Functional foods are increasingly used by patients with chronic diseases, including hypertension, yet whether their therapeutic use is associated with medication adherence remains unclear. We conducted a cross-sectional...Functional foods are increasingly used by patients with chronic diseases, including hypertension, yet whether their therapeutic use is associated with medication adherence remains unclear. We conducted a cross-sectional study of adults with self-reported hypertension who were receiving antihypertensive medication, using data from the Japan COVID-19 and Society Internet Survey (JACSIS 2024; December 2024-January 2025). Respondents were classified as functional food users if they reported using functional foods specifically to treat hypertension; non-users served as comparators. Medication adherence was measured with the Japanese 8-item Morisky Medication Adherence Scale (MMAS-8); low adherence was defined as MMAS-8 <6. Among 4063 treated hypertensive adults (586 users; 3477 non-users), functional food use was associated with a higher risk of low adherence after adjusting for demographic, socioeconomic, and health-related factors: risk ratio 1.24 (95% CI 1.04-1.48). These findings suggest that therapeutic use of functional foods may be linked to suboptimal adherence to prescribed antihypertensive therapy, warranting further investigation. However, causal relationships cannot be inferred due to the cross-sectional design, and the self-reported nature of both exposures and outcomes may introduce measurement error.
Katsuya T, Nakatsu F, Eguchi S
… +4 more, Nakamura Y, Matsukawa M, Iekushi K, Hiramitsu S
Hypertens Res
· 2026 Apr · PMID 41530466
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This real-world, non-interventional, retrospective cohort study evaluated the achievement rate of guideline-recommended target blood pressure (BP) and representative safety profile of the treatment incorporating sacubitr...This real-world, non-interventional, retrospective cohort study evaluated the achievement rate of guideline-recommended target blood pressure (BP) and representative safety profile of the treatment incorporating sacubitril/valsartan (Sac/Val) in Japanese patients with essential hypertension. Data were collected from electronic health records from ~4700 clinics across Japan, covering ~11.4% of the nationwide population. Of the 1405 eligible patients, 1247 were included in the effectiveness analysis. The primary endpoint investigated the proportion of patients achieving the Japanese Society of Hypertension 2019-recommended antihypertensive goals within 8 weeks of initial Sac/Val administration (index date). Secondary endpoints included description of baseline characteristics and their relative contribution to BP goal attainment, description of prescription patterns, and safety. A total of 29.8% of patients achieved individual estimated BP goals, with significant mean reductions in systolic and diastolic BPs (-15.6 mmHg and -6.1 mmHg, respectively, p < 0.0001). Patients aged ≥75 years, those with cerebrovascular disease, and those classified as Grade I hypertension were more likely to meet BP goals. Among patients with BP reduction of ≥10 mmHg, the most common prescription pattern at index date was a combination of calcium channel blocker (CCB) and Sac/Val, and a majority switched from CCB and angiotensin receptor blocker combination or were on CCB monotherapy. The most common signs of adverse events were hypotension and diuresis-related events, particularly during summer. The discontinuation rates following these signs were 1.0% and 0.8%. This real-world study demonstrated the clinical utility and representative safety profile of treatments involving Sac/Val in Japanese patients with essential hypertension.
Whether high remnant cholesterol (RC) is associated with an increased risk of incident hypertension, independent of its well-known risk factors, in the general population remains unclear. We followed 5264 participants (3...Whether high remnant cholesterol (RC) is associated with an increased risk of incident hypertension, independent of its well-known risk factors, in the general population remains unclear. We followed 5264 participants (3312 women; mean age 39.1 years) from Tehran Lipid and Glucose Study. RC was calculated as total cholesterol minus the sum of the high- and low-density lipoprotein-cholesterol. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, or diastolic blood pressure (DBP) ≥ 90 mmHg, or using anti-hypertensive medications. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In a random-effects meta-analysis we combined our results with six previous studies. In our cohort study, during a median follow-up of 12.4 years, 2189 events of hypertension occurred. Accordingly, in multivariable analyses, the association between RC and hypertension reached non-significant after adjusting for baseline SBP and DBP as covariates in both continuous (per 1-SD increase: 1.00 (0.91-1.10)) and categorical analyses (Q4 vs. Q1: 1.02 (0.85-1.22) (P for trend = 0.343)). However, in the meta-analysis, elevated RC was significantly associated with hypertension (pooled 11 effect-sizes, 1.30 (1.14-1.48); I = 99.80; N = 7 studies (6 studies used calculated RC); 2,559,478 participants). In subgroup analyses of meta-analysis, this association was generally more pronounced among individuals with lower baseline risk. In conclusion, in our cohort study, elevated RC was not significantly associated with higher risk of incident hypertension in the presence of large set of confounders, including baseline SBP and DBP levels. We investigated the association between remnant cholesterol and risk of hypertension through a prospective study and meta-analysis. In our cohort study, the association between RC and hypertension was not independent of baseline SBP and DBP levels among Iranian adults. However, the meta-analysis revealed a significant association, albeit with substantial heterogeneity.
Li X, Zhu Z, Hui Y
… +17 more, Shi H, Fan J, Hong W, Hu X, Zhu X, Li H, Yue L, Zhang S, Liang X, Chen S, Lv H, Zhao P, Li J, Wu Y, Yu Z, Wu S, Wang Z
Hypertens Res
· 2026 Apr · PMID 41530464
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Elevated blood pressure (BP) has been linked to brain structure changes and cognitive decline. However, few studies have accounted for long-term cumulative BP exposure. We investigated the association between cumulative...Elevated blood pressure (BP) has been linked to brain structure changes and cognitive decline. However, few studies have accounted for long-term cumulative BP exposure. We investigated the association between cumulative BP exposure, brain volume, cerebral blood flow (CBF), and cognitive decline. Furthermore, we explored whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. We included 1012 adult participants from the Kailuan study. Cumulative BP exposure was calculated from 2006 to 2020. Brain MRI scans and the Montreal Cognitive Assessment (MoCA) were performed in 2020. Generalized linear regression models were used to investigate the associations between cumulative BP, brain volume, CBF, and cognitive function. Mediation analysis was performed to examine whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. Compared with the lowest tertiles, the highest tertiles of cumulative SBP were associated with lower volumes in total brain (-9.11 [-16.25, -1.97]), total GM (-5.53 [-10.02, -1.04]), frontal lobe (-2.46 [-4.15, -0.78]), temporal lobe (-1.37 [-2.51, -0.23]) and hippocampus (-0.15 [-0.26, -0.03]), and the highest tertiles of cumulative DBP were associated with lower volume in frontal lobe (-2.33 [-3.98, -0.68]) and temporal lobe (-1.15 [-2.27, -0.04]). Higher cumulative SBP and DBP were associated with lower total and regional CBF and MoCA scores (all P < 0.05). The associations between cumulative DBP and cognitive decline were mediated by the volumes in total GM, frontal lobe and temporal lobe. Early intervention in cumulative BP may help preserve brain structure and function.
Sugawara H, Yoshida K, Saito C
… +11 more, Saito Y, Kato M, Kato A, Narita I, Maruyama S, Wada J, Wada T, Yamamoto M, Ito H, Yamagata K, Ogata H
Hypertens Res
· 2026 Apr · PMID 41530463
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Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those...Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those with proteinuric CKD. Effectiveness of RASi in treating non-proteinuric CKD is still unknown, yet. In order to evaluate the impact of RASi on cardiovascular morbidity and mortality in patients with non-proteinuric CKD, we performed a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study. A urine protein-to-creatinine ratio less than 0.15 g/g or negative/trace protein on urinalysis was considered as non-proteinuric CKD. Those who have undergone dialysis, kidney transplant recipients, and patients who refused to give their consent were excluded. A composite of cardiovascular events, initiation of renal replacement therapy, and all-cause mortality was studied as the primary outcome. Of 2379 patients with CKD, 630 met the criteria for non-proteinuric CKD. Among them, 490 used RASi, and 140 did not. Although the RASi group was considerably younger and had a higher prevalence of hypertension and calcium channel blocker use, baseline characteristics were comparable. 12.1% of the control group and 16.7% of the RASi group experienced the primary outcome during follow-up, with no significant difference (adjusted HR: 1.37; 95% CI: 0.81-2.31). Secondary outcomes and analyses of RASi use for the whole observation period did not show any significant differences (adjusted HR: 0.81; 95% CI: 0.43-1.56). These results imply that RASi was not linked to a decreased risk of mortality or long-term events in those with nonproteinuric CKD.
Kario K, Nishiyama A, Shibata S
… +6 more, Nakamura S, Kishi T, Ishida M, Hoshide S, Mogi M, Promoting Committee of the Eradication of Morning Hypertension
Hypertens Res
· 2026 Mar · PMID 41530462
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Publisher ↗
Seasonal variations in blood pressure (BP) and cardiovascular risk represent one of the most consistently reproduced yet under-recognized phenomena in hypertension research. In Japan, where winter temperatures can fluctu...Seasonal variations in blood pressure (BP) and cardiovascular risk represent one of the most consistently reproduced yet under-recognized phenomena in hypertension research. In Japan, where winter temperatures can fluctuate sharply in both outdoor and indoor environments, the burden of winter-associated cardiovascular events is strikingly visible in epidemiological data. The so-called "heat shock" phenomenon is defined as acute cardiovascular events triggered by sudden temperature changes. Recent statements by the Japanese Society of Hypertension, including the initiative "Morning BP Action in Winter," emphasize that winter mornings constitute a uniquely hazardous physiological "heat shock" window-one in which sympathetic activation, thermal stress, and behavioral triggers converge to sharply elevate BP and precipitate acute cardiovascular events. This editorial commentary expands on the scientific rationale, clinical implications, and public health significance of this initiative, aiming to contextualize winter morning BP management as an essential preventive strategy.
Hypertens Res
· 2026 Mar · PMID 41514030
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Hypertension is the primary modifiable risk factor for both ischemic stroke and intracerebral hemorrhage (ICH), yet recommendations for blood pressure (BP) management vary across contemporary guidelines. This narrative r...Hypertension is the primary modifiable risk factor for both ischemic stroke and intracerebral hemorrhage (ICH), yet recommendations for blood pressure (BP) management vary across contemporary guidelines. This narrative review compares BP targets and therapeutic strategies in the 2025 American Heart Association (AHA), 2024 European Society of Cardiology (ESC), 2023 European Society of Hypertension (ESH), and 2025 Japanese Society of Hypertension (JSH) guidelines, with emphasis on acute and chronic phases of ischemic stroke and ICH. In acute ischemic stroke without reperfusion therapy, all four guidelines discourage routine BP lowering unless systolic BP (SBP) is ≥220 mmHg or diastolic BP ≥ 120 (110) mmHg, and then recommend only modest reductions of about 15% within 24 hours. For patients receiving IV thrombolysis or mechanical thrombectomy, the guidelines converge on pre-treatment BP<185/110 mmHg and maintenance <180/105 mmHg during the first 24 hours, with JSH specifying micro-infusion calcium channel blockers as preferred agents. In chronic ischemic stroke, AHA, ESH, and JSH generally endorse BP<130/80 mmHg, whereas ESC prioritizes an SBP range of 120-9 mmHg. For acute ICH, all guidelines support rapid but carefully titrated SBP reduction toward approximately 140 mmHg, while emphasizing avoidance of overshoot, large variability, and excessive early declines, particularly when baseline SBP exceeds 220 mmHg in the AHA and ESC guidelines. Long-term after ICH, targets of <130/80 mmHg are widely recommended. Thiazide diuretics, ACE inhibitors, and angiotensin receptor blockers remain foundational for secondary prevention, with calcium channel blockers central to acute parenteral therapy and β-blockers reserved for specific indications. Despite regional nuances, the guidelines converge on conservative acute management in ischemic stroke, proactive early lowering in ICH, and intensive long-term BP control as the global benchmark for secondary cerebrovascular prevention.
Matsumoto M, Arakawa K, Asai K
… +1 more, Tsuchihasi T
Hypertens Res
· 2026 Feb · PMID 41514025
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The estimation formula by Tanaka et al. for predicting the 24-h urinary sodium (Na) excretion (24Na) from a single causal urine sample is widely used. However, it overestimates values in the low 24Na range. We aimed to d...The estimation formula by Tanaka et al. for predicting the 24-h urinary sodium (Na) excretion (24Na) from a single causal urine sample is widely used. However, it overestimates values in the low 24Na range. We aimed to develop a formula to improve the accuracy, particularly for samples with 24Na < 2 g/day. Stored data from 187 hypertensive patients (mean age, 66.1 years; 56.7% female) who underwent both 24-h home urine collection and a fasting morning causal urine test the following day were analyzed. We used a machine learning approach to extract conditional branches based on the threshold relationships among the variables. The proposed estimation formula was constructed by adding a correction term to the Na/Creatinine(Cr) ratio in Tanaka's formula and the modified formula was applied to each conditional branch. The correction terms included body mass index (BMI), age, and concentration of causal urine Na and were applied in different forms according to each branch. Compared with the Tanaka method, our method improved the agreement rate by ~25% and reduced the disagreement rate by 25% in samples with 24Na < 2 g/day. The correlation coefficient was higher (Ours: 0.51, Tanaka: 0.29), the range of error with 24Na was narrower (Ours: 4.89, Tanaka: 5.69), and the percentage of absolute errors for <1 g improved by 9.8%. Although developed from a specific dataset, our formula is useful for low-24Na samples prone to misestimation by the conventional formula and may improve the accuracy of dietary salt intake assessments from causal urine.
Dollin C, Ward M, Stafford MYC
… +6 more, Krason-Kidzinska E, Crawford L, McNulty H, Barry F, Murphy M, Lees-Murdock DJ
Hypertens Res
· 2026 Apr · PMID 41514024
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Chronological age is a well-established risk factor for Hypertension (HTN), yet while biological ageing markers such as epigenetic age acceleration (EAA), have been associated with HTN, findings are inconsistent. This st...Chronological age is a well-established risk factor for Hypertension (HTN), yet while biological ageing markers such as epigenetic age acceleration (EAA), have been associated with HTN, findings are inconsistent. This study aimed to conduct a systematic review and meta-analysis to evaluate the association between EAA, HTN and blood pressure (BP) to provide an understanding of the role of EAA in HTN development and progression. Six databases were searched, and studies which reported associations between DNA and HTN, and/or BP were included. Functional enrichment analysis was conducted using DAVID and STRING to elucidate underlying molecular pathways. From 4334 studies, 165 met the inclusion criteria. Qualitative analysis indicated that 17.0% of studies reporting global methylation and 49.1% of studies reporting gene-specific methylation demonstrated significant associations with HTN and/or BP. A random effects meta-analysis of 16,136 participants from 8 studies using three epigenetic clock algorithms demonstrated that HTN was associated with increased EAA (β: 0.29, 95%Cl: 0.15-0.43; P < 0.0001). All three individual epigenetic clocks demonstrated a positive association between clinically measured HTN and EAA (Horvath β: 0.33, 95%Cl: 0.08-0.58, P = 0.010; Hannum β: 0.64, 95%Cl: 0.09-1.20; PhenoAge β: 1.21, 95%Cl: 0.56-1.86), whereas this relationship was not clear when using self-reported HTN. This study is the first to systematically demonstrate that HTN is associated with EAA. We recommend the use of clinically measured over self-reported HTN in appropriately powered studies of epigenetic age to obtain an accurate understanding of BP regulation/HTN on the epigenome, supporting pathways to translation and development of novel therapeutic targets for HTN.
Hypertens Res
· 2026 Mar · PMID 41514023
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Cardiovascular diseases (CVDs) have been a major cause of global morbidity and mortality, necessitating continuous innovation in diagnostic methods, better mechanistic understanding, and the development of risk stratific...Cardiovascular diseases (CVDs) have been a major cause of global morbidity and mortality, necessitating continuous innovation in diagnostic methods, better mechanistic understanding, and the development of risk stratification strategies. This review summarizes significant updates in vascular and cardiovascular health from 2024 to 2025, focusing on novel non-invasive assessment technologies, deeper insights into molecular and cellular pathophysiology, and effective approaches to clinical risk assessment. Key advancements include the development and validation of artificial intelligence-driven models for vascular age assessment, plethysmographic methods for endothelial function evaluation, and refined pulse wave velocity measurements for proximal aortic stiffness. Mechanistic studies have further investigated the roles of long noncoding RNAs, mitochondrial dynamics, and Piezo ion channels in various CVD pathologies. Clinically, new evidence supports the importance of central arterial stiffness in atrial myopathy, the association of pulse wave velocity with cerebral microbleeds, and the prognostic value of supine hypertension and combined vascular biomarkers, such as the cardio-ankle vascular index and ankle-brachial index. Furthermore, these updates will improve our understanding of vascular health and provide novel approaches to early detection, personalized intervention, and improving patient outcomes in the management of CVD.
Tagami K, Iwama N, Hamada H
… +15 more, Tomita H, Kumagai N, Wang H, Izumi S, Watanabe Z, Ishikuro M, Obara T, Metoki H, Miura Y, Ota C, Kuriyama S, Arima T, Yaegashi N, Saito M, Japan Environment and Children’s Study Group
Hypertens Res
· 2026 Apr · PMID 41514022
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This study investigated the associations of twin pregnancies with early-onset (EO)- and late-onset (LO)-hypertensive disorders of pregnancy (HDP). Totally, 86,717 pregnant women were included in a prospective birth cohor...This study investigated the associations of twin pregnancies with early-onset (EO)- and late-onset (LO)-hypertensive disorders of pregnancy (HDP). Totally, 86,717 pregnant women were included in a prospective birth cohort study. The associations of dichorionic diamniotic (DD)- and monochorionic diamniotic (MD)-twin pregnancies with EO-HDP (Diagnosed from 20 to <34 weeks of gestation) and LO-HDP (Diagnosed at ≥34 weeks of gestation) were analyzed using a multinomial logistic regression model. Compared with singleton pregnancies, both DD- and MD-twin pregnancies had significantly higher odds for EO- and LO-HDP. The adjusted odds ratios (aORs) for EO-HDP were 2.05 (95% confidence interval [Cl]: 1.51-2.78) in DD-twin pregnancies and 2.80 (95% Cl: 2.01-3.90) in MD-twin pregnancies, respectively. Also, the aORs for LO-HDP were 1.32 (95% CI: 1.03-1.69) in DD-twin pregnancies and 1.64 (95% Cl: 1.24-2.17) in MD-twin pregnancies, respectively. Although no statistically significant differences were observed, MD-twin pregnancies tended to have higher odds for both EO- and LO-onset HDP compared with DD-twin pregnancies. In conclusion, both DD- and MD-twin pregnancies are risk factors for the development of EO- and LO-HDP. We showed that both dichorionic diamniotic and monochorionic diamniotic twin pregnancies are risk factors for the development of early-onset and late-onset hypertensive disorders of pregnancy.
Hypertens Res
· 2026 Mar · PMID 41514021
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Publisher ↗
The measurement of an individual's blood pressure (BP) while he or she is in a seated position is the standard BP measurement method. The significance of BP measurements obtained from an individual while he or she is in...The measurement of an individual's blood pressure (BP) while he or she is in a seated position is the standard BP measurement method. The significance of BP measurements obtained from an individual while he or she is in the supine position has also been described. Supine BP values are usually lower than seated BP values, and thus the condition of high supine BP is abnormal and called 'supine hypertension.' Although the mechanisms that underlie supine hypertension are not completely understood, it has been speculated that fluid retention and abnormal sympathetic nervous activity can lead to supine hypertension. Hypertension-mediated organ damage and cardiovascular events have been shown to be associated with supine hypertension; not only supine hypertension with neurogenic orthostatic hypotension but also supine hypertension without it. The treatment of supine hypertension has not been established. Considering the pathophysiological background of this condition, the use of antihypertensive drugs and bedtime dosing may be effective. Further research is necessary to clarify the significance of supine hypertension and to establish the optimal treatment for this condition.
Satoh M, Nakayama S, Nobayashi H
… +5 more, Iwabe Y, Izumi S, Murakami T, Hirose T, Metoki H
Hypertens Res
· 2026 Mar · PMID 41514020
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Hypertension is a major contributor to the global disease burden, affecting more than one billion individuals worldwide. Despite decades of recognition of its adverse health effects, hypertension control rates remain sub...Hypertension is a major contributor to the global disease burden, affecting more than one billion individuals worldwide. Despite decades of recognition of its adverse health effects, hypertension control rates remain suboptimal. Epidemiology provides essential knowledge for understanding disease distribution and identifying risk factors at the individual, social, and environmental levels. Recent evidence emphasizes both traditional lifestyle determinants, including excess sodium intake, low potassium intake, obesity, physical inactivity, smoking, and alcohol consumption, and emerging contributors, such as gut microbiota dysregulation and infectious diseases. Among those, the urinary sodium-to-potassium ratio has gained attention as an important factor associated with hypertension risk. Additionally, social determinants of health, including socioeconomic disparities, neighborhood deprivation, and structural racism, exacerbate the risk of hypertension and impede its effective control. Environmental factors such as air pollution, extreme temperatures, and occupational stress further contribute to the complexity of hypertension epidemiology. Regarding contemporary epidemiological methodology, our proposed concepts of the "Bench and Real-World Cycle" and "Real-World Evidence Cycle" highlight the necessity of continuously integrating real-world evidence into practice. In addition to classical cohort studies, real-world data derived from electronic health records including health checkups and insurance claims data are indispensable tools for addressing previous research limitations. This multifaceted perspective will accelerate evidence-based epidemiological approaches for preventing and treating hypertension.
Zahnd J, Thompson B, Rigon PA
… +2 more, Taffé P, Wuerzner G
Hypertens Res
· 2026 Mar · PMID 41514019
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Home blood pressure monitoring (HBPM) is essential for long-term hypertension management, but its accuracy and reliability is questionable due to user inconsistencies and non-standard usage conditions. This study compare...Home blood pressure monitoring (HBPM) is essential for long-term hypertension management, but its accuracy and reliability is questionable due to user inconsistencies and non-standard usage conditions. This study compared two validated HBPM devices - a wrist-based and a reference upper-arm monitor - in a home-like setup where participants placed the devices themselves. A total of 121 participants underwent four concurrent blood pressure (BP) measurements, with two taken in each arm, followed by a crossover of devices between arms after the initial two readings. Wrist-derived BP readings were higher than upper-arm measurements. With higher blood pressure levels, both devices exhibited greater bias, accompanied by reduced precision in systolic BP measurements. Additionally, hypertension classification showed only moderate agreement (Cohen's kappa=0.58). The wrist monitor tended to over-diagnose hypertension and exhibited greater variability than the upper-arm device. These findings highlight the need for more guidance and education as well as critical evaluation of home blood pressure measurements provided by patients.