Hypertens Res
· 2026 May · PMID 41792247
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We sought to assess the validity of risk stratification table of Japanese Society of Hypertension (JSH) 2025 guideline, based on Scheie hypertensive fundus changes. We analyzed the data of medical checkup of Saitama Red...We sought to assess the validity of risk stratification table of Japanese Society of Hypertension (JSH) 2025 guideline, based on Scheie hypertensive fundus changes. We analyzed the data of medical checkup of Saitama Red Cross Hospital from 2017 to 2024 who underwent fundus examination (N = 6953). Based on the risk stratification table of JSH 2025 guideline, age, sex, comorbidities, past history, and blood pressure (BP) at the health checkup examination were used to stratify the risk into 12 groups. As the original of this study, those with BP < 130/80 mmHg were further examined and a total of 15 groups were analyzed. Risk 1st category and BP < 130/80 mmHg were set as a control group. As the risk category and BP level each increased, the rate of Scheie hypertensive changes significantly increased. Samely, the rate of Scheie sclerotic changes also significantly increased. In the range of BP < 130/80 mmHg, the rate of fundus changes significantly increased as the risk category increased. In conclusion, the risk stratification table of JSH 2025 guideline was valid based on Scheie hypertensive changes in subjects with medical checkup. Furthermore, those with BP < 130/80 mmHg could be added in the risk stratification table.
Elkholy M, Maaly A, Farghaly M
… +6 more, Mahrokhian S, Tsai L, Hanna I, Vaidya A, Sacks B, Moussa M
Hypertens Res
· 2026 May · PMID 41792246
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This study is to determine peripheral sample collection timing impact on selectivity index (SI) and success of unstimulated adrenal venous sampling (AVS) for primary aldosteronism (PA) subtyping. In this study, a retrosp...This study is to determine peripheral sample collection timing impact on selectivity index (SI) and success of unstimulated adrenal venous sampling (AVS) for primary aldosteronism (PA) subtyping. In this study, a retrospective discovery and a prospective validation arm were conducted. 74 patients undergoing AVS before and after-ACTH stimulation were reviewed. Discovery dataset was divided into 1) "pre" group, peripherals collected 30-min before AVS and 2) "post" group, peripherals collected 1-min after AVS. SIs were calculated using 30-min-pre and 1-min-post values. Patients with samples having SIs < 2 and SIs ≥ 5 on before and after-ACTH were classified as false negative and those with SI ≥ 2 and SI ≥ 5 on before and after-ACTH as true positive. Data was analyzed using Chi-squared test. For validation, 27 patients were enrolled prospectively as a paired group. In each, two peripherals were collected approximately 30 min before and 1 min after AVS. Cortisol was compared using Wilcoxon matched-pair signed rank test. Retrospectively, 38% of "30 min-pre" patients had SI < 2 in right adrenals, compared to 14% in "1 min-post" patients (P = 0.007). For the left, 45.9% of "30 min pre" patients had SIs < 2 compared to 13.5% in "1 min-post" patients, (P = 0.002). Prospectively, peripheral cortisol 1 min post decreased by 28% compared to 30-min pre (median, 6.4 to 4.6 μmol/L; P < 0.001). SIs increased 40% bilaterally (P < 0.001). In conclusion, in unstimulated AVS, collecting peripheral samples after sampling the adrenal veins is more likely to give more accurate SI than before sampling the adrenal veins.
Nishikawa M, Suzuki Y, Kaneko H
… +16 more, Okada A, Takeda N, Morita H, Fujiu K, Azegami T, Hayashi K, Kitaoka K, Miura K, Mizuno A, Nomura A, Kario K, Node K, Yasunaga H, Nangaku M, Arima H, Takeda N
Hypertens Res
· 2026 May · PMID 41781766
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Identifying and prioritizing modifiable risk factors is crucial for the primary prevention of hypertension. However, large-scale data on the population attributable fraction (PAF) for a comprehensive range of modifiable...Identifying and prioritizing modifiable risk factors is crucial for the primary prevention of hypertension. However, large-scale data on the population attributable fraction (PAF) for a comprehensive range of modifiable risk factors for incident hypertension in the Japanese population have been scarce. This study analyzed 1,069,948 participants (median age 56, 43.7% men) without a history of hypertension from the DeSC database. Using Cox proportional hazards models, we evaluated the association between modifiable risk factors (obesity, diabetes mellitus, dyslipidemia, smoking, habitual alcohol consumption, physical inactivity, and sleep disorders) and incident hypertension to calculate their PAFs. Over a median follow-up of 3.64 years, 116,690 new hypertension diagnoses were recorded. Obesity had the highest PAF at 6.36%, followed by sleep disorder (4.11%), current smoking (3.39%), dyslipidemia (2.74%), habitual alcohol consumption (2.10%), physical inactivity (1.93%), and diabetes mellitus (1.55%). The PAF of obesity for incident hypertension decreased with age, from 15.10% among individuals aged <40 years to 7.93% among those aged 40-64 years and 3.70% among those aged ≥65 years. Similarly, obesity's PAF was higher in men (7.93%) than in women (5.02%). The total PAF for all evaluated modifiable risk factors showed a more pronounced contribution among younger adults and men. In conclusion, this research reveals that obesity is the largest modifiable contributor to incident hypertension in the Japanese population. Furthermore, the impact of modifiable risk factors for hypertension is more significant in younger adults and men. These findings offer valuable insights for developing effective public health policies aimed at preventing hypertension.
She SC, Lin CW, Chen CW
… +8 more, Wu CH, Huang SS, Lai CJ, Kuo TBJ, Yang DI, Hsie YH, Kuo KL, Yang CCH
Hypertens Res
· 2026 May · PMID 41766041
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Intermittent hypoxia (IH), the key physiological stressor in obstructive sleep apnea, is commonly quantified by respiratory event frequency. However, clinical heterogeneity in hypertension among patients with comparable...Intermittent hypoxia (IH), the key physiological stressor in obstructive sleep apnea, is commonly quantified by respiratory event frequency. However, clinical heterogeneity in hypertension among patients with comparable apnea-hypopnea index (AHI) suggests that episode timing, including the duration and frequency of desaturation-reoxygenation cycles, may exert distinct biological effects even under equal cumulative burden. To test this, male Wistar-Kyoto rats were exposed for 21 days (8 h/day) to IH with either 10-s hypoxia duration at 30 cycles/h (10s-30c) or 5-s hypoxia duration at 60 cycles/h (5s-60c), while room air served as a control. Cardiovascular regulation was evaluated by continuous measurement of mean arterial pressure, heart-rate variability, and baroreflex sensitivity, and broader systemic effects were assessed through sleep-wake architecture, EEG activity, spatial memory, and cortical/hippocampal protein markers. Both IH groups had elevated blood pressure and disrupted autonomic balance compared with controls. The 5s-60c group produced more sustained hypertension, blunted nocturnal dipping, greater baroreflex impairment, and enhanced beta power during sleep, indicating persistent sympathetic drive. By contrast, the 10s-30c group was associated with increased paradoxical sleep, impaired spatial memory, reduced NeuN expression, and stronger upregulation of IBA-1 and NF-κB. These findings demonstrate that equivalent cumulative hypoxic exposure with different temporal structures yields divergent cardiovascular and neurocognitive outcomes. High-frequency, short-duration episodes preferentially promoted cardiovascular dysregulation, whereas longer episodes were linked to neurocognitive vulnerability. Consideration of hypoxic episode duration may improve the mechanistic interpretation of cardiovascular heterogeneity associated with sleep-disordered breathing.
Huang QF, An DW, Aparicio LS
… +21 more, Cheng YB, Wei FF, Boggia J, Yang WY, Sheng CS, Martens DS, Stolarz-Skrzypek K, Wojciechowska W, Rajzer M, Tikhonoff V, Casiglia E, Gilis-Malinowska N, Narkiewicz K, Seidlerová J, Filipovský J, Kawecka-Jaszcz K, Wang JG, Nawrot TS, Li Y, Staessen JA, International database of central arterial properties for risk stratification investigators
Hypertens Res
· 2026 May · PMID 41760901
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Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However, whether these indexes contribute to risk stratification...Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However, whether these indexes contribute to risk stratification in the general population is unknown. SPTI, DPTI and SEVR were noninvasively measured by the SphygmoCor technology. Incidence rates and standardized (per 1-SD increment) multivariable-adjusted hazard ratios (HRs) for cardiovascular (primary) and cardiac endpoints and stroke were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5099). Model refinement was assessed by the area under the curve (AUC) and the integrated discrimination (IDI) and net reclassification (NRI) improvement. Over 4 years (median), 215 cardiovascular, 133 cardiac endpoints and 79 strokes occurred. For SPTI, fully adjusted HRs were 1.37 (95% CI: 1.18-1.59), 1.35 (1.11-1.64) and 1.33 (1.05-1.69) for the cardiovascular and cardiac endpoints and stroke. The corresponding HRs for DPTI were 1.49 (1.31-1.69), 1.23 (1.02-1.48) and 1.74 (1.46-2.07). For SEVR, none of the HRs reached significance. Analyses with these indexes categorized by quartiles were confirmatory. Analyses stratified by various risk factors did not reveal subgroup differences. For the cardiovascular endpoint, adding SPTI or DPTI to the base model improved the AUC, while adding SPTI or DPTI combined with mean arterial pressure, increased IDI by ~1.7% and NRI by ~17% (P < 0.001 for all). Whereas cardiovascular and cardiac endpoints and stroke were related with the non-invasively measured SPTI and DPTI, SEVR was not.
Chang KC, Lin KY, Kuan DT
… +5 more, Huang KC, Lin TT, Wu CK, Lin LC, Lin LY
Hypertens Res
· 2026 May · PMID 41760900
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Heart failure with preserved ejection fraction (HFpEF) is characterized by impaired relaxation and increased stiffness, leading to elevated filling pressures and inefficient cardiac performance despite preserved ejection...Heart failure with preserved ejection fraction (HFpEF) is characterized by impaired relaxation and increased stiffness, leading to elevated filling pressures and inefficient cardiac performance despite preserved ejection fraction (LVEF ≥ 50%). These changes alter pressure-volume (PV) loop profiles. Noninvasive PV loop analysis using cardiovascular magnetic resonance (CMR) and brachial cuff pressure offers a novel approach to evaluating ventricular energetics. This study aimed to assess the prognostic value of CMR-derived PV loop parameters in HFpEF. Patients with HFpEF confirmed by invasive cardiopulmonary exercise testing who underwent CMR were included. PV loop parameters-including potential energy (PE), stroke work (SW), ventricular efficiency (VE), external power, and energy per ejected volume-were derived from CMR cine imaging and brachial cuff pressure measurement. The primary outcome was a composite of cardiovascular death and heart failure hospitalization. Associations were assessed using multivariable Cox proportional hazards models. Between February 2017 and August 2021, 161 patients (median age 55.1 years; 42.9% female) were enrolled. Nineteen (11.8%) experienced the primary endpoint over a median follow-up of 1.63 years. In unadjusted analysis, PE and VE were significantly associated with events (P < 0.05). In multivariable models adjusting for age, sex, hypertension, diabetes, hematocrit, and SW, PE remained an independent predictor (HR 3.59, 95% CI 1.24-10.42, P = 0.02). Noninvasive PV loop analysis using CMR and brachial cuff pressure identifies PE as a novel predictor of cardiovascular events in HFpEF, emphasizing impaired ventricular energetics as a key mechanism.
Vallelonga F, Cesareo M, Sanapo M
… +13 more, Colombo BM, Maloberti A, Fucile I, Totaro S, Aggiusti C, Salvetti M, Mancusi C, Pende A, Giannattasio C, Cipollini F, Muiesan ML, Milan A, Eridano Consortium
Hypertens Res
· 2026 May · PMID 41760897
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Hypertensive emergencies (HE) and urgencies (HU) are significant challenges for emergency physicians and hypertension specialists. The Eridano study is a prospective multicenter investigation assessing acute blood pressu...Hypertensive emergencies (HE) and urgencies (HU) are significant challenges for emergency physicians and hypertension specialists. The Eridano study is a prospective multicenter investigation assessing acute blood pressure (BP) disorders, subclinical hypertension-mediated organ damage (HMOD), and short- and long-term prognosis, including cardiovascular complications, new ED admissions, and BP control. Patients with symptomatic BP ≥ 180/110 mmHg admitted to the ED were enrolled and managed by ED personnel. Clinical evaluation and subclinical-HMOD assessment were performed at a Hypertension Centre within 72 h, followed by a 3-month follow-up. A total of 252 patients (21 HE, 231 HU) were included (mean age 61 ± 14 years, 52% males). Subclinical-HMOD was more common in HE (90% vs. 65%), including cardiac (76% vs. 43%), renal (40% vs. 11%), and cerebral (73% vs. 12%) damage. Vascular-HMOD was similar between the groups (54%), with increased pulse wave velocity (PWV) in 44% of patients. BP control (<140/90 mmHg) was achieved in 36% at 72 h. At 3 months, both groups showed lower systolic BP, and 29% of patients with uncontrolled BP at baseline achieved control. Female sex, lower ascending aorta diameter, and lower E/e' ratio were associated with BP control. The composite endpoint (cardiovascular events and new ED admissions) occurred in 12% of patients at 3 months (4% major events, 7% new HU). Multivariate analysis showed female sex and PWV were associated with adverse outcomes. Two-thirds of patients had subclinical HMOD, primarily affecting large arteries and the heart. Female sex and PWV were associated with worse outcomes.
Hypertens Res
· 2026 May · PMID 41741628
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Conceptual framework illustrating differential fluid dynamics between SGLT2 inhibitor monotherapy and combination therapy with conventional diuretics in patients with chronic kidney disease. Combination therapy preferent...Conceptual framework illustrating differential fluid dynamics between SGLT2 inhibitor monotherapy and combination therapy with conventional diuretics in patients with chronic kidney disease. Combination therapy preferentially reduces interstitial fluid while preserving plasma volume, potentially through attenuation of vasopressin activity, natriuresis, and transcapillary fluid shift.
Nikpour A, Pourmontaseri H, Sepehrinia M
… +5 more, Vahid F, Farjam M, Hébert JR, Homayounfar R, Dehghan A
Hypertens Res
· 2026 May · PMID 41741627
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Hypertension is a major public health challenge globally and in Iran. Given the role of inflammation in hypertension development, this study aimed to examine the association between the inflammatory potential of diet, qu...Hypertension is a major public health challenge globally and in Iran. Given the role of inflammation in hypertension development, this study aimed to examine the association between the inflammatory potential of diet, quantified using the energy-adjusted Dietary Inflammatory Index (E-DII™), and the incidence of hypertension. The data of the present study were extracted from the Fasa Adult Cohort Study database. In this prospective cohort study, 10,138 participants were recruited at the baseline phase. Participants were contacted by telephone at regular intervals over 7 years. A selected group was also revisited after 5 years. Survival analysis was conducted to investigate the association between E-DII and hypertension incidence over a 7-year follow-up period, using Cox regression. Participants in the highest E-DII tertile (most pro-inflammatory diet) had a significantly higher risk for hypertension incidence during 7 years (HR = 2.24, P value < 0.001). Moreover, the association of E-DII with hypertension incidence after 5 years was examined using logistic regression. Logistic regression revealed a significantly higher hypertension incidence after 5 years among participants in the highest E-DII tertile (OR = 2.62, P value < 0.001). Linear regression showed positive and significant associations between E-DII and change in blood pressure components over 5 years. However, the associations in all models were attenuated and became statistically insignificant after adjustment for body mass index. Our findings indicate that consuming a pro-inflammatory diet was associated with an increased risk of developing hypertension. Moreover, body mass index emerged as a key covariate in this relationship.
Hayashi S, Kogure M, Chiba I
… +20 more, Hatanaka R, Nakaya K, Takase M, Tokioka S, Orui M, Kodama EN, Hamanaka Y, Ishikuro M, Obara T, Nagaie S, Nakamura T, Ogishima S, Nagayoshi S, Kuwabara M, Iwaoka T, Fuse N, Izumi Y, Nakaya N, Kuriyama S, Hozawa A
Hypertens Res
· 2026 May · PMID 41735578
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Prevention of hypertension (HT), a risk factor for cardiovascular diseases, and blood pressure (BP) control are important. For the prevention and management of high BP, increased physical activity (PA) is recommended as...Prevention of hypertension (HT), a risk factor for cardiovascular diseases, and blood pressure (BP) control are important. For the prevention and management of high BP, increased physical activity (PA) is recommended as a lifestyle intervention. Although various PA assessment methods exist, their associations with clinical BP have been inconsistent. This study aimed to compare self-reported and accelerometer-measured PA in relation to home HT prevalence based on home BP, which has better reproducibility than office BP. We conducted this cross-sectional study of 5895 participants (mean age: 57.5 years, 70.4% women) in the Tohoku Medical Megabank Project Cohort Study. Total PA was assessed using two methods: self-reported activities (leisure, occupational/household) and accelerometer-measured values. Home HT was defined as morning home BP ≥ 135/85 mmHg or under HT treatment. Modified Poisson regression analysis showed no statistically significant association between self-reported total PA and the prevalence of home HT. In contrast, higher levels of accelerometer-measured total PA were associated with lower prevalence of home HT (P for trend <0.05). Regarding other accelerometer-measured components, higher light PA and more steps were also significantly associated with lower prevalence of home HT. These associations were largely mediated by body mass index. In conclusion, accelerometer-measured PA, unlike self-reported PA, was associated with home HT, suggesting that PA assessed by accelerometers is useful for understanding the relationship between PA and HT, preventing HT, and managing high BP.