Andrew Edward Moran

BACKGROUND: Whether isolated diastolic hypertension (IDH) in young adults represents a benign, age-specific phenotype or confers increased cardiovascular disease risk remains uncertain. We assessed the associations between hypertension subtypes, IDH, isolated systolic hypertension, and systolic-diastolic hypertension, with atherosclerotic cardiovascular disease and heart failure. We also characterized longitudinal transitions in hypertension subtypes from young adulthood into later life. METHODS: Adults aged ≥18 years without cardiovascular disease were included from 4 US cohorts. Hypertension subtypes were defined using blood pressure thresholds of ≥130/80 mm Hg. Cox proportional hazards models were used to estimate the associations of hypertension subtypes with atherosclerotic cardiovascular disease and heart failure. RESULTS: Among 23 957 participants (mean age, 44.5 years, 42.5% were young adults aged 18–39 years, 45.1% were male), 2320 atherosclerotic cardiovascular disease and 1243 heart failure events occurred over a median follow-up of 17.2 years. Among young adults, the adjusted hazard ratios (95% CI) for atherosclerotic cardiovascular disease were 1.36 (95% CI, 1.11–1.68) for IDH, 1.54 (95% CI, 1.02–2.32) for isolated systolic hypertension, and 1.84 (95% CI, 1.46–2.32) for systolic-diastolic hypertension, compared with normotension. Corresponding hazard ratios for heart failure were 1.69 (95% CI, 1.24–2.31) for IDH, 1.92 (95% CI, 1.09–3.40) for isolated systolic hypertension, and 1.69 (95% CI, 1.17–2.43) for systolic-diastolic hypertension. Associations were consistent among adults aged ≥40 years. Among young adults with IDH, 29.8% remained with IDH, whereas 36.5% progressed to systolic-diastolic hypertension later in life. CONCLUSIONS: IDH in young adulthood represents an early marker of increased cardiovascular disease risk and a precursor to more adverse hypertension subtypes. These findings underscore the importance of early recognition, ongoing blood pressure monitoring, and guideline-concordant pharmacological treatment, when indicated, among young adults with IDH to reduce long-term cardiovascular disease risk.

The Nigeria Hypertension Control Initiative (NHCI) launched a national treatment program in 2020, guided by the HEARTS technical package for cardiovascular disease prevention in primary care. This study presents a thematic analysis of key informant interviews with primary care experts from Abuja, Kano, and Ogun, exploring NHCI implementation experiences. Using a structured qualitative approach, we analyzed responses across four domains: service delivery, medication procurement and availability, task shifting, and broader program aspects. Findings highlight improvements in service delivery, medication access, task shifting, and health-seeking behavior. However, challenges persist, including incomplete training, user fees, administrative burdens, and logistical barriers such as transportation costs and stockouts. Despite these issues, satisfaction with the standardized treatment protocol was high. Task shifting was well-received, easing pressure on senior staff but underscoring the need for continued training. Recommendations include integrating diabetes care, decentralizing medication sourcing, and enhancing training to strengthen NHCI’s efficiency and sustainability in resource-limited settings.

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. This paper presents Phase 3 of HEARTS 2.0, an evidence-informed process to prioritize clinical and health-system interventions to support the operationalization of integrated cardiovascular, kidney, and metabolic (CKM) care in primary health care (PHC) and to inform the update of the HEARTS Clinical Pathway. CKM conditions frequently coexist, sharing common risk factors and pathophysiological mechanisms that exacerbate cardiovascular disease burden. Despite their overlap, clinical practice often remains siloed due to condition-specific guidelines, and its integration remains limited. To prioritize evidence-informed clinical and health-system interventions that support the operationalization of integrated CKM care within PHC and inform the update of the HEARTS Clinical Pathway. Methods: Building on previous phases of HEARTS 2.0, a multidisciplinary panel evaluated 45 candidate interventions in different areas. The selection process utilized structured evidence appraisal, Evidence-to-Decision frameworks, and a modified RAND/UCLA appropriateness method involving anonymized rating rounds. Results: A total of 38 interventions were prioritized for implementation. Although hypertension management remains the primary entry point, the resulting framework integrates early detection of diabetes and chronic kidney disease, lifestyle interventions, risk-based combination pharmacotherapy, task-sharing, and longitudinal follow-up. Conclusions: By translating dispersed guideline recommendations into implementable interventions, Phase 3 of HEARTS 2.0 provides an evidence-informed basis for advancing integrated CKM care at scale in PHC and guiding the forthcoming update of the HEARTS Clinical Pathway. The resulting framework offers a flexible, scalable approach for countries confronting similar epidemiological and health system challenges.

The current guideline-recommended clinic blood pressure (BP) measurement procedure takes nearly 10 minutes to complete and may not be feasible to implement in busy clinical practice settings. Additionally, evidence supporting the steps in the current guideline-recommended procedure is of uneven quality. A streamlined, evidence-based approach to clinic BP measurement that still produces accurate and precise BP measurements may facilitate improved hypertension diagnosis and management. We summarized the latest evidence from studies that have quantified the impact of streamlining certain steps in the BP measurement procedure on BP measurement accuracy and precision. We translated this evidence into a practical, streamlined protocol for office BP measurement in usual primary care and potentially other settings. Studies have demonstrated it is possible to reduce the rest period before measurements from 5 to 0 minutes, and the interval between measurements from 60 to 30 seconds, without compromising accuracy. Additionally, analyses of studies with replicate BP measurements performed according to clinical practice guideline recommendations showed that repeating the initial screening measurement only when the first one is ≥130/80 mm Hg optimized accuracy and efficiency. Meanwhile, using the proper cuff size, arm support, and patient positioning are critical for BP measurement accuracy and recommendations for these steps remain unchanged from current guidelines. Broad implementation of a streamlined approach would result in more efficient BP measurement without compromising accuracy or precision, thereby increasing capacity to screen, diagnose, and manage hypertension.