Background Peripheral artery disease (PAD) is common but often underrecognized in people with hypertension because symptoms are frequently absent or atypical and access to physiologic testing is uneven. This narrative review examines how hypertension care can support risk-stratified PAD recognition while keeping targeted case-finding distinct from universal screening.Methods We conducted a structured narrative review of PubMed/MEDLINE from inception through 31 July 2026, supplemented by citation searching and review of major US and European guidelines and relevant US policy and coverage sources. Evidence was interpreted according to the question it could answer: association/prognosis, diagnostic accuracy, treatment effect, implementation, or policy status.Results Hypertension and PAD share age-related, metabolic, renal, and tobacco-related determinants, while pressure-related vascular injury provides biological plausibility for their association. Resting ankle-brachial index (ABI) is the initial physiologic test for appropriately selected people; toe-brachial index with waveforms is preferred for noncompressible ankle arteries, exercise ABI for persistent exertional symptoms despite normal or borderline resting values, and duplex ultrasound when anatomic definition will change management. Guideline-supported risk-based testing differs from universal screening of unselected asymptomatic adults, for which outcome benefit remains unproven. Detection is clinically meaningful only when linked to appropriate prevention, symptom management, foot protection, and referral.Conclusion This narrative review supports a risk-stratified, treatment-linked approach to PAD recognition in hypertension care, but the proposed case-finding pathway itself has not been proven to improve clinical outcomes. Pragmatic trials of the complete care pathway are needed.
Background The Chinese visceral adiposity index (CVAI) has been shown to be a practical indicator of visceral adiposity, but its association with prevalent hypertension in older adults remains unclear. This study aimed to investigate the association between CVAI and prevalent hypertension and to compare the discriminatory ability of CVAI with conventional obesity indicators among older adults in rural China.Methods This cross-sectional study included 3,280 adults aged 65 years or older who were recruited in Baima Town, Taizhou, China, in 2025. Logistic regression models with progressive adjustment were used to evaluate the association between CVAI and prevalent hypertension. Restricted cubic spline (RCS) analysis was performed to assess the dose–response relationship. Subgroup and sensitivity analyzes were conducted to examine the robustness of the findings. Receiver operating characteristic (ROC) curve analyzes were performed to compare the discriminatory ability of CVAI with body mass index (BMI) and waist circumference (WC).Results Of the 3,280 participants, 2,692 (82.1%) had hypertension. Participants with hypertension had higher CVAI values than those without hypertension [108.35 (79.80–134.24) vs 86.34 (55.72–112.39), P < 0.001]. After full adjustment, each 10-unit and 1-standard deviation increase in CVAI was associated with higher odds of prevalent hypertension (OR = 1.143, 95% CI:1.114–1.173 and OR = 1.709, 95% CI:1.528–1.915, respectively; both P < 0.001). RCS analysis demonstrated a positive association between CVAI and prevalent hypertension, with no evidence of significant nonlinearity (P for nonlinearity = 0.153).Conclusion CVAI was independently associated with prevalent hypertension among older adults in rural China. CVAI may provide information for cardiometabolic risk assessment among older adults in rural China.
BACKGROUND:Contemporary hypertension management increasingly emphasizes hypertension-mediated organ damage (HMOD) rather than blood pressure (BP) targets alone. Electroacupuncture (EA) has been studied mainly as a non-pharmacological antihypertensive intervention, but whether its reported organ-level effects reflect BP lowering or additional tissue-level mechanisms remains unclear. METHODS:This narrative mechanistic review synthesized preclinical and clinical literature from PubMed, Web of Science, Scopus and CNKI to organize EA-related evidence within a dual-pathway framework distinguishing BP-dependent from candidate BP-independent mechanisms across the brain, heart, kidney and vasculature. RESULTS:Preclinical evidence, mainly from spontaneously hypertensive rats, suggests that EA attenuates central sympathetic outflow, modulates brainstem-hypothalamic autonomic circuits, downregulates systemic and tissue renin-angiotensin-aldosterone system signaling, and reduces oxidative stress and inflammation. Organ-level evidence is graded moderate, and is the most developed of the four domains, for cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis; it is low-to-moderate for conduit-artery vascular changes and low for renal and cerebral effects. Across available studies, BP reduction and favorable organ-level changes occur together. No study has used BP-matched controls to isolate a BP-independent component, and no human trial with validated organ-specific HMOD endpoints was identified. CONCLUSION:Current evidence supports a hypothesis-generating dual-pathway framework in which EA-related organ effects may arise through BP-dependent mechanisms and candidate BP-independent tissue-level pathways. However, BP-independent organ protection remains unproven and requires BP-matched preclinical designs and sham-controlled human trials using validated HMOD surrogate endpoints.
OBJECTIVE:Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexists with hypertension, yet comparative data on antihypertensive medication classes remain limited. We examined associations between antihypertensive medication class and liver fibrosis and mortality in US adults with MASLD. METHODS:We conducted a prevalent-user analysis using National Health and Nutrition Examination Survey (NHANES) 1999-2018 data linked to mortality through 2019. Antihypertensive exposure was defined at baseline based on self-reported medication use, consistent with a prevalent-user design. Steatosis was defined by the US Fatty Liver Index (US-FLI). Fibrosis was assessed using FIB-4 and APRI within a model-based framework derived from vibration-controlled transient elastography. Analyses comparing antihypertensive classes were restricted to monotherapy users. Logistic regression and Cox models with inverse probability of treatment weighting and survey weights were applied. RESULTS:Among participants with MASLD receiving antihypertensive monotherapy (n = 458; 86 deaths), ACEIs and ARBs were associated with lower all-cause mortality compared with calcium channel blockers (CCBs, reference group; n = 47; 15 deaths) (ACEIs: adjusted hazard ratio [aHR], 0.30; 95% CI, 0.11-0.82; ARBs: 0.25; 95% CI, 0.07-0.94). In cross-sectional analyses, antihypertensive medication use was associated with lower odds of liver fibrosis defined by FIB-4 and APRI within US-FLI-defined populations (MASLD: FIB-4 aOR 0.51 [0.29-0.91]; APRI aOR 0.49 [0.28-0.89]). Findings were broadly consistent across sensitivity analyses, including alternative model specifications and expanded covariate adjustment. CONCLUSIONS:Antihypertensive medication use, particularly ACEIs and ARBs, was associated with lower fibrosis prevalence and all-cause mortality in MASLD. These findings are hypothesis-generating and require confirmation in prospective studies.
