Higher body mass index (BMI) in childhood is associated with hypertension (HTN) especially in young adulthood. We examined whether longitudinal patterns of BMI development in childhood are associated with HTN across adult ages. We included 124 670 children (51% boys), born between 1960-1996, from the Copenhagen School Health Records Register with height and weight measurements at ages 6-15 years. Latent class trajectory models were used to identify five sex-specific BMI trajectories: below-average, average, above-average, overweight, and obesity. Individuals were followed from age 25 in national health registers from 1995-2022 for HTN. Cox models were used to estimate sex-specific hazard ratios (HRs) with 95% confidence intervals (CIs) for HTN across childhood BMI trajectories, with adjustment for birth cohort and parental education. Follow-up was split into ages 25-39, 40-49, and 50-62 years. Over a median 18-year follow-up, 5 970 men (9.4%) and 5 712 women (9.3%) developed HTN. Men and women with above-average, overweight, and obesity childhood BMI trajectories had higher hazards of HTN than those with the average trajectory. Associations attenuated with age but remained significant. Compared to men with the average trajectory, the obesity trajectory was associated with a HR = 4.31 (95% CI: 3.45-5.37) at ages 25-39 and HR = 2.12 (1.63-2.76) at ages 50-62 years. Compared to women with the average trajectory, the obesity trajectory was associated with a HR = 3.53 (2.89-4.30) at ages 25-39 and HR = 2.19 (1.70-2.82) at ages 50-62 years. Childhood BMI trajectories are positively associated with adult HTN in a dose-response manner highlighting the potential value of early obesity prevention.
Primary aldosteronism (PA) is a common and treatable cause of hypertension, affecting up to 15% of patients in primary care, yet it remains substantially underdiagnosed. Recent international guidelines recommend routine screening for PA in all individuals with hypertension, highlighting the need for effective implementation strategies in general practice. We aim to determine whether an electronic clinical decision support (eCDS) tool integrated into general practice software improves PA screening and diagnosis. CONSEP (CONn Syndrome screening and Evaluation in Primary care) is a pragmatic cluster randomised controlled trial conducted in general practices across three Australian states. Practices will be block-randomised by size and location (state) in a 1:1 ratio to intervention (eCDS) or control. Patients eligible for analysis will be adults with hypertension attending participating practices. De-identified data will be extracted from clinical software at baseline, 12 months, and 24 months. Analyses will follow intention-to-treat principles using regression models accounting for clustering at the practice level. Primary outcomes are the proportion of patients screened for PA within 12 months and the proportion diagnosed with PA within 24 months. Secondary outcomes include blood pressure control, antihypertensive medication burden, cost-effectiveness, and a process evaluation assessing acceptability, feasibility, and sustainability. By embedding guideline-based screening into routine workflows, this trial addresses a major evidence-practice gap in hypertension care. If effective, the intervention could improve hypertension management, increase detection of PA, and reduce long-term cardiovascular risk in primary care.
High blood pressure and elevated glycemia increase cardiovascular risk in older adults. Physical activity and diet are cornerstone non-pharmacological strategies to manage these risk factors. However, interventions in community settings focusing on the combination of exercise and nutrition are scarce. This pragmatic randomized controlled trial compared combined exercise training with versus without nutritional counseling on fasting blood glucose (primary outcome), blood pressure, body composition, and cardiorespiratory fitness in older adults with hypertension. Thirty-two participants (50-80 years) were randomly assigned to exercise training alone (EX; n = 16), comprising walking/jogging and calisthenics (60 min per session, twice weekly), or exercise training plus nutritional counseling based on the Brazilian Dietary Guidelines (EX + N; n = 16; six biweekly group sessions emphasizing food quality and reduction of ultra-processed foods without energy restriction). The 12-week combined training was conducted in outdoor athletics track. Data were analyzed using generalized estimating equations with intention-to-treat principle. Between-group differences used Bonferroni correction, effect sizes used Hedges' g, and significance was α < 0.05. Twenty-nine participants completed the intervention. Fasting blood glucose was lower in EX + N than EX (-10 mg/dL; P = 0.004; g = 1.07). Systolic blood pressure decreased within EX + N (-10 mmHg; P = 0.034; g = 0.89) but not within EX, with no between-group difference (P = 0.220; g = 0.43). No between-group differences for diastolic blood pressure, body composition, or cardiorespiratory fitness. Nutritional counseling added to a community-based exercise program reduced fasting blood glucose compared with exercise alone, supporting the addition of nutritional counseling to exercise as a pragmatic strategy.
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide, and in Mexico, hypertension is the most important modifiable risk factor driving this burden. Excessive sodium intake is a key determinant of elevated blood pressure and CVD risk, yet population-level consumption continues to exceed World Health Organization (WHO) recommendations. In Mexico, average sodium intake remains well above recommended levels, reflecting structural characteristics of contemporary food environments rather than individual dietary choices alone. The growing consumption of ultra-processed foods, inherently high in sodium, has become a major contributor to excessive intake and poses a significant challenge for prevention efforts. The WHO SHAKE framework provides clear, evidence-based guidance for reducing population sodium intake through integrated action across surveillance, food reformulation, labeling and marketing standards, fiscal measures, education and communication, and healthier food environments. The 2025 update of this framework further emphasizes prioritizing interventions based on the dominant sources of sodium in each country and moving beyond isolated or voluntary measures. Mexico has made important advances, including front-of-package warning labels and restrictions on ultra-processed food sales in schools; however, these actions remain fragmented and insufficient to achieve meaningful reductions in population sodium intake. This comment argues for the urgent implementation of a comprehensive sodium reduction policy in Mexico, aligned with WHO guidance and informed by regional experience. Moving from partial measures toward a coherent, mutually reinforcing policy framework would complement existing nutrition initiatives, prevent avoidable cardiovascular morbidity and mortality, and generate long-term health and economic benefits for the Mexican health system.
ABSTARCT:Hypertension remains a major global health challenge, accounting for a substantial burden of mortality and morbidity. In India, despite advances in pharmacological management, optimal blood pressure (BP) control is still not achieved in a significant proportion of the population. Abnormal lipid profiles frequently coexist with hypertension, synergistically increasing the risk of cardiovascular diseases. Emerging evidence suggests that DNA methylation may mediate the effects of metabolic stressors on gene regulation, contributing to the pathophysiology of hypertension and related cardiometabolic disorders. This population-based study investigates the interrelationship between blood pressure, lipid profiles, and global 5-methylcytosine (5mC) levels across normotensive individuals, hypertensives identified by the investigators and not yet on medication, and hypertensives on medication (both controlled and uncontrolled). A total of 900 individuals (450 hypertensive cases and 450 age- and sex-matched controls) were recruited from rural Punjab. Anthropometric parameters (BMI, WC, HC), BP, lipid levels, and global DNA methylation were assessed using standardized protocols. Data were analyzed using SPSS v22. Findings revealed that abnormal levels of triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were significantly higher among hypertensive individuals on medication with uncontrolled BP. These individuals also exhibited significantly lower global 5mC levels, indicating hypomethylation. The results suggest that a high lipid burden may not only compromise the efficacy of antihypertensive medication but also contribute to global DNA hypomethylation, which is often associated with accelerated biological aging and elevated cardiovascular risk. The study highlights the importance of lipids not in hypertension control but also in maintenance of Global DNA methylation.
Mineralocorticoid receptor antagonists (MRAs) exhibit distinct pharmacologic profiles, yet their differential clinical relevance remains underexplored. This study assessed cardiovascular prevention with nonsteroidal esaxerenone (ESAX) relative to steroidal spironolactone (SPL) in hypertensive populations. From a nationwide claims database, we identified individuals with hypertension who newly initiated ESAX or SPL. Cardiovascular disease (CVD) was defined as a composite outcome of heart failure, atrial fibrillation, myocardial infarction, or stroke. We compared the incidence between the two groups using propensity score-based overlap weighting. A total of 5,960 individuals were included in the analysis: 3,776 who initiated ESAX and 2,184 SPL. The median (interquartile range) age was 73 (67-79) years, and 2,977 (50%) were men. The median estimated glomerular filtration rate was 66 (56-76) ml/min/1.73 m², and 1,210 (20%) had diabetes mellitus. During a median follow-up of 451 (208-816) days, 1,060 CVD events were observed. In weighted Cox regression, ESAX use was associated with a lower likelihood of developing CVD compared with SPL (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.70-0.91). This finding was mainly attributable to risk reductions in heart failure (HR, 0.80; 95% CI, 0.70-0.92) and atrial fibrillation (HR, 0.63; 95% CI, 0.44-0.91), with associations for myocardial infarction (HR, 0.97; 95% CI, 0.48-1.96) and stroke (HR, 0.88; 95% CI, 0.64-1.19) being non-significant. Our analysis showed a reduced incidence of CVD associated with ESAX, pointing to potential drug-specific differences within the MRA class.
Previous experimental studies showed that dysfunctions of mitofusin 2 (Mfn2), a mitochondrial dynamin-related protein, are associated with the presence of left ventricular hypertrophy (LVH). We examined the association of MFN2/rs2336384 and MFN2/rs2236057 polymorphic variants with the presence of LVH in three-hundred-forty-five patients with essential hypertension. One-hundred-thirteen individuals (33%) presented LVH. Hypertensive patients carrying the GG genotype at the MFN2/rs2336384 had a significant increase of echocardiographically-assessed septal thickness, posterior wall thickness, relative wall thickness (RWT), LV mass/ body surface area (BSA) (p = 0.001), LV mass/height2, and left atrium volume index (LAVi) compared to subjects carrying either TT or TG genotypes. These results were confirmed after adjustment for age, gender, body mass index (BMI), office blood pressure (BP), antihypertensive treatment with a combination of two or more drugs and the number of BP-lowering agents. With regard to MNF2/rs2236057, hypertensive subjects carrying the mutant A allele had a significant increase of septal thickness, posterior wall thickness, RWT, LV mass/BSA, LV mass/height2 and LAVi compared to wild-type homozygotes (GG genotype) and heterozygotes (GA genotype). After adjustment for covariates, the results were still significant for septal thickness, posterior wall thickness, LV mass/BSA and LAVi. Multivariable logistic regression analysis demonstrated that the carrier status of both G allele at rs2336384 and A allele at rs2236057 was associated with an increased risk of LVH. Our results demonstrate a significant association of MFN2 variants with LVH in hypertensives and highlight the potential role of MFN2-dependent mitochondrial dysfunction on increased susceptibility to cardiac damage in human hypertension. Relationship between Mitofusin 2 polymorphisms and left ventricular hypertrophy. CI, confidence interval; LVH, left ventricular hypertrophy; MFN2, mitofusion 2; OR, odds ratio.
Hypertension guidelines recommend home blood pressure monitoring (HBPM) using a standardised protocol to ensure accuracy and guide effective management. However, the extent to which HBPM is performed according to standardised protocol is unclear. The study aimed to explore how HBPM is used and understood by both health professionals and community members. A targeted, qualitative content analysis was conducted using a hybrid approach that combined deductive and inductive strategies to identify themes related to HBPM. Data was collected across 17 consultations and 19 co-design workshops with community members (adults 18 years and above, n = 154), and primary health professionals (general practitioners, general practice staff, nurses, health workers, pharmacists, n = 73) for a total of 227 participants. Sessions included unprompted discussions about experiences with HBPM, perceptions of accuracy, and practices in BP measurement and were conducted across three Tasmanian regions. Both community members and health professionals reported HBPM to be valuable and practical for hypertension management. Community members consistently ranked HBPM as a key preference for where they wanted their BP measured. However, there was variability in HBPM technique and limited awareness of evidence-based protocols. Instead, participants described ad hoc, individualised, and often invalid methods for measuring and recording BP at home. HBPM is an acceptable and widely used strategy for monitoring hypertension, but ad hoc, non-standardised use in practice undermines its accuracy and clinical utility. Addressing barriers to standardisation and integration into primary care are essential for optimising the role of HBPM in hypertension management.
The influence of mobility on asleep blood pressure among adults aged 80 years and older, particularly considering frailty, remains poorly understood. This cross-sectional study aimed to examine the association between objectively measured mobility parameters and asleep blood pressure alterations in a frail and non-frail population aged 80 years and older. Seventy-one participants (mean age 85 ± 4 years; 33 non-frail and 38 frail) completed both ambulatory blood pressure monitoring (ABPM) and objective mobility assessment using actigraphy. Baseline characteristics were similar between groups, except for a higher prevalence of hypertension and greater comorbidity burden in frail individuals. Mobility measures reflected a more sedentary profile in the frail group. In the total population, sedentary time, walking time, steps/day, cadence, and energy expenditure (METs-h) showed significant linear associations with asleep SBP and/or SBP dipping. Higher sedentary time correlated with elevated asleep SBP and reduced SBP dipping, whereas greater walking time, steps/day, cadence, and METs-h were protective. Among frail individuals, cadence was the only parameter consistently associated with both asleep SBP and dipping. In multivariable logistic regression adjusted for age, hypertension, and frailty status, higher cadence remained independently protective against elevated asleep SBP (OR 0.56, 95% CI 0.39-0.80) and non-dipping pattern (OR 0.87, 95% CI 0.79-0.95). In conclusion, mobility parameters were closely associated with asleep blood pressure alterations, specifically elevated asleep SBP and changes in the dipping pattern, among frail and non-frail adults aged 80 years and older. Cadence emerged as the most robust and clinically applicable measure.
Although numerous studies have investigated the association between hypertension and coronavirus disease 2019 (COVID-19) severity, differences in study characteristics have limited the consistency and generalizability of the available evidence. This systematic review and meta-analysis systematically evaluated the association between hypertension and COVID-19 severity by synthesizing evidence from 30 studies involving 15,549 participants comparing the prevalence of hypertension in non-severe and severe COVID-19 patients. Pooled odds ratios (ORs) were calculated using a random-effects model. Heterogeneity was assessed using I² and τ² statistics, while subgroup analyses and meta-regression examined the effects of region, sample size, study quality, age, and gender. Publication bias was evaluated using funnel plots and Egger's test. Hypertension was more frequently observed in severe COVID-19 cases across the included studies with a pooled odds ratio (OR) of 2.73 (95% CI: 1.85-4.02, p < 0.00001), However, substantial heterogeneity was observed (I² = 88%), limiting the precision of the pooled estimate. Subgroup analysis showed that sample size, NOS scores, and age did not significantly explain heterogeneity, with gender composition also not significantly associated with effect size (β = 0.021, p = 0.38). Funnel plot analysis and Egger's test showed no significant publication bias. Overall, hypertension was associated with an increased likelihood of severe COVID-19, although the high level of heterogeneity suggests that the findings should be interpreted with caution. These findings contribute to the understanding of the association between hypertension and COVID-19 severity and may inform clinical risk stratification and public health decision-making.
The clinical significance of peripheral autonomic dysfunction in assessing cardiovascular risk in non-diabetic hypertensive patients is unclear. In a cohort of 93 hypertensive patients without diabetes or neurodegenerative diseases, we examined the correlation between electrochemical skin conductance, arterial stiffness, ambulatory blood pressure parameters, and cardiovascular risk scores. Electrochemical skin conductance was not associated with arterial stiffness or global cardiovascular risk. However, it was lower in older patients and in patients with impaired renal function, suggesting a potential link with microvascular or end-organ involvement.
Globally, only about one in five of the 1.4 billion people with hypertension achieve blood pressure (BP) control to <140/90 mmHg, despite strong evidence and clear guideline recommendations for optimal management. Many patients require three or more antihypertensive medicines, yet real-world barriers, including limited access, poor adherence and health system complexities, prevent them from achieving optimal BP control. Single pill combinations (SPCs) improve adherence, simplify treatment, and enhance efficacy with favourable safety through complementary pharmacological mechanisms at lower, better-tolerated doses. The World Health Organization in 2025 added triple drug antihypertensive SPCs to the 24th Model Essential Medicines List, building on the 2019 inclusion of dual drug SPCs. This paper reviews the clinical trial and real-world evidence supporting the inclusion of triple drug SPCs as essential medicines-their efficacy, safety, cost, and role in current guideline recommendations. Randomized control trials show that triple drug SPCs achieve greater BP reduction (~5.4/3.2 mmHg) and higher control than dual therapy. Low-dose triple drug SPCs further improve adherence, accelerate BP control, and enhance real-world effectiveness in primary care. Economic analyses suggest that SPCs are often cost-saving due to reduced pill burden, fewer clinic visits, and improved outcomes, though affordability varies across settings. The inclusion of triple drug SPCs in the Essential Medicines List signals their global priority. However, translation to population-level benefit will depend on inclusion in national formularies, standardized treatment protocols, and deliberate strategies to improve access in low- and middle-income countries where treatment gaps are widest.
Although routine screening for primary aldosteronism (PA) is increasingly recognized among patients with obstructive sleep apnea (OSA), data regarding aldosterone-to-renin ratio (ARR) screening positivity among Southeast Asian OSA populations remain limited, particularly in resource-limited settings. This study aimed to determine the prevalence and clinical correlates of ARR positivity screening among obese hypertensive OSA patients. In this cross-sectional study, obese hypertensive adults with confirmed OSA were recruited. Blood samples were analyzed for plasma aldosterone concentration (PAC), plasma renin concentration (PRC), serum potassium, and standard metabolic indices. Therapeutic intensity score (TIS) was used to quantify antihypertensive burden. ARR-based categories were applied to stratify patients into (i) positive ARR (Group 1), (ii) low renin/negative ARR (Group 2), or (iii) negative ARR (Group 3). Among 160 patients, 11.9% were classified in Group 1 and 20.0% as Group 2. Serum potassium levels were significantly lower in Group 2 compared with Group 3. An inverse association between PRC and uric acid was observed in the overall cohort, although the model fit was weak. In males, serum potassium, uric acid, and TIS were significantly associated with RAAS activity and were associated with greater likelihood for ARR positive screen. A substantial proportion of obese hypertensive OSA patients demonstrated ARR positivity. However, routine clinical and metabolic parameters alone were insufficient to reliably identify affected individuals. These findings support maintaining a low threshold for PA screening in hypertensive OSA patients.
Primary light chain (AL) amyloidosis is a rare but lethal systemic disorder. Prior work suggests that vascular involvement may independently affect survival. Mechanistic data are needed to clarify its clinical role. We sought to explore vascular-cardiac interactions by examining associations between vascular and cardiac markers. We recruited 151 newly-diagnosed patients with AL amyloidosis who underwent peripheral vascular assessment including flow-mediated dilation (FMD) and pulse wave velocity (PWV). Transthoracic echocardiography was performed in all patients, and cardiac magnetic resonance (CMR) in a subgroup (n = 59). Ventricular-arterial coupling was assessed using PWV/global longitudinal strain (GLS), central systolic blood pressure (CSBP)/GLS, and tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP). Vascular and hemodynamic markers were associated with cardiac involvement, including left ventricle (LV) and right ventricle (RV) systolic and diastolic function, LV hypertrophy and CMR parameters (T2 and late gadolinium enhancement). Markers of vasodilation and low peripheral resistance correlated with more severe cardiac involvement. Low peripheral and central blood pressure and pressure-strain indices predicted worse survival. Peripheral vascular dysfunction was linked to adverse cardiac structure and function in AL amyloidosis. These observational findings suggest that arterial-myocardial uncoupling parallels disease severity and serves as a marker of advanced cardiovascular involvement highlighting its prognostic significance.
