BACKGROUND:Heart failure is associated with renal function decline and increased morbidity and death. We evaluated the association of systolic blood pressure control over time, measured by time in target range (TTR), with renal function decline and death in patients with heart failure. METHODS:We analyzed a multicenter prospective cohort of patients hospitalized for heart failure across 52 hospitals in China between 2016 and 2018. Systolic blood pressure was measured at 1, 6, and 12 months after discharge. The 12-month systolic blood pressure TTR was calculated by linear interpolation for a target range of 110 to 130 mm Hg. Outcomes were 1-year renal function decline (≥20% reduction in estimated glomerular filtration rate from 1 to 12 months plus estimated glomerular filtration rate <60 mL/min per 1.73 m2 at 12 months) and 5-year all-cause death. RESULTS:The analysis included 1529 patients for renal function decline and 2195 patients for death. Median follow-up was 1.0 and 4.2 years, respectively. Renal function decline and death decreased significantly from the lowest to highest TTR tertile (Ptrend<0.001 and 0.009, respectively), supported by restricted cubic spline analyses. After multivariable adjustment, each 1-SD increase in TTR (35%-36%) was associated with lower risks of renal function decline (odds ratio, 0.74 [95% CI, 0.60-0.93]; P=0.008) and all-cause death (hazard ratio, 0.90 [95% CI, 0.83-0.98]; P=0.01). Results were consistent across subgroups, using 6-month TTR, and for cardiovascular death. CONCLUSIONS:Better long-term systolic blood pressure control, assessed by TTR, was independently associated with lower risks of renal function decline and long-term death in patients with heart failure. REGISTRATION INFORMATION:clinicaltrials.gov Identifier: NCT02878811.

BACKGROUND:It is challenging to achieve sustained blood pressure (BP) lowering by traditional lifestyle guidance including exercise. OBJECTIVES:We aimed to evaluate the short-term effects of baduanjin on ambulatory BP with monitoring and long-term effects without monitoring among individuals with high-normal BP. METHODS:We conducted a multicenter, open-label, blinded-outcome randomized controlled trial at 7 communities. Participants aged ≥40 years with systolic blood pressure (SBP) 130 to 139 mm Hg and/or diastolic BP 85 to 89 mm Hg were randomly assigned in a 2:1:1 ratio to the baduanjin, self-directed exercise alone, or brisk walking arms for a 52-week intervention. The primary outcomes were the changes in 24-hour SBP from baseline to 12 and 52 weeks. Intention-to-treat analyses of primary outcomes followed a hierarchical testing sequence: 1) superiority of baduanjin vs self-directed exercise alone at 12 weeks; 2) superiority of baduanjin vs self-directed exercise alone at 52 weeks; and 3) superiority of baduanjin vs brisk walking at 52 weeks. RESULTS:Among 216 eligible participants (mean age 57.3 years; 64.8% women), 108, 54, and 54 participants were randomly assigned to the baduanjin, self-directed exercise alone, and brisk walking arms, respectively. The baduanjin arm obtained a significantly greater reduction in 24-hour SBP compared with the self-directed exercise alone arm at 12 weeks (-3.1 mm Hg; 95% CI: -5.9 to -0.2 mm Hg; P = 0.036) and 52 weeks (-3.3 mm Hg; 95% CI: -6.3 to -0.3 mm Hg; P = 0.031). There was no significant difference between the baduanjin and brisk walking arms (-0.7 mm Hg; 95% CI: -3.9 to 2.6 mm Hg; P = 0.683) at 52 weeks. The effects were not heterogeneous across subgroups. No significant difference in adverse events was detected across 3 arms. CONCLUSIONS:Baduanjin lowered SBP after 3 months of intervention in individuals with high-normal BP, with sustained BP-lowering effect until 1 year without monitoring, and showed comparable efficacy to brisk walking. (Baduanjin Lowering Elevated Blood PreSsure Study [BLESS]; NCT05397535).

BACKGROUND:Inadequate blood pressure (BP) control remains a major public health challenge worldwide. Rigorous evidence is lacking on how to implement targeting systolic BP (SBP) <120 mm Hg in real-world settings. OBJECTIVES:We aimed to examine the implementation and effect heterogeneity of targeting SBP <120 mm Hg in diverse hypertensive patients with high cardiovascular risk, particularly those with longstanding uncontrolled BP. METHODS:Using data from the ESPRIT (Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs) trial, we analyzed achieved average BP level, time to intensive control, medication use, clinic visit frequency, major vascular events, all-cause death, and safety outcomes among all participants and across subgroups. RESULTS:We included 11,255 participants (mean age: 64.6 ± 7.1 years; 41.3% women). The achieved median SBP of the intensive arm was 117 mm Hg (IQR: 113-123 mm Hg) in all participants, with 62.5% of participants in the intensive arm achieving intensive BP control. Older participants, male and those with a higher baseline SBP, longer hypertension duration, history of stroke and diabetes, and used more antihypertensive medications at baseline were less likely to achieve sustained intensive control. The median time to intensive control was 62 days (IQR: 33-96 days), and higher baseline SBP levels, obesity, or diabetes were associated with a longer time to reach intensive control. At the 1-year visit, the medication equivalent was 3.3 in the intensive arm and 2.0 in the standard arm. Male, obese, diabetic patients and those with hypertension duration ≥10 years or baseline SBP ≥140 mm Hg required more medications. Clinic visit frequency in the first year was 6.9 and 5.4 for intensive and standard arms, respectively, and visits decreased during the following years. There was no significant interaction between treatment effects and subgroups of hypertension duration and baseline SBP combination (all P for interaction > 0.05), except for myocardial infarction (P for interaction = 0.019). CONCLUSIONS:For the diverse hypertensive patients with high cardiovascular risk, including those with longstanding uncontrolled BP, sustaining SBP <120 mm Hg is achievable with modest additional medical resources. Applying ESPRIT evidence could improve BP control and reduce cardiovascular burden globally. (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing RIsk of Vascular events Study [ESPRIT]; NCT04030234).

BACKGROUND:The impact of intensive blood pressure (BP) control on cognitive function in East Asian populations remains uncertain. We aimed to assess the effect of a lower systolic BP target on global cognitive function in Chinese hypertensive adults. METHODS:This secondary analysis of a randomized trial involved hypertensive patients with high cardiovascular risk across 116 sites in China. Participants were assigned to receive intensive treatment (systolic BP target <120 mm Hg) or standard treatment (systolic BP target <140 mm Hg) for a median of 3.4 years. Cognitive function was assessed via MMSE (Mini-Mental State Examination) at baseline and the end of the study. Prespecified outcomes were a change in MMSE score and investigator-reported probable dementia. RESULTS:Among 11 255 randomized participants, all completed cognitive assessment at baseline and 10 440 (92.8%) at the end of the study. The mean change in MMSE score was not significantly different between arms (difference, 0.05 [95% CI, -0.07 to 0.17]), with a mean change of -0.54 (95% CI, -0.63 to -0.46) in the intensive arm and -0.60 (95% CI, -0.68 to -0.51) in the standard arm. Results were robust across sensitivity analyses and consistent across most subgroups. Exceptions included subgroups of coronary heart disease or antiplatelet treatment. The incidence of probable dementia was too low for meaningful interpretation. CONCLUSIONS:Intensive systolic BP lowering to a target of <120 mm Hg for 3 years did not adversely affect global cognitive function in Chinese hypertensive adults, irrespective of age, sex, BP level, and comorbidities, affirming the cognitive safety of this treatment strategy. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT04030234.

Aims This study aims to test the association between multidimensional renal dysfunction biomarkers and cerebral small vessel disease (CSVD) risk using data from the UK Biobank. Methods The present study encompasses two cohorts. The whole cohort consisted of 43,314 adults without neurological diseases at baseline, who underwent brain magnetic resonance imaging (MRI) during the follow-up period. CSVD imaging markers, including white matter hyperintensity (WMH) volume, mean diffusivity (MD), and fractional anisotropy (FA), were extracted. The sub-cohort consisted of 9786 adults randomly selected from the whole cohort. CSVD MRI features, including the presence of lacunes, white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMBs), as well as CSVD burden score, were assessed. Results In the whole cohort, renal dysfunction as reflected by abnormalities in estimated glomerular filtration rates and blood urea nitrogen was associated with increased WMH and MD values and decreased FA values, compared to the healthy group. We observed consistent findings in the sub-cohort: multidimensional renal dysfunction was associated with increased risk of lacunes, WMHs, EPVS, and CMBs, as well as greater severity of CSVD burden. Conclusions Our large-scale epidemiological study provides evidence that multidimensional renal dysfunction biomarkers are independently associated with CSVD risk in adults.

Postoperative headache and cerebrospinal fluid (CSF) leakage are common complications after meningioma resection, which may prolong hospitalization, increase infection risk, and negatively affect patient recovery. Although maintaining a 30° head-of-bed (HOB) elevation is standard postoperative nursing care to reduce intracranial pressure, the optimal elevation angle remains uncertain. This study aimed to evaluate the efficacy of an improved HOB elevation of 30° to 35° in reducing postoperative headache severity and CSF leakage in patients undergoing meningioma resection. This retrospective cohort study included 128 patients who underwent meningioma resection between January 2021 and December 2023 at our hospital. Patients were allocated to the control group (n = 64, HOB = 30°) or the improved group (n = 64, HOB = 30°-35°). Postoperative headache severity, CSF leakage incidence, wound healing, and patient satisfaction were compared between groups. Statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk), and a P value <0.05 was considered statistically significant. An early postoperative HOB elevation of 30° to 35° after meningioma resection significantly reduces postoperative headache severity, reduces CSF leakage, and improves patient satisfaction compared with the conventional 30° position. These findings suggest that slightly increasing the HOB angle could be considered as part of optimized postoperative nursing protocols. Compared with the control group, the improved group exhibited significantly lower headache scores on postoperative day 3 (3.12 ± 1.21 vs 4.58 ± 1.44, t = 5.487, P < .001) and day 7 (2.11 ± 0.93 vs 3.72 ± 1.26, t = 7.023, P < .001). The incidence of CSF leakage was markedly reduced in the improved group (3.13% vs 14.06%, χ2 = 4.398, P = .036), while patient satisfaction was significantly higher (93.75% vs 79.69%, χ2 = 5.184, P = .023).

The long-term consequences of childhood hypertension (HTN) subtypes remain unclear. In this cohort study, we examined whether childhood isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH) are differentially associated with adult HTN and subclinical target organ damage (TOD). The study included 1228 participants from the Beijing Blood Pressure Cohort Study with a mean follow-up of 22.9 ± 0.6 years. Childhood blood pressure subtypes were classified as non-hypertensive, ISH, IDH, or SDH. Adult outcomes included HTN, cardiac remodeling, arterial stiffness, kidney damage, and overall TOD, defined as the presence of any of these abnormalities. We found that ISH was the predominant childhood hypertensive subtype (78.4%). Compared with non-hypertensive children, those with childhood ISH had a higher risk of adult HTN and cardiac remodeling and showed adverse arterial stiffness phenotypes, including higher carotid-femoral and brachial-ankle pulse wave velocity and greater risks of aortic and peripheral arterial stiffness. Childhood IDH and SDH showed distinct patterns of association, mainly involving aortic stiffness and left ventricular hypertrophy, respectively; these subgroup-specific estimates should be interpreted cautiously. In conclusion, childhood hypertensive subtypes were associated with differing long-term cardiovascular phenotypes, with the most consistent evidence observed for ISH. These findings support closer long-term surveillance of childhood HTN, particularly ISH.

Association between obstructive sleep apnea (OSA) and frailty progression across various stages of cardiovascular-kidney-metabolic (CKM) syndrome. Data processing and analysis were performed using R version 4.4.0. Multivariate logistic regression models were utilized to assess the association between OSA and Frailty Index. The Cox proportional hazards regression model was utilized to examine the relationship between sleep apnea and frailty across various CKM stages. A total of 5961 participants were included in this study. Compared to the non-frail group (Frailty Index ≤0.21), people with sleep apnea and in the advanced stage of CKM are more prone to developing frailty. In Model 3, adjusted for multiple covariates, the rarely OSA group (odds ratio [OR] = 1.71, 95% confidence interval [CI]: 1.17-2.48), occasionally OSA group (OR = 1.81, 95% CI: 1.25-2.61), and frequently OSA group (OR = 3.08, 95% CI: 1.98-4.79) exhibited an average 71%, 81%, and 208% increase in frailty risk, respectively. For patients with OSA, advanced-stage CKM significantly increases the risk of frailty. Simultaneously, after excluding other confounding factors, patients with advanced-stage CKM had a significantly increased risk of all-cause mortality compared with the population with "no OSA + early-stage CKM." OSA (especially frequent OSA) and advanced CKM (including progressive stages) are independent and synergistic risk factors for frailty. CKM progression may amplify the adverse effects of OSA on frailty.

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.

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.

Background Urinary proteomic profiling (UPP) provides insights in disease mechanisms and origin of symptoms. Using UPP, this study aimed at deepening insight in the biology of exercise tolerance. Methods In the HOMAGE trial, 268 patients at risk of heart failure underwent the incremental shuttle walk test (SWT) and UPP by capillary electrophoresis coupled with mass spectrometry at baseline (discovery) and the 9-month final visit (replication). Sequencing of 1498 urinary peptides identified 170 non-collagen and 40 collagen-derived proteins. Ten exercise-related variables, including heart rate and blood pressure responses, symptoms and walking distance were summarised into a single factor, higher values indicating exercise intolerance. In exploratory analyses, exercise intolerance was related to the UPP, first in linear and logistic regression models, considering one peptide at a time, and next by elastic net regression considering the peptides retained in the previous step. Replicated proteins were subjected to pathway analysis. Findings Twenty-nine non-collagen and 31 collagen-derived peptides were associated with reduced exercise capacity with correction for multiple testing. In elastic net regression, exercise intolerance was in >50% of 1000 bootstrap runs associated with the non-collagen proteins FXYD2, GAPDH, HBB, KCNB1, MB, MYOCD, SECTM1, SNX9, TACC3, TMSB4X, and TTN and with collagens COL5A1, COL6A1, COL11A2, and COL28A1. Enriched pathways involved oxygen homoeostasis, oxidative stress regulation, metabolic and developmental processes, and muscle biology. Interpretation In HOMAGE patients, UPP identified parent proteins regulating exercise endurance, which are involved in oxygenation, vascular and muscle structure and function, maintenance of the circulating volume, and protection against oxidative stress. Funding European Union.

Background Central systolic blood pressure (cSBP) reflects the pressure experienced by vital organs and may be more closely related to hypertensive cardiac damage than brachial SBP. Twenty‐four–hour ambulatory blood pressure monitoring provides additional insight into cardiovascular load beyond office readings. This study investigated the association of 24‐hour cSBP, measured noninvasively with a validated device, with left ventricular mass index (LVMi) and LV hypertrophy. Methods We analyzed data from 21 centers worldwide (n=2367; 45.5% women; mean age 49.5 years) participating in the International 24‐Hour Aortic Blood Pressure Consortium. Brachial and central 24‐hour SBPs were recorded using the Mobil‐O‐Graph device, calibrated by either systolic/diastolic (cSBP C1) or mean/diastolic (cSBP C2) pressure; LVMi was derived echocardiographically. BP phenotypes (normotension, isolated diastolic and systolic hypertension, and systolic‐diastolic hypertension) were based on 24‐hour brachial BPs, subdivided by cSBP. Results LVMi correlated most strongly with 24‐hour cSBP C2 (P<0.001) consistently, across sex, body mass index (BMI), age, and treatment strata. Receiver operating characteristic analysis showed superior prediction of LV hypertrophy for 24‐hour cSBP C2 (area under the curve=0.68). Both brachial BP phenotype and central SBP status were independently associated with LVMi (P=0.0045 and <0.001, respectively), without interaction. Discordant classification occurred in 14.4% of participants and was linked to higher LVMi in normotension and lower LVMi in systolic‐diastolic hypertension. Conclusions Twenty‐four–hour central SBP calibrated with oscillometric mean/diastolic pressure (cSBP C2), is more closely associated with LVMi and LV hypertrophy than brachial SBP. These findings highlight the potential clinical value of incorporating central pressure monitoring into risk assessment and hypertension management.

AIMS:Cerebral ischemic stroke triggers extensive neuronal membrane breakdown, releasing a massive load of cholesterol that overwhelms resident microglia. Dysregulated microglial cholesterol metabolism has been implicated in post-stroke neuroinflammation, yet the specific pathogenic microglial subpopulations, their molecular signatures, and the downstream inflammatory cascades remain poorly defined. METHODS:We employed a permanent distal middle cerebral artery occlusion (dMCAO) model combined with single-cell RNA sequencing (scRNA-seq) to profile immune cell transcriptomes and identify cholesterol-associated microglial markers. Cholesterol dynamics, lipid droplet accumulation, and inflammatory marker expression were quantified via immunofluorescence and transmission electron microscopy. Therapeutic interventions included pharmacological cholesterol mobilization with 2-hydroxypropyl-β-cyclodextrin (HβCD), pharmacological STING inhibition with C-176, and microglia-targeted STING knockdown using AAV9 vectors. Cerebral injury and neurological function were assessed through infarct volume measurement, white matter integrity analysis, and behavioral assays (rotarod and grip strength) in dMCAO, tMCAO, and perioperative stroke (PIS) models. RESULTS:Using scRNA-seq, we identified interferon-induced transmembrane protein 3 (IFITM3) as a specific marker for a microglial subpopulation that was characterized by upregulated ACAT1, enhanced cholesterol esterification, and accumulation of cholesterol crystals and lipid droplets. This IFITM3+ microglia population peaked at 7 days post-stroke and correlated with NLRP3 inflammasome activation and STING signaling. Pharmacological reduction of cholesterol burden with HβCD attenuated lipid droplet formation, suppressed mitochondrial DNA leakage, and inhibited STING pathway activation. Correspondingly, HβCD and C-176 administration significantly reduced cerebral infarct size, mitigated white matter demyelination, and improved motor function in dMCAO and tMCAO models. We further found that AAV-mediated STING knockdown recapitulated the above protective effects in HβCD and C-176 treated stroke mice. Furthermore, HβCD treatment ameliorated microglial inflammation and improved functional outcomes in a PIS model. CONCLUSION:IFITM3+ microglia is a pro-inflammatory and cholesterol-laden subpopulation that exacerbates post-stroke cerebral ischemic brain injury. Targeting the microglial cholesterol axis by HβCD or inhibiting the STING pathway represents a promising therapeutic strategy to mitigate ischemic brain injury and improve neurological function.

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.

BACKGROUND:Novel hypertension phenotypes are described by cross-classification of brachial and aortic SBP (brSBP/aoSBP). OBJECTIVES:The aim of this study is to examine their prevalence and age and sex-distribution, factors that potentially modulate them, and their association with left ventricular hypertrophy (LVH). METHODS:Data on 24-h ambulatory BP monitoring (ABPM) using the Mobilograph device (IEM GmbH, Stolberg, Germany) and LVH from the I nternational 24-h A mbulatory aortic B lood pressure C onsortium (i24ABC) were retrieved from 31 centers (17 countries). The population was categorized into four phenotypes; concordant systolic normotension (CSN: both SBPs normal), isolated brachial systolic hypertension (IbrSH: high brSBP/normal aoSBP), isolated aortic systolic hypertension (IaoSH: normal brSBP/high aoSBP), and concordant systolic hypertension (CSH: both SBPs high). RESULTS:In 8738 participants (age: 58.4 ± 15.1 years; 51.8% men), the prevalence of IaoSH was 7.7%, being more prevalent in men, and presenting a U-shape age-distribution in them compared to a linear distribution in females. IaoSH was associated with lower heart rate and beta-blockade medications. The prevalence of IbrSH was 6.5%, presenting an inverted U-shape age-distribution; it was higher in the presence of higher heart rate and calcium channel-blockade. In 2307 individuals with LVH data, after adjustment for age, sex, DBP, IaoSH - but not IbrSH - had 2.6 higher odds of LVH compared to CSN (95% confidence interval, 1.7-3.9) and similar to CSH. CONCLUSION:IaoSH and IbrSH amounted to almost 15% and showed specific clinic characteristics. Only IaoSH was significantly associated with LVH. Outcome-driven randomized controlled trials are needed to further investigate their clinical relevance.

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.

Ischemic stroke is a major global health burden, leading to considerable mortality and long-term disability. Endovascular thrombectomy and mechanical recanalization have revolutionized acute stroke care. Nonetheless, many patients experience poor long-term neurological outcomes, which are often attributed to the no-reflow phenomenon and activation of inflammatory cascades. The perioperative period of endovascular thrombectomy, managed under either general anesthesia or conscious sedation, represents a critical window where anesthetic strategies may influence recovery through hemodynamic control and possibly immune modulation. This consensus review was generated by an international multidisciplinary expert group and synthesizes preclinical and clinical evidence to evaluate the promise of various immunomodulatory strategies for improving functional outcomes in patients with ischemic stroke following endovascular thrombectomy. Our goal is to provide a foundational reference for future research and development of novel perioperative immune therapies for patients with endovascular thrombectomy.