The American Heart Association’s (AHA) annual meeting, AHA24, was held from November 16-18, 2024, at the McCormick Place Convention Center in Chicago, Illinois. This prestigious event serves as the premier global platform for showcasing the latest advancements in cardiovascular science and medicine, providing attendees with the opportunity to engage with cutting-edge research and practice-changing educational content.

During AHA24, several key abstracts were presented focusing on hypertension. These abstracts included discussions on the impact of a telemedicine hypertension management program, emerging therapies for hypertension, the relationship between comorbid insomnia and obstructive sleep apnea with hypertension, and more. These presentations highlighted below, shed light on important developments in the field of hypertension management and show the ongoing efforts to improve patient outcomes in this critical area of cardiovascular health.

Endothelium Dependent and Non-Dependent Effects of Age and Blood Pressure on the Progression of Arterial Stiffness in Hypertension

  • Endothelial dysfunction is known to have a significant impact on arterial stiffness. Age and blood pressure are key factors that contribute to the advancement of arterial stiffness, and they also play a role in the development of endothelial dysfunction. However, it remains unclear whether these factors directly influence arterial stiffness or if their effects are mediated by endothelial dysfunction.
  • In individuals who are taking anti-hypertensive medication, the progression of arterial stiffness may be hastened as they age and as their systolic blood pressure increases. In these cases, age and blood pressure may have a direct impact on the progression of arterial stiffness without the involvement of endothelial dysfunction.
  • It is important to further investigate the relationship between age, blood pressure, endothelial dysfunction, and arterial stiffness in order to better understand the mechanisms at play and to develop more effective treatment strategies.

Serum Glucocorticoid Regulated Kinase 1 (SGK-1) Inhibitor Reduced Hypertension in a Salt-Sensitive Hypertension Model of Heart Failure with Preserved Ejection Fraction

  • Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by various cardiac and extracardiac pathophysiological changes. Despite accounting for half of all heart failure diagnoses, treatment options for HFpEF are currently limited. Serum and glucocorticoid regulated kinase 1 (SGK1), a PI3-kinase-dependent kinase, has been identified as playing a significant role in heart failure and atrial fibrillation.
  • Given SGK1’s involvement in renal sodium homeostasis, inflammation, and fibrosis, researchers hypothesized that inhibiting SGK1 could potentially halt the progression of HFpEF. To test this hypothesis, the efficacy of a novel and potent SGK1 inhibitor, SGK1-I, was evaluated in a rat model of HFpEF.
  • Preliminary data analysis indicates that administration of SGK1-I reduces increases in blood pressure and subsequent changes in left ventricular morphology in Dahl SS rats fed a high-salt diet. These findings suggest the potential of SGK1 inhibition as a promising therapeutic target for treating HFpEF associated with hypertension. Further preclinical studies are warranted to explore this potential treatment option in more depth.

Abnormal Day-Night Blood Pressure and Systemic Hemodynamics in Heart Failure Compared to Normotension and Controlled Hypertension

  • Elevated nighttime blood pressure (BP) and heart rate (HR), as well as inadequate decreases in nighttime BP and HR (known as “non-dipping”), are indicators of increased morbidity and mortality. Non-dipping has been observed in some patients with hypertension (HT) or a history of acute heart failure (HF), but the specific abnormalities in ambulatory systemic hemodynamics have not been fully elucidated.
  • The aim of the present studies was to determine whether patients with a history of HF exhibit abnormal dipping of BP and HR, and to identify potential differences in ambulatory hemodynamics between HF patients, normotensives (N), and individuals with controlled HT (C-HT, 24-hour systolic BP <135 mmHg).
  • HF patients, regardless of ejection fraction (EF), frequently experience nocturnal hypertension (night-time systolic BP >120 mmHg) and elevated HR compared to N and C-HT. Additionally, they demonstrate blunted nocturnal dipping of BP and HR. These findings suggest that 24-hour ambulatory BP-PWA monitoring could be beneficial in the routine management of HF. Our study also demonstrates the feasibility of ambulatory PWA in HF patients, revealing distinct hemodynamic patterns in HF compared to N and C-HT. HF patients, regardless of EF, exhibit consistently low stroke volume index (SVI) and persistently high HR and total vascular resistance index (TVRI) throughout the day and night, indicative of excessive sympathetic nervous system activity. Further research is needed before recommending routine systemic hemodynamic assessment in HF.

Evaluation of Therapeutic Intensification for Uncontrolled Hypertension Using Different Sources of Electronic Health Records

  • Healthcare system interventions aimed at monitoring therapeutic intensification for uncontrolled blood pressure (BP) can help address potential therapeutic inertia. However, the most effective methods for evaluating therapeutic intensification using various electronic health record sources remain unknown.
  • The question arises: To what extent do medication orders and pharmacy data offer comparable or distinct assessments of therapeutic intensification?
  • A significant number of patients with uncontrolled BP do not fill their new prescriptions, highlighting the importance of utilizing medication order data to assess therapeutic intensification. Among those who do fill their prescriptions, only minimal differences were noted in the evaluations based on medication orders versus pharmacy data.

Geographic, Gender, & Racial Trends in Mortality Due to Coronary Artery Disease in Hypertensive Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis

  • Coronary artery disease (CAD) in patients with hypertension poses a significant health concern for adults in the United States. This study delves into the trends and demographic disparities in mortality rates attributed to CAD in hypertensive patients aged 25 and above from 1999 to 2020.
  • The analysis uncovers notable demographic and geographic discrepancies in mortality rates linked to CAD in hypertensive adults across the U.S. The Age-Adjusted Mortality Rate (AAMR) has surged fivefold over the past two decades, particularly affecting specific racial groups and geographical areas. These findings emphasize the critical necessity for targeted interventions and equitable healthcare access to address these disparities and enhance outcomes.

Gender Differences in Accelerated Vascular Aging in Patients with Resistant Hypertension

  • Resistant hypertension (RHTN) is characterized by elevated blood pressure levels that persist above target levels despite the use of three or more antihypertensive medications. Individuals with RHTN are at a significantly higher risk of developing cardiovascular disease (CVD), which remains the leading cause of mortality for both men and women. While premenopausal women may have some degree of protection against CVD, the risk increases substantially following menopause.
  • Arterial stiffening is a known risk factor for the development of CVD and overall mortality, independent of traditional CVD risk factors. Research has shown that the association between arterial stiffness and mortality is nearly twice as high in women compared to men. Furthermore, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction are more prevalent forms of CVD in women, often linked to increased arterial stiffness.
  • This study aims to investigate the role of accelerated vascular aging (AVA) in female patients with RHTN, compared to those with essential hypertension (HTN), as a potential mechanism for the elevated rates of CVD and associated morbidity and mortality. The results suggest a higher degree of accelerated vascular aging in women with RHTN, despite a later onset and similar duration of hypertension compared to men.

Evaluating a Team-Based Telemedicine Hypertension Management Program to Address Inequities in Hypertension Care Among Black Patients

  • While telemedicine programs have shown to be superior to clinic-based care, current programs aimed at managing hypertension are found to be less effective in Black patients. The lack of adequate support for Black patients’ self-care skills and social needs may be contributing to this disparity. To address this issue, researchers conducted a pilot study on a 12-week team-based telemedicine intervention involving pharmacists, nurses, community health workers (CHWs), and social workers (SWs). This intervention focused on providing tailored self-care and social support to Black patients.
  • This team-based telemedicine program has the potential to promote equity in hypertension care for Black patients. If proven to be clinically effective, this program could significantly enhance hypertension control within this population.

Factors Associated with the Development of Incident Chronic Hypertension in the Postpartum Period: An Electronic Medical Record Analysis

  • Hypertensive disorders of pregnancy (HDP), such as preeclampsia and gestational hypertension, have been linked to a higher likelihood of developing cardiovascular disease (CVD) later in life. This connection is largely influenced by the subsequent development of chronic hypertension (HTN). The aim of our study is to pinpoint clinical factors associated with the onset of HTN in a diverse group of postpartum patients by analyzing electronic health record (EHR) data.
  • Patient factors routinely documented in EHRs, such as HDP and BMI, have shown a strong correlation with an increased risk of developing HTN between 6-24 months after giving birth in a racially diverse population. Additionally, systolic blood pressure (SBP) at 6 weeks postpartum has been identified as an independent and often overlooked risk factor for HTN. Our future research will focus on creating and validating predictive models for incident postpartum HTN in this high-risk group for CVD.

Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) are Related to Incident Hypertension in a 20-Year Retrospective Cohort Study of 1.3 million Younger Men and Women Veterans: Associations by Sex

  • Insomnia and obstructive sleep apnea (OSA) are both known to increase the risk of hypertension (HTN). In older adults, the co-occurrence of insomnia and OSA, known as COMISA, has been found to have a negative synergistic effect on the development of cardiovascular disease (CVD). However, it remains unclear whether this comorbidity is also associated with an increased risk of HTN at a younger age.
  • The research questions we aim to address are as follows: 1) Is COMISA associated with the development of HTN in younger adults? 2) Do the associations between COMISA and HTN differ based on certain factors?
  • Our study found that in a younger population, Veterans with COMISA had a 19-21% higher risk of developing HTN compared to those without either disorder. This risk was found to be similar across different factors and slightly higher than the risk associated with either insomnia or OSA alone. Therefore, it is crucial to prioritize the identification of disordered sleep among younger adults as a key component of cardiovascular disease prevention efforts.

Thank you for joining us for this recap of the AHA24 Scientific Sessions. We recommend visiting this link to explore all the posters presented at the event. We look forward to seeing you at AHA25 in New Orleans!

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