Background This study aimed to evaluate the effect of catheter-based renal denervation (RDN) on orthostatic blood pressure (BP) adaptation in patients with uncontrolled hypertension. Methods This prospective observational study enrolled patients who had been previously included in the multicenter Iberis-HTN trial and Netrod™-HTN trial. Eligible patients were randomly assigned to undergo either radiofrequency RDN or a sham procedure. BP and heart rate (HR) changes during a 3-min orthostatic challenge from supine to standing were measured at baseline and 6 months after randomization. Results At 6 months, the RDN group exhibited a significantly greater reduction in ambulatory BP, office systolic blood pressure (SBP) and BP in both supine and standing positions compared to the sham group. After adjusting for baseline values, the magnitude of changes in orthostatic SBP and diastolic blood pressure (DBP) at the 3-min timepoint, along with the maximum changes observed throughout the 3-min orthostatic test, was significantly smaller in the RDN group at 6 months (3 min: SBP/DBP, p = 0.008/0.010; Maximum: SBP/DBP, p = 0.041/0.004). The changes in orthostatic HR at 6 months were comparable between the RDN and the sham group. Conclusions Catheter-based radiofrequency RDN significantly reduced BP in both supine and standing positions during active standing at 6 months compared to the sham group. Additionally, RDN attenuated BP elevation during postural changes, and the response pattern to orthostatic stress was partially restored toward the range of normal physiological variation. This observation may be related to the reduction in excessive vascular tone in response to orthostatic stress after RDN.

BACKGROUND:Epidemiological studies indicate that the unique high-altitude environment may promote the prevalence of hypertension. Nevertheless, whether chronic plateau exposure affects antihypertensive efficacy in hypertensive highlanders remains unknown. METHODS:This is a post hoc analysis of the OMAN Trial, a randomized controlled study that compared the antihypertensive efficacy of morning versus bedtime administration of olmesartan/amlodipine. Hypertensive patients from the OMAN Trial were stratified into highlanders (Sichuan-Tibet Plateau, altitude ≈ 3000 m) and lowlanders (Sichuan-Chengdu Plain, altitude ≈ 500 m) based on 1 : 1 propensity score matching. After 4-week treatment of olmesartan/amlodipine (20/5 mg once daily), between-group differences in office/ambulatory blood pressure (BP) reduction, control rates, and rhythms were analyzed. RESULTS:Each group comprised 171 hypertensive patients with balanced baselines. While office BP reductions were comparable between groups, highlanders showed significantly smaller reductions in 24-h ambulatory BP compared with lowlanders (between-group difference in 24-h SBP reduction: -2.39 mmHg, P  = 0.048; between-group difference in 24-h DBP reduction: -1.60 mmHg, P  = 0.025). More pronounced between-group differences in BP reduction were observed during the morning (ΔSBP: -7.18 mmHg, P  < 0.001; ΔDBP: -4.01 mmHg, P  = 0.002) and daytime (ΔSBP: -3.81 mmHg, P  = 0.005; ΔDBP: -2.29 mmHg, P  = 0.005) periods. Similarly, both office BP control (lowlanders: 77.2% vs. highlanders: 60.2%, P  = 0.001) and 24-h BP control rates (lowlanders: 50.9% vs. highlanders: 34.5%, P  = 0.002) were significantly lower in highlanders. Intriguingly, nocturnal BP reduction and control rates showed no significant intergroup differences. CONCLUSION:Our findings suggest chronic plateau exposure may attenuate antihypertensive efficacy, potentially necessitating intensified treatment regimens for BP control in highlanders. REGISTRATION:URL: https://www.chictr.org.cn/ ; Registration number: ChiCTR2200059719.

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

Orthostatic blood pressure (BP) adaptations are associated with the risk of adverse cardiovascular events. This study aimed to evaluate the effect of catheter-based renal denervation (RDN) on orthostatic BP adaptations in patients with uncontrolled hypertension. The Iberis-HTN Trial is a randomized, sham-controlled, multicenter study conducted at 16 centers in China. Eligible patients were randomly assigned to undergo either radiofrequency RDN or a sham procedure. As one of the participating centers in the Iberis-HTN trial, BP and heart rate (HR) changes during a 3-min orthostatic challenge from supine to standing were measured at baseline and 6 months after randomization. Between March 2018 and January 2022, a total of 30 patients were assigned to the RDN group (n = 15) and sham group (n = 15). Of these 30 patients, 10 in the RDN group and 12 in the sham group completed orthostatic BP measurements at both baseline and 6 months. At 6 months, the RDN group exhibited a significantly greater reduction in ambulatory blood pressure, office systolic blood pressure (SBP) and BP in both supine and standing positions compared to the sham group. The changes in orthostatic SBP and diastolic blood pressure (DBP) at 3 minutes, and the maximum changes during a 3-min orthostatic test at 6 months were smaller in the RDN group than in the sham group after adjusting for baseline values (3 min: SBP -9.4 mmHg [95%CI: -16.0 to -2.8], P = 0.008; DBP -6.7 mmHg [95%CI: -12.4 to -1.1], P = 0.022. Maximum: SBP -10.9 mmHg [95%CI: -21.1 to -0.6], P = 0.039; DBP -9.2 mmHg [95%CI: -16.2 to -2.1], P = 0.013). The orthostatic HR changes at 6 months were similar between the RDN and sham group. Catheter-based radiofrequency RDN significantly reduced office BP, ambulatory BP, and BP in both supine and standing positions during active standing at 6 months compared to the sham group. Additionally, RDN mitigated the inappropriate increase in orthostatic BP and partly restored the normal response pattern to orthostatic challenges. Further studies are warranted to investigate whether the differential effects of RDN on orthostatic BP correlated with long-term cardiovascular outcomes.

PURPOSE:Our study tends to perform a network meta-analysis to compare the effect of different treatments on resistant hypertension (RH). METHODS:A systematic search was conducted in databases up to April 1, 2026. We conducted a network meta-analysis using random effects to compare the change of systolic/diastolic blood pressure (SBP/DBP) between the following interventions: second-generation renal denervation (RDN), mineralocorticoid receptor antagonist (MRA), endothelin receptor antagonist, aldosterone synthase inhibitor (ASI), sodium-glucose cotransporter-2 inhibitors, baroreflex activation therapy, central arteriovenous anastomosis, lifestyle, and control group. RESULTS:Thirty-three eligible studies were included in the final analysis. After conducting sensitivity analyses, MRA significantly lowered both office and 24-h blood pressure (BP) compared to control group (mean difference -9.11, [95% confidence interval -10.44 to -7.79] for office SBP; -4.97 [-5.83 to -4.11] for office DBP; -9.64 [-11.73 to -7.54] for 24-h SBP; -3.75 [-5.08 to -2.42] for 24-h DBP). RDN effectively reduced both office and 24-h BP, and it caused a large reduction in office DBP compared to control group (-6.63 [-8.58 to -4.68] for office DBP; -3.36 [-4.57 to -2.14] for 24-h DBP). Lifestyle and ASI effectively reduced office and 24-h BP, and it as well as MRA were almost in the top three treatments. CONCLUSION:MRA can be the priority treatment for RH. ASI and RDN are also optimal alternatives to MRA, particularly suitable for 24-h BP and uncontrolled DBP management, respectively. A combination of lifestyle alongside pharmacological/device-based therapies may represent the optimal approach. More trials concerning other treatments for RH are needed.

Introduction:Although low-dose aspirin effectively reduces atherothrombosis occurrence in individuals diagnosed with cardiovascular disease (CVD) or in those with high-risk factors, it is significantly associated with increased bleeding. No evidence has been established for a lower dose of aspirin. Methods:The Lower-dose Aspirin for Primary and Secondary Prevention of Cardiovascular Disease in the Elderly (LAPIS) is a multicenter, prospective, observational cohort study, which compared the benefits and risks in adults aged 60 years and older taking aspirin 50 or 100 mg/day for primary and secondary CVD prevention in a propensity score-matched population. The efficacy outcome was a composite of the first occurrence of major adverse cardiovascular events (MACE). The safety outcome was the first occurrence of any hemorrhagic events. Results:In this interim analysis of LAPIS, 7,021 participants were followed up for a median of 183 (95% CI 169-197) days (primary prevention cohort, 2,070; secondary prevention cohort, 4,951). After adjusting for baseline characteristics using propensity score matching, the MACE incidence did not differ significantly between the two dosage groups in either cohort. However, in the primary prevention cohort, the incidence of any bleeding [8.89 vs. 3.45 events/100 patient-years, hazard ratio (HR) 2.917, 95% confidence interval (CI) 1.719-4.952, P < 0.001] and gastrointestinal events (8.30 vs. 5.04 events/100 patient-years, HR 1.745, 95% CI 1.047-2.907, P = 0.037) was higher in the 100 mg/day group. In the secondary prevention cohort, the 100 mg/day group showed higher rates of any bleeding (9.19 vs. 6.37 events/100 patient-years, HR 1.473, 95% CI 1.087-1.998, P = 0.015), minor bleeding (9.10 vs. 6.06 events/100 patient-years, HR 1.541, 95% CI 1.116-2.127, P = 0.009), and gastrointestinal adverse events (7.10 vs. 3.53 events/100 patient-years, HR 1.943, 95% CI 1.291-2.925, P = 0.002). Conclusion:Aspirin 50 mg/day was associated with lower hemorrhage and gastrointestinal adverse event risks, with similar cardiovascular benefits, compared with aspirin 100 mg/day, and may be preferred to balance efficacy and safety for older Chinese adults in primary and secondary CVD prevention.

Objective: While photoplethysmogram (PPG) signals are physiologically linked to cardiac activity and widely used for cuffless blood pressure (BP) estimation, their correlation with BP remains limited in reliability due to inter-individual heterogeneity. This study aims to isolate the PPG components that have a strong causal relationship with BP, and leverage them to construct reliable cuffless BP estimation models. Methods: We propose a causal decomposition framework combining ensemble empirical mode decomposition (EEMD) with counterfactual inference to isolate physiologically causal components in PPG signals. First, PPG signals are adaptively decomposed into multi-scale intrinsic mode functions (IMFs) via EEMD. Then counterfactual PPG sequences are generated through sequentially excluding each IMF, and their causal relationships with BP are quantified via structure causal modeling to identify hemodynamically significant components. Subsequently, robust cuffless BP estimation models are constructed by selectively incorporating components demonstrating strong causal effects. To validate the framework, we benchmark our causality-based models against conventional approaches: pulse arrival time (PAT)-based physiological model, gradient-boosted regression tree (GBRT)-based feature model, and convolutional neural network (CNN)-based time-series model. Result: mid-frequency PPG components (IMF4-6) showed strongest BP causality, with CNN model achieving superior estimation performance over PAT and GBRT when utilizing these components. Using IMF45 components, the CNN model achieved BP estimation mean absolute errors of 5.55/3.45 mmHg (systolic/diastolic BP), improving accuracy by 26.39%/17.86% over original PPG. Conclusion: Specific PPG frequency bands exhibit physiologically meaningful causal BP relationships. Our causality-driven approach enhances both accuracy and interpretability in cuffless BP estimation. Significance:This work establishes a theoretical framework for causal feature selection in BP estimation, and a novel paradigm for physiological signal analysis through causal decomposition.

Systemic hypertension at high altitude is clinically important but mechanistically heterogeneous. Excessive erythrocytosis (EE), commonly discussed in relation to high-altitude polycythemia (HAPC) or the erythrocytotic component of chronic mountain sickness (CMS), is one of the most visible maladaptive responses to chronic high-altitude hypoxia. Emerging human studies suggest that erythrocytosis burden may be associated with the hypertensive phenotype at high altitude. Here, we critically evaluate the evidence linking EE and systemic hypertension and discuss the principal mechanistic pathways that may connect these phenotypes, including hyperviscosity-related vascular stress, endothelial dysfunction, hypoxemia with sleep-disordered breathing, sympathetic activation, and renal-metabolic disturbance. Current evidence can be organized into three tiers: direct association studies, indirect human physiological studies, and clinical extension studies addressing vascular or organ-damage phenotypes. The evidence base remains limited in sample size, predominantly cross-sectional, and largely restricted to selected high-altitude populations, especially Tibetans. Available data support association more strongly than causation. The key unresolved question is whether EE is a causal determinant of high-altitude hypertension, a marker of more severe hypoxic maladaptation, or a maladaptive amplifier within a broader blood pressure dysregulation phenotype. Clarifying this distinction will require phenotype-rich longitudinal studies integrating hemoglobin burden, blood viscosity, oxygenation, sleep-disordered breathing, ambulatory blood pressure, and vascular phenotyping.

BACKGROUND:Obstructive sleep apnoea (OSA) is a prevalent disorder closely linked to obesity. While weight loss is a recommended strategy to target its root cause, evidence on the efficacy and sustainability of non-surgical interventions remains unclear. This meta-analysis aimed to systematically evaluate their effects on OSA severity and cardiometabolic outcomes, and to explore sources of heterogeneity. METHODS:This meta-analysis of randomized controlled trials was conducted PRISMA guidelines (PROSPERO: CRD420250641507). We searched PubMed, EMBASE, Cochrane Library, and Web of Science for trials assessing non-surgical weight loss interventions in adults with OSA. The primary outcome was the Apnea-Hypopnea Index (AHI); secondary outcomes included anthropometric and blood pressure measures. Data were synthesized using random-effects models, with heterogeneity explored via pre-specified subgroup analyses (by follow-up duration and type 2 diabetes status). Risk of bias and evidence certainty (GRADE) were assessed. RESULTS:Eighteen studies involving 2242 participants were included. Non-surgical weight loss interventions significantly reduced AHI (MD = -11.10; p < 0.0001). Significant improvements were observed in all secondary outcomes: body weight (MD = -6.53), body mass index (MD = -2.40), waist circumference (MD = -5.13), neck circumference (MD = -0.97), systolic blood pressure (MD = -6.51), and diastolic blood pressure (MD = -3.26) (all p < 0.01). Evidence for benefits was most robust in the short to mid-term. Heterogeneity was high (I2 >90%) for most outcomes. The overall certainty of evidence was rated as very low. CONCLUSION:Non-surgical weight loss constitutes a viable short-to-midterm strategy for improving OSA severity and cardiometabolic health. It should be integrated as a foundational component of initial management, with emphasis on long-term weight maintenance. High-quality research with extended follow-up is needed to confirm the durability of benefits.

INTRODUCTION:Hypertension is a primary risk factor for cardiovascular mortality and frequently co-occurs with depression and anxiety, though their combined impact remains inadequately characterized in this high-risk population. AIM:This study aimed to investigate the associations of depression and anxiety with cardiovascular mortality specifically in adults with hypertension. METHODS:We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire, while anxiety was measured through self-reported days. The associations were evaluated using weighted multivariable cox regression and restricted cubic spline (RCS) models. RESULTS:A total of 3728 participants were included, with a mean follow-up of 9.2 years and 285 cardiovascular deaths. In Model3, depression (PHQ-9) was positively associated with cardiovascular mortality (Hazard ratio (HR) [95% CI] 1.07 [1.03-1.10], P < 0.001). When PHQ-9 was categorized into quartiles, the greatest HR in men was observed in Q3 (2.65 [1.09-6.44], P = 0.032) but that for women was in Q4 (3.94 [1.39-11.2], P = 0.01). RCS curve revealed linear positive association between depression and cardiovascular mortality (P-overall < 0.001; P-nonlinear > 0.05). No interaction was observed in the stratified analyses (P > 0.05). Sensitivity analyses showed the HR of Q4 was attenuated in the overall population but remained stable in women (3.97 [1.29-12.2], P = 0.019). No significant association was found between anxiety and cardiovascular mortality (P > 0.05). CONCLUSIONS:Depression, but not self-reported anxious days, was positively associated with cardiovascular mortality in hypertensive patients, with a stronger association observed in women.

Background The objective of this study was to ascertain whether cardiometabolic index(CMI), visceral adiposity index (VAI), dysfunctional adiposity index (DAI), and body adiposity index (BAI) are superior predictors of future hypertension risk when compared with conventional indicators such as waist circumference(WC), body mass index (BMI) and waist-to-height ratio(WHtR). Material and Methods: This is a post hoc analysis of the MONICA protocol. We selected 597 patients based on inclusions criteria. Data collection began in 1992, and follow-up was conducted on the same group of participants in 2007. The study collected anthropometric indexes and biochemical data. Results: After adjusting for confounding factors using multivariate Cox regression analysis, the following results were observed: CMI [HR: 1.754 (1.240–2.480); P = 0.001], VAI [HR: 1.533 (1.074–2.187); P = 0.018], DAI [HR: 1.382 (0.982–1.945); P = 0.064], BAI [HR: 2.791 (1.790–4.352); P < 0.001], WC [HR: 2.234 (1.510–3.307); P < 0.001], WHtR [HR: 2.303 (1.589–3.339); P < 0.001], and BMI [HR: 2.488 (1.778–3.561); P < 0.001] were all significantly associated with the incidence of hypertension. ROC curve analysis showed that the area under the curve (AUC) for WC product was the highest (0.649, 95

[This corrects the article DOI: 10.3389/fcvm.2026.1845046.].

High-altitude erythrocytosis (HAE) may have vascular implications, but its association with arterial stiffness in long-term high-altitude residents remains unclear. We conducted a cross-sectional study of adults from Chengdu and high-altitude areas of Sichuan Province between January 2024 and February 2026. After excluding participants with ankle-brachial index <0.90 or atrial fibrillation, 3346 participants were included (2271 low-altitude and 1075 high-altitude residents). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV); the primary outcome was mean baPWV, and the clinical outcome was mean baPWV ≥1800 cm/s. High-altitude residents had higher mean baPWV than low-altitude residents (1576.1 ± 403.1 vs 1474.4 ± 309.4 cm/s), with a higher prevalence of mean baPWV ≥1800 cm/s (23.8% vs 14.8%). Among high-altitude residents, 114 had HAE and 961 did not. Participants with HAE had higher mean baPWV (1969.4 ± 563.0 vs 1529.5 ± 352.0 cm/s). After adjustment for age, sex, body mass index, systolic blood pressure, heart rate, smoking, alcohol drinking, diabetes, lipid parameters and estimated glomerular filtration rate, HAE remained associated with higher mean baPWV (β, 297.5 cm/s; 95% CI, 219.6-375.5; P < 0.001) and higher odds of mean baPWV ≥1800 cm/s (OR, 3.30; 95% CI, 1.98-5.48; P < 0.001). Hemoglobin-category, continuous hemoglobin, and restricted cubic spline analyses supported a positive, nonlinear hemoglobin-baPWV association. HAE was associated with greater baPWV burden among long-term high-altitude residents, but causality cannot be inferred.

Introduction Hypertension constitutes the primary health burden of cardiovascular diseases, and the global control of blood pressure (BP) remains insufficient. Single pill combinations (SPCs) are employed as a means to streamline the management of poor BP control due to non-adherence and treatment inertia. The compound reserpine and triamterene tablets constitute a quadruple SPC, comprising reserpine 0.1 mg, dihydralazine 12.5 mg, hydrochlorothiazide 12.5 mg and triamterene 12.5 mg. It is widely employed in primary medical institutions and has favourable efficacy, tolerability and cost-effectiveness.Methods and analysis The COSPQ-BP trial is a 12-week prospective randomised controlled trial to enrol 1332 patients with primary mild-to-moderate hypertension. Participants who meet the inclusion criteria will be randomly assigned to a 1:1 ratio to an intervention group (compound reserpine and triamterene tablets) or a control group (valsartan/hydrochlorothiazide). The primary outcome will be mean changes from baseline in 24-hour ambulatory systolic BP after intervention for 12 weeks. The secondary outcomes have been predetermined and will primarily encompass the following: (1) changes in other BP measures, as well as changes in blood lipids, blood glucose and uric acid at 12 weeks and (2) evaluation of the impact of starting antihypertensive therapy with compound reserpine and triamterene tablets or valsartan/hydrochlorothiazide on the depressive and anxiety statess of patients.Ethics and dissemination The study protocol (version number: V5.0, version date: 17 January 2023) has been approved by the ethics committee (Biomedical Ethics Committee of West China Hospital of Sichuan University, approval number: Review (51) in 2023). Written informed consent will be obtained from each participant by researchers. The findings of this study will be disseminated through conference presentations and peer-reviewed publications.Trial registration This study was registered at the Chinese Clinical Trials Registry (ChiCTR2300067920). The COSPQ-BP trial is currently enrolling. The study period will be from 1 January 2024 to 31 December 2025.

ObjectTo investigate the possible association between pan-immune-inflammation value (PIV) and dyslipidemia.MethodsThis cross-sectional study used the data obtained from National Health and Nutrition Examination Survey (NHANES). The independent variable used the logarithmic form of PIV-log2 (PIV). The definition of dyslipidemia was based on the National Cholesterol Education Program standards. Weighted multivariate logistic regression analyses, the restricted cubic spline (RCS) and threshold effect analysis were explore the association between PIV and dyslipidemia. Stratified analyses were used to identify potential associations with other covariates. The receiver operating characteristic (ROC) curve was constructed compared to systemic immune-inflammation index (SII).Results6,821 participants were included, of whom 47% were male and 77% had dyslipidemia. After adjusting for all confounders, PIV and dyslipidemia had an significantly positive association (OR (95%CI): 1.13 (1.01-1.25); P = 0.03). Compared to participants with lowest quartile (Q1) of PIV, participants with the highest quartile (Q4) had a significantly higher risk of dyslipidemia (OR (95%CI): 1.37 (1.05-1.80); P = 0.022). The RCS curve showed an inverted J-shaped relationship between PIV and dyslipidemia (P-nonlinear = 0.0415, P-overall < 0.001). The threshold effect analysis revealed that the inflection point was 9.192. Stratified analyses showed that age and BMI modified the PIV-dyslipidemia relationship (P for interaction < 0.05). The ROC curve found that compared with SII, PIV had a similar predictive value (area under curve (AUC): 0.566 vs 0.558; P = 0.073).ConclusionThis study discovered that PIV had a significantly positive relationship with dyslipidemia, especially in young and overweight individuals.

Ambulatory blood pressure monitoring (ABPM) studies for high altitude (HA) hypertensive patients are limited. We aimed to explore the hypertension phenotypes, and investigate their associations with hemoglobin in untreated hypertensives permanently living in HA. A total of 342 untreated hypertensive patients were included. Among the whole population, 91.80

OBJECTIVE: This study was conducted to investigate the association between visceral fat area (VFA) and heart rate variability (HRV) in high-altitude migrants with obstructive sleep apnea (OSA). METHOD: We conducted a cross-sectional study comprising 152 OSA participants from 2022 to 2024. We employed multivariable linear regression to further elucidate the association between VFA and HRV. Mediation analysis was utilized to investigate the indirect effects of insulin resistance and white blood cell counts on this relationship. Sensitivity analysis assessed the robustness of the results. To explore the influence of gender on the results, we conducted gender-specific subgroup analyses and interaction tests. RESULTS: Multivariable regression analysis revealed that for every 20-unit increase in VFA, there were significant reductions in SDNN (-4.00, 95% CI: -5.90, -2.11), SDANN (-3.51, 95% CI: -5.43, -1.60), SDNN index (-1.35, 95% CI: -2.13, -0.56), rMSSD (-0.92, 95% CI: -1.51, -0.33), and pNN50 (-0.58, 95% CI: -0.99, -0.17). Additionally, a significant positive association was found between VFA and the low-frequency/high-frequency ratio (LF/HF ratio) (0.25, 95% CI: 0.11, 0.39). Mediation analysis indicated a significant mediating effect of HOMA-IR on the VFA-HRV association, with proportions of 20.32%, 18.76%, and 26.23% for SDNN index, rMSSD, and LF/HF ratio, respectively. The mediating effect based on white blood cell count did not reach statistical significance. There was no gender difference in the association between VFA and HRV. The sensitivity analysis indicated that the findings remained robust. CONCLUSION: Our findings indicated that visceral fat serves as a significant determinant of cardiovascular health among OSA patients residing at high altitudes and may represent a viable target for intervention and preventive strategies.