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.

Hypertension is a leading cause of cardiovascular morbidity and mortality, yet the management remains suboptimal especially with monotherapy. Recently, low-dose triple and quadruple (quadpill) combinations have emerged as a promising therapeutic advancement resulting in control of hypertension. However, there still remains controversy around the long-term safety and efficacy of these therapies. We conducted an updated meta-analysis on the influence of these combinations on hypertension control. A systematic review and meta-analysis was conducted according to 2020 PRISMA guidelines and the protocol was prospectively registered in the PROSPERO. An extensive search on several databases including PubMed, Google scholar, C , and Cochrane Central Register of Trials. Primary outcome assessed was reduction in systolic blood pressure, and proportion of participants in range and secondary outcomes included: reduction in diastolic blood pressure, along with various safety outcomes. Low-dose combination significantly reduced systolic BP as compared to the placebo at 4-12 weeks (MD -14.97 mmHg), along with sustained reduction at 6 months (MD -6.58 mmHg). Patients who received low-dose combinations were more likely to reach target BP < 140/90, compared with a placebo drug (RR 2.18) and standard therapy (RR 1.37). Dizziness, headaches and pedal edema were noted more frequently in the intervention group, while MSK complaints were higher in the control populations. Our study's findings suggest that low-dose combinations with triple and quadruple therapies are significantly more efficacious in reducing systolic and diastolic BPs of adult populations. However, generally higher adverse events were noted for the intervention group receiving low-dose combination therapy.

Hypertension remains a leading global contributor to cardiovascular morbidity and mortality, with women exhibiting lower blood pressure(BP) control rates and greater susceptibility to hypertension-related cardiovascular complications. Although isometric handgrip training (IHT) has recently been incorporated into clinical guidelines as a non-pharmacological strategy for BP control, its effects on BP responses during acute physical stress, an outcome strongly associated with cardiovascular risk and target-organ damage, remain insufficiently characterized, particularly in women. In this secondary analysis of a randomized controlled trial, 12 weeks of IHT reduced resting and absolute BP levels during an isometric handgrip test, while the magnitude of BP reactivity remained unchanged. These findings suggest that IHT lowers the absolute hemodynamic load during stress, allowing the cardiovascular system to operate within a lower pressure range in medicated hypertensive women.

49 yet untreated adolescents with PH in a mean age of 15.2 ± 1.9 years, and 47 healthy, normotensive adolescents, matched both for sex and age (mean age of 14.7 ± 1.0 years) were included in the study. The percentage of positive cells (PPC) and mean fluorescence intensity (MFI) of PBL and monocytes was analyzed. in hypertensive adolescents PBL and monocytes presented greater PPC and MFI of AR and α7nAChR in comparison with normotensive group. Carotid intima-media thickness and carotid wall cross sectional area correlated with extracellular MIF of α1AR (r = 0.438 and r = 0.602, respectively; p < 0.05), left ventricular mass index with extracellular MFI of α7nAChR (r = 0.340; p < 0.05) and PPC of α1AR (r = 0.340; p < 0.05). Stroke volume, and total peripheral resistance correlated with extracellular MIF of β2AR (r = 0,283, and r = -0.221, respectively; all p < 0.05). Serum uric acid levels correlated with AR and α7nAChR expression. However, hsCRP did not correlate with AR and α7nAChR expression. adolescents with PH show significant alterations in the expression of adrenergic and cholinergic receptors in PBL. These changes correlate with hypertension mediated organ damage, hemodynamic and metabolic parameters typical of childhood hypertension.

Nocturnal hypertension, a critical subtype of hypertension, has garnered extensive attention due to its significant association with increased cardiovascular event risk and all-cause mortality. This review systematically explores the pathophysiology of nocturnal hypertension, encompassing neuroendocrine regulation, renal dysfunction, and sleep disorders, integrating the latest research advancements to provide an in-depth analysis of its pathophysiological basis. Moreover, this review summarizes diagnosis and blood pressure monitoring of nocturnal hypertension, and highlights effective clinical intervention strategies, including pharmacological treatment, lifestyle modifications, and emerging technological approaches, aiming to offer theoretical foundations and practical guidance for clinical diagnosis and management. This review also emphasizes the importance of precise diagnosis and individualized therapy in the management of nocturnal hypertension, underscoring the need for tailored approaches to improve patient outcomes and reduce cardiovascular risk.

Hypertensive Nephrosclerosis (HSN), a progressive kidney disease, has significantly impacted mortality and morbidity, via cardiovascular events, end-stage renal disease, and infections. Despite its clinical and public health impact, comprehensive analyses of U.S. mortality trends remain understudied. We aim to assess trends in Nephrosclerosis-related deaths in the United States (1999-2020). We extracted HSN-related deaths in older adults aged ≥65 years (1999-2020) using the CDC WONDER database [using ICD-10 code: I-12 (Hypertensive renal disease)]. Crude- and age-adjusted mortality rates (CMR and AAMR) per 100,000 population were determined. We used Joinpoint regression to examine changes in trends and average- and annual percentage change (AAPC and APC) overall and then stratified into demographic and geographical subgroups. A total of 519,817 deaths were recorded due to HSN. Overall, the AAMR rose from 21.51 (1999) to 132.03 (2020) [AAPC, 8.80 (95% CI: 6.53 to 12.08)], especially in age-group 85+ (CMR: 203.36). The overall mortality surged the most remarkably between 2011 and 2014 [APC, 34.74 (95% CI: 1.31 to 50.76)]. Males demonstrated higher AAMRs (67.56) than females (48.93). Racially/ethnically, Non-Hispanic (NH) Blacks (117.99), followed by Hispanics (70.22), exhibited increased vulnerability. Geographically, the Western region (65.71) and rural areas (56.88) held the highest mortality burden. State-wise AAMRs ranged between Connecticut to the District of Columbia (28.58 and 85.8, respectively). In conclusion, HSN-related mortality has increased trends over the last two decades. Males, NH Blacks, 85+ age group, individuals from Western region, and rural residents were the high-risk subgroups. These results call for future research to explore the correlation between observed disparities.