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cally the leading cause of death (Table). The leading causes of death were assault, diseases of the heart, and accidents (Figure, B and Table).Among Hispanic individuals aged 25 to 44 years, COVID-19 was the leading cause of death from March through December 2020 (Figure, C and Table) and during the third and fourth quarters of 2020. During the third quarter, more COVID-19attributed deaths were recorded among Hispanic individuals aged 25 to 44 years than for the next 2 most-common causes combined (accidents and unintentional overdoses).Among White individuals aged 25 to 44 years, COVID-19 was the sixth leading cause from March through December 2020 (Figure , D). The leading causes of death were unintentional overdoses and accidents (Figure, D and Table).Discussion | Results of this cohort study demonstrated that during March through December 2020, the first 10 months of the COVID-19 pandemic in the US, COVID-19 was the second leading cause of death among Black, Hispanic, and White residents of Texas aged 25 to 44 years, and the most common cause during the third quarter of 2020, with a markedly disproportionate increase in mortality among Hispanic residents. One possible explanation may be that Hispanic persons were more likely to be essential workers and, therefore, were less able to avoid exposure to SARS-CoV-2, which has previously been linked to socioeconomic factors. 5,6 Another possible explanation is that Hispanic residents were less likely to have access to primary care and, therefore, more likely to experience unmanaged medical comorbidities associated with worse COVID-19 outcomes. Limitations of this study include the accuracy of data from death certificates and the preliminary nature of 2020 data. Nevertheless, these findings highlight the markedly disparate effects of the COVID-19 pandemic in different populations of young adults, particularly among Hispanic residents of Texas.

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Background The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of weight loss and sodium reduction to reduce hypertension medication use in older adults. However, the longer-term effects of drug withdrawal (DW) on blood pressure (BP), adverse events, and orthostatic symptoms were not reported. Methods TONE enrolled adults, ages 60–80 years, receiving treatment with a single antihypertensive and systolic BP (SBP)/diastolic BP <145/<85 mm Hg. Participants were randomized to weight loss, sodium reduction, both, or neither (usual care) and followed up to 36 months; ~3 months postrandomization, the antihypertensive was withdrawn and only restored if needed for uncontrolled hypertension. BP and orthostatic symptoms (lightheadedness, feeling faint, imbalance) were assessed at randomization and throughout the study. Two physicians independently adjudicated adverse events, masked to intervention, classifying symptomatic (lightheadedness, dizziness, vertigo), or clinical events (fall, fracture, syncope). Results Among the 975 participants (mean age 66 years, 48% women, 24% black), mean (±SD) BP was 128 ± 9/71 ± 7 mm Hg. Independent of assignment, DW increased SBP by 4.59 mm Hg (95% confidence interval [CI]: 3.89, 5.28) compared with baseline. There were 113 adverse events (84 symptomatic, 29 clinical), primarily during DW. Compared with usual care, combined weight loss and sodium reduction mitigated the effects of DW on BP (β = −4.33 mm Hg; 95% CI: −6.48, −2.17) and reduced orthostatic symptoms long term (odds ratio = 0.62; 95% CI: 0.41, 0.92), without affecting adverse events (hazard ratio = 1.81; 95% CI: 0.90, 3.65). In contrast, sodium reduction alone increased risk of adverse events (hazard ratio = 1.75; 95% CI: 1.04, 2.95), mainly during DW. Conclusions In older adults, antihypertensive DW may increase risk of symptomatic adverse events, highlighting the need for caution in withdrawing their antihypertensive medications. Clinical trials registration Trial Number NCT00000535.

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Guidelines recommend 1 to 2 minutes between repeated, automated office-based blood pressure (AOBP) measures, which is a barrier to broader adoption. Patients from a single hypertension center underwent a 3-day evaluation that included a 24-hour ambulatory blood pressure (BP) monitor (ABPM) and one of two nonrandomized, unattended AOBP protocols. Half of the patients underwent 3 AOBP measurements separated by 30 seconds, and the other half underwent 3 BP measurements separated by 60 seconds. All measurements were compared with the average awake-time BP from ABPM and the first AOBP measurement. We used linear regression to assess whether the 30-second protocol was associated with individual or average AOBP measurements or awake-time ABPM and used an interaction term to determine whether interval modified the relationship between AOBP measurements (individual and mean) with awake-time ABPM. Among 102 patients (mean age, 59.2±16.2 years; 64% women; 24% Black), the average awake-time BP was 132.5±15.6/77.7±12.2 mm Hg among those who underwent the 60-second protocol and 128.6±13.6/76.5±12.5 mm Hg for the 30-second protocol. Mean systolic/diastolic BP was lower with the second and third AOBP measurement by −0.5/−1.7 mm Hg and −1.0/−2.3 mm Hg for the 60-second protocol versus −0.8/−2.0 mm Hg and −0.7/−2.7 mm Hg for the 30-second protocol; protocol did not significantly modify these differences. Differences between AOBP measurements (first, second, or third) and awake-time ABPM were nearly identical across protocols. In conclusion, a 30-second interval between AOBP measurements was as accurate and reliable as a 60-second interval. These findings support shorter time intervals between BP measurements, which would make AOBP more feasible in clinical practice.

Background: Intensive blood pressure (BP) treatment reduces the risk of cardiovascular disease, but there are ongoing concerns that it also might be harmful by increasing the risk of orthostatic hypotension (OH). However, individual trials have been inconclusive. Methods: In this individual participant data meta-analysis, we systematically reviewed MEDLINE, EMBASE, and CENTRAL databases through October 7, 2019 for randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) on measured OH. OH was defined as a drop in SBP ≥20 mmHg or DBP ≥10 mmHg after changing positions from seated to standing. Ultimately, five trials of BP treatment goal were identified. Effects were examined overall and in subgroups of baseline characteristics, including diabetes, standing BP pre-randomization (<110 vs ≥110 mm Hg), and pre-randomization OH. Results: There were 18,466 participants with 127,998 follow-up visits. Most trials demonstrated low risk of bias with minimal heterogeneity of effects across trials ( I 2 = 0.0%). Intensive BP treatment significantly lowered risk of OH (OR 0.93; 95% CI: 0.86, 0.99). Effects were strongest among adults without diabetes (OR 0.90 vs 1.10; P -interaction = 0.015) and adults with lower standing SBP (OR 0.66 for <110 mmHg vs 0.96 for ≥110 mmHg; P -interaction = 0.02). Effects did not differ by pre-randomization OH ( P -interaction = 0.80). In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged ( Figure ). Conclusion: OH prior to or in the setting of more intensive BP treatment should not be viewed as a reason to avoid or to de-escalate treatment for hypertension.