American Heart Association Blood Pressure Categories Predict Disability Worsening in MS

The American Heart Association (AHA) stage II hypertension blood pressure category has the strongest association with disability status in multiple sclerosis (MS), compared with other measures of hypertension. These study results were presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2025, held in Barcelona, Spain from September 24 to 26, 2025.

Hypertension is a recognized risk factor for worse outcomes in patients with MS, but uncertainty remains about the most reliable metric to identify individuals at greatest risk. To address this, researchers conducted a retrospective cohort analysis of patients seen at an academic MS clinic at least twice between 2020 and 2024. The study compared multiple measures of blood pressure (BP), including mean systolic BP, mean diastolic BP, physician-diagnosed hypertension, and AHA BP categories, with longitudinal disability outcomes.

A total of 138 individuals were evaluated, of whom 72% were women, mean (SD) age was 45 (12) years, 92% had relapsing-remitting MS, and, using AHA criteria, 71.7% had hypertension. At baseline, mean (SD) systolic BP and diastolic BP were 131 (14) and 81 (8) mm Hg, respectively. By AHA classification, 18.1% had normal BP, 12.3% had elevated BP, 46.4% had stage I hypertension, and 23.2% had stage II hypertension.

Disability progression, measured by change in expanded disability status scale, was significantly associated with higher mean systolic BP (B=0.027; 95% CI, 0.006-0.049; P =.012) and AHA stage II hypertension (B=1.362; 95% CI, 0.405-2.320; P =.006). After adjusting for variables such as demographics, MS subtype, length of follow-up, treatment category, and mean serum neurofilament light chain, the associations persisted. In contrast, average diastolic BP and hypertension defined strictly by diagnostic coding showed no relationship with disability progression.

“Stage II [hypertension] as defined by the AHA has the strongest association with [change in expanded disability status scale],” the study authors noted. They concluded, “Future research and clinicians may consider using the AHA [hypertension] categories for improved risk stratification.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.