Journal of Hypertension

Hypertension is commonly defined as a binary condition despite substantial heterogeneity in diagnosis, treatment, and blood pressure (BP) control. We propose a three-axis state model integrating diagnosis status, treatment intensity, and BP control to better characterize hypertension phenotypes. The framework generates 27 possible states that can be condensed into seven clinically meaningful groups. We applied the model to 5,129,584 Japanese adults using the National Database of Health Insurance Claims and Specific Health Checkups. Hierarchical cluster analysis, sensitivity analysis excluding patients with cardiovascular diseases other than hypertension, and validation against antihypertensive medication use were performed. Overall, 64% of participants were classified as normotensive, whereas 36% belonged to hypertension-related groups, including 11% with unrecognized hypertension and 7% with diagnosed but untreated hypertension. Agreement with data-driven hierarchical cluster analysis was substantial (weighted {kappa}=0.87). The group distribution remained largely unchanged in the sensitivity analysis, supporting the robustness of the proposed classification. Hypertension diagnosis also showed high validity, with a sensitivity of 96.5%, specificity of 91.8%, and substantial agreement with antihypertensive medication use ({kappa}=0.78). This three-axis framework provides a robust and clinically interpretable approach for characterizing hypertension phenotypes, enabling systematic identification of care gaps and supporting research, clinical decision-making, and population health management.

Abstract Background:Patients with hypertension commonly exhibit reduced exercise capacity. Impedance cardiography (ICG) enables continuous, non-invasive assessment of exercise-derived hemodynamic parameters; however, the relative associations of different ICG-derived parameters with exercise capacity remain unclear. Methods:In this retrospective cross-sectional study, 211 patients with hypertension who completed both ICG assessment and the six-minute walk test (6MWT) were enrolled. Exercise-derived hemodynamic parameters, including maximum heart rate (HRmax), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR), were continuously measured using the PhysioFlow(R) system. Univariable and multivariable linear regression analyses were performed to evaluate the associations between ICG-derived parameters and six-minute walk distance (6MWD). HRmax tertile and subgroup analyses were subsequently conducted. Results:In the final multivariable model, age ({beta} = -2.76, 95% CI, -3.85 to -1.67, P < 0.001), male sex ({beta} = 33.50, 95% CI, 8.40-58.60; P = 0.009), and HRmax ({beta} = 1.26, 95% CI, 0.69-1.83; P < 0.001) were independently associated with 6MWD. 6MWD increased progressively across HRmax tertiles (P for trend < 0.001). The positive association between HRmax and 6MWD remained consistent across all prespecified and exploratory subgroups. Conclusions:Among multiple exercise-derived ICG hemodynamic parameters, HRmax demonstrated the strongest and most consistent independent association with exercise capacity in patients with hypertension. These findings suggest that HRmax may represent the most informative dynamic hemodynamic parameter during exercise and that combining ICG with the 6MWT may provide a simple and accessible complementary approach for evaluating exercise capacity.

Background Hypertension is a major global health challenge with well-established cardiovascular risks, yet its relationship with bone mineral density and the skeletal relevance of antihypertensive-related targets remain unclear. Methods Based on individual-level data from 366,443 European-ancestry participants in the UK Biobank, this study adopted restricted cubic spline models to explore linear and nonlinear associations between systolic/diastolic blood pressure (SBP/DBP) and heel estimated bone mineral density (BMD). We stratified participants by median DBP to conduct systematic biomarker analyses covering renal, endocrine, inflammatory and metabolic indicators. Drug-target Mendelian randomization (MR) combined with colocalization and mediation analyses was further performed to identify and validate causal antihypertensive-related target genes associated with BMD. Results A significant inverted U-shaped association was identified between DBP and BMD (P non-linear=3.23e-9), with peak BMD observed at a DBP of 80-90 mmHg, while SBP showed a trend of nonlinear correlation. Biomarker analyses revealed that renal biomarker cystatin C and endocrine biomarker IGF-1 exhibited DBP-dependent associations with BMD, mediating the nonlinear DBP-bone density relationship. Drug-target MR demonstrated that genetically proxied MMP9 expression (ACE inhibitor-related) was negatively correlated with BMD (beta=-0.036, P=5.29e-6), whereas CACNA1G expression (T-type calcium channel blocker target) was positively associated with BMD (beta=0.042, P=1.57e-9). Conclusion The inverted U-shaped association between blood pressure and bone mass might partly reflected by renal dysfunction. Antihypertensive pathways mediated by MMP9 and CACNA1G exert opposing effects on bone mass, implying that skeletal health should be considered when selecting antihypertensive agents for vulnerable older populations.

Background Blood pressure (BP) regulation in individuals with sickle cell disease (SCD) is influenced by a complex interplay of genetic and physiological factors. While SCD has traditionally been associated with lower BP, there is an increased risk of hypertension. Emerging BP research suggests significant heterogeneity across genotypes, age groups, and sex. Objectives: This study investigated the longitudinal effects of population-level characteristics and continuous clinical and laboratory predictors on systolic (SBP) and diastolic blood pressure (DBP) in individuals with SCD, with emphasis on the interactions between baseline and predicted blood pressure slopes over time. Methods We retrospectively analyzed longitudinal data from a cohort of 2,739 patients with diverse SCD genotypes. Descriptive statistics were documented across sex, age range, genotype, health status and relative systemic hypertension risk categories (rHTN-risk). Linear mixed-effects models provided estimates of fixed- and random-effects of baseline BP and of time-related BP effects, respectively. Post-estimation margins provided contrasts of baseline-adjusted BP means and of pre-specified time effects on BP patterns. Results Males had significantly higher baseline SBP ({beta} = 6.64, p < 0.001) but lower baseline DBP ({beta} = -2.61, p < 0.001) compared with age-matched HbSS females. Baseline SBP was more unstable compared with baseline DBP and baseline DBP was more predictive of future BP trends than baseline SBP. Genotype was a consistent predictor of DBP (p < 0.05), but not of SBP. Similarly, we observed increased risks of relative diastolic hypertension across most genotypes, while the prevalence and magnitude of systolic hypertension was lower across all genotype compared with HbSS. Conclusions Blood pressure trajectories in SCD patients are not uniform and are significantly related to genotype, age group and sex over time. Baseline diastolic levels were less heterogenous and exhibited clear upward trajectories over time. These findings support the need for patient-specific BP surveillance in the care and management of SCD.

Background Hypertension remains one of the most challenging healthcare problems in the community. It is a common, measurable, and treatable condition that is nonetheless responsible for millions of preventable deaths each year. Hypertension affects approximately 1.28 billion adults worldwide, yet fewer than half (46%) are aware of their condition. Undiagnosed hypertension is a critical public health gap, contributing to preventable cardiovascular morbidity through silent end-organ damage. Machine learning can enable community-level screening using routinely available, non-invasive data, without the requirement of laboratory investigations. Methods We conducted a cross-sectional ML study using the National Health and Nutrition Examination Survey (NHANES) 2017-2018 cycle. Adults aged [&ge;]18 years were included; those with a self-reported prior hypertension diagnosis (n=1,930) were retained as negative controls. Probable undiagnosed hypertension was defined as mean blood pressure [&ge;]130/80 mmHg among participants reporting no prior hypertension diagnosis, consistent with the ACC/AHA 2017 threshold. Three classifiers: Logistic Regression (LR), Random Forest (RF), and Extreme Gradient Boosting (XGBoost) were trained on eight non-invasive predictor variables. Performance was assessed using AUC-ROC, sensitivity, specificity, and F1 score with bootstrap 95% confidence intervals (CIs). Stratified 5-fold cross-validation was applied. Results Of 9,254 NHANES 2017-2018 participants, 5,237 adults were included after exclusion criteria were applied; 1,072 (20.5%) had probable undiagnosed hypertension. LR achieved the highest test AUC of 0.611 (95% CI: 0.571-0.652), with sensitivity 0.535 (95% CI: 0.473-0.600) and specificity 0.594 (95% CI: 0.560-0.626). RF demonstrated near-absent sensitivity (0.047) despite adequate AUC (0.607), while XGBoost performed intermediately (AUC: 0.599; sensitivity: 0.279). Diabetes status, sex, and age were the most influential predictors by permutation feature importance. Conclusion ML classifiers trained on eight non-invasive variables demonstrated modest but consistent discrimination for identifying probable undiagnosed hypertension, supporting the feasibility of laboratory-free community screening. External validation in diverse populations is warranted before clinical implementation.

Introduction: Diastolic pulse wave analysis provides non-invasive indices of arterial elasticity, but their associations with cardiac structure and function remain incompletely understood. Objective: To examine associations between arterial elasticity assessed by diastolic pulse wave analysis and echocardiographic measures of cardiac structure and function in a community-based cohort. Methods: A population-based cohort recruited 2816 randomly selected men and women aged 30-75 years between 2002 and 2005. A random subsample (n = 1,035) underwent echocardiography by a single senior cardiologist. Large-artery elasticity (C1) and small-artery elasticity (C2) were assessed by radial artery applanation tonometry. The analytical sample included 991 participants. Associations were examined using multivariable linear and logistic regression with sequential adjustment. The final model included sex, age, heart rate, diabetes mellitus, LDL cholesterol, body mass index, antihypertensive medication use, current smoking, alcohol intake, leisure-time physical activity, and systolic blood pressure. Results: Among 991 participants, mean age was 51 years, 488 were men, and 160 had left ventricular hypertrophy. Mean C1 was 16.0 {+/-} 5.1 mL/mmHg x 10, mean C2 was 6.9 {+/-} 3.5 mL/mmHg x 100, and mean EF was 73.4 {+/-} 8.5%. Higher C2 was associated with higher EF after systolic blood pressure adjustment ({beta} per 1-SD increase: 1.2; 95% CI: 0.5-1.9; p < 0.001). Higher C1 was associated with lower odds of left ventricular hypertrophy (OR per 1-SD increase: 0.61; 95% CI: 0.44-0.84; p = 0.003). Conclusions: Higher C2 was associated with better systolic function, whereas higher C1 was associated with lower odds of left ventricular hypertrophy.

BackgroundHypertension, the persistent elevation of blood pressure (BP), is characterized by chronic low-grade inflammation and systemic cytokine release. Circulating cytokines contribute to the development of hypertension and end-organ damage. However, the specific immune profile associated with the progression of hypertension remains unclear. We hypothesize that a plasma cytokine signature reflects early BP changes in older adults. MethodsSeventy participants aged 57-81 years were categorized as normotensive (n = 17), elevated BP (n = 10), or hypertensive (n = 43) based on 24-hour ambulatory BP monitoring and antihypertensive treatment status. Plasma IL-1{beta}, IL-6, IL-10, IL-17A, IL-21, IL-22, IL-23, and TNF- were quantified using immunoassays. Partial Pearson correlations adjusted for demographic and biochemical covariates were used to assess associations between cytokines, BP, and cytokine-cytokine networks. ResultsIn untreated hypertensive individuals, plasma IL-23 was positively correlated with 24-hour diastolic BP. Antihypertensive treatment was associated with reduced IL-17A concentrations, which are negatively associated with 24-hour systolic BP. In the elevated BP group, IL-21 concentrations were higher than in normotensive individuals. To further characterize the cytokine signature, cytokine-cytokine correlations were examined. IL-23 and IL-17A were positively correlated with most interleukins, whereas TNF- showed few associations. IL-1{beta} exhibited strong correlations with both IL-23 and IL-17A, particularly in untreated participants. ConclusionIL-23 and IL-17A are associated with BP status and are broadly interconnected with other inflammatory cytokines, highlighting the potential importance of the IL-23/IL-17A axis in the hypertension of development. Early alterations in IL-21 in elevated BP may reflect immune changes that precede the onset of hypertension.

Background. The imprecision of current metrics to capture the complex genetic admixture and racial identity among Hispanic/Latino individuals in the United States [US] is a concern. We examined the relationship of self-reported race and genetic ancestry with hypertension [HTN] among Hispanics/Latinos. Methods. Cross-sectional study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), including 10,586 Hispanic/Latino unrelated adults. Genetic ancestry: West African [AA], Amerindian [AI], and European [EA]. Self-reported race: White, Black, Native American, or Multiple/Missing (More than one race or Unknown/Not reported/Refused). HTN: systolic (SBP) [&ge;]130 mmHg, diastolic blood pressure (DBP) [&ge;]80 mmHg, and/or use of HTN medications. Age- and sex adjusted models were used. Results. Self-reported race was White (38{middle dot}6%), Black (3{middle dot}6%), Native American (4{middle dot}1%), and Multiple/Missing (53{middle dot}7%), with Unknown/Not reported/Refused representing 32{middle dot}7%. Black and White Hispanics/Latinos had the greatest AA (55{middle dot}7%) and EA (69{middle dot}3%) ancestries, respectively. Each 10% AA increase was associated with OR 1{middle dot}15, SBP beta +0{middle dot}9 mmHg, and DBP beta +0{middle dot}7 mmHg. Conversely, each 10% AI increase was associated with OR 0{middle dot}83, SBP beta -0{middle dot}4 mmHg, and DBP beta -0{middle dot}6 mmHg. HTN prevalence was highest among those with Black race or in the highest AA quantile (45{middle dot}6% and 48{middle dot}0%, respectively), and lowest among those with Native American race or in the highest AI quantile (37{middle dot}6% and 26{middle dot}7%, respectively). Conclusion. One-third of Hispanics/Latinos did not self-report race. Black or White self-reporting race did somewhat relate to AA or EA ancestry, respectively. HTN profiles were related to self-reported race and genetic ancestry in this admixed population.

Background: Hypertension is a leading modifiable cardiovascular risk factor prominently influenced by health-related social needs (HRSN). Whether detailed information on HRSN can improve identification of hypertension among minoritized women is unknown. Methods: Black and Latina women aged 18-65 years completed the Centers for Medicare and Medicaid Services Accountable Health Communities Screening Tool, assessing 13 HRSN domains. Hypertension was ascertained by a validated EHR-based algorithm or self-report of hypertension. Logistic regression tested associations of HRSN with hypertension. LASSO regression with 10-fold cross-validation was used to derive a poly-social risk score in the training set (random 70%) and tested in the validation set (30%) against a sociodemographic model (age, race, income, education). Results: Among 1302 participants (mean [SD] age 40.1 [11.3] years, 70.4% Black, 44.3% Latina), higher cumulative burden of HRSN was associated with increased odds of hypertension (adjusted odds ratio [aOR] for each additional domain of HRSN: 1.07 [95% CI 1.01-1.14], P=0.02). Food insecurity (aOR 2.30 [1.37-3.87], P= 0.002), lapse in utilities (aOR 1.44 [1.04-1.96], P=0.02), poor concentration (aOR 1.57 [1.13-2.17], P=0.007), and social isolation (aOR 1.77 [1.14-2.73], P=0.01) were associated with hypertension. In the validation set, the poly-social risk score did not improve discrimination for hypertension vs. the sociodemographic model (AUC 0.76 [95% CI 0.71-0.81] vs. AUC 0.80 [0.75-0.85]). Conclusion: In this cross-sectional analysis of Black and Latina women, greater cumulative social disadvantage was associated with hypertension. While inclusion of HRSN did not improve hypertension prediction beyond conventional sociodemographic indices, findings may inform targeted interventions among minorities at cardiometabolic risk.

Background: Pediatric hypertension (HTN) remains underdiagnosed despite established guidelines. Prior studies evaluating social drivers of health (SDOH) relied on diagnostic codes or single-visit blood pressure (BP) measurements, limiting identification of persistent BP elevation. We evaluated longitudinal BP patterns and associated SDOH among children with continuity of care. Methods: We conducted a retrospective cohort study of children aged 6-17 years with [&ge;]3 primary care visits between 2017 and 2024 within a large healthcare network. BP was classified according to guidelines. Multivariable logistic regression evaluated associations between persistent abnormal BP ([&ge;]3 abnormal readings, would meet guideline-based diagnosis for HTN) and stage 1/2 HTN with demographic, clinical, and neighborhood-level factors, including Area Deprivation Index (ADI), Child Opportunity Index (COI), and insurance instability. Results: Among 71,683 children, 2,911 (4.2%) had persistent abnormal BP, whereas only 848 (1.2%) had a documented HTN diagnosis. Obesity, age [&ge;]13 years, male sex, prematurity, and insurance instability were associated with abnormal BP and stage 1/2 HTN. Higher ADI quartiles were associated with increased odds of abnormal BP (Q3: OR 2.48) and stage 1/2 HTN (Q3: OR 4.89). Higher COI socioeconomic opportunity was associated with lower odds of abnormal BP, whereas higher educational opportunity was associated with higher odds; these associations were not observed for stage 1/2 HTN. Conclusions: Among children with continuity of care, substantial gaps in HTN recognition persist despite repeated opportunities for diagnosis. SDOH factors remained associated with BP abnormalities, supporting the need for system-level and community-based strategies to improve HTN detection.

Purpose: To determine whether the velocity reflection index (VRI) is the carotid Doppler waveform feature most strongly associated with chronological age after adjustment for sex and exercise habit, and whether its feature ranking remains stable across cross-validated and cohort-sensitivity analyses. Methods: Eight waveform-derived features were analysed in 197 participants meeting the study eligibility criteria and measured using a validated continuous-wave carotid Doppler system. Pearson and partial correlations and multivariable regression evaluated associations with chronological age. Random Forest regression with repeated 10-fold cross-validation, held-out permutation importance and bootstrap resampling assessed feature ranking. Sensitivity analysis evaluated the influence of cohort construction. Results: VRI showed the strongest association with chronological age (r = 0.738, 95% CI [0.667, 0.796]) and remained strongly associated after adjustment for sex and exercise habit (partial r = 0.798). VRI ranked first by both impurity-based (0.536) and held-out permutation (0.765) importance; repeated cross-validation yielded MAE = 6.87 +/- 1.26 years and R^2 = 0.572 +/- 0.153. Its leading ranking was stable in 85.3% of bootstrap resamples and the age-VRI correlation was essentially unchanged in the cohort-sensitivity analysis. The exercise association was significant after age adjustment (B = -0.043, p = 0.018) but attenuated after additional adjustment for sex (B = -0.026, p = 0.098). The sex association remained significant after adjustment for age and height. Conclusion: VRI was robustly associated with chronological age and retained the leading feature-importance ranking across adjusted statistical and cross-validated machine-learning analyses. Validation against an established arterial-stiffness measure in an independent cohort is required before VRI can be considered a clinical vascular-aging biomarker.

Background: Electrocardiographic (ECG) markers of atrial cardiopathy (AC) are associated with stroke mortality, but whether this association is modified by blood pressure (BP) is unknown. Methods: We analyzed 7,191 adults free of cardiovascular disease from the Third National Health and Nutrition Examination Survey who underwent baseline ECG. AC was defined by three ECG markers: prolonged P-wave duration 120 ms), abnormal P-wave axis (<0{degrees} or >75{degrees}), and deep terminal negativity of the P wave in V1 (<100 V). AC burden (per additional AC marker) and AC presence (1 vs. 0 markers) were examined in relation to stroke mortality using Cox proportional hazards models. Participants were stratified by BP as normal/elevated (<130/80 mmHg), stage 1-2 hypertension (130-159/80-99 mmHg), or severe hypertension (160/100 mmHg). Interaction by BP category was assessed. Results: During a median follow-up of 13.8 years, 183 stroke deaths occurred. In multivariable adjusted model, AC burden was associated with a 41% higher risk of stroke mortality (HR (95%CI): 1.41 (1.13-1.77)). This association was significantly modified by BP (interaction P=0.003). The HRs (95% CIs) per additional AC marker were 0.88 (0.52-1.49), 1.39 (1.03-1.88), and 2.94 (1.82-4.75) for normal/elevated BP, stage 1-2 hypertension, and severe hypertension, respectively. A similar pattern of associations was observed for AC presence, although the interaction with BP was not statistically significant. Conclusions: ECG-defined AC burden was independently associated with stroke mortality, with substantially stronger associations among individuals with severe hypertension, supporting BP as an important modifier of its prognostic significance.

Background: Primary aldosteronism (PA) is increasingly recognized as a common cause of hypertension. The 2025 Endocrine Society guideline introduced a simplified diagnostic framework, but its real-world clinical implications remain unclear. Methods: We conducted a multicenter retrospective cohort study of hypertensive patients undergoing PA testing in Taiwan. PA was defined biochemically according to the 2025 Endocrine Society criteria. Multivariable logistic regression identified factors associated with PA diagnosis and aldosterone-targeted therapy. Among patients with suppressed renin (?1 ng/mL/h), restricted cubic splines evaluated the adjusted association between renin and PA probability. Results: Among 18,766 patients undergoing PA testing, 6,760 (36.0%) met diagnostic criteria for PA. PA was associated with older age, female sex, lower potassium, resistant hypertension, and a higher antihypertensive medication burden. Among patients with suppressed renin, lower renin remained significantly associated with higher adjusted PA probability. However, only 39.0% of patients with PA received aldosterone-targeted therapy, including 28.2% who received mineralocorticoid receptor antagonist therapy within 6 months and 9.4% who underwent adrenalectomy during follow-up. Lower renin, higher aldosterone, lower potassium, and resistant hypertension were associated with aldosterone-targeted therapy, while younger patients with fewer comorbidities were more likely to undergo adrenalectomy. Conclusions: Using the updated diagnostic framework, PA was highly prevalent among hypertensive patients undergoing PA testing. Nevertheless, many patients who met these biochemical criteria did not receive aldosterone-targeted therapy in routine care. These findings highlight the potential treatment implications of broader PA recognition and support the development of practical pathways to guide MRA therapy, adrenalectomy referral, and individualized management.

The Cytochrome P450 Family 11 Subfamily B Member 2 (CYP11B2) is the gene responsible for the synthesis of aldosterone synthase, the enzyme catalysing the terminal steps in the production of aldosterone. Polymorphism at the promoter region of this gene has been implicated to upregulate the synthesis of aldosterone synthase and the downstream production of aldosterone. A high aldosterone (hyperaldosteronism) is a known risk factor for hypertension. However, the association of the T-344C polymorphism with aldosterone production and the development of hypertension in the Ghanaian population has not been explored. Consequently, this study aims to unravel the relationship between T-344C (rs1799998) polymorphism, hypertension and serum aldosterone level. This study employed a case-control design enrolling 200 subjects of which 100 were hypertensive patients and 100 healthy controls in the Tamale Metropolis. Using a combination of genotyping, biochemical blood analysis and logistic modelling, we reveal that the frequency of the risk allele of rs1799998 (C) was higher amongst the patient group (0.565) than the control (0.315) group (p<0.0001). The adjusted (age and sex) logistic regression model revealed that the TC genotype [OR= 2.17 (1.08-4.38), p=0.0302] and the CC genotype [OR= 6.35 (2.60-15.54, p-value<0.0001] were significantly associated with hypertension. Under the genetic models, the recessive model (CC vs TC+TT) showed that the CC risk genotype was associated with hypertension [OR = 4.055 (1.838-8.949) p<0.001] after adjusting for age and sex. Furthermore, the CC risk genotype was associated with an elevated plasma aldosterone. In conclusion, the CYP11B2 gene polymorphism (T-344C) was associated with high plasma aldosterone and hypertension.

This study enrolled 152 hypertensive patients with an ARR > 3.7 to assess the relationship between the traditional hypokalemia cutoff (3.5 mmol/L) and primary aldosteronism (PA) screening, and to establish a new cutoff. Under the traditional cutoff, only 35.7% of PA patients presented with hypokalemia. ROC curve analysis identified a new cutoff of 4.22 mmol/L, which increased sensitivity from 35.7% to 77.5%, with a specificity of 91.1% and an AUC of 0.897. The findings indicate that the traditional cutoff is insufficiently sensitive, while the new cutoff markedly improves screening sensitivity and facilitates early detection of PA.

Ambulatory blood pressure monitoring (ABPM) is recommended for confirming hypertension and assessing out-of-office blood pressure (BP). However, patient burden and device tolerability may limit broader implementation. We compared participant experience with a traditional oscillometric ABPM device and a compact cuff-integrated ABPM. The PRO-BP Study was a pilot randomized crossover study of 20 adults in New York City. Participants completed two 24-hour ABPM periods over 7 days using the SpaceLabs 90227 and SOMNOmedics ABPM Pro devices. After each period, participants rated comfort, pain, sleep interference, embarrassment, noise, skin irritation, and interference with daytime activities. Both devices achieved guideline-based recording-quality thresholds. Compared with SpaceLabs, ABPM Pro was associated with greater comfort (median 7.0 [IQR, 5.0-8.5] vs 3.5 [IQR, 2.0-6.5]; P=0.004), less pain (1.5 [0-3.5] vs 5.0 [0.5-7.0]; P=0.003), and less embarrassment (0.5 [0-3.5] vs 3.0 [0-6.0]; P=0.01). Other experience ratings did not differ significantly. Participant experience should be considered alongside recording quality when evaluating validated ambulatory BP monitoring technologies.

We evaluated the blood pressure (BP) lowering efficacy and safety of triple vs dual therapy of antihypertensive drug (AHTD) combinations, among adults with hypertension. Seventeen randomized, double-blind trials (41 comparisons and 13,461 participants) comparing triple versus dual therapy for 3 weeks identified by multiple literature databases searches including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) until October 2024 were included in the meta-analysis. Triple therapy achieved a greater reduction in systolic BP (SBP) compared with dual therapy (26.9 vs. 21.7 mmHg, mean difference 5.4 mmHg [95% CI, 4.7 to 6.2]). Among patients receiving dual therapy at submaximal and maximal doses, the addition of a third drug further reduced SBP by 7.5 and 3.6 mmHg, respectively. BP control was significantly better with triple therapy (60% vs. 47%, RR=1.34 [1.27 to 1.41]). Withdrawal due to adverse events was slightly higher in the triple therapy group (4% vs. 3%, RR=1.5 [1.2 to 1.8]). Triple AHTD therapy provides superior BP reduction and is well-tolerated compared to dual therapy.

BackgroundMultiple epidemiological studies have given a global perspective that hypertension leads to changes in telomere length (TL). This study aimed to investigate the association between leukocyte telomere length and lifestyle factors among individuals with hypertension, a family history of the disease and healthy controls. MethodsThis pilot exploratory cross-sectional study included 45 participants (n = 15 per group) divided into hypertensive, familial hypertensive, and control groups. Lifestyle behaviors were assessed using the FANTASTIC Lifestyle Checklist, evaluating domains such as physical activity, diet, sleep, and stress. Relative telomere length (T/S ratio) of leucocytes was measured from peripheral blood samples using quantitative real-time PCR (qPCR). Data were analyzed using SPSS software, with ANOVA, Kruskal-Wallis test, and multivariable linear regression applied for statistical analysis. ResultsRelative telomere length differed significantly among the study groups (p = 0.008), with hypertensive participants demonstrating the highest median telomere-to-single-copy gene (T/S) ratio (2.66), followed by familial hypertensive (1.25) and control participants (0.87). Total lifestyle scores also varied significantly across groups (p < 0.001), with hypertensive individuals exhibiting higher mean scores (77.07 {+/-} 5.59) than familial hypertensive (67.20 {+/-} 3.00) and control participants (67.07 {+/-} 5.97). A modest positive correlation was observed between total lifestyle score and relative telomere length (r = 0.329, p < 0.05), suggesting that healthier lifestyle behaviors in diagnosed hypertensive subjects following healthy lifestyles and regular medications were associated with longer telomeres. However, in multivariable linear regression analyses, lifestyle score, age, gender, hypertension status, and family history of hypertension were not independently associated with telomere length (all p > 0.05). ConclusionLifestyle scores were positively associated with telomeres, and significantly higher telomere ratios in hypertensive subjects suggest complex biological interactions that require further investigation through larger longitudinal studies in the target population.

Background: Vascular calcification (VC) is prevalent among patients with atherosclerosis, hypertension, diabetes, elderly individuals, and those with chronic kidney disease. However, effective diagnostic and therapeutic strategies are lacking. Plasma and urinary biomarkers are commonly used in clinical settings to assess disease progression. Objective: This study investigates causal relationships between plasma/urinary biomarkers and VC using Mendelian randomization (MR), aiming to identify potential targets for VC intervention, and to assess whether biomarkers mediate the effects of modifiable risk factors on VC. Methods: We performed two-sample bidirectional MR using large-scale genome-wide association study data (n=363,228 for biomarkers, n=28,654 for VC) to investigate the causal effects of plasma/urinary biomarkers on VC. Then, a literature review was performed to identify common VC risk factors, followed by univariate MR to select risk factors associated with both VC and biomarkers. Finally, mediation analysis was conducted to explored whether biomarkers mediate the effects of modifiable risk factors on VC. Results: MR analysis identified 7 plasma biomarkers linked to VC, 5 of which were positively correlated. A literature review revealed 856 VC risk factors, with 28 identified through univariate MR analysis, 11 of which correlated with identified biomarkers. Mediation analysis showed that 5 biomarkers (TRIG, GGT, CA, BILD, SHBG) partially mediated the effects of 4 modifiable risk factors on VC. Conclusion: This study identifies several clinically common used biomarkers for diagnosing and treating VC, suggesting that modulating these biomarkers through lifestyle changes, such as controlling smoking, intake of milk, blood pressure and diabetes, may slow VC progression in patients.

Background: Hypertension is the leading modifiable cardiovascular risk factor globally, with the fastest-growing burden in low- and middle-income countries. This study aimed to estimate national hypertension prevalence, map provincial patterns, assess spatial clustering, and identify individual and community-level determinants among Zambian adults using the 2017 WHO STEPS survey. Methods: This cross-sectional study used data from the 2017 WHO STEPS survey, a nationally representative sample of 4,301 adults aged 18-69 years. Hypertension was defined as systolic BP [&ge;]140 mmHg, diastolic BP [&ge;]90 mmHg, or current antihypertensive use. Spatial autocorrelation was assessed via Moran's I and LISA. Four nested generalised linear mixed models with PSU-level random intercepts identified individual and community-level determinants. Results: Overall weighted hypertension prevalence was 24.0%. Lusaka recorded the highest prevalence (30.2%), followed by Southern (29.9%) and Muchinga (28.3%) provinces; Western Province had the lowest (12.4%). Spatial clustering was statistically significant but modest (Moran's I = 0.0247, p < 0.001). Between-cluster variation reduced from ICC = 5.9% to 1.8% in the full model, indicating geographic differences were largely explained by individual characteristics. Age was the strongest predictor; adults aged 60-69 had nearly sevenfold higher odds than those aged 18-29 (AOR 6.92, 95% CI: 4.95-9.66). Women had lower odds than men (AOR 0.64, 95% CI: 0.52-0.79). Obesity (AOR 2.34), overweight (AOR 1.65), high cholesterol (AOR 1.40), diabetes (AOR 1.35), and single marital status (AOR 1.34) were independently significant. Western Province showed consistently lower odds than Central Province (AOR 0.48). Conclusion: Hypertension affects one in four Zambian adults, driven primarily by age, sex, obesity, dyslipidaemia, and diabetes. Geographically prioritised interventions, including community health worker-led screening programmes in Lusaka and Southern Province, would maximise population-level impact. Population-level salt reduction and alcohol policies represent cost-effective complementary strategies. Longitudinal studies with finer spatial resolution are needed to clarify causal pathways underlying observed geographic clustering and inform SDG Target 3.4 progress.