Publications by Year: 2026

BACKGROUND: Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are common among adults with hypertension and may complicate antihypertensive treatment selection.However, the impact of specific antihypertensive agents on orthostatic blood pressure (BP) responses and risk of OH or OHT remains incompletely characterized.

METHODS: We performed a secondary analysis of the Treatment of Mild Hypertension Study (TOMHS), a multicenter randomized clinical trial (1987-1993). A total of 902 adults aged 45-69 years with diastolic BP 90-99 mmHg were randomized to acebutolol, amlodipine, chlorthalidone, doxazosin, enalapril, or placebo. Orthostatic BP change (standing minus seated BP) was assessed at randomization, 1 month, and every 3 months up to 54 months. OH was defined as a systolic BP decrease ≥20 mmHg or diastolic BP decrease ≥10 mmHg; OHT was defined as a systolic BP increase ≥20 mmHg or diastolic BP increase ≥10 mmHg. Generalized estimating equations evaluated associations between agents and orthostatic BP changes overall, by baseline BP, and over time.

RESULTS: Among 897 participants with orthostatic BP measurements (mean age 54.8 years; 38.5% female; 19.6% Black), doxazosin increased odds of OH (OR 1.45; 95% CI, 1.05-2.02) and reduced odds of OHT (OR 0.66; 95% CI, 0.51-0.86) versus placebo. Chlorthalidone reduced OHT among participants with baseline OHT (P=0.018). Amlodipine and doxazosin attenuated orthostatic systolic BP changes across baseline orthostatic BP change strata. Over time, amlodipine and chlorthalidone reduced odds of OH (P=0.001, 0.044).

CONCLUSIONS: Specific antihypertensive agents demonstrated distinct effects on orthostatic BP regulation. Consideration of orthostatic effects during antihypertensive selection may help individualize therapy, improve hemodynamic stability, and optimize treatment for patients at risk of orthostatic dysregulation.

OBJECTIVE: This study aimed to examine associations of gestational weight gain (GWG) and postpartum weight retention (PPWR) with women's mid-life cardiovascular health.

METHODS: We studied 838 Project Viva participants enrolled 1999-2002 (mean age: 32.6 years). We categorized GWG as inadequate, adequate, or excessive using 2009 Institute of Medicine guidelines and calculated PPWR at 6 months, 1 year, and 2 years. At the Mid-Life Visit (2017-2021; mean age: 51.0 years), we derived Life's Essential 8 (LE8) scores (0-100; higher = better). We used linear regression models adjusted for pre-pregnancy BMI, age at enrollment, pregnancy smoking status, household income, and educational attainment.

RESULTS: Excessive versus adequate GWG was associated with worse weight status (β = -8.99, 95% CI: -12.81, -5.18) but not with the overall LE8 score (β = -1.93, 95% CI: -3.92, 0.07) or the biomedical domain score (β = -2.31, 95% CI: -5.66, 1.05). Each 1-kg higher 1-year PPWR was associated with worse biomedical domain (β = -0.49, 95% CI: -0.84, -0.14), weight status (β = -1.54, 95% CI: -1.90, -1.17), and blood pressure scores (β = -0.62, 95% CI: -1.15, -0.10). PPWR at 6 months and 2 years was also associated with worse glycemic traits scores.

CONCLUSIONS: Excessive GWG was associated primarily with worse mid-life weight status, whereas higher PPWR was associated with worse mid-life cardiovascular health.

The 2025 AHA/ACC blood pressure (BP) management guidelines recommend BP treatment for 10-year cardiovascular disease (CVD) ≥7.5% from the PREVENT equation, replacing the prior pooled cohort equations (PCE). We examined associations between risk in PCE and PREVENT and a composite of CVD or cardiovascular death in SPRINT. Among 1794 participants, 477 (26.6%) were at low risk in both, 119 (6.6%) were high-risk in PREVENT only, 89 (5.0%) were high-risk in PCE only, and 1109 (61.8%) were high-risk in both. Those at high risk in both equations receiving intensive treatment had a lower risk of the primary outcome [hazard ratio (HR): 0.46, 95% confidence interval (CI): 0.24, 0.89]. Intensive treatment did not affect the risk of any outcomes for those at high-risk in PREVENT only or PCE only due to low event rates. These findings confirm the neutrality of the change from PCE to PREVENT for BP treatment recommendations.

BACKGROUND: Assessment and treatment of orthostatic hypotension (OH) are recommended to prevent falls in older adults. However, the optimal timing of standing blood pressure (BP) assessments to identify clinically relevant OH remains unclear.

METHODS: We measured 3 supine BP readings after 5 minutes of rest at 30-second intervals and 6 standing BP readings (timed at 0, 1, 2, 3, 4, and 5 minutes after standing) during the ARIC study (Atherosclerosis Risk in Communities) visit 10. OH was defined as a drop in BP (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) on standing from the supine position. We quantified the prevalence and predictors of initial OH (immediately after standing), early OH (within 3 minutes), late OH (after 3 minutes), and sustained OH (all 6 minutes). We examined their associations with orthostatic symptoms and falls using logistic regression and negative binomial models, respectively.

RESULTS: Of the 863 participants (mean age, 83.7 years), 41.3% had initial OH. Participants on antihypertensive medications had higher odds of all types of OH irrespective of controlled (<130/80 mm Hg) or uncontrolled (≥130/80 mm Hg) hypertension compared with those without hypertension (<130/80 mm Hg) and no antihypertensive use. Initial and early OH were strongly associated with orthostatic symptoms in the process of standing from the supine position (odds ratio, 2.34 [95% CI, 1.42-3.86]; odds ratio, 1.82 [95% CI, 1.11-2.98], respectively). Finally, participants with initial OH had higher fall rates (rate ratio, 1.45 [95% CI, 1.02-2.06]) than those without OH.

CONCLUSIONS: Measuring BP within 3 minutes of standing, particularly the first BP measurement immediately after standing, may provide clinicians with important information on falls risk and orthostatic symptoms.

INTRODUCTION: Previous research has shown narrowing racial disparities in self-reported health. However, these disparities may have worsened in recent years, particularly during and after the COVID-19 pandemic. Less is known regarding the current state of disparities in self-reported health.

METHODS: Participants are from the 2023 and 2024 U.S. National Health Interview Survey. Using survey-weighted, age- and sex-adjusted modified Poisson regression models, we examined associations of race, ethnicity, and socioeconomic status with fair or poor self-reported health, both overall and stratified by levels of education, income, and health insurance status.

RESULTS: Among 251,930,438 adults aged ≥ 18 years (unweighted N = 60,449), 14.9% (95% CI: 14.5, 15.3) reported fair or poor health. Compared to those with a bachelor's degree or higher, those who had not completed high school had a higher prevalence of fair or poor health (prevalence ratio [PR] = 3.79, 95% CI: 3.52, 4.08). Additionally, compared to people with household income ≥ 4 times the federal poverty line, those with household incomes below the federal poverty line had a higher prevalence of fair or poor health (PR = 3.94, 95% CI: 3.70, 4.19). Non-Hispanic Black (PR = 1.56, 95% CI: 1.46, 1.67) and Hispanic (PR = 1.49, 95% CI: 1.39, 1.59) adults were more likely than non-Hispanic White adults to report fair or poor health.

CONCLUSION: In this U.S. nationally representative study, fair or poor self-reported health was more prevalent among adults with lower socioeconomic status and among non-Hispanic Black and Hispanic adults. These findings underscore the need for policy interventions that simultaneously address socioeconomic inequality and structural racism to improve population health outcomes.

BACKGROUND: Successful trial recruitment depends on balancing initial interest with participants' commitment and eligibility. It is uncertain how different motivational advertisement themes affect recruitment of interested and eligible trial participants.

METHODS: The GoFresh trials examined how healthy groceries affect blood pressure among Black adults from Boston healthy food priority areas. Using Facebook's "A/B testing" feature, users 18 years and older in eligible ZIP codes were randomly shown one of four digital advertisement themes-science volunteerism, study incentives, blood pressure reduction, or wellness in the Black community-between November 2023 and December 2024. We tracked Facebook and website analytics by theme. 'Interest' was defined as submission of an online interest form. 'Commitment' as visit no-show rates, and 'Eligibility' as qualification following the in-person visit. The 'number needed to screen' was calculated as 1 divided by the proportion of inquiries who were eligible.

RESULTS: Advertisements reached 603,418 Facebook users and generated 32,168 clicks, 264 inquiries, 73 scheduled visits, and 23 eligible participants. The community theme generated the highest inquiry engagement rate (54%) but lower commitment (8 no-shows) and the highest number needed to screen (17). The blood pressure theme had the lowest inquiry engagement rate (32%) but yielded the highest commitment (2 no-shows) and the lowest number needed to screen (8).

CONCLUSION: Beyond generating study interest, motivational themes may select for participants with varying degrees of commitment and eligibility, which could affect the cost-effectiveness of recruitment and long-term retention. These findings have important implications for timely and representative recruitment for cardiovascular trials.

REGISTRATION: URL: https://clinicaltrials.gov/; Unique Identifier: NCT05121337 &NCT05393232.

BACKGROUND: Current clinical guidelines recommend home blood pressure monitoring (HBPM) to confirm hypertension diagnosis, guide therapy, and support long-term control. However, the optimal number of HBPM measurements needed for valid assessment is not established.

METHODS: At ARIC Visit 10 (2023), participants completed an eight-day HBPM protocol with morning and evening measurements and three readings per session. We evaluated the validity between the eight-day mean (reference) and streamlined protocols (fewer days, less than three readings per session, or only morning or evening measurements). In secondary analyses, we assessed the validity of these HBPM protocols relative to ambulatory BP.

RESULTS: Among 812 participants (median age 83 years, 24% Black adults, 40% male, 84% using anti-hypertensive medications), median BP varied by less than 3 mmHg across the eight-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from one to two days. By three days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mmHg of the reference for both systolic and diastolic BP. Averaging ≥2 readings per session, including both morning and evening measurements, yielded greater validity than a single reading or timepoint.

CONCLUSIONS: In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each. While further studies are required to validate generalizability beyond this engaged cohort, these findings support shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.

Per- and polyfluoroalkyl substances (PFAS) and metals are ubiquitous environmental contaminants that have been individually linked to childhood adiposity, but their combined effects remain understudied. In the Project Viva cohort (n = 845), we evaluated joint associations of six first-trimester PFAS in plasma and five essential and six nonessential metals in erythrocytes with child and adolescent body mass index (BMI) z-scores and dual-energy X-ray absorptiometry (DXA) total and truncal fat mass indices. We used Bayesian kernel machine regression to evaluate joint associations of PFAS and metals with adiposity. Higher prenatal PFAS and nonessential metal mixture levels were significantly associated with higher mid-childhood and early adolescent BMI z-scores (75th vs 50th percentile: 0.17 [95% Credible Interval (CrI): 0.06, 0.28]; 0.14 [95% CrI: 0.02, 0.25]) and DXA total fat mass (0.17 kg/m2 [0.05, 0.30]; 0.20 kg/m2 [0.07, 0.32]), but not adiposity in late adolescence. Children with lower levels of the prenatal essential metal mixture had higher early and late adolescent DXA total fat mass (25th vs 50th percentile: 0.13 [0.04, 0.22]; 0.08 [0.01, 0.16]). Our findings underscore the importance of considering concurrent prenatal exposures across multiple chemical classes when evaluating environmental influences on child adiposity.

BACKGROUND: Orthostatic hypotension is thought to be associated with coronary heart disease, falls, and syncope due to low blood pressure (BP) upon standing.

METHODS: The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing BP among adult participants aged 45 to 64 years once at baseline and followed them for over 35 years. We evaluated higher and lower supine and standing systolic BP, diastolic BP, mean arterial pressure, pulse pressure, absolute and relative orthostatic changes in BP after standing, and mean BP across positions. Associations with adjudicated coronary heart disease and mortality events, as well as hospitalizations and medical claims-based falls and syncope, were assessed via adjusted Cox models in strata of antihypertensive treatment.

RESULTS: Among 11 386 participants (mean age, 54 years [SD, 5.7 years]; 56% female; 25% Black adults), drops in systolic BP upon standing (absolute or relative) were associated with coronary heart disease, syncope, and mortality. Higher supine systolic BP and mean arterial pressure were associated with syncope among untreated participants. Increases in systolic BP ≥20 mm Hg upon standing were associated with falls (hazard ratio, 1.52 [95% CI, 1.14-2.02]) and syncope (hazard ratio, 1.40 [95% CI, 1.03-1.92]), particularly among untreated participants. Lower standing systolic BP was associated with a higher risk of syncope among treated participants (hazard ratio, 1.55 [95% CI, 1.14-2.12]). Regardless of treatment status, a higher pulse pressure was associated with coronary heart disease and mortality, but this was not observed for falls or syncope.

CONCLUSIONS: Higher BP, rather than lower standing BP alone, may be an important risk factor for both cardiovascular and hypotension-related events, especially among untreated adults.