To prevent hypertension and cardiovascular diseases, many studies have aimed to develop a convenient formula for estimating 24-hour sodium excretion. However, previous formulas that use regression analysis based on spot...To prevent hypertension and cardiovascular diseases, many studies have aimed to develop a convenient formula for estimating 24-hour sodium excretion. However, previous formulas that use regression analysis based on spot urine samples have been criticized for several evaluation metric problems including adjusted coefficient of determination, correlation coefficient, mean bias, and systematic bias, and being not suitable for individual-level predictions. This study aimed to address these limitations by developing a new formula with higher predictive accuracy in a population. We hypothesized that more accurate predictions could be achieved by incorporating additional individual-specific information into the regression model. Specifically, we proposed that four refinements would improve prediction accuracy: accounting for sex differences, including voided volume, considering the time elapsed since the last meal at the time of spot urine collection, and categorizing participants into two groups based on predicted sodium salt excretion. To test these hypotheses, we provided low- and high-salt meals to 104 young healthy volunteers over 3 days. We collected all urine samples from the participants and measured sodium and creatinine levels. Using these data, we refined the Tanaka formula to provide a more accurate estimate of 24-hour sodium excretion in young people. The four refinements significantly improved the performance of previous formulas, leading to better correlation between predicted and observed sodium excretion values, reduced systematic bias, and overall enhanced accuracy. Although our refined formula has improved accuracy in predicting the average sodium excretion of a population, there may be still room for improvement in the future.
Despite the growing burden of hypertension, the rate of controlled blood pressure (BP) in hypertension in Indonesia remains low. Understanding the factors associated with uncontrolled hypertension is crucial to improving...Despite the growing burden of hypertension, the rate of controlled blood pressure (BP) in hypertension in Indonesia remains low. Understanding the factors associated with uncontrolled hypertension is crucial to improving its management and developing effective interventions. This study aimed to determine the prevalence of uncontrolled hypertension and identify associated factors among Indonesian adults with hypertension. This study used a secondary database from the 2023 Indonesian Health Survey. Sociodemographic (e.g., age, gender, marital status, education level, occupation, province of residence) and disease-related factors (e.g., duration of hypertension, hypertension education, medication adherence) were assessed through a self-reported questionnaire. BP was measured three times using a digital sphygmomanometer. The average of these three readings was used to assess the patient's BP. The association between these factors with uncontrolled hypertension (BP ≥ 140/90 mmHg) was analyzed using logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. A total of 53,049 respondents with hypertension were included. The majority had uncontrolled hypertension (78.87%). Older than 24 years old (OR = 2.15; 95% CI = 1.39-3.32), female sex (OR = 1.15; 95% CI = 1.05-1.27), unmarried status (OR = 1.12; 95% CI = 1.02-1.23), lower education level (OR 1.42; 95% CI = 1.35-1.50), residence in Kalimantan (OR = 1.49; 95%CI = 1.21-1.85), obese (OR 1.99; 95% CI = 1.65-2.40) and medication non-adherence (OR = 1.53; 95% CI = 1.42-1.65) were significantly associated with uncontrolled hypertension. This study revealed a high prevalence of uncontrolled hypertension among Indonesian respondents. Various socioeconomic and disease-related factors were significantly associated with uncontrolled hypertension. These findings underscore the importance of incorporating patient-specific factors into tailored interventions to improve the management of hypertension in Indonesia.
Increased stiffness in the proximal aorta and carotid artery, both crucial for regulating blood pressure and flow pulsatility, may contribute to cerebral microcirculation damage and cognitive decline. While aortic stiffn...Increased stiffness in the proximal aorta and carotid artery, both crucial for regulating blood pressure and flow pulsatility, may contribute to cerebral microcirculation damage and cognitive decline. While aortic stiffness measured by aortic characteristic impedance (Zc) has been linked to suspected mild cognitive impairment (MCI), the role of carotid stiffness remains unclear due to inconsistent findings using traditional distensibility measures. This study investigates the relationship between carotid characteristic impedance (CCI) and suspected MCI, and examines how CCI interacts with Zc in contributing to cognitive dysfunction. A total of 1423 healthy community residents (average age 59.8 ± 11.7 years; 46.9% male) underwent comprehensive hemodynamic evaluations and carotid ultrasonography. CCI and Zc were calculated in the time domain, and the characteristic impedance ratio (CIR), defined as CCI/Zc, was used to assess the influence of impedance mismatch. Suspected MCI was determined using education-adjusted Mini-Mental State Examination (MMSE) cut-offs. Among participants, 478 (33.6%) were identified with suspected MCI. These individuals showed significantly higher CCI, while other carotid distensibility parameters were not significantly different. CCI was the only carotid stiffness measure independently associated with suspected MCI (OR per SD: 1.18; 95% CI: 1.02-1.36). CIR was negatively associated with MCI (OR: 0.84; 95% CI: 0.73-0.95), suggesting that a mismatch in impedance contributes to cognitive decline. The combination of elevated Zc and CCI was the strongest predictor of suspected MCI (OR: 2.10; 95% CI: 1.47-2.98). These findings underscore CCI as a sensitive and valuable marker for assessing carotid stiffness in relation to cognitive dysfunction.
Cardiovascular-kidney-metabolic (CKM) syndrome, a recently proposed concept focusing on the interrelationship among cardiovascular system, chronic kidney disease, and metabolic risk factors, is associated with high morbi...Cardiovascular-kidney-metabolic (CKM) syndrome, a recently proposed concept focusing on the interrelationship among cardiovascular system, chronic kidney disease, and metabolic risk factors, is associated with high morbidity and mortality. The mechanism of CKM syndrome has not yet been fully examined due to the lack of an animal model. Here, we investigated whether an adenine-supplemented high-fat diet (AHFD) can induce CKM syndrome in mice. We fed normal chow diet (NCD), adenine-supplemented diet (AD), high-fat diet (HFD), and 0.15% AHFD to 129×1/Sv mice for 16 weeks and 0.2%AHFD to 129×1/Sv for 6 weeks. Also, C57BL/6 N mice were fed with 0.15%AHFD for 16 weeks. Metabolic parameters, blood pressure, organ weights, histology, and RNA sequencing were analyzed. The 0.15%AHFD group exhibited hypercholesterolemia, elevated blood pressure, kidney atrophy with fibrosis, and cardiac hypertrophy with interstitial fibrosis. Both kidney and cardiac RNA sequencing in the 0.15%AHFD group revealed upregulation of inflammatory and immune-related gene sets, whereas genes involved in cardiac contraction were downregulated. In contrast, 0.2%AHFD induced body weight loss, severe kidney dysfunction, and cardiac atrophy without functional impairment in 129×1/Sv mice. Of note, the C57BL/6 N mice exhibited metabolic abnormality and cardiac hypertrophy with diastolic dysfunction after 0.15%AHFD feeding despite mild renal dysfunction. We report a novel mouse model of CKM syndrome with dietary intervention, which exhibits fibrosis and myocardial hypertrophy in the heart. This model could be a valuable tool for analyzing the mechanism of CKM syndrome and assessing therapeutic options.
Hypertensive disorders of pregnancy are defined according to office blood pressure (BP), yet out-of-office BP phenotypes may carry different prognostic implications. White-coat hypertension (WCH) is traditionally defined...Hypertensive disorders of pregnancy are defined according to office blood pressure (BP), yet out-of-office BP phenotypes may carry different prognostic implications. White-coat hypertension (WCH) is traditionally defined using 24-h ambulatory BP monitoring (ABPM) without considering nighttime BP, despite growing evidence supporting the prognostic relevance of nocturnal hypertension. This study aimed to evaluate the maternal-fetal risk associated with WCH according to the presence or absence of nighttime hypertension during the second half of pregnancy. We conducted a retrospective cohort study including high-risk pregnant women between 20 and 34 weeks of gestation referred for BP evaluation. Office BP and 24-h ABPM were performed using a standardized protocol. Women with office BP ≥ 140/90 mmHg were classified as having sustained hypertension, WCH without nighttime hypertension, or WCH with nighttime hypertension according to ambulatory blood pressure values across the different ABPM periods. The primary outcome was a composite of preeclampsia, eclampsia, or HELLP syndrome. Among 991 women evaluated, 79 met criteria for office hypertension. Of these, 40 had sustained hypertension, 28 had WCH without nighttime hypertension, and 11 had WCH with nighttime hypertension. The overall incidence of preeclampsia was 35%. Women with WCH and nighttime hypertension had a significantly higher risk of preeclampsia compared with those without nighttime hypertension, with a risk magnitude comparable to sustained hypertension. After multivariable adjustment, WCH with nighttime hypertension remained independently associated with preeclampsia (OR 11.95, p = 0.018). In conclusion, incorporating nighttime BP into the definition of WCH identifies a high-risk subgroup with prognostic implications similar to sustained hypertension. These findings support the routine use of ABPM, including nighttime BP assessment, in pregnant women with elevated office BP after 20 weeks of gestation.
Kario K, Ohbayashi H, Ishii H
… +20 more, Kato M, Nozaki M, Abiru N, Fukui T, Nomura K, Fukushima Y, Itabashi N, Uchiyama K, Nishizawa M, Hata Y, Nakamura N, Kodono S, Hirano K, Katsuya T, Shimosawa T, Shiosakai K, Kato G, Taguchi T, Ohishi M, ESCORT-HT investigators
Mineralocorticoid receptor blockers (MRBs) are positioned as second-line antihypertensive agents in the 2025 Japanese Society of Hypertension guidelines, yet evidence in older patients remains limited. This 12-week, mult...Mineralocorticoid receptor blockers (MRBs) are positioned as second-line antihypertensive agents in the 2025 Japanese Society of Hypertension guidelines, yet evidence in older patients remains limited. This 12-week, multicenter, randomized, open-label, parallel-group, non-inferiority ESCORT-HT study (jRCTs031240300; September 2024-June 2025) compared esaxerenone with angiotensin II receptor blockers (ARBs) as add-on therapy to amlodipine in Japanese patients aged ≥65 years whose morning home systolic blood pressure (SBP) remained ≥135 mmHg despite stable amlodipine. The mean age was 75.5 years in both the esaxerenone (n = 202; female: 52.5%) and ARB (n = 200; female: 56.5%) groups. At the end of treatment, the least squares mean change from baseline in morning home SBP (primary endpoint) was -10.6 (95% confidence interval: -12.0, -9.1) mmHg with esaxerenone treatment and -9.0 (-10.4, -7.5) mmHg with ARB treatment; the between-group difference was -1.6 (-3.7, 0.5) mmHg, meeting the pre-defined non-inferiority margin (3.8 mmHg). Both treatments lowered the urine albumin-to-creatinine ratio, whereas only esaxerenone significantly reduced N-terminal pro-B-type natriuretic peptide. Treatment-emergent adverse events occurred in 25.1% and 30.8% of the esaxerenone and ARB groups; serious events were reported in 2 versus 7 patients, including one death (esaxerenone group). Hyperkalemia occurred in one esaxerenone-treated patient and none who received ARBs. No serious adverse event was judged to be drug-related. Esaxerenone was non-inferior to ARBs in lowering morning home SBP and showed a favorable safety profile in older Japanese patients with inadequately controlled hypertension on amlodipine. These data support the clinical use of esaxerenone as an effective second-line treatment option for this population.
Iwasa K, Omori N, Aritake S
… +3 more, Aoki Y, Kanai Y, Nagai A
Hypertens Res
· 2026 Jun · PMID 42020821
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Asymptomatic brain lesions (ABLs), including white matter hyperintensities (WMHs), silent brain infarcts (SBIs), and cerebral microbleeds (CMBs), are common MRI markers of cerebral small-vessel disease and predictors of...Asymptomatic brain lesions (ABLs), including white matter hyperintensities (WMHs), silent brain infarcts (SBIs), and cerebral microbleeds (CMBs), are common MRI markers of cerebral small-vessel disease and predictors of future stroke. However, the optimal blood pressure (BP) target for primary prevention in individuals with ABLs remains unclear. We analyzed 2363 neurologically healthy adults (mean age 61.9 ± 10.9 years; 54% men) who underwent brain MRI screening ("Brain Dock") and were followed for incident stroke over a mean of 8.9 years. ABLs were defined as the presence of SBI, WMH (Fazekas grade ≥ 2), or CMBs. The association between systolic BP (SBP) and stroke risk was evaluated using Cox proportional hazards models with restricted cubic splines, stratified by ABL status, and adjusted for age, sex, HbA1c, LDL-C, and antihypertensive use. The interaction between SBP and the ABL status was not significant. Stroke risk increased progressively with increasing SBP in both groups. In the ABL-positive group, the risk appeared to increase at comparatively lower SBP levels; however, this observation was descriptive and should not be interpreted as indicating a specific threshold. Due to limited stroke events and wide confidence intervals, particularly at higher SBP levels, these spline-based patterns should be considered exploratory rather than definitive. However, confirmation in larger prospective cohorts and interventional studies is needed before MRI-defined cerebrovascular markers can inform clinical blood pressure strategies.
Hypertens Res
· 2026 Jun · PMID 42014853
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Despite the adverse health effects of excessive salt consumption, many people continue to consume high amounts of salt. This study aims to examine the mediating role of awareness of recommended salt intake in the associa...Despite the adverse health effects of excessive salt consumption, many people continue to consume high amounts of salt. This study aims to examine the mediating role of awareness of recommended salt intake in the associations between sociodemographic factors and salt consumption among adults in Sri Lanka. Data from 6138 adults aged 18-69 years who participated in the WHO STEPwise approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) survey were used in linear regression models to examine how sociodemographic factors were associated with salt consumption. Understanding of the recommended daily salt intake was included as a potential mediator and assessed using structural equation modelling. Results show that adults who were less educated, of Indian Tamil ethnicity, single or married and in the third quintile of the wealth index demonstrated higher salt consumption than their counterparts. Knowledge of salt intake recommendations explained about 14% of the association between tertiary education and salt consumption. It also mediated 3% of the effect of marital status (being married) on salt intake. Approximately 4% to 5% of the effects of ethnicity on salt consumption were explained by awareness of the recommended salt intake. The associations between salt consumption, gender and the wealthiest quintile were fully mediated by knowledge of salt intake recommendations. In conclusion, awareness of salt intake recommendations plays a pivotal role in mediating the associations between various sociodemographic factors and salt consumption. Therefore, policymakers should prioritize improving knowledge of salt intake recommendations among adults across diverse sociodemographic backgrounds.