Aug 2026· American Journal of Physiology. Heart and Circulatory Physiology· 0 citations
Medicine
TL;DR
The identification of a high-risk SSI, based on 24-hour ABPM, is validated as a generalizable implementable approach for the clinical diagnosis of the SSBP, with a potential greater clinical diagnostic value in hypertensive versus normotensive individuals.
Abstract
The salt sensitivity of blood pressure (SSBP) is rarely assessed and represents a critical barrier in precision hypertension treatment. The current approaches to assess salt sensitivity are labor and resource intensive limiting their clinical implementation. The salt sensitivity index (SSI), derived from 24-hour ambulatory blood pressure monitoring (ABPM) data, has been proposed as a clinical diagnostic approach to classify individuals at low-, intermediate-, or high-risk for the SSBP. This study utilized the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial control diet arm dataset (N=170), in which the SSBP was assessed by the gold standard dietary approach, to address the hypothesis that identification of a high-risk SSI can predict the individual SSBP. In the high-risk SSI category 72% of DASH-Sodium Trial participants exhibited a salt-sensitive phenotype. For all participants with a high-risk SSI (male and female and normotensive and hypertensive) sensitivity (ability to correctly identify individuals with the SSBP) was 85%, specificity (ability to correctly identify individuals without the SSBP) was 41%, positive predictive value (probability that a person who tests positive has the SSBP) was 72%, negative predictive value was 60% (probability that a person who tests negative does not have the SSBP) and accuracy was 69%. For hypertensive participants only with a high-risk SSI (males and females), sensitivity was 86%, specificity was 44%, the positive predictive value increased to 83%, the negative predictive value was 50% and accuracy increased to 76%. This study validates the identification of a high-risk SSI, based on 24-hour ABPM, as a generalizable implementable approach for the clinical diagnosis of the SSBP, with a potential greater clinical diagnostic value in hypertensive versus normotensive individuals.
The results of the CareBP study show the extended value of 14 days of individual blood pressure monitoring and underline the relevance of this approach for cardiovascular disease prevention.
This represents the first evaluation of a Device Type 3 cuffless blood pressure algorithm (automated, wearable, demographic-calibrated, not at heart level) meeting ESH awake/asleep test criteria, suggesting Alysis-001's potential as a clinically viable alternative for ambulatory blood pressure monitoring in hypertensive patients.
Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.
BACKGROUND
Hypertension guidelines generally recommend uniform sodium restriction although determinants of salt sensitivity, or sodium-blood pressure responsiveness, remain incompletely quantified. We estimated the population sodium-blood pressure dose-response, identified clinical modifiers, quantified high salt sensitivity prevalence, and derived the number needed to restrict sodium intake to prevent 1 cardiovascular event across clinical strata.
METHODS
PubMed, Embase, and Cochrane were searched from inception to April 2025 for sodium intervention trials and observational studies. Blood pressure response was standardized per 50-mmol/d sodium difference. Random-effects metaregression evaluated clinical modifiers. A highly salt-sensitive phenotype was defined a priori as a systolic blood pressure (SBP) decrease ≥3 mm Hg per 50-mmol/d reduction.
RESULTS
We included 160 studies (255 estimates; n=16 443). Each 50-mmol/d higher urinary sodium excretion was associated with 1.76-mm Hg higher SBP (95% CI, 1.54-1.98). Age and baseline SBP were the strongest modifiers (0.41 mm Hg per 5 years; 0.23 mm Hg per 5 mm Hg). Salt-sensitive phenotype prevalence rose from 12.5% (age <40 years) to 56.5% (>60 years) and from 16.3% (SBP <120 mm Hg) to 54.1% (≥130 mm Hg). Under a policy-relevant 100-mmol/d sodium reduction, number needed to restrict ranged from ≈1334 in younger, normotensive, lean individuals (age <60 years, SBP <130 mm Hg, and body mass index <25 kg/m2) to ≈87 in older adults with hypertension and elevated body mass index (age ≥60 years, SBP ≥130 mm Hg, and body mass index ≥25 kg/m2), a 15-fold gradient.
CONCLUSIONS
Salt sensitivity varied across age, SBP, and body mass index strata. These findings suggest that routinely measured clinical characteristics may help identify populations with greater expected blood pressure response to sodium reduction.
Hypertension is a major contributor to cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) complements office blood pressure measurement by detecting white-coat hypertension, masked hypertension, and nocturnal blood pressure abnormalities, and this study aimed to assess its diagnostic value in the management of hypertension in private cardiology practice in Senegal. A prospective, descriptive, and analytical study was conducted from July to September 2024 at Clinique Urgence Cardio in Dakar, including patients aged 18 years or older with a valid 24-hour ABPM recording. Clinical, anthropometric, and treatment data, together with cardiovascular risk factors, were collected; office and ambulatory blood pressure measurements were compared; and logistic regression was used to identify factors associated with discordance between the two methods. Of the 104 patients assessed, 97 had valid ABPM recordings. The mean age was 53.2 ± 14.1 years, and women predominated. Cardiovascular risk factors included abdominal obesity (77.3%), known hypertension (54.6%), physical inactivity (43.3%), dyslipidemia (37.1%), and diabetes (16.5%). Mean office blood pressure was 145.7/91.4 mmHg, compared with 130.5/80.2 mmHg over 24 hours, 134.4/82.4 mmHg during daytime, and 125/75 mmHg during nighttime. ABPM identified sustained hypertension in 53.61% of patients, white-coat hypertension in 18.56%, masked hypertension in 9.28%, and normotension in 18.56%, with overall agreement between office and ambulatory measurements of 72.2%. Among patients with elevated office blood pressure, 25.7% had white-coat hypertension, while 33.3% of those with normal office blood pressure had masked hypertension. Non-dipping and reverse-dipping patterns were observed in 45.4% and 19.6% of patients, respectively, and discordance was independently associated with alcohol consumption (OR = 5.08; p = 0.007). ABPM improves the diagnostic classification of hypertension and reveals a high prevalence of discordant phenotypes and nocturnal blood pressure abnormalities, and wider use of ABPM may help optimize patient management in this setting.
N. Gaye, J. Mingou, Coumba Kaba et al.· Cardiology and Cardiovascula...· 0 citations
May Measurement Month (MMM) is an annual, global blood pressure (BP) screening campaign that aims to raise awareness of the risks associated with hypertension. During MMM 2024, community pharmacies across Newfoundland and Labrador (NL) participated in the initiative, contributing BP screening data to local, national, and international research efforts. The primary objective of this study was to assess the local burden of elevated BP among those with and without known hypertension.
This cross-sectional study followed a modified version of the MMM protocol. All consenting adults 18 years or older were eligible to participate. Data were collected at 25 community pharmacies in NL. Descriptive statistics were used to summarize data; logistic regression was used to identify associations between elevated BP and selected covariates.
Among 220 participants (mean age 53.3 ± 17.8 years), 68.2% were female, and 40.9% had known hypertension. Analysis included 208 participants with 3 BP readings. Elevated BP was observed in 25.5%, including 18.3% without known hypertension and 36.9% taking antihypertensives. Body mass index and diabetes were statistically significant predictors of elevated BP in the multivariate model.
The proportion of participants in this study with elevated BP exceeds national statistics. The large number of participants with elevated BP and known hypertension and/or diabetes suggests that improvements are needed in the primary health care setting to support patients in reaching their BP targets.
Community pharmacists in NL uncovered large numbers of patients with elevated BP as part of MMM 2024, demonstrating the success of this community-based initiative.
Stephen D. Coombs, Stephanie W. Young, Ross T. Tsuyuki et al.· Canadian Pharmacists Journal...· 2 citations