Hypertensive disorders of pregnancy (HDPs) are major contributors to maternal and neonatal morbidity and are closely linked to metabolic disturbances. Women with gestational diabetes mellitus (GDM) exhibit significant li...Hypertensive disorders of pregnancy (HDPs) are major contributors to maternal and neonatal morbidity and are closely linked to metabolic disturbances. Women with gestational diabetes mellitus (GDM) exhibit significant lipid abnormalities, yet whether atherogenic lipid indices predict hypertensive complications in this population remains unclear. This study evaluated the predictive value of the atherogenic index of plasma (AIP) and cumulative AIP for HDPs and neonatal outcomes in women with GDM. In this two-center retrospective cohort study, a total of 3967 women with GDM were included. AIP was calculated as log10 (TG/HDL-C). Cumulative AIP was estimated as the mean AIP values measured during the second and third trimesters multiplied by the corresponding exposure time. Adverse outcomes were identified using generalized linear models with P for trend <0.05. Associations between AIP indices and outcomes were evaluated using regression models, dose-response analyses, and subgroup analyses. Predictive performance was assessed using receiver operating characteristic analysis. Both AIP and cumulative AIP were significantly associated with HDPs, including preeclampsia and preeclampsia with severe features, as well as neonatal intensive care unit (NICU) admission (all P < 0.05). Incorporating AIP into clinical models improved discrimination for preeclampsia (AUC 0.699 vs. 0.780, P = 0.025), severe preeclampsia (AUC 0.729 vs. 0.874, P = 0.002), and NICU admission (AUC 0.588 vs. 0.643, P = 0.029). Cumulative AIP produced similar improvements. In conclusion, elevated AIP and cumulative AIP are independently associated with increased risks of HDPs and NICU admission in women with GDM and may serve as practical cardiometabolic biomarkers for risk stratification.
The primary objective of this prospective cohort study was to assess changes in energy metabolism and body composition following unilateral adrenalectomy in patients with unilateral primary aldosteronism (UPA). Patients...The primary objective of this prospective cohort study was to assess changes in energy metabolism and body composition following unilateral adrenalectomy in patients with unilateral primary aldosteronism (UPA). Patients with UPA undergoing adrenalectomy were enrolled and underwent standardized evaluations before surgery and at a 3-month postoperative follow-up. 24-h energy metabolism and body composition were measured using whole-room indirect calorimetry and dual-energy X-ray absorptiometry (DXA), respectively. At 3 months after surgery, mean 24-h energy expenditure decreased from 1923.67 ± 378.85 to 1851.71 ± 353.90 kcal/day (P = 0.0063). Carbohydrate oxidation declined from 136.87 ± 29.75 to 122.53 ± 33.37 g/day (P = 0.013), whereas protein oxidation increased from 62.82 ± 17.51 to 70.09 ± 14.55 g/day (P < 0.001). Postoperative body composition showed a reduction in lean mass (44.70 ± 10.31 to 43.54 ± 10.44 kg; P < 0.001), an increase in fat mass (20.45 ± 6.76 to 21.15 ± 6.41 kg; P = 0.026), and a rise in body fat percentage (29.96 ± 5.36% to 31.36 ± 5.04%; P < 0.001). Body weight did not change significantly (p = 0.25). Concurrently, insulin sensitivity indices also changed, with a lower Matsuda index (P = 0.0010) and Quantitative Insulin Sensitivity Check Index (QUICKI) (P = 0.0098), and higher Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (P = 0.015). Unilateral adrenalectomy in patients with UPA is associated with a shift in postoperative metabolic phenotype, characterized by altered energy metabolism, body composition as well as insulin sensitivity. These findings underscore the need for individualized postoperative metabolic monitoring in this population.
Hypertensive disorders of pregnancy are a leading cause of maternal-fetal morbidity and mortality, with preeclampsia representing a major contributor to adverse outcomes. Ambulatory blood pressure monitoring (ABPM) has i...Hypertensive disorders of pregnancy are a leading cause of maternal-fetal morbidity and mortality, with preeclampsia representing a major contributor to adverse outcomes. Ambulatory blood pressure monitoring (ABPM) has improved risk stratification by identifying blood pressure phenotypes, particularly nocturnal hypertension. Given the shared autonomic mechanisms underlying nocturnal blood pressure elevation, a non-dipping heart rate pattern may theoretically provide additional prognostic information. We conducted a retrospective cohort study of 1336 high-risk pregnant women evaluated between 20 and 34 weeks of gestation using 24-h ABPM. Heart rate dipping was defined as a nocturnal reduction ≥10% compared with daytime values. Maternal and fetal outcomes included preeclampsia/eclampsia/HELLP syndrome, preterm birth, and low birth weight. A non-dipping heart rate pattern was observed in 39% of participants and was associated with higher office and ambulatory blood pressure levels and less favorable clinical profiles. Although non-dippers exhibited a higher absolute risk of adverse outcomes in unadjusted analyses, these associations were no longer significant after adjustment for established clinical risk factors and office blood pressure. Models incorporating ambulatory blood pressure averages showed substantial multicollinearity and did not support an independent prognostic role of heart rate non-dipping. Sensitivity analyses excluding women treated with beta-blockers yielded consistent results. In high-risk pregnancies, a non-dipping heart rate pattern assessed by ABPM reflects underlying blood pressure abnormalities but does not independently predict adverse maternal-fetal outcomes beyond conventional clinical and blood pressure parameters.
Reducing sodium intake in populations is essential, but insufficient for preventing and managing high blood pressure, while the importance of increasing potassium intake is overlooked. We investigated the effects of 1-ye...Reducing sodium intake in populations is essential, but insufficient for preventing and managing high blood pressure, while the importance of increasing potassium intake is overlooked. We investigated the effects of 1-year population-approach programs (2021-2022) promoting salt reduction and potassium intake using urinalysis feedback and food environment improvement. This retrospective observational study included 7649 participants (mean age, 54.0 years; 45.3% women) from 11 municipalities and 4 workplaces. Outcomes in intensive support programs-including urinary sodium, potassium, and sodium-to-potassium (Na/K) ratio measurements with feedback, dietary promotion, and food environment improvement-were compared with standard support programs providing usual health guidance. In linear regression adjusted for demographics, lifestyle factors, and medical history, the reduction in urinary Na/K ratio was greater in the intensive support group (n = 4064) than in the standard support group (n = 3585) (mean difference -0.14 [95% confidence interval, -0.27 to -0.01]). Although estimated potassium intake decreased in both groups, the decline was smaller in the intensive support group (mean difference 31 [12 to 51] mg/day). Estimated salt intake did not differ between the groups. The intensive support group showed greater increases in diastolic blood pressure and high-density lipoprotein cholesterol and smaller increases in blood glucose, as well as greater reductions in hemoglobin A1c and Salt Check Sheet scores. Mean differences between the groups for endpoints were not heterogeneous across intensive support program types. Our findings support the development of hypertension prevention and management strategies that promote healthier dietary behaviors and can be implemented in community and workplace settings, with broad public health applicability.
The oscillometric method is the predominant technique for non-invasive blood pressure (BP) measurement worldwide, and has enabled widespread adoption of home BP monitoring, which is crucial for hypertension management. H...The oscillometric method is the predominant technique for non-invasive blood pressure (BP) measurement worldwide, and has enabled widespread adoption of home BP monitoring, which is crucial for hypertension management. However, limitations in the usability of BP monitors, and particularly the pain and discomfort caused by excessive cuff inflation, can discourage consistent daily use of home BP monitors. To address this, we developed a novel oscillometric-based technology that reduces maximum cuff pressure (MaxCP) and measurement time while maintaining accuracy. We validated the performance of the novel method using a pre-existing dataset of oscillometric waveforms by comparing the estimated BP values with reference values obtained using the conventional method. The calculated BP values demonstrated high agreement with the conventional method, with intraclass correlation coefficients of 0.98 (systolic BP) and 0.94 (diastolic BP). Furthermore, the novel method reduced average MaxCP by 38.1 mmHg and measurement time by 6.3 s. These findings suggest that our approach can significantly enhance the user experience in BP monitoring without compromising measurement accuracy, potentially improving adherence to daily monitoring routines.
To explore the effect of the indoor environment on blood pressure (BP) at home, individuals moving into newly constructed, well-insulated, and well-ventilated apartment buildings were targeted in this study. The BP of th...To explore the effect of the indoor environment on blood pressure (BP) at home, individuals moving into newly constructed, well-insulated, and well-ventilated apartment buildings were targeted in this study. The BP of the participants was measured in February for two consecutive years before and after the participants moved. The analysis included 179 and 178 individuals with morning and evening BP measurements, respectively. No overall change in BP was observed before and after the participants moved. In the subgroup analysis, in the antihypertensive treatment group, the systolic and diastolic morning BP decreased by ~7 and 5 mmHg, respectively. In the hypertension and elderly participant groups, the systolic and diastolic BP decreased by ~4-6 mmHg and 2-4 mmHg, respectively. This reduction in BP correlated with the subjective temperature in the bedroom. These results demonstrate the impact of the indoor environment on BP control in apartments.
Liu J, Kario K, Ding X
… +16 more, Li Z, Gao T, Li Y, Zhang Y, Chen W, Chia YC, Fan Y, Hoshide S, Mao H, Shin J, Sukonthasarn A, Teo BW, Turana Y, Yao L, Zhang H, Wang JG
High-quality hypertension management is a new concept proposed to improve blood pressure (BP) control in Asia. Out-of-office BP measurements, including ambulatory and home BP monitoring, and wearable BP measurement, are...High-quality hypertension management is a new concept proposed to improve blood pressure (BP) control in Asia. Out-of-office BP measurements, including ambulatory and home BP monitoring, and wearable BP measurement, are recommended for BP assessment. Long-acting antihypertensive agents at full dose or in combination are priority strategies for achieving 24-h (24-h) BP control, reducing blood pressure variability (BPV) and improving time-in-target range (TTR). High-quality hypertension management across multiple disciplines will be a pragmatic strategy for the reduction in the risk of cardio-cerebrovascular and renal complications and mortality among Asian hypertensive patients.
Hypertens Res
· 2026 May · PMID 42120774
·
Publisher ↗
BMI alone may conceal biologically distinct vascular-aging phenotypes. In our external cohorts, osteoporosis tracked with wider pulse pressure and hypertension, while insulin resistance and triglycerides tracked with hig...BMI alone may conceal biologically distinct vascular-aging phenotypes. In our external cohorts, osteoporosis tracked with wider pulse pressure and hypertension, while insulin resistance and triglycerides tracked with higher systolic blood pressure and pulse pressure, supporting layered phenotyping in future blood pressure-trajectory analyses.
Patients in the post-advanced acute kidney injury (post-advanced AKI) period are vulnerable to cardiovascular complications, infection, and mortality. Whether seasonal influenza vaccination mitigates these risks after ad...Patients in the post-advanced acute kidney injury (post-advanced AKI) period are vulnerable to cardiovascular complications, infection, and mortality. Whether seasonal influenza vaccination mitigates these risks after advanced AKI remains unknown. To address this gap, we emulated a target trial using the global TriNetX electronic health record network. The hypothetical trial compared influenza vaccination versus no vaccination among adults in the post-advanced AKI period following dialysis-requiring AKI or decline in eGFR to <15 ml/min/1.73 m². After propensity score matching, vaccinated and unvaccinated cohorts were followed for one year. Primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and pneumonia. Secondary outcomes included, major adverse kidney events (MAKE), re-dialysis, and heart failure. Among 981,700 patients with post-advanced AKI, only 1.3% (n = 12,659) received influenza vaccination. Our analysis revealed that vaccination was associated with lower risks of all-cause mortality (aHR 0.73), MACE (aHR 0.54), pneumonia (aHR 0.51), MAKE (aHR 0.70), re-dialysis (aHR 0.57; all p < 0.001), and heart failure (aHR 0.62) after a mean follow-up of 11.7 months. Furthermore, a dose-response relationship was observed with repeated annual vaccination, and interrupted time-series analysis showed a 15.4-case monthly reduction in pneumonia per 1000 patients after vaccination. In this target trial emulation, influenza vaccination during the post-advanced AKI period was associated with substantially lower one-year risks of mortality, cardiovascular events, and pneumonia. These findings support integrating influenza vaccination into routine post-advanced AKI care to reduce clinical complications.
Arterial stiffness is a key marker of vascular aging. We compared the prognostic performance of brachial-ankle pulse wave velocity (baPWV) and estimated PWV (ePWV) for major adverse cardiovascular events (MACE). We retro...Arterial stiffness is a key marker of vascular aging. We compared the prognostic performance of brachial-ankle pulse wave velocity (baPWV) and estimated PWV (ePWV) for major adverse cardiovascular events (MACE). We retrospectively analyzed adults aged 40-75 years who underwent baPWV at a tertiary center (n = 9521). ePWV was computed from age and mean blood pressure. The primary endpoint was MACE (cardiac death, non-fatal myocardial infarction, coronary revascularization, non-fatal ischemic stroke). During a median follow-up of 3.77 years, 271 MACEs occurred (2.8%). Multivariable Cox regression models showed that higher arterial stiffness by both baPWV and ePWV was independently associated with increased MACE risk (P < 0.05 for each). Consistently, baPWV identified stepwise increases in risk from lower to higher categories and produced larger effect estimates. However, ePWV retained independent prognostic value but with a weaker gradient. With dichotomized cutoffs, C-index values were similar for baPWV and ePWV (0.736 vs. 0.728; P = 0.323). When participants were stratified into tertiles, baPWV showed superior discrimination, yielding a higher C-index than ePWV (0.755 vs. 0.729; P = 0.033) and clearer separation of Kaplan-Meier curves across risk strata. These findings indicate that both measures add information beyond traditional risk factors, but baPWV provides stronger risk stratification, particularly when risk is partitioned into multiple levels. ePWV remains a practical alternative in settings where device-based testing is not feasible.
Hypertension represents a major public health challenge in sub-Saharan Africa, characterised by substantial underdiagnosis and inadequate management. This secondary analysis of cross-sectional survey data examined the as...Hypertension represents a major public health challenge in sub-Saharan Africa, characterised by substantial underdiagnosis and inadequate management. This secondary analysis of cross-sectional survey data examined the association between physical activity patterns and hypertension prevalence amongst HIV-positive and HIV-negative populations in rural South African communities. Data were drawn from the ongoing Agincourt Health and Socio-Demographic Surveillance System Site (AHDSS), collected between August 2022 and May 2023, involving 4,436 participants aged ≥ 15 years. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) within the WHO STEPwise framework, and blood pressure was measured using an automated digital device (OMRON R6 wrist monitor). Statistical analyses employed chi-squared tests, two-sample t tests, and multivariable logistic regression models adjusting for demographic, anthropometric, metabolic, and behavioural confounders. Moderate physical activity was associated with lower odds of hypertension irrespective of HIV serostatus, supporting the integration of physical activity counselling into HIV care and primary healthcare services in resource-limited settings (adjusted OR = 0.74, 95% CI: 0.56-0.99, p = 0.043). Hypertension prevalence was 40.4% overall. HIV-positive males demonstrated higher prevalence (60.2%) compared with HIV-negative males (46.9%, p < 0.001). HIV-positive status was independently associated with increased odds of hypertension (adjusted OR = 1.45, 95% CI: 1.18-1.78). Age, male sex, obesity, elevated waist-hip ratio, and current alcohol consumption showed significant positive associations with hypertension. Moderate physical activity provides protective benefits against hypertension irrespective of HIV serostatus, supporting the integration of physical activity counselling into HIV care and primary healthcare services in resource-limited settings. Visual summary of key findings. Physical activity and hypertension amongst HIV-positive and HIV-negative populations in rural South Africa: moderate physical activity provides protective benefits against hypertension regardless of HIV status.
Cardiovascular diseases, particularly hypertension, remain a major global health burden, highlighting the need for accurate and accessible blood pressure (BP) monitoring. Cuffless BP measurement (BPM) based on pulse wave...Cardiovascular diseases, particularly hypertension, remain a major global health burden, highlighting the need for accurate and accessible blood pressure (BP) monitoring. Cuffless BP measurement (BPM) based on pulse wave propagation methods (PWPM), including pulse arrival time (PAT), pulse transit time (PTT), and pulse wave velocity (PWV), has attracted increasing research interest. This review comprises two components. First, a narrative review of studies published up to June 2025 examines sensing technologies, mathematical models, and validation protocols used in PWPM-based BPM. Second, a statistical re-evaluation of 22 studies published between 2015 and 2025 was conducted using the Credence of Device Acceptability (CDA) and the Probability of Tolerable Error (PTE), grounded in the statistical principles of ISO 81060-2. Accuracy varied widely across physiological conditions, sensing technologies, and study designs, with no single approach demonstrating consistent superiority. The re-evaluation provided a more stringent assessment of performance: only five studies achieved CDA values exceeding 0.95 for both systolic and diastolic BP. Overall, diastolic BP estimation demonstrated superior accuracy compared with systolic BP. Incorporating physiological indices such as arterial compliance and sympathetic activity may improve the robustness and accuracy of BP estimation models. While machine learning shows promise for enhanced feature extraction, calibration tolerance and real-world reliability remain critical challenges. Importantly, the evaluation and development of cuffless BPM technologies should align with validation standards appropriate to the intended application. We recommend that future early-stage studies apply the CDA and PTE framework as supportive accuracy metrics to better assess methodological performance and inform device development and validation.