Home blood pressure telemonitoring reveals race-specific patterns of target organ damage.

Systolic Blood Pressure Variability and Risk of Ischemic Stroke in Patients Receiving Hemodialysis.

BACKGROUND AND OBJECTIVES Blood pressure variability (BPV) has been recognized as a cardiovascular risk factor beyond mean blood pressure, but its role in ischemic stroke among patients receiving hemodialysis remains incompletely defined, particularly across stroke subtypes. We evaluated the association between visit-to-visit BPV and incident ischemic stroke in a multicenter hemodialysis cohort. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS In this prospective cohort study, 1,136 patients undergoing maintenance hemodialysis were enrolled from 12 centers. Pre-dialysis blood pressure measurements were collected over a standardized 12-week baseline period (approximately 36 readings per patient). BPV was quantified using the coefficient of variation (CV) and analyzed per 10% greater CV and by tertiles. The primary outcome was incident ischemic stroke, including large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs), adjusting for demographics, blood pressure, comorbidities, medication, and dialysis-related factors. RESULTS During a median follow-up of 54 months, 144 patients developed ischemic stroke. Higher systolic BPV was independently associated with greater stroke risk (sHR per 10% greater CV, 1.74; 95% confidence interval [CI], 1.10-2.76, P=0.02) in the clinically adjusted model, with consistent findings in extended analyses. In subtype-specific analyses, systolic BPV was significantly associated with LAA and showed a directionally consistent but attenuated association with SVO after extended adjustment. In contrast, diastolic BPV showed weaker associations that were not statistically significant after multivariable adjustment. CONCLUSIONS Higher systolic BPV was independently associated with ischemic stroke in patients receiving hemodialysis, with the most consistent subtype-specific association observed for large artery atherosclerosis. These findings suggest that systolic BPV may serve as a clinically accessible marker of cerebrovascular risk beyond mean blood pressure in this high-risk population.

Blood Pressure, Kidney Function, and Kidney Mortality Among Mexican Adults.

RATIONALE & OBJECTIVE Chronic kidney disease (CKD) is a major cause of death in Mexico and blood pressure (BP) may be an important contributor. This study investigated the associations of BP with CKD, albuminuria, and death from kidney failure. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 133,470 adults aged ≥35 to <85 years without CKD or other chronic disease (except diabetes), recruited from two districts of Mexico City between 1998 and 2004, and who survived ≥5 years after recruitment. A random subset of 9198 underwent additional evaluation 2015-2019. EXPOSURES Systolic BP (SBP), diastolic BP (DBP) and hypertension (participant report of taking blood pressure lowering medication or BP ≥140/90 mm Hg). OUTCOMES Kidney failure mortality during follow-up, and CKD (self-report and/or eGFR <60 mL/min/1.73m2) and albuminuria at the time of repeat clinical evaluation. ANALYTICAL APPROACH Multivariable Cox regression for the association of BP with kidney failure mortality and multivariable logistic regression for the association of baseline BP with CKD and albuminuria at the time of re-evaluation. RESULTS Among all participants, SBP showed a continuous "log-linear" association with kidney failure mortality; each 20 mm Hg lower SBP being associated with 24% lower risk at ages 40-84 years (kidney failure death hazard ratio [HR] 0.76, 95% confidence interval 0.69-0.84). The association was stronger among those without diabetes (HR 0.54, 0.45-0.69) than with diabetes (HR 0.90, 0.80-1.01) but the absolute excess risk associated with higher BP was similar in these subgroups. Hypertension accounted for 9% of kidney failure deaths. Among those re-evaluated, 6% had developed CKD and 25% had albuminuria. 20 mm Hg lower baseline SBP was associated with 24% lower odds of both CKD (odds ratio [OR] 0.76, 0.68-0.85) and albuminuria (OR 0.76, 0.68-0.84) at the time of re-evaluation. Results were similar for DBP. LIMITATIONS Baseline urine samples were unavailable and kidney function trends over time could not be assessed. CONCLUSIONS This large prospective study in Mexican adults highlights elevated BP as a major modifiable risk factor for kidney failure mortality, CKD, and albuminuria.

Association of morning home systolic blood pressure and albuminuria with cardiovascular events in Japanese patients with type 2 diabetes mellitus: The KAMOGAWA-HBP study.

Short-term blood pressure variability assessed by ambulatory blood pressure monitoring as a predictor of subclinical target organ damage

Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.

Blood pressure phenotypes and hypertension-associated cardiac damage.

BACKGROUND The aim of this study was to characterize hypertension-associated cardiac damage in the blood pressure (BP) phenotypes sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT) and sustained hypertension (SHT). METHODS In a population-based study, 4115 individuals were examined with office and home BP measurement, computed tomography, coronary computed tomography angiography and echocardiography. The odds ratios of hypertension-associated cardiac damage in the BP phenotypes were analysed with SNT and SHT as references, respectively, for coronary artery calcium score (CACS) at least 100 and at least 300, Segment Involvement Score (SIS) at least 4, any significant (>50%) coronary stenosis, left ventricular ejection fraction (LVEF) less than 50%, E/e΄ ratio (E/e΄) at least 14, and global longitudinal strain (GLS) greater than -17 (men) or greater than -18 (women). RESULTS The odds of having hypertension-associated cardiac damage were significantly higher for WCHT than for SNT [LVEF < 50%: OR 1.83 (1.17-2.86), CACS ≥ 100: OR 1.58 (1.19-2.11)], and for SHT than for SNT [LVEF < 50%: OR 2.34 (1.53-3.57), CACS ≥ 100: OR 1.52 (1.14-2.02)]. The odds of having hypertension-associated cardiac damage were also significantly higher for MHT than for SNT (LVEF < 50%: OR 2.68 (1.41-5.10), CACS ≥ 100: OR 2.15 (1.37-3.38) and CACS ≥ 300: OR 2.34 (2.21-4.52)]. CONCLUSION The prevalence of hypertension-associated cardiac damage was higher in WCHT and in MHT compared to SNT. WCHT and MHT should therefore be considered when assessing cardiovascular risk, and BP should be measured both in the office and at home when diagnosing and monitoring hypertension.

Blood Pressure Phenotypes and Cardio-Kidney Outcomes: Findings From UK Biobank Data.

BACKGROUND Hypertension is a leading cause of cardio-kidney outcomes (CKO). However, distinct blood pressure (BP) phenotypes and their effect on CKO remain underexplored. This study aimed to evaluate the independent contributions of BP phenotypes to CKO. METHODS This prospective, population-based study included UK Biobank participants enrolled between 2006 and 2010 with baseline systolic BP ≥90 mm Hg and estimated glomerular filtration rate ≥60 mL/min per 1.73 m2, excluding those with prior chronic kidney disease and cardiovascular disease. Five BP phenotypes were constructed based on the 2017 American Heart Association hypertension criteria (≥130/80 mm Hg): normotension, systolic-diastolic hypertension, isolated systolic hypertension, isolated diastolic hypertension, and isolated low diastolic BP. The primary outcome was CKO, a composite of incident chronic kidney disease, 3-point major cardiovascular events, and all-cause mortality based on the International Classification of Diseases and Office of Population Censuses and Surveys Classification of Interventions and Procedures, Version 4, codes. Associations between BP phenotypes and CKO were evaluated using multivariable Cox proportional hazards models adjusted for demographic, lifestyle, and clinical covariates. RESULTS Among 322 328 participants (mean age, 55.8±8.1 years; 42.5% men), 61 918 (19.2%) had normotension, 159 853 (49.6%) had systolic-diastolic hypertension, 43 939 (13.6%) had isolated systolic hypertension, 28 169 (8.7%) had isolated diastolic hypertension, and 28 339 (8.8%) had isolated low diastolic BP. Over a median follow-up of 13.6 years, 32 440 CKO events occurred. All BP phenotypes were associated with an increased CKO risk compared with normotension: isolated systolic hypertension (hazard ratio, 1.22 [95% CI, 1.17-1.27]), systolic-diastolic hypertension (hazard ratio, 1.21 [95% CI, 1.16-1.25]), isolated diastolic hypertension (hazard ratio, 1.11 [95% CI, 1.05-1.17]), and isolated low diastolic BP (hazard ratio, 1.10 [95% CI, 1.05-1.17]). CONCLUSIONS Distinct BP phenotypes beyond absolute BP thresholds confer differential risks for CKO. Interventional studies are needed to evaluate strategies targeting combined systolic-diastolic phenotypes to reduce CKO risk.