Gallagher A, Smyth B, Alexeev S
… +6 more, Mangos G, Schutte AE, Sharman JE, Jardine MJ, Brown MA, Inpatient Blood Pressure Measurement Expert Panel
Hypertension
· 2026 Jun · PMID 41930396
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BACKGROUND: Accuracy of blood pressure (BP) measurement depends on quality technique, yet there are no existing guidelines for accurate measurement of inpatient BP. We assessed the performance of BP measurements in a maj...BACKGROUND: Accuracy of blood pressure (BP) measurement depends on quality technique, yet there are no existing guidelines for accurate measurement of inpatient BP. We assessed the performance of BP measurements in a major teaching hospital by comparison with consensus criteria. METHODS: Routine BP measurement methods were observed across 3 noncritical care wards (aged care, acute surgical, and hematology) at St George Hospital, Sydney, over a 3-week period. Aspects of BP measurement were compared for concordance with an ideal BP measurement technique, consisting of 10 consensus criteria, as determined by an expert panel. RESULTS: A total of 278 BP measurements were observed in 153 patients. Concordance with the consensus criteria was high for device calibration (92%), uncrossed legs (82%), using the correct cuff size (77%), and back support (75%). Concordance was moderate for the criteria of correctly positioned cuff on a bare arm (both 65%), and poor for the remaining criteria (seated position [26%], no talking [23%], cuff at heart height [15%], and taking at least 2 measurements [7%]). No observed measurement met all 10 of the consensus criteria for BP measurement quality. CONCLUSIONS: Our findings indicate considerable discordance between routine BP measurement and optimal technique (as determined by an expert panel) in an Australian hospital setting. The lowest concordance was observed for the 3 highest-ranked consensus criteria for accurate BP measurement. This variability may result in inaccurate and biased readings. Standardized, hospital-specific BP measurement guidelines and training are needed to improve BP measurement accuracy.
Hypertension
· 2026 May · PMID 41906910
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Primary aldosteronism is the most common surgically treatable form of hypertension. Surgically amenable forms are characterized by lateralized aldosterone overproduction, which may occur along a spectrum ranging from tru...Primary aldosteronism is the most common surgically treatable form of hypertension. Surgically amenable forms are characterized by lateralized aldosterone overproduction, which may occur along a spectrum ranging from true unilateral hypersecretion to asymmetrical bilateral production. Historically attributed to solitary aldosterone-producing adenomas, lateralized primary aldosteronism is now recognized to encompass a range of histopathologic lesions, including aldosterone-producing micronodules, reflecting a continuum from subclinical autonomous secretion to overt primary aldosteronism. This review synthesizes recent evidence demonstrating how histopathology, genetics, and cellular mapping can collectively explain some of the heterogeneity in surgical outcomes. The Histopathology of Primary Aldosteronism consensus classifies lateralized primary aldosteronism into classical (aldosterone-producing adenoma-predominant) and nonclassical (aldosterone-producing micronodule-predominant) forms, with the former linked to biochemical remission and the latter associated with persistent or recurrent aldosteronism. Somatic driver mutations further correlate with histology and outcomes, while single-cell and spatial omics data reveal distinct pathogenic trajectories and metabolic profiles underlying tumor progression. Together, these advances offer a more precise, pathophysiology-based framework to improve diagnosis, subtyping, and outcome prediction, advancing tailored management for this disease.
Hypertension
· 2026 Jun · PMID 41906877
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BACKGROUND: Although some individuals exhibit salt sensitivity, others demonstrate salt resistance or inverse salt sensitivity-blood pressure reduction during a high-sodium diet. The molecular mechanisms underlying heter...BACKGROUND: Although some individuals exhibit salt sensitivity, others demonstrate salt resistance or inverse salt sensitivity-blood pressure reduction during a high-sodium diet. The molecular mechanisms underlying heterogeneous blood pressure responses to dietary sodium remain poorly understood. METHODS: We conducted a randomized crossover trial in 20 adults (blood pressure <140/90 mm Hg), comparing 8-day low-sodium (10 mmol/d) versus high-sodium (300 mmol/d) diets. Plasma proteomics used SomaLogic's 7K v4.1 platform (≈7000 proteins). Protein changes between diets were compared with blood pressure changes. RESULTS: Despite higher weight (+1.4 kg) during high-sodium diet (=1.08×10), diastolic blood pressure (67.0±7.5 versus 69.7±8.0 mm Hg, =0.009), and mean arterial pressure (82.1±7.6 versus 84.8±8.3 mm Hg; =0.006) were significantly lower. Thus, our participants exhibited inverse salt sensitivity. In body mass index-adjusted models, 2 independent aptamers targeting SVEP1 (sushi, von Willebrand Factor type A, EGF [Epidermal Growth Factor], and pentraxin domain-containing 1) ranked second (Benjamini-Hochberg-adjusted; =7.08×10) and sixth (Benjamini-Hochberg-adjusted =4.42×10) among all measurements, outranking established sodium-regulatory hormones including renin (14th) and NT-proBNP (N-terminal pro-B-type natriuretic peptide; 25th). SVEP1 upregulation correlated inversely with blood pressure changes (=-0.51; =0.026). SVEP1 changes correlated strongly with NT-proBNP (=0.80, <0.001). Reactome analysis revealed coordinated extracellular matrix remodeling as the dominant biological response to sodium loading. CONCLUSIONS: SVEP1 emerges as a key molecular correlate of blood pressure responses to dietary sodium, likely through a volume- or stretch-mediated stimulus. Given SVEP1's established functions in vascular smooth muscle relaxation and lymphangiogenesis, these findings suggest novel pathways mediating cardiovascular adaptation to sodium challenges and potential biomarkers for identifying salt-sensitive versus salt-resistant individuals.
Panarelli A, Araujo-Castro M, Mermejo LM
… +29 more, Turcu AF, Kim JH, Park SS, Bioletto F, Parasiliti-Caprino M, Sone M, Markou A, Puar T, Kmieć P, Mulatero P, Wada N, Tsuiki M, González-Boillos M, Jimenez López N, Yoneda T, Ceccato F, de Castro M, Espiard S, Ichijo T, Izawa S, Murakami M, Palmieri S, Favero V, Katabami T, Falhammar H, Naruse M, Quinkler M, Reincke M, Nowak E
Hypertension
· 2026 May · PMID 41884892
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BACKGROUND: Bilateral macronodular adrenocortical disease is often linked to autonomous cortisol secretion, but may also present with primary aldosteronism (PA). METHODS: This international (Europe, United States, Asia)...BACKGROUND: Bilateral macronodular adrenocortical disease is often linked to autonomous cortisol secretion, but may also present with primary aldosteronism (PA). METHODS: This international (Europe, United States, Asia) retrospective cohort study included adults with radiological evidence of bilateral macronodular adrenocortical disease and biochemically confirmed PA. The primary endpoints was major adverse cardiovascular events (MACE); secondary end points included cardiometabolic comorbidities and surgical outcomes per PA surgical outcome criteria. RESULTS: Two hundred forty-nine patients from 41 centers in 12 countries were included (median age, 55 years; 62% male). Median hypertension duration at PA diagnosis was 9.9 years. Among 178 tested, 52% had cortisol cosecretion and 47% isolated PA. At baseline, 56% had metabolic comorbidities, and 16% had ≥1 MACE. Patients with MACE were older, more often male, had longer hypertension duration, and higher diabetes rates. Eighty-nine patients underwent adrenalectomy: 50 without MRA (mineralocorticoid receptor antagonists), 38 with MRA, and 1 with steroidogenesis inhibitors. One hundred twenty-four patients received continued MRA without adrenalectomy or steroidogenesis inhibitors. Adrenal venous sampling showed lateralized PA in 89% of surgical versus 19% of MRA-treated patients (<0.001). Over a median follow-up of 36 (MRA) and 18 months (surgery; =0.2), MACE occurred in 8% and 6%, respectively (=1.0). Blood pressure and organ damage were similar, but more MRA-treated patients needed ≥3 antihypertensives (MRA: 48% versus adrenalectomy: 14%; <0.001). Among operated patients, complete clinical and biochemical success was 26% and 71%, respectively. CONCLUSIONS: Bilateral macronodular adrenocortical disease with PA carries a high cardiometabolic burden. Early detection and precise subtyping are key to optimizing management and preventing target organ damage.
Varzideh F, Mone P, Kansakar U
… +3 more, Pande S, Jankauskas SS, Santulli G
Hypertension
· 2026 Jun · PMID 41884885
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Hypertension remains the most prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide, yet rates of effective blood pressure control remain persistently suboptimal despite the availability o...Hypertension remains the most prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide, yet rates of effective blood pressure control remain persistently suboptimal despite the availability of multiple therapeutic options. This gap reflects fundamental limitations of current care models, which rely on episodic measurements, population-based treatment algorithms, and incomplete representation of the biological, behavioral, and social complexity underlying blood pressure regulation. Artificial intelligence (AI) offers a transformative framework to address these challenges by enabling the integration of longitudinal, multimodal data and modeling nonlinear, dynamic relationships that are difficult to capture with conventional approaches. This systematic review synthesizes emerging evidence on the application of AI across the hypertension care continuum, including risk prediction, phenotyping, blood pressure measurement, wearable-based monitoring, clinical trial analysis, population health modeling, detection of secondary hypertension, behavioral and adherence interventions, and multi-omics-driven precision medicine. We highlight the methodological foundations required for clinically meaningful AI, emphasizing robust ground-truth definitions, external and temporal validation, interpretability, workflow integration, and equity-aware design. The review also examines the promise and limitations of natural language processing, cuffless blood pressure technologies, and AI-guided decision support systems, alongside ethical, regulatory, and implementation challenges. Collectively, current evidence suggests that AI has the potential to shift hypertension management from a reactive, threshold-based paradigm toward a more predictive, personalized, and patient-centered model. Realizing this potential will depend on rigorous validation, thoughtful implementation, and sustained alignment with clinical, ethical, and equity principles.
Saji AM, Chandarana R, Pana TA
… +2 more, Carter B, Myint PK
Hypertension
· 2026 Jun · PMID 41878817
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The heritability of hypertensive disorders of pregnancy (HDP) and HDP's association with cardiovascular disease in adult offspring were explored through a systematic review and meta-analysis. MEDLINE and EMBASE were sear...The heritability of hypertensive disorders of pregnancy (HDP) and HDP's association with cardiovascular disease in adult offspring were explored through a systematic review and meta-analysis. MEDLINE and EMBASE were searched independently by 2 reviewers (inception to February 18, 2025). Maternal chronic hypertension, antenatal complications, and pediatric cardiovascular disease were excluded. The Critical Appraisal Skills Program checklist was used for critical appraisal. Random-effects meta-analysis was conducted using a generic inverse variance method. Narrative synthesis and pooled results were expressed as odds ratios with 95% CIs. Of 225 studies screened, 11 studies (n=59 185; 48.3% women) assessed cardiovascular disease, and 9 studies (n=58 512) assessed HDP. Offspring age ranged from 19 to 55 years. There were 11 good- and 9 fair-quality studies. Fifteen studies were included in the meta-analysis (n=266 244). Adult offspring exposed to HDP had systolic and diastolic blood pressure that was 3.40 mm Hg (95% CI, 2.44-4.37; I=40%) and 2.19 mm Hg higher (95% CI, 1.40-2.98; I=51%). Higher odds of hypertension were observed (odds ratio, 1.50 [95% CI, 1.18-1.91]; I=66%). Female offspring exhibited 72% increased odds of HDP (OR, 1.72 [95% CI, 1.41-2.09]; I=81%) and 90% increased odds of preeclampsia (odds ratio, 1.90 [95% CI, 1.47-2.46]; I=36%) following exposure to the same disorders. Increased odds of premature acute coronary syndrome and higher stroke risk were observed following HDP and severe preeclampsia exposure, respectively. In adult offspring, heritability of HDP was high. HDP were associated with hypertension, acute coronary syndrome, and stroke. Lifestyle modifications, cardiovascular disease monitoring, and prevention are paramount.
Chang YC, Hung CS, Chen ZW
… +10 more, Chang YY, Chang CC, Lu CC, Lee BC, Chueh JS, Wang SM, Wu VC, Tsai CH, Lin YH, TAIPAI Study Group
Hypertension
· 2026 May · PMID 41878808
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BACKGROUND: Sex differences influence cardiovascular risk assessment and management; however, their role in aldosterone-mediated cardiac remodeling in primary aldosteronism remains incompletely understood. METHODS: We co...BACKGROUND: Sex differences influence cardiovascular risk assessment and management; however, their role in aldosterone-mediated cardiac remodeling in primary aldosteronism remains incompletely understood. METHODS: We conducted a retrospective study of 547 patients with primary aldosteronism, including 249 men and 298 women. Clinical and echocardiographic data were collected at baseline and 1 year following aldosterone-targeted therapies. RESULTS: The mean age was 53.8 years in men and 54.6 years in women. At baseline, men had a higher left ventricular mass index (LVMI), whereas women had a higher prevalence of left ventricular (LV) hypertrophy and worse diastolic function, as indicated by a higher ratio of early diastolic transmitral to mitral annular velocity (E/e') and left atrial volume index. In multivariable analyses, plasma aldosterone concentration (PAC) was associated with baseline LVMI in both sexes. Associations between PAC and baseline diastolic indices, including E/e' and left atrial volume index, were observed in men but not in women in sex-stratified models. However, formal interaction testing did not demonstrate significant sex-by- PAC interactions for left atrial volume index, E/e', or LAVI. After 1 year of treatment, LVMI reduction was comparable between sexes. Improvement in E/e' was significantly less pronounced in women. LAVI decreased significantly in men but not in women, although between-sex differences in change were not statistically significant. CONCLUSIONS: Sex-specific differences in cardiac remodeling and diastolic function were observed in patients with primary aldosteronism. Despite lower baseline LVMI, women exhibited a more adverse cardiac phenotype, with a higher prevalence of left ventricular hypertrophy and worse diastolic function. Following aldosterone-targeted therapies, structural regression was similar between sexes, whereas diastolic function improved to a lesser extent in women.
Zeng J, Li D, Wang J
… +14 more, Wang R, Huang Z, Bai D, Liu X, Sun D, Fu G, Kang K, Liu X, Yang L, Zhao F, Luo L, Li R, Zhang Y, Gou D
Hypertension
· 2026 Jun · PMID 41873540
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BACKGROUND: Pulmonary hypertension (PH) is a progressive disease marked by pulmonary arterial remodeling and right ventricular dysfunction. The molecular mechanisms driving this remodeling, particularly ECM (extracellula...BACKGROUND: Pulmonary hypertension (PH) is a progressive disease marked by pulmonary arterial remodeling and right ventricular dysfunction. The molecular mechanisms driving this remodeling, particularly ECM (extracellular matrix)-mediated processes, remain poorly understood. This study investigates THBS4 (thrombospondin-4), an ECM glycoprotein, as a key regulator of pulmonary vascular remodeling in pulmonary hypertension. METHODS: Whole-transcriptomic analysis was conducted on pulmonary arteries from rat models of pulmonary hypertension induced by hypoxia, hypoxia-SUGEN, and monocrotaline. THBS4 expression was measured in these models and in serum and lung tissue from patients with pulmonary arterial hypertension. The role of HIF-1α (hypoxia-inducible factor 1-alpha), SMAD2 (mothers against decapentaplegic homolog 2), and p38 MAPK (mitogen-activated protein kinase) signaling pathways in regulating THBS4 was explored. Functional assays assessed THBS4's impact on pulmonary artery smooth muscle cells. In vivo, THBS4 silencing was performed to evaluate its effect on vascular remodeling and right ventricular hypertrophy. RESULTS: THBS4 was upregulated in pulmonary arteries across all pulmonary hypertension models, with expression correlating with disease severity. Elevated THBS4 levels were observed in pulmonary arterial hypertension patient serum and lung tissue. Hypoxia-induced THBS4 expression was mediated by HIF-1α, while TGF (transforming growth factor)-β1 stimulation enhanced THBS4 via SMAD2 and p38 MAPK pathways. THBS4 promoted pulmonary artery smooth muscle cell proliferation, phenotypic modulation, and ECM remodeling. In vivo silencing of THBS4 attenuated pulmonary vascular remodeling and right ventricular hypertrophy. CONCLUSIONS: Our findings identify THBS4 as a central regulator in a self-reinforcing THBS4-TGF-β/SMAD2 signaling axis driving pulmonary vascular remodeling. Targeting THBS4 represents a promising therapeutic strategy to mitigate pathological vascular remodeling in pulmonary hypertension.
Chen Y, Zhao L, Zheng Y
… +14 more, Carr JJ, Gao T, Terry JG, Qu Y, Ning H, Zhang X, Wilkins JT, Bae S, Carnethon MR, Allen NB, Jacobs DR, Lloyd-Jones DM, Hou L, Zhang X
Hypertension
· 2026 Jun · PMID 41867060
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BACKGROUND: Although high blood pressure (BP) is a risk factor for steatotic liver disease (SLD), whether longitudinal BP trajectories starting in young adulthood are associated with midlife SLD is unclear. METHODS: We u...BACKGROUND: Although high blood pressure (BP) is a risk factor for steatotic liver disease (SLD), whether longitudinal BP trajectories starting in young adulthood are associated with midlife SLD is unclear. METHODS: We used data from a US-based prospective cohort, the CARDIA study (Coronary Artery Risk Development in Young Adults), which enrolled 5115 Black and White adults aged 18 to 30 years in 1985 to 1986 (Year 0, Y0). Diastolic and systolic BP and hypertension trajectories were evaluated based on up to 8 BP measures over a 25-year follow-up. SLD at Y25 was measured using noncontrast abdominal computed tomography scans. RESULTS: Among 2817 participants included in the analytic sample, 622 SLD cases were identified. Compared with the low-stable diastolic BP group, other trajectories showed higher SLD prevalence (22.0%-37.5% versus 12.8%), with multivariable-adjusted relative risks of 1.47 (95% CI, 1.17-1.84) for moderate-stable, 1.77 (1.33-2.35) for moderate-increasing (remaining below the threshold for hypertension), 1.57 (1.21-2.04) for elevated-stable, and 2.02 (1.41-2.88) for the elevated-increasing trajectory. Similar positive associations were observed for systolic BP trajectories. Compared with those persistently normotensive, participants who developed hypertension had significantly higher SLD risks: 1.62-fold for late-onset and 1.75-fold for both mid-adulthood and early onset. Consistently, a faster rate of BP increase was linked to higher SLD risk. CONCLUSIONS: Long-term BP and hypertension patterns in young adulthood were independently associated with increased midlife SLD risk, with rapidly increasing BP exhibiting the greatest risk. Long-term BP changes may assist in more accurate identification of individuals at higher risk of SLD.
Ma L, Gao Y, He Q
… +5 more, Wei Y, Li J, Li Y, Sun F, Ma Y
Hypertension
· 2026 Jun · PMID 41867034
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BACKGROUND: Preeclampsia is a severe pregnancy-related disease. Aberrant remodeling of maternal spiral arteries is one of the core pathological hallmarks. However, the precise molecular mechanisms remain unclear. METHODS...BACKGROUND: Preeclampsia is a severe pregnancy-related disease. Aberrant remodeling of maternal spiral arteries is one of the core pathological hallmarks. However, the precise molecular mechanisms remain unclear. METHODS: Public databases were used to analyze histone modifications associated with preeclampsia, and histone acetyltransferase KAT14 (lysine acetyltransferase 14) was identified. Next, we assessed KAT14 expression across gestation and in preeclamptic placentas. Stable overexpression and knockout cell lines of KAT14 were constructed in HTR-8/SVneo and JEG3 cells to assess proliferation, migration, invasion, and angiogenesis in vitro and in vivo. Bulk RNA sequencing, coimmunoprecipitation, EMSA, luciferase reporter assays, chromatin immunoprecipitation, and a conditional knockout mouse model were performed to study the role of KAT14 and serum response factor in jointly regulating CDH5 and their impact on spiral artery remodeling. RESULTS: We identified KAT14 as a key regulator of trophoblast cell proliferation, migration, invasion, and the placental spiral arteries. Trophoblast-specific knockout of KAT14 (mediated by CYP19A1) presented phenotypes resembling preeclampsia, including elevated blood pressure and proteinuria. The placenta was thinned, and the vascular network was abnormal. RNA sequencing identified significant CDH5 downregulation, and its overexpression effectively rescued the phenotypes in KAT14-deficient mice. Furthermore, CDH5-Cre; KAT14 knockout mice displayed high fetal mortality and defective spiral artery remodeling. Mechanistically, KAT14 acetylates histones H3K9 and H3K18, facilitating transcription factor serum response factor binding to activate CDH5 expression. CONCLUSIONS: Our study identifies KAT14 as a critical epigenetic regulator of placental spiral artery remodeling involved in preeclampsia. These findings provide novel mechanistic insights into the disease pathogenesis and identify KAT14 as a potential therapeutic target.
Liu T, Vonen HD, Henao R
… +10 more, Pencina MJ, Rexrode KM, Hong C, Quist-Nelson J, Meng ML, Stuart JJ, Honigberg MC, Chavarro JE, Mukamal KJ, Rich-Edwards JW
Hypertension
· 2026 Jun · PMID 41859799
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BACKGROUND: Few studies have examined how multiple types of adverse pregnancy outcomes across women's reproductive lives relate to long-term cardiovascular disease. METHODS: In 59 154 parous participants in Nurses' Healt...BACKGROUND: Few studies have examined how multiple types of adverse pregnancy outcomes across women's reproductive lives relate to long-term cardiovascular disease. METHODS: In 59 154 parous participants in Nurses' Health Study II, lifetime history of gestational diabetes, gestational hypertension, preeclampsia, preterm delivery, and low birth weight was self-reported, and cardiovascular events, including myocardial infarction, stroke, and coronary revascularization, were identified through June 2017. We used Cox proportional hazards models to estimate associations between adverse pregnancy outcomes and cardiovascular disease and quantified the extent to which these associations were explained by the later development of hypertension, diabetes, and hypercholesterolemia. We evaluated whether adding adverse pregnancy outcomes improved prediction of premature cardiovascular disease beyond established risk factors such as systolic blood pressure and diabetes. RESULTS: Each adverse pregnancy outcome was associated with a higher risk of long-term cardiovascular disease. Only gestational hypertension (hazard ratio, 1.62 [95% CI, 1.36-1.92]) and preeclampsia (1.31 [1.11-1.55]) retained independent associations after accounting for the cooccurrence of other adverse pregnancy outcomes. Postpregnancy hypertension, diabetes, and hypercholesterolemia jointly accounted for substantial attenuation (58.4% [38.7%-75.8%]) of the association between adverse pregnancy outcomes in the first pregnancy and later cardiovascular disease. Adding adverse pregnancy outcomes only modestly improved discrimination and slightly improved reclassification. CONCLUSIONS: Common adverse pregnancy outcomes, especially gestational hypertension and preeclampsia, are associated with higher future cardiovascular risk, with much of this association attenuated after accounting for subsequent cardiovascular risk factors. However, given the limited predictive gains, more nuanced integration of adverse pregnancy outcomes is needed to enhance their clinical utility in cardiovascular risk prediction.
Binder J, Palmrich P, Sugulle M
… +8 more, Kalafat E, Schirwani-Hartl N, Khalil A, Pixner L, Kantoush K, Kedziora SM, Kraeker K, Haase N
Hypertension
· 2026 Jun · PMID 41859787
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BACKGROUND: Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular impairment reflected by abnormal maternal hemodynamics. Current treatment strategies target blood pressure rather than the maternal...BACKGROUND: Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular impairment reflected by abnormal maternal hemodynamics. Current treatment strategies target blood pressure rather than the maternal hemodynamic profile. Therefore, this study evaluated the effects of antihypertensive treatment on cardiovascular parameters in women with HDP, healthy pregnant women, and in a preeclamptic rat model. METHODS: This multicenter, prospective translational case-control study was conducted at the Medical University of Vienna and the Max Delbruck Center for Molecular Medicine, Berlin, between July 2019 and July 2024. Cardiovascular parameters including cardiac output, stroke volume, systemic vascular resistance, and inotropy index were measured pre- and posttreatment with α-methyldopa as well as postnatally using the USCOM 1A Monitor. In the rat model, the effects of α-methyldopa, nifedipine, and labetalol were evaluated. RESULTS: A total of 238 women were included: 132 with HDP (69 gestational hypertension, 63 preeclampsia) and 106 controls. In gestational hypertension, treatment led to increased cardiac output (median, 0.38 L/min [95% CI, 0.06-0.71]; =0.021) and a decrease in systemic vascular resistance (median, -0.08 log dynes/s per cm [95% CI, -0.14 to -0.03]; =0.005). In preeclampsia, no significant hemodynamic changes were observed. Systemic vascular resistance remained elevated and stroke volume index reduced in both HDP groups up to 1-year postpartum. Similar patterns were observed in the preeclamptic rat model, with persistently increased vascular resistance and reduced cardiac output and stroke volume. CONCLUSIONS: Antihypertensive therapy does not influence cardiovascular impairment despite lowering blood pressure in preeclampsia. Novel therapeutic approaches are needed to improve maternal cardiovascular health after HDP.
Kanbay M, Guldan M, Ozbek L
… +2 more, Al-Shiab R, Laffin LJ
Hypertension
· 2026 Jun · PMID 41853854
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Hypertension is the leading modifiable risk factor for cardiovascular disease, stroke, chronic kidney disease, and premature mortality. Although AGT (angiotensinogen) is a central component of the renin-angiotensin-aldos...Hypertension is the leading modifiable risk factor for cardiovascular disease, stroke, chronic kidney disease, and premature mortality. Although AGT (angiotensinogen) is a central component of the renin-angiotensin-aldosterone system, it was historically viewed primarily as a biochemical substrate rather than an active regulator of blood pressure and received less attention as a therapeutic target in hypertension compared with downstream renin-angiotensin-aldosterone system components such as angiotensin-converting enzyme and angiotensin II receptors. However, emerging evidence highlights its dynamic, tissue-specific role in blood pressure regulation and its responsiveness to metabolic, hormonal, and inflammatory stimuli. This narrative review examines the molecular biology, structure-function relationships, and regulatory mechanisms of AGT, including genetic variants such as M235T and -6G>A, which contribute to interindividual and population-level susceptibility to hypertension. We further explore AGT's pathogenic role in salt-sensitive hypertension, obesity-related inflammation, and renin-angiotensin-aldosterone system escape phenomena. Recent translational advances, including RNA-based therapeutics such as small interfering RNAs (zilebesiran) and antisense oligonucleotides (tonlamarsen), demonstrate promising blood pressure reductions and favorable safety profiles in clinical trials. AGT also shows potential as a biomarker for hypertensive nephropathy and treatment responsiveness. This review underscores the value of AGT as an upstream therapeutic target and diagnostic marker, offering new avenues for precision medicine and long-acting strategies in the management of both conventional and resistant hypertension while possibly addressing medication adherence-related obstacles.
Korzinski TJ, Prescott BR, Hamel-Sellman DJ
… +7 more, Xanthakis V, Cooper LL, Hamburg NM, Tsao CW, Benjamin EJ, Vasan RS, Mitchell GF
Hypertension
· 2026 Jun · PMID 41853838
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BACKGROUND: Arterial pressure waveform shape conveys information regarding interactions between the left ventricle and aorta that could provide an estimate of biological heart age and cardiovascular disease (CVD) risk. M...BACKGROUND: Arterial pressure waveform shape conveys information regarding interactions between the left ventricle and aorta that could provide an estimate of biological heart age and cardiovascular disease (CVD) risk. METHODS: Artificial intelligence heart age (AI-HA) was estimated by averaging results from 2 convolutional neural networks trained to predict mitral annulus tissue Doppler e' and s' peak velocities using an uncalibrated arterial tonometry or photoplethysmography waveform as input. Models were developed using FHS (Framingham Heart Study) participant pressure waveforms and echocardiographic measurements (N=6916 participants, 38 174 waveforms, 56% women, mean age 61±12). We validated AI-HA using Cox modeling in an FHS holdout set of baseline radial waveforms (N=7018, 54% women, age 50±16 years) and in UK Biobank participants (N=67 986, 53% women, age 57±8 years). RESULTS: In FHS (up to 10 years of follow-up, 148 heart failure [HF] and 331 CVD events), using models that adjusted for PREVENT (AHA Predicting Risk of CVD Events) risk factors, AI-HA was associated with incident HF (hazard ratio, 2.09 [CI, 1.64-2.68]; continuous net reclassification, 0.22 [CI, 0.13-0.30]) and CVD (hazard ratio, 1.52 [CI, 1.28-1.81]; continuous net reclassification, 0.13 [CI, 0.07-0.20]). In UK Biobank (up to 10 years of follow-up, 1408 HF and 2709 CVD events), AI-HA was associated with incident HF (hazard ratio, 1.23 [CI, 1.13-1.33]; continuous net reclassification, 0.09 [CI, 0.06-0.12]) and CVD (hazard ratio, 1.22 [CI, 1.15-1.30]; continuous net reclassification, 0.08 [CI, 0.06-0.09]). CONCLUSIONS: AI-HA is a novel and accessible measure of left ventricle function and HF risk in community-based samples.
Parisien-La Salle S, Ferrebus A, Abel EE
… +5 more, Tsai LC, Newman AJ, Tsai CH, Vaidya A, Brown JM
Hypertension
· 2026 May · PMID 41841247
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BACKGROUND: Hypertensive disorders of pregnancy (HDP) affect up to 15% of pregnancies and are linked to adverse maternal and fetal outcomes. Primary aldosteronism (PA) affects up to 25% of patients with hypertension. In...BACKGROUND: Hypertensive disorders of pregnancy (HDP) affect up to 15% of pregnancies and are linked to adverse maternal and fetal outcomes. Primary aldosteronism (PA) affects up to 25% of patients with hypertension. In women with prior HDP and PA risk factors, we examined PA prevalence and its relationship to hypertension trajectory. METHODS: Adults across the US meeting guideline-recommended screening criteria for PA were prospectively tested. Women with a self-reported history of HDP completed a questionnaire examining the relationship between PA and hypertension trajectory. RESULTS: Of 330 hypertensive parous women (62.4±9.8 years; 32.1% non-White), 83 (25.2%) reported a history of HDP. Women with HDP were younger at hypertension diagnosis (38.8 versus 47.9 years; <0.001). The prevalence of a positive PA test was similarly high in those with and without HDP (26.5% versus 32%; =0.35). Among women with HDP, 63 completed the follow-up questionnaire, of whom 15 (23.8%) tested positive for PA. Compared with PA-negative women, those with PA reported a higher proportion of pregnancies complicated by hypertension (76.5% versus 60.9%; =0.11) and fetal complications (55.6% versus 27.9%; <0.01). Hypertension trajectories also differed: sustained hypertension persisting beyond the postpartum period was nearly twice as frequent in women testing positive for PA (66.7 versus 37.5%; =0.047). CONCLUSIONS: Over 25% of women with hypertension, ≥1 PA risk factor, and prior pregnancy tested positive for PA, highlighting its high prevalence, irrespective of a history of HDP. Women with HDP face elevated cardiovascular risk, and PA may represent a targetable contributor.