are crucial for reducing the burden of cardiovascular diseases and improving public health outcomes in rural communities.

Lifelong impact of elevated blood pressure from childhood to adulthood.

Elevated blood pressure (BP) during childhood and adolescence is increasingly being recognized as a precursor to adult hypertension and cardiovascular disease (CVD). This review examines the existing evidence of the relationship between early BP elevations and long-term cardiovascular (CV) outcomes. Previous studies demonstrated a moderate association between childhood BP and adult hypertension, with early BP elevations contributing to subclinical CV changes such as left ventricular hypertrophy and increased carotid intima-media thickness as well as major premature CVD events in adulthood. However, evidence also indicates that BP normalization before adulthood may mitigate these risks, suggesting a critical interventional window before irreversible CV changes occur. Multiple modifiable and nonmodifiable factors contribute to early-life BP elevations, including genetic predisposition, a high sodium intake, obesity, sedentary behavior, and sleep disturbances. Although establishing a direct causal association between childhood BP and adult hypertension or CVD remains challenging owing to the need for long-term follow-up and large sample sizes, further research is essential to addressing the existing knowledge gaps in pediatric hypertension prevention, detection, impact, and treatment. This review highlights the importance of preventing BP elevations early in life to reduce the long-term burden of hypertension and CVD. Promoting healthy behaviors, such as maintaining a healthy weight, reducing one's sodium intake, engaging in physical activity, and ensuring adequate sleep, is essential for managing BP at an early age. These efforts reduce individual CV risk and help alleviate the broader future public health burden of hypertension and CVD.

Hypertension and obstructive sleep apnoea syndrome in adults with heart failure in nigeria: clinical correlates and association with clinical outcomes: Erratum

Hypertension and obstructive sleep apnoea syndrome in adults with heart failure in nigeria: clinical correlates and association with clinical outcomes: Erratum

Impact of Mediterranean Diet Adherence on the Incidence of New-Onset Hypertension in Adults With Obesity in Korea: A Nationwide Cohort Study.

This study investigated the association between adherence to the Mediterranean diet (MD) and new-onset hypertension (HTN) in a cohort of community-dwelling, middle-aged, older Korean individuals with obesity. We used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort study. The Korean version of the MD Adherence Screener was used to evaluate compliance with the MD. The primary endpoint was the incidence of new-onset HTN. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval for HTN incidence with increasing MD adherence. Data from 1995 participants with obesity without HTN at baseline were analyzed. After adjusting for confounders, participants with moderate (Group 2) and high adherence (Group 3) to the MD had HRs for new-onset HTN of 0.72 (0.57-0.90) and 0.73 (0.56-0.95), respectively, compared with those with low adherence (Group 1). Sex and age differences were associated with MD adherence and HTN incidence. The association between MD adherence and HTN incidence was only significant in males and in participants aged 40-64years. There was no significant association between MD adherence and new-onset HTN in females or those aged ≥ 65years. In conclusion, this study found a significant association between adherence to the MD and a reduction in new-onset HTN in Korean adults with obesity. Considering its value and sustainability, the adoption of the MD may contribute to the prevention of new-onset HTN in populations with obesity.

Prevalence of non-compliance to prescribed antihypertensive medication among hypertensive middle-aged adults at a tertiary care hospital, Faisalabad, Pakistan: a descriptive cross-sectional study.

ABSTRACT BACKGROUND &amp; OBJECTIVE: Uncontrolled hypertension due to non-compliance with prescribed treatment is one of the main reasons for premature illness and mortality in Pakistan. There is a lack of data on the prevalence of non-compliance with prescribed antihypertensive therapy among hypertensive middle-aged adults in Pakistan. To determine the overall prevalence of non-compliance with prescribed antihypertensive medication among middle-aged hypertensive patients at a tertiary care hospital in Faisalabad, Pakistan. METHODOLOGY: A Descriptive cross-sectional study was conducted over six months from December 2023 to May 2024. All hypertensive patients aged between 40 and 59 years who are conveniently available are included in this study. Data were directly collected from participants by using a structured questionnaire Hill-Bone Medication Adherence Scale. Informed consent was obtained, and participants were briefed on the research topic. The researcher explained the questionnaire in Urdu, which was completed in their presence, ensuring confidentiality to respect participants' ethical rights. RESULTS: A non-compliance score below 25 suggests a low non-compliance rate of 1.56%. Scores between 25-35 indicate moderate non-compliance at 8.31%. Scores of 35-45 show substantial non-compliance with a rate of 62.86%. Severe non-compliance, with scores above 45, results in a high rate of 27.27%. CONCLUSION: The study reveals varying compliance levels among hypertensive patients, highlighting minimal to severe non-compliance, necessitating targeted interventions to reduce non-compliance rates.

Efficacy of a 6-week VR exergame for older adults with essential hypertension: a randomized controlled pilot trial

This study aimed to examine the initial efficacy of a virtual reality (VR) exergame for blood pressure (BP), body composition, lung function, physical working capacity, and mobility in older hypertensive adults. Furthermore, the objective was to explore the exercise intensities that can be reached during the training. This study was designed as a randomized controlled pilot trial. The exergame group (EG) completed 6-week training using VR; the conventional training group (CTG) performed conventional group training over the same time period. The sample included thirty-five participants with essential hypertension randomized with a ratio of 2:1 to EG (n = 23) and CTG (n = 12). The training was performed twice a week and consisted of strength endurance and endurance training sessions in alteration, which lasted from 20 to 30 min. Within the groups, systolic and diastolic BP were significantly reduced only in the EG. There were no group differences with regard to BP. The heart rate (HR) results showed no significant differences within and between groups in the pre–post comparison. Overall, a significant increase in HR during exercise was observed in both groups. On average, only the EG was able to reach the target intensity of 40–60%. In addition, blood pressure was significantly lower 5 min after training in EG than in CTG. This pilot study showed that 6 weeks of training with VR can lead to reaching the target heart rate during exercise and indicate a greater reduction in BP after training in older adults with hypertension. This pilot study provides useful insights into the potential of VR exergaming and for future research.

The Link Between Dietary Habits and Body Mass Index in Relation to the Occurrence of Hypertension in The Jatiwarna Village Community Health Center

High blood pressure is a prevalent condition in the community and is a significant risk factor for heart disease. Hypertension is often called “the silent killer” because it is a highly perilous condition that can strike individuals without any detectable signs. There are various elements that can impact high blood pressure, such as dietary habits and obesity, which can be assessed by determining body mass index. To establish the correlation between dietary habits and BMI in relation to the prevalence of hypertension at the Jatiwarna Village Community Health Center. This investigation is a quantitative analysis with a cross-sectional methodology. The example utilized in this study consisted of 79 participants selected through the purposive sampling method. An examination of the connection between factors was conducted using chi square. The findings of the chi square analysis examination on the connection between diet and the occurrence of hypertension obtained p-value = 0,038 (&lt;0,05) and an OR value = 3,117 and the correlation between body mass index and the occurrence of hypertension resulted in a p-value = 0.781 (greater than 0.05). There is a noteworthy connection between diet and the prevalence of hypertension and there is no substantial connection between body mass index and the prevalence of hypertension in adulthood.

Population pharmacokinetics of selexipag for dose selection and confirmation in pediatric patients with pulmonary arterial hypertension.

Selexipag is an oral selective prostacyclin receptor agonist approved for the treatment of pulmonary arterial hypertension (PAH) in adults. To date, no treatment targeting the prostacyclin pathway is approved for pediatric patients. Our goal is to identify a pediatric dose regimen that results in comparable exposures to selexipag and its active metabolite JNJ-68006861 as those shown to be efficacious in adult PAH patients. Extrapolation from the population pharmacokinetic (PK) model developed in adults (GRIPHON study; NCT01106014) resulted in the definition of three different pediatric body weight groups (≥9 to <25 kg, ≥25 to <50 kg, and ≥50 kg) with corresponding starting doses (100, 150, and 200 μg twice daily) and maximum allowed doses (800, 1200, and 1600 μg twice daily). The proposed pediatric dose regimen was subsequently tested in a clinical study (NCT03492177), including 63 pediatric PAH patients ≥2 to <18 years of age and a body weight range of 9.9-93.5 kg. The body weight-adjusted dose regimen for selexipag resulted in comparable systemic exposures to selexipag and its active metabolite in pediatric patients as previously observed in adult PAH patients. Updating the adult selexipag population PK model provided overall consistent parameters and confirmed that the PK characteristics of selexipag and its active metabolite were comparable between pediatric and adult patients. The presented selexipag dose regimen for pediatric PAH patients is considered appropriate for continuing the clinical evaluation of the safety and efficacy of selexipag in pediatric patients ≥2 years of age.

Hypertension in Adults With Diabetes in Southeast Asia: A Systematic Review.

Diabetes is one of the most pressing health issues in the Southeast Asian region, and hypertension has been commonly reported as a comorbidity in adults with diabetes. This systematic review aimed to synthesize evidence on theprevalence and management of hypertension in adults with diabetes in Southeast Asian countries. A literature search was conducted in Ovid MEDLINE and Embase Classic + Embase from database inception until March 15, 2024. Studies were included if (1) they were conducted in Southeast Asian countries, (2) the study populations were adults with diabetes, and (3) there was information related to hypertension or blood pressure (BP) in the study results. Of the 7486 abstracts found, 90 studies qualified for this review. Most studies reported a hypertension prevalence of 70% or higher (ranging from 29.4% to 93.4%). Despite this high prevalence, a substantial proportion of these populations did not receive adequate BP control, with most studies indicating a control rate of less than 40%. There was limited evidence on the prescription of antihypertensive therapies and medication adherence. There was a lack of studies from 4 of the 11 countries in the region. This review highlights that BP control in adults with diabetes remains a significant challenge in Southeast Asia. Given the ongoing epidemiological transition, and the increasing older population in this region who are likely to accumulate multiple chronic conditions complicating medication strategies, this review highlights the urgent need to improve BP management in those with diabetes.

Chinese expert consensus on the management of hypertension in adults with type 2 diabetes.

Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence-to-decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.

Association of tricarboxylic acid cycle related-metabolites with hypertension in older adults: a community-based cross-sectional study.

Hypertension is still a common chronic disease worldwide and seriously affects human health. Aim of this study was to investigate the association between tricarboxylic acid (TCA) cycle-related metabolites and hypertension in older adults. A total of 1127 community-dwelling older adults were included in this cross-sectional analysis, of whom 609 were assigned to the hypertension group and 518 to the no-hypertension group. Plasma concentrations of 8 TCA cycle-related metabolites (citrate, cis-aconitate, isocitrate, 2-oxoglutarate, succinate, maleate, fumarate, and malate) were determined by gas chromatography-triple quadrupole mass spectrometry. Multivariate logistic regression was used to assess the association between these metabolites and hypertension risk. After adjustment for covariates, we found that the increased plasma concentrations of 2-oxoglutarate and malate were significantly associated with hypertension. These two associations remained unchanged after using the false discovery rate (FDR)-adjustment method (both FDR-adjusted P-trend <0.05). In stratified analysis, these two associations were not modified by overweight, physical activity, and current drinking (all P-interaction >0.05). In the multivariate diagnostic model, the inclusion of these two metabolites modestly and significantly improved the diagnosis of hypertension (AUC = 0.64, 95% CI: 0.60-0.67). These results indicated that plasma 2-oxoglutarate and malate might be the candidate metabolic markers of hypertension among older adults. However, further longitudinal and experimental studies are necessary to confirm this finding.

Abstract 4113411: Long Term Outcomes of Hypertension and Antihypertensive Drugs in Young Healthy Adults: A Nationwide Population-based Prospective Cohort Study in Korea

Background: Long term follow-up data on elevated blood pressure (BP) or antihypertensive drugs in young adults are scarce. The effect of hypertension (HTN) and antihypertensive medications on the cardiovascular disease incidence in young healthy adults (20~45 years) was analyzed using a large-scale population medical use database in Korea. Methods: In total, 4,590,597 young Korean adults without comorbidities who underwent regular health examination were included in this study. They were stratified into four groups according to their BP (optimal BP, normal BP, high normal BP, and HTN). The primary outcome was a composite of the incidence of myocardial infarction and ischemic and hemorrhagic stroke, obtained by tracking the medical use data of the first-ever ICD-10 codes. Subgroup analysis was conducted by categorizing the HTN group into two subgroups according to the prescription ratios of the antihypertensive drugs during the follow-up period. Results: The average age was 33.8 years and median follow-up duration was 15.9 years. HTN elevated the incidence risk of major cardiovascular disease by 2.16 times compared to that of the optimal BP group. Dyslipidemia and HTN were the most dominant risk factors for myocardial infarction and stroke, respectively. In the subgroup analysis, antihypertensive medications decreased the incidence of cardiovascular disease by 70% in all diseases. Conclusions: Cardiovascular risk factors, including HTN, contribute to major cardiovascular disease incidence in young adults. The antihypertensive medications decreased the major cardiovascular disease incidence estimates.

Effect of Alternate Nostril Breathing Exercise on Cardiorespiratory Functions in Hypertensive Adults: A Systematic Review

Background: Cardiovascular diseases (CVDs), primarily driven by hypertension (HTN), are a leading global health concern. While medication is commonly used to manage HTN, non-pharmacological approaches like ANB are gaining interest. ANB is a yogic breathing technique believed to modulate the autonomic nervous system, influencing heart rate and blood pressure. Methods: A systematic review adhering to PRISMA guidelines assessed studies published between 2015 and 2022 that investigated the effects of ANB on blood pressure in human subjects. Results: Six studies were included, with findings suggesting a potential benefit of ANB for reducing blood pressure. All studies, except one, reported significant reductions in systolic and/or diastolic blood pressure after ANB practice. Intervention duration varied across studies, ranging from single sessions to six weeks of daily practice. Some studies also observed a decrease in heart rate and improved vascular function following ANB. However, limitations exist: unclear control groups in some studies and varying intervention protocols. Discussion: Despite promising preliminary evidence, further well-designed, randomized controlled trials with larger sample sizes and standardized protocols are needed. Future research should compare ANB with sham interventions or standard medical management, and explore the underlying mechanisms of how ANB might influence blood pressure. Conclusion: While the current evidence requires further confirmation, ANB appears to be a safe and potentially beneficial non-pharmacological intervention for managing blood pressure, potentially as an adjunct to medication. Healthcare professionals may consider suggesting ANB to hypertensive patients, alongside lifestyle modifications and medication, but emphasize the importance of consulting a healthcare provider before starting any new practice.

Predictive modeling of preoperative acute heart failure in older adults with hypertension: a dual perspective of SHAP values and interaction analysis

BackgroundIn older adults with hypertension, hip fractures accompanied by preoperative acute heart failure significantly elevate surgical risks and adverse outcomes, necessitating timely identification and management to improve patient outcomes.Research objectiveThis study aims to enhance the early recognition of acute heart failure in older hypertensive adults prior to hip fracture surgery by developing a predictive model using logistic regression (LR) and machine learning methods, optimizing preoperative assessment and management.MethodsEmploying a retrospective study design, we analyzed hypertensive older adults who underwent hip fracture surgery at Hebei Medical University Third Hospital from January 2018 to December 2022. Predictive models were constructed using LASSO regression and multivariable logistic regression, evaluated via nomogram charts. Five additional machine learning methods were utilized, with variable importance assessed using SHAP values and the impact of key variables evaluated through multivariate correlation analysis and interaction effects.ResultsThe study included 1,370 patients. LASSO regression selected 18 key variables, including sex, age, coronary heart disease, pulmonary infection, ventricular arrhythmias, acute myocardial infarction, and anemia. The logistic regression model demonstrated robust performance with an AUC of 0.753. Although other models outperformed it in sensitivity and F1 score, logistic regression’s discriminative ability was significant for clinical decision-making. The Gradient Boosting Machine model, notable for a sensitivity of 95.2%, indicated substantial capability in identifying patients at risk, crucial for reducing missed diagnoses.ConclusionWe developed and compared efficacy of predictive models using logistic regression and machine learning, interpreting them with SHAP values and analyzing key variable interactions. This offers a scientific basis for assessing preoperative heart failure risk in older adults with hypertension and hip fractures, providing significant guidance for individualized treatment strategies and underscoring the value of applying machine learning in clinical settings.