The association between maternal morning blood pressure (BP) levels and adverse pregnancy outcomes (APOs), including severe preeclampsia, target organ damage, preterm birth, placental abruption, postpartum hemorrhage, sm...The association between maternal morning blood pressure (BP) levels and adverse pregnancy outcomes (APOs), including severe preeclampsia, target organ damage, preterm birth, placental abruption, postpartum hemorrhage, small-for-gestational-age infants, and pregnancy loss, is not well understood. In a retrospective cohort study of 1833 high-risk singleton pregnancies with outpatient ambulatory BP monitoring, 26.7% had morning hypertension. Morning BP strongly correlated with non-morning daytime BP (Pearson r = 0.89) and nighttime BP (r = 0.78), but only moderately with office BP (r = 0.54). Compared to office BP, adding morning BP improved diagnostic accuracy for nighttime, masked, and non-morning daytime hypertension (Δ area under the curve 0.062 to 0.127, all P < 0.001). A J-shaped, non-linear association was observed between morning BP and the risk of composite APOs, with identified thresholds at systolic/diastolic BP ≥ 132/79 mmHg. Isolated morning hypertension, compared to isolated nighttime or non-morning daytime hypertension, did not independently increase composite APO risk. However, co-occurrence of morning hypertension with nighttime (odds ratio [OR] 3.16, 95% confidence interval [CI]: 2.34 to 4.27) or non-morning daytime (OR 3.41, 95% CI: 2.54 to 4.60) hypertension amplified the risks for APOs. The strongest association between co-occurring morning and nighttime hypertension and APO risk was observed between 28 and 34 weeks of gestation (OR 5.50, 95% CI: 2.13 to 7.43). Sensitivity analyses with alternative morning time windows and adjustments for non-morning mean arterial pressure consistently confirmed these findings. Our findings support morning BP measurement as a valuable and practical marker for screening and identifying high-risk BP patterns during pregnancy.
Hypertens Res
· 2026 Apr · PMID 41714711
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The sympathetic nervous system plays a pivotal role in the pathophysiology of hypertension. Although the contribution of the sympathetic nervous system to an elevation of blood pressure is well established, the determina...The sympathetic nervous system plays a pivotal role in the pathophysiology of hypertension. Although the contribution of the sympathetic nervous system to an elevation of blood pressure is well established, the determinants of persistent sympathetic overactivity remain incompletely understood. This review summarizes the findings of recent basic research that have expanded the understanding of sympathetic regulation in hypertension, highlighting emerging mechanisms and providing insights into the development of novel therapeutic strategies.
Hypertens Res
· 2026 Apr · PMID 41714710
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Constant light (LL) disrupts biological rhythms, although more data are available on circadian than on ultradian rhythms. LL has been linked to elevated blood pressure (BP), although most evidence comes from tail-cuff pl...Constant light (LL) disrupts biological rhythms, although more data are available on circadian than on ultradian rhythms. LL has been linked to elevated blood pressure (BP), although most evidence comes from tail-cuff plethysmography in males. However, in nocturnal animals, LL should suppress activity, increase sleep, and lower BP. Therefore, the aim of this study is to provide a comprehensive analysis of the impact of LL on (1) cardiovascular parameters and sleep and (2) circadian and ultradian variability in female rats. We used telemetry for continuous monitoring of heart rate (HR), BP, and locomotor and sleep-wake activity in female rats exposed to LL for four weeks. LL progressively reduced basal systolic BP and HR and weakened the strength of circadian rhythms. Moreover, the loss of daily variability enhanced the acute cardiovascular response. Spectral analysis revealed disrupted ultradian rhythms, with HR power shifting from longer (~7-9 h) to shorter (~1-3 h) periods and locomotor activity showing a parallel decline, including a complete loss of 7-9 h rhythms by week 4. HR variability and baroreflex analysis showed parasympathetic dominance under LL. Sleep analysis revealed significant sleep disruption, characterised by altered distribution of sleep-wake states, reduced non-REM sleep during the light phase, increased fragmentation, and a complete loss of circadian organisation. LL reduced BP in female rats despite leaving total sleep duration largely unchanged, while markedly disrupting cardiovascular circadian and ultradian variability and sleep architecture. These findings suggest that LL-induced chronodisruption imposes a maladaptive physiological load also in nocturnal rodents.
The incremental value of 24-hour central systolic blood pressure in identifying target organ damage based on blood pressure phenotypes remains unclear. This multicenter, cross-sectional study enrolled 2589 non-dialysis p...The incremental value of 24-hour central systolic blood pressure in identifying target organ damage based on blood pressure phenotypes remains unclear. This multicenter, cross-sectional study enrolled 2589 non-dialysis patients with chronic kidney disease. Clinic and ambulatory brachial blood pressure were used to define blood pressure phenotypes. The net reclassification index and logistic regression analyses were performed. 24-h central systolic blood pressure gradually elevated across four blood pressure phenotypes with a linear trend (P-trend <0.001). Incorporating 24-h central systolic blood pressure into blood pressure phenotypes significantly improved target organ damage discrimination, particularly 24-h central systolic blood pressure with c2 calibration (mean arterial pressure and diastolic blood pressure calibration method) for left ventricular hypertrophy (NRI = 0.192, 95% CI [0.085-0.298], P < 0.001). Multivariable logistic regression revealed that, compared with normotension without central systolic hypertension (c2 calibration), only masked hypertension and sustained hypertension with central systolic hypertension (c2 calibration) had significantly increased odds of both left ventricular hypertrophy (ORs: 3.220 [95% CI, 1.861-5.537; P < 0.001] and 4.054 [95% CI, 2.772-5.996; P < 0.001]) and carotid hypertrophy (ORs: 2.059 [95% CI, 1.240-3.461; P = 0.006] and 1.368 [95% CI, 1.001-1.860; P = 0.049]). Moreover, the prevalence of kidney injury was higher in the masked hypertension and sustained hypertension groups with central systolic hypertension (c2 calibration) than in the group without central systolic hypertension (c2 calibration). 24-h central systolic blood pressure may provide additional value for target organ damage risk stratification based on blood pressure phenotypes in non-dialysis patients with chronic kidney disease.
Ikeda N, Yamaguchi M, Kashino I
… +2 more, Miura K, Nishi N
Hypertens Res
· 2026 Apr · PMID 41714708
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Excessive dietary salt intake remains a major public health concern in Japan and worldwide, contributing to noncommunicable diseases, including hypertension and cardiovascular disease. Although national health promotion...Excessive dietary salt intake remains a major public health concern in Japan and worldwide, contributing to noncommunicable diseases, including hypertension and cardiovascular disease. Although national health promotion strategies in Japan have emphasized behavioral change through nutrition education and awareness campaigns to achieve population-level salt-reduction targets, average intake continues to exceed recommended levels. This suggests that the food environment needs structural modifications through multisectoral collaboration to increase the nutritional quality of consumer foods and the availability of healthier options. Voluntary reformulation by the food industry is a key component of these efforts. To support voluntary reformulation, we developed a practical guide for setting salt-reduction targets and planning feasible reformulation strategies, informed by consultation with registered dietitians working in national and local governments, reviews of guidance documents and voluntary corporate initiatives in other high-income countries, and feedback from Japanese food companies on the draft guide. This guide promotes target setting aligned with the Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) framework for goal-setting and outlines methodological options for product scope, nutrient focus (salt alone, or salt and other nutrients such as fat and sugar), metrics, sodium criteria, and implementation timelines. The guide also addresses organizational structures and collaboration with external stakeholders. Business incentives are highlighted, including opportunities for product innovation, contributions to environmental, social, and governance performance, and the building of consumer trust. By providing a structured and adaptable framework, the guide aims to foster coordinated industry engagement in salt reduction to prevent hypertension and cardiovascular disease. This mini review presents a guide to help Japanese food companies set voluntary salt-reduction targets and plan feasible product reformulation strategies. It integrates international guidance, registered dietitians' and companies' feedback, and the SMART framework to help translate policy goals into actionable objectives, promoting consistent salt reduction across the food industry.
Emerging evidence links maternal immune dysregulation to hypertensive disorders of pregnancy (HDP), yet gestational immune alterations preceding symptom onset remain unclear. This study aimed to evaluate the associations...Emerging evidence links maternal immune dysregulation to hypertensive disorders of pregnancy (HDP), yet gestational immune alterations preceding symptom onset remain unclear. This study aimed to evaluate the associations between first-trimester immune biomarkers and incident HDP risk across clinical subtypes. This retrospective cohort study enrolled pregnant women aged ≥18 years undergoing first-trimester antenatal screening at a tertiary hospital from March to November 2023. First-trimester peripheral immune markers-neutrophils, monocytes, lymphocytes, and platelets-were measured, with derived indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI). Outcomes included HDP, gestational hypertension (GHTN), and preeclampsia confirmed via electronic medical records. Multivariable logistic regression models were performed to evaluate the relationship between peripheral immune markers and outcomes. Among the 2739 pregnant women who met inclusion criteria, 195 developed HDP, including 96 GHTN and 99 preeclampsia. Multivariable logistic regression demonstrated that first-trimester neutrophils, monocytes, platelets, lymphocytes, SII, and AISI were independently and positively associated with HDP risk in a linear dose-response manner (all FDR P < 0.05), with platelets exhibiting the strongest association (OR : 2.20; per log-SD: OR = 1.55). Distinct biomarker profiles were identified between GHTN and preeclampsia: GHTN exhibited associations with neutrophils, platelets, SII, and AISI, while preeclampsia correlated with monocytes, platelets, lymphocytes, SII, and AISI (all FDR P < 0.05). Elevated first-trimester immune markers correlate with HDP, particularly platelet-related indices. Divergent immune signatures between GHTN and preeclampsia suggest subtype-specific pathophysiological mechanisms.
Kanai M, Park S, Miki T
… +4 more, Hagiwara Y, Hashimoto A, Nambo H, Karashima S
Hypertens Res
· 2026 Apr · PMID 41699289
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Mobile health (mHealth)-based disease management programs enable continuous monitoring of blood pressure (BP) and related health behaviors. Feature engineering may help to extract informative predictors from longitudinal...Mobile health (mHealth)-based disease management programs enable continuous monitoring of blood pressure (BP) and related health behaviors. Feature engineering may help to extract informative predictors from longitudinal data, potentially improving BP change prediction. This study aimed to evaluate whether feature-engineered predictors can improve the prediction of systolic BP (SBP) changes using an mHealth-based disease management program. We analyzed data from participants with hypertension, dyslipidemia, or diabetes mellitus who completed the 24-week Mystar program, which combined phone-based coaching, remote monitoring, and app-based logging of BP and behavioral data. The primary outcome was the change in morning SBP from baseline to the end of the program. Prediction models for SBP changes were developed using ElasticNet regression at weeks 4, 8, 12, and 22 by comparing models with and without feature-engineered variables generated by feature tools. In total, 2318 participants were included in the analysis. At week 4, the top feature after feature engineering showed a stronger correlation with SBP change (r = 0.561) than the best original predictor (r = 0.455), although the model-level performance was similar (r = 0.561 vs. 0.559). By week 22, both models achieved a high correlation of approximately 0.85 with no substantial difference in performance. Feature engineering increased the correlation between individual predictors and SBP change in the early phase; however, the overall prediction performance of the ElasticNet model remained largely unchanged. Further studies are required to confirm these findings and examine their applicability in broader clinical and implementation contexts. Data from a 24-week mHealth-based program were analyzed to predict systolic blood pressure SBP changes using feature-engineered variables and ElasticNet regression. In the early phase, feature-engineered predictors ranked highest in importance, although overall model performance remained similar with and without feature engineering. Prediction accuracy improved over time, with correlations reaching ~0.85 by week 22.
Ohya Y, Arakawa K, Arata N
… +57 more, Arima S, Arima H, Asayama K, Dohi Y, Fukami A, Furuhashi M, Goto K, Goto R, Hatta T, Hirawa N, Hirooka Y, Hisamatsu T, Hoshide S, Ikezumi Y, Inoue S, Ishida M, Ishimitsu T, Iwashima Y, Kabayama M, Kabutoya T, Kai H, Kaneko H, Kanno Y, Katsuya T, Kikuchi T, Koga M, Kudo M, Kuwabara M, Matsumura K, Metoki H, Mito A, Miura SI, Miura K, Miyashita K, Mogi M, Kawakami-Mori F, Morimoto S, Mukai M, Mukoyama M, Munakata M, Nakagawa N, Ohkubo T, Okura T, Rakugi H, Shibata S, Shinohara K, Takami T, Takase H, Takemi Y, Tanaka A, Tomiyama H, Toyoda K, Tsuchihashi T, Ueda S, Yamamoto E, Yamamoto K, Sakima A
Bayaraa N, Yano Y, Kadota A
… +11 more, Azahar NM, Phap TNH, Hisamatsu T, Kondo K, Torii S, Fujiyoshi A, Ohkubo T, Shiino A, Nozaki K, Miura K, SESSA Research Group
Hypertens Res
· 2026 Apr · PMID 41688592
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Hypertension, encompassing white-coat hypertension (WCH), masked hypertension (MH), and sustained hypertension (SH), is an established risk factor for cardiovascular diseases (CVDs), including atherosclerosis. However, a...Hypertension, encompassing white-coat hypertension (WCH), masked hypertension (MH), and sustained hypertension (SH), is an established risk factor for cardiovascular diseases (CVDs), including atherosclerosis. However, among the general population, findings on which target organ is affected by the different phenotypes of hypertension remain unclear. In this community-based observational study of Shiga Epidemiological Study of Subclinical Atherosclerosis, 740 Japanese men underwent brain magnetic resonance imaging to assess the presence of lacunar infarction, white-matter hyperintensities, microbleeds, and intracranial artery stenosis (ICAS) between 2012 and 2015. They also underwent office blood pressure (BP) measurements, home BP monitoring for at least five consecutive days, and coronary artery calcification (CAC) assessments between 2010 and 2014. The final analysis included 686 participants without a history of CVDs. Of the 686 participants, the mean age ( ± SD) was 68.0 ( ± 8.3) years, and 39.3% were taking antihypertensive medication. In multivariable-adjusted models, each of WCH, MH, and SH was significantly associated with a higher risk of microbleeds compared to normotension. However, the association of WCH with microbleeds was evident only among those on antihypertensive medication (adjusted odds ratio [OR] 6.75 [95% CI 1.83-24.86]) and absent in those not on such medication (adjusted OR 1.20 [95% CI 0.31-4.73]). SH was associated with lacunar infarction, ICAS, and CAC. Among Japanese men, WCH, MH, SH were associated with subclinical cerebrovascular diseases, whereas only SH was associated with CAC. Moreover, any elevated BP phenotype increased the risk of microbleeds. Our findings suggest that different hypertension phenotypes distinctly affect target organs, particularly the brain and heart.
We investigated the prognostic value of within-visit and short- and long-term between-visit blood pressure variability (BPV) for all-cause and cardiovascular mortality, fatal and nonfatal cardiovascular events and incide...We investigated the prognostic value of within-visit and short- and long-term between-visit blood pressure variability (BPV) for all-cause and cardiovascular mortality, fatal and nonfatal cardiovascular events and incident atrial fibrillation in an elderly Chinese population. Participants were elderly (≥65 years) inhabitants, enrolled in a trial for atrial fibrillation screening. Blood pressure was measured three times consecutively at baseline and in a subset also at least two weekly visits during the first month of follow-up or at least two quarterly visits during the first year of follow-up. BPV indices included standard deviation, coefficient of variation, and other statistical measures. We computed hazard ratios (HR) for the risks of clinical outcomes associated with a 1-SD increase in these BPV indices, while accounting for confounding factors. Among 6711 participants, diastolic within-visit BPV indices were significantly (P ≤ 0.02) and positively associated with the risks of all-cause and cardiovascular mortality, and fatal and nonfatal cardiovascular events, but systolic BPV indices were negatively associated with the risk of incident atrial fibrillation (HRs 1.03-1.09 and 0.87-0.92, respectively). Among 362 participants, none of the short-term between-visit BPV indices were associated with the clinical outcomes (P ≥ 0.09). For the long-term between-visit BPV among 1582 participants, significant associations were observed for systolic BPV indices in relation to cardiovascular mortality (P ≥ 0.03), and diastolic BPV indices in relation to incident atrial fibrillation (P ≤ 0.03), with the HRs ranging from 1.05-1.43, and from 1.07-1.20, respectively. In conclusion, some of the BPV indices were weakly associated with the risk of mortality, cardiovascular events and incident atrial fibrillation.
Recent studies indicate a stronger association between the urinary sodium-to-potassium (Na/K) ratio and blood pressure (BP) than individual sodium (Na) or potassium (K) levels. This study aimed to examine whether urinary...Recent studies indicate a stronger association between the urinary sodium-to-potassium (Na/K) ratio and blood pressure (BP) than individual sodium (Na) or potassium (K) levels. This study aimed to examine whether urinary Na/K ratio could predict the onset of hypertension in the general population. The ratio was calculated using overnight urine samples from 23,014 adults (mean age; 51.4 ± 13.2 years, 13,525 men) who underwent annual physical checkups between 2010 and 2023. Cross-sectional analysis of first-visit data revealed significantly higher Na/K ratios among individuals with hypertension compared to normotensive individuals (5.05 ± 2.85 vs. 4.39 ± 2.47, p < 0.001). Multiple regression analysis showed a significant association between the Na/K ratio and systolic BP. After excluding participants with hypertension, 12,483 normotensive individuals (48.7 ± 11.9 years; 7087 men) were followed for a median of 1788 days. During the follow-up period, 4056 participants developed hypertension. Kaplan-Meier analysis indicated an increased risk of hypertension across baseline Na/K ratio quartiles (log-rank, p < 0.001). Univariate Cox regression analysis identified the Na/K ratio as a significant predictor of incident hypertension, with hazard ratios increasing across quartiles. Multivariate analysis confirmed the association (hazard ratio [HR] = 1.408, 95% confidence interval [CI]; 1.225-1.619), although the Na/K ratio was not independently associated with hypertension onset after additional adjustment for baseline systolic BP. These findings suggest that the urinary Na/K ratio is significantly associated with the risk of hypertension in the general population. Therefore, dietary interventions that lower the Na/K ratio may prevent the development of hypertension.
Arima H, Itoh H, Ohkubo T
… +39 more, Ohya Y, Kabayama M, Kishi T, Hirawa N, Miura K, Miura SI, Yamamoto K, Yoshimura C, Rakugi H, Asayama K, Inoue T, Ohishi M, Kusaka M, Goto K, Shimosawa T, Nishiyama A, Hoshide S, Yano Y, Kaneko K, Uesugi F, Shigyo M, Suenaga E, Masujima T, Kawachi S, Okayama A, Miyakawa M, Miyamatsu N, Nakamura K, Saito I, Murakami Y, Ishida M, Kitagawa K, Ohnishi H, Okada H, Fujioka Y, Ogawa Y, Shide K, Inoue S, Japanese Society of Hypertension Committee on the Guidelines for Blood Pressure Control Using Digital Technologies