To evaluate the efficacy and safety of sitokiren (SPH3127) tablet in patients with mild-to-moderate essential hypertension in comparison to valsartan capsule. This multicentre, randomised, double-blind, parallel Phase III trial was designed in 2 stages. In the 1st stage, eligible patients were randomised to receive 50 mg, 100 mg or 200 mg of SPH3127 tablet or 80 mg of valsartan capsule once daily (QD) for 12 consecutive weeks. In the 2nd stage, eligible patients were randomised to receive assigned dose of SPH3127 tablet based on the results from the 1st stage or valsartan 80 mg QD for 12 consecutive weeks. Primary outcome was the change from baseline in mean sitting diastolic blood pressure (msDBP) at Week 12. Safety outcome measures included any adverse events. Exploratory outcomes included plasma concentration of SPH3127, as well as the assessment of the correlation between SPH3127 exposure with the level of renin inhibition, clinical efficacy and occurrence of adverse events. The 1st stage enrolled 189 patients, of which 129 eligible patients were randomised. High plasma renin activity (PRA) inhibitory effect (83

Hypertension is a significant risk factor for cognitive impairment (CI), yet the corresponding neural network abnormalities remain underexplored. In this study, we examined the associations among global and domain-specific cognitive dysfunction, neuroimaging measures, and blood pressure in a subgroup of hypertensive patients with CI (N = 41) from a randomized controlled trial who underwent ultra-high-field 7 T MRI. Structural atrophy related to CI was localized to regions overlapping the attention networks. Both whole-brain and within-network dysfunction of the attention networks were associated with worse global cognitive performance. Notably, hyperconnectivity within key attention network hubs, including the right anterior insula and posterior intraparietal sulcus, was associated with declined processing speed in hypertensive patients, mediating the association between pulse pressure and processing speed. These findings provide new insights into the neural pathophysiology of hypertension-related CI and suggest potential network-based targets for intervention.

ABSTRACT Mucin‐1 was reported be correlated with organ fibrosis. Pulse pressure amplification (PPA) was a marker of arterial stiffness. We investigate the association of serum mucin‐1 (CA15‐3) concentration with peripheral and central blood pressure and PPA in untreated Chinese patients. The study participants were outpatients who were suspected of hypertension, but had not been treated with antihypertensive medication for at least two weeks. Serum mucin‐1 (CA15‐3) concentration was measured by the enzyme‐linked immunosorbent assay method. PPA was the brachial‐to‐aortic pulse pressure ratio. The 1761 participants included 916 (52.0%) women, and 578 (32.8%) participants with clinic hypertension. Mean (±standard deviation [SD]) age was 51.3±10.6 years. After adjustment for confounders, higher serum mucin‐1 (CA15‐3) concentration was significantly associated with higher peripheral and central systolic and diastolic blood pressure ( p ≤0.009) and lower PPA ( p = 0.037). Among 428 participants with a PPA equal or greater than 130% at baseline, 185 progressed to be a lower PPA (<130%) during a median follow‐up of 4.65 years. Hazard ratio expressed the relative risk of lower PPA per 1 SD increment in the log transformed serum mucin‐1 (CA15‐3) concentration was 1.22 ( p = 0.027). In women but not in men, the risk of lower PPA was significantly higher with increased baseline serum mucin‐1 (CA15‐3) concentration ( p for interaction 0.015). Higher circulating mucin‐1 (CA15‐3) concentration was independently associated with higher peripheral and central blood pressure and lower PPA in untreated Chinese patients. It also correlated with the progression of arterial stiffness as indicated by a lower PPA, especially in women.

Background Current hypertension guidelines recommend either ambulatory or home blood pressure (BP) monitoring for the management of hypertension. How we should properly utilize these 2 out-of-office BP measurement techniques remains under investigation. Objectives The purpose of this study was to investigate ambulatory and home BP monitoring in the definition of BP phenotypes with regard to cardiovascular outcomes. Methods In a nationwide prospective cohort, baseline observations were collected from August 2009 to October 2017, with last follow-ups in July 2024. Results Among 4,935 participants (mean age 54.3 years), median follow-up time was 4.9 years. The incidence rate of all cardiovascular events (n = 256), stroke (n = 100), and cardiac events (n = 171) was significantly (P ≤ 0.001) higher in 2,894 treated (14.9, 5.9, and 9.7 per 1,000 person-years, respectively) than 2,041 untreated outpatients (4.5, 1.4, and 3.2 per 1,000 person-years, respectively). In untreated patients, the analyses adjusted for confounders and mutually one for another out-of-office BP measurement technique showed that ambulatory but not home (masked and sustained) hypertension was associated with a higher risk of cardiac events relative to normotension (HR: 9.01; 95% CI: 1.10-73.91; and HR: 9.74; 95% CI: 1.01-94.25, respectively). In treated patients, the similarly adjusted analyses showed that home but not ambulatory sustained uncontrolled hypertension was associated with a higher risk of all cardiovascular events (HR: 1.80; 95% CI: 1.12-2.92; P = 0.02) and stroke (HR: 2.32; 95% CI: 1.00-5.42; P = 0.05) relative to controlled hypertension. Conclusions Our study in young and middle-aged outpatients indicates a preferable role of ambulatory and home BP monitoring, respectively, in untreated and treated patients in cardiovascular prediction.

BACKGROUND:Whether central systolic blood pressure (cSBP) compared with brachial systolic blood pressure (bSBP) improves risk stratification remains debated. This study investigated whether cSBP is more closely associated with total and cardiovascular mortality than bSBP when recorded by 24-hour ambulatory BP monitoring with an arm cuff-based oscillometric monitor. METHODS:Consecutive patients referred for ambulatory BP monitoring and enrolled in the Shanghai Ruijin Ambulatory BP Monitoring Registry (2017-2023) were analyzed. bSBP and cSBP were recorded over 24 hours. cSBP was calibrated on brachial systolic and diastolic BP (cSBPc1) or on mean arterial pressure and brachial diastolic BP (cSBPc2). Total and cardiovascular mortality up to December 31, 2024, was assessed by record linkage with International Classification of Diseases, Tenth Revision, coded death certificates. Linear and nonlinear Cox proportional hazard regression was applied with age as the underlying time-scale and adjusted for established cardiovascular risk factors. RESULTS:Over 4.0 years of follow-up, 505 of 36 594 participants (52.8% women; median age, 53.4 years) died, 174 from cardiovascular disease. With multivariable adjustment applied, the nonlinear compared with linear Cox models provided a better model fit for both end points (P<0.001), irrespective of the period of the day and the calibration method of cSBP. Adding any 24-hour SBP to the base model increased the C statistics for total and cardiovascular mortality (0.003≤P≤0.06). Adding cSBPc1 or cSBPc2 to the base model extended by bSBP also increased the C statistics, but not by a statistically significant amount (0.054≤P≤0.22). CONCLUSIONS:cSBP compared with bSBP did not improve the associations with mortality. Measurement of the ambulatory bSBP is adequate for BP-based risk stratification.

BACKGROUND:Aldosterone dysregulation is an important contributor in the pathogenesis of hard-to-control hypertension. We aimed to assess the effect of baxdrostat, a selective aldosterone synthase inhibitor, on ambulatory blood pressure in patients with resistant hypertension. METHODS:The Bax24 international, phase 3, randomised, double-blind, placebo-controlled trial recruited adults (aged ≥18 years) with seated systolic blood pressure (SBP) ≥140 mm Hg and <170 mm Hg, despite receiving three or more antihypertensive medications, including a diuretic, from 79 clinical sites (primary, secondary, and tertiary centres, in addition to research centres) in 22 countries. Following a 2-week placebo run-in period, patients with 24 h ambulatory SBP ≥130 mm Hg were randomly assigned (1:1) to receive 2 mg baxdrostat or placebo orally once daily for 12 weeks, in addition to background therapy (stratified by baseline ambulatory SBP <140 mm Hg or ≥140 mm Hg). Investigators, patients, and trial staff were masked to treatment assignment. The primary endpoint was change in 24 h ambulatory SBP from baseline to week 12, assessed by analysis of covariance in patients administered at least one dose of study medication with valid ambulatory SBP measurement at baseline and week 12. Missing or invalid ambulatory SBP measurements were not imputed. The safety analysis included all patients who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT06168409, and is complete. FINDINGS:Between March 1, 2024, and April 16, 2025, 854 patients were screened, 636 were excluded (437 before the placebo run-in and 199 during the placebo run-in) and 217 were randomly assigned to and received baxdrostat (n=108) or placebo (n=109). 140 patients (65%) were male, 77 (35%) patients were female, and 170 patients (78%) were White. The median age was 60·0 years (IQR 51·0-68·0). At 12 weeks, the change from baseline in the least-squares mean 24 h ambulatory SBP was -16·6 mm Hg (95% CI -18·8 to -14·3) in the baxdrostat group (n=89) and -2·6 mm Hg (-4·7 to -0·4) in the placebo group (n=95); the estimated placebo-corrected difference was -14·0 mm Hg (-17·2 to -10·8; p<0·0001). Adverse events occurred in 56 (52%) of 108 patients in the baxdrostat group and 40 (37%) of 109 patients in the placebo group. A confirmed potassium level of more than 6 mmol/L occurred in three (3%) of the 108 baxdrostat recipients and in none of the placebo recipients. INTERPRETATION:Baxdrostat significantly reduced 24 h ambulatory SBP versus placebo in patients with resistant hypertension, providing further evidence of the potential of aldosterone synthase inhibition for treatment of hard-to-control hypertension. FUNDING:AstraZeneca.

Hyperuricaemia is a known cardiovascular risk factor. Several angiotensin receptor blockers, such as losartan, can decrease serum uric acid level, but the effect on serum uric acid of angiotensin receptor neprilysin inhibitor remains unclear. This analysis aimed to investigate the effects of Sacubitril/Allisartan on serum uric acid level in Chinese patients with both hypertension and hyperuricaemia. We performed post-hoc analysis of data from a randomized controlled trial that compared the blood pressure-lowering effect at 12 weeks of treatment with Sacubitril/Allisartan (240 or 480 mg/d) and Olmesartan (20 mg/d). Hyperuricaemia was defined as a serum uric acid concentration exceeding the limit (420 μmol/L in male and 360 μmol/L in female) or patients already on antihyperuricemic drugs. The outcome measures included serum uric acid levels at 12, 24 and 52 weeks of treatment. Of the 1197 randomized patients, 401 (33.5%) patients with both hypertension and hyperuricaemia were included in this analysis. Mean serum uric acid levels at baseline were 441.4 ± 60.3 μmol/L, 430.5 ± 67.1 μmol/L, and 449.9 ± 78.6 μmol/L for the Sacubitril/Allisartan 240 mg, Sacubitril/Allisartan 480 mg, and Olmesartan groups, respectively (P = 0.41). Over the 12-week double-blind treatment period, serum uric acid levels decreased significantly from baseline in both Sacubitril/Allisartan groups compared to Olmesartan (-7.7 μmol/L), with a more pronounced reduction in the 240 mg (-37.7 μmol/L) and 480 mg groups (-43.3 μmol/L). Least square mean changes in serum uric acid reductions were greater with Sacubitril/Allisartan versus Olmesartan, with a difference of -30.0 μmol/L (P = 0.01) for Sacubitril/Allisartan 240 mg and -35.6 μmol/L (P = 0.002) for Sacubitril/Allisartan 480 mg. Treatment with Sacubitril/Allisartan decreased serum uric acid levels significantly more than Olmesartan in Chinese patients with both hypertension and hyperuricaemia, demonstrating a unique uricosuric effect of Sacubitril/Allisartan.

Environmental pollution-including air, noise, and light-and progressive climate change are major contributors to global health burdens, responsible for over 9 million premature deaths annuallysa. Among environmental exposures, air and noise pollution show the strongest epidemiological links to hypertension and cardiovascular disease, while emerging evidence also implicates light pollution, toxic metal exposure, and climate-related factors. Hypertension, the leading global cause of mortality, is increasingly recognized as a sentinel marker of environmental damage. Fine particulate matter (PM2.5) and road traffic noise exposure are associated with significant increase in hypertension prevalence and incidence. While historical guidelines overlooked environmental contributors, recent updates by the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) have integrated environmental risk factors into hypertension management frameworks. This position paper from the ESH Working Group on Environment and Hypertension synthesizes current evidence on the epidemiology and pathophysiology of environmental pollution in the development of hypertension. It highlights the mechanistic pathways involving oxidative stress, vascular dysfunction, and neurohormonal dysregulation triggered by pollution exposure. Importantly, the paper outlines mitigation strategies at both population and individual levels, including legislative initiatives, urban planning, and personal exposure reduction techniques. Considering hypertension as an early manifestation of environmental harm offers a critical opportunity for preventive intervention. It is vital to emphasize strict blood pressure control, enhanced screening in high-risk populations and the integration of environmental exposure monitoring into clinical practice. This comprehensive document seeks to raise awareness among healthcare professionals and inform evidence-based strategies for reducing pollution-related hypertension and cardiovascular morbidity.

We investigated the prognostic value of within-visit and short- and long-term between-visit blood pressure variability (BPV) for all-cause and cardiovascular mortality, fatal and nonfatal cardiovascular events and incident atrial fibrillation in an elderly Chinese population. Participants were elderly (≥65 years) inhabitants, enrolled in a trial for atrial fibrillation screening. Blood pressure was measured three times consecutively at baseline and in a subset also at least two weekly visits during the first month of follow-up or at least two quarterly visits during the first year of follow-up. BPV indices included standard deviation, coefficient of variation, and other statistical measures. We computed hazard ratios (HR) for the risks of clinical outcomes associated with a 1-SD increase in these BPV indices, while accounting for confounding factors. Among 6711 participants, diastolic within-visit BPV indices were significantly (P ≤ 0.02) and positively associated with the risks of all-cause and cardiovascular mortality, and fatal and nonfatal cardiovascular events, but systolic BPV indices were negatively associated with the risk of incident atrial fibrillation (HRs 1.03-1.09 and 0.87-0.92, respectively). Among 362 participants, none of the short-term between-visit BPV indices were associated with the clinical outcomes (P ≥ 0.09). For the long-term between-visit BPV among 1582 participants, significant associations were observed for systolic BPV indices in relation to cardiovascular mortality (P ≥ 0.03), and diastolic BPV indices in relation to incident atrial fibrillation (P ≤ 0.03), with the HRs ranging from 1.05-1.43, and from 1.07-1.20, respectively. In conclusion, some of the BPV indices were weakly associated with the risk of mortality, cardiovascular events and incident atrial fibrillation.

Wearable wristwatch-type cuff oscillometric blood pressure (BP) monitors represent a new category of BP devices and are the first wearable monitors to use established cuff-oscillometric BP measurement technology. This consensus statement by the European Society of Hypertension Working Group on BP Monitoring reviews the published evidence on their design, accuracy, validation, clinical application, and remaining research questions. Of 281 articles identified through a systematic PubMed search, 26 were relevant. Several devices are currently available; however, only two have published validation studies performed according to established standards (Omron HeartGuide and Huawei Watch D/D2). Static validation studies generally showed acceptable accuracy, whereas data on 24-h ambulatory use, in special populations, and clinical applications remain limited. Potential advantages include self-initiated measurement at home, at work, and in other settings and conditions; more convenient and repeatable 24-h ambulatory monitoring; more convenient and accurate assessment of asleep BP; capture of stress-related and other BP-related episodes. However, proper wrist position, user adherence, ambulatory performance, and clinical applications require further investigation. More research is needed to establish the accuracy and clinical utility of these novel devices and their role in improving the diagnosis and management of hypertension.

The C-reactive protein (CRP) to albumin ratio (CAR) has emerged as a novel marker of inflammation. However, its potential predictive value for the development of left ventricular aneurysm (LVA) has not yet been evaluated. This study aims to explore the association between CAR and the risk of LVA in patients experiencing acute ST-segment elevation myocardial infarction (STEMI). This study recruited 551 patients in the first cohort and 471 patients in the validation cohort. Multivariable logistic regression analysis, restricted cubic splines (RCS) analysis, and receiver operating characteristic were conducted to assess the predictive value of CAR for LVA. The prevalence of LVA were 14.5% in the first cohort and 13.6% in the validation cohort. Multivariable logistic regression analysis indicated that individuals in the highest quartile of CAR (Q4) were significantly associated with the risk of LVA formation compared to those in the lowest quartile (Q1) in both cohorts (First cohort: OR = 3.26, 95% CI = 1.51-7.05, P = 0.003; Validation cohort: OR = 4.05, 95% CI = 1.71-9.60, P = 0.002). RCS analysis demonstrated a positive and nonlinear association between CAR and the risk of LVA (overall P < 0.05, nonlinear P < 0.05). Furthermore, the discriminative ability of CAR for LVA is 0.72 in the first cohort and 0.74 in the validation cohort, exceeding that of both CRP and albumin alone. Subgroup analyses further corroborated the robustness of our findings. Elevated CAR was independently linked to an increased risk of LVA development in patients with STEMI who received primary PCI. This finding may hold considerable significance for clinical practice and could aid in the development of a personalized prevention strategy that incorporates the monitoring of CAR.

OBJECTIVE:This study investigated the exercise-induced changes in blood pressure (BP) and pulse rate using a wearable oscillometric BP monitor and their associations with cardiac structure and function. METHODS:The study included 137 participants (mixed hypertensive and normotensive) who underwent standardized symptom-limited cycle ergometer testing. BP and pulse rate were measured at rest, at peak exercise, and during recovery using HUAWEI WATCH D2, with reserves calculated as the peak minus rest values. Cardiac structure and function were assessed by echocardiography. RESULTS:The study participants had a mean age of 36.7 years, and included 63 women (46.0%) and 69 patients with hypertension (50.4%). During exercise, SBP rose by 31.7 (± 17.5) mmHg (from 119.9 mmHg at basal to 151.7 mmHg at maximal), DBP by 4.9 (± 9.4) mmHg (from 79.0 to 84.0 mmHg), and pulse rate by 62.8 (± 18.6) beats/min (from 81.4 to 149.6 beats/min). After adjustment, SBP reserve was significantly associated with cardiac structure ( P  ≤ 0.024), but only with stroke volume ( P =0.048) among the functional measurements ( P  ≥ 0.443). Pulse rate reserve were negatively associated with cardiac structural measurements ( P  ≤ 0.046), and positively with diastolic function ( P  ≤ 0.048). These observed associations tended to be stronger in women. CONCLUSION:Wearable BP monitors can trace hemodynamic responses to exercise. The exercise-induced changes in pulse rate and SBP are associated with cardiac structure and function, especially in women.

Percutaneous transluminal renal angioplasty (PTRA) is the first-line treatment for fibromuscular dysplasia (FMD)-related renal artery stenosis. Previous meta-analyses were predominantly based on white populations. We updated the meta-analysis to include Asian data and allow ethnicity-specific comparisons. Seven databases were systematically searched for clinical studies published since 2000 reporting PTRA outcomes in FMD. Data were pooled using random-effects models. Twenty-nine studies (1470 patients) were included: 15 Asian ( n  = 823) and 14 white ( n  = 647). Hypertension cure was significantly higher in Asians (40 vs. 17%; P  < 0.001). Cure or improvement tended to be higher in Asians (90 vs. 78%; P  = 0.08). SBP reduction tended to be greater (-33 vs. -23mmHg; P  = 0.08), and DBP reduction was significantly greater in Asians (-21 vs. -11 mmHg; P  = 0.016). Reduction in antihypertensive drugs (-1.1 vs. -0.8; P  = 0.10), technical success (97 vs. 99%; P  = 0.25), and restenosis (20 vs. 19%; P  = 0.96) were similar. Overall reported periprocedural complications were more frequent in whites (12 vs. 1%; P  = 0.01), with no deaths in either group. In meta-regression, younger age and a higher proportion of men were associated with hypertension cure in univariable analyses. However, when both variables were included in a multivariable model, only age remained independently predictive. PTRA shows comparable safety and procedural success in Asian and white patients with renal FMD, while BP responses are more favorable in Asians. Age independently predicts hypertension cure, underscoring the importance of early diagnosis and timely intervention.