Applications of artificial intelligence and computational approaches to imaging for hypertension identification, phenotyping, and outcome prediction: a systematic review.

Abstract

Current hypertension guidelines focus on blood pressure control, but incorporating end-organ imaging could improve understanding of disease manifestations. We undertook a systematic review to evaluate current task-level applications of artificial intelligence (AI) and computational approaches to imaging for hypertension identification, phenotyping, and outcome prediction. A systematic search was conducted across multiple databases up to end of December 2025. Retrieved studies were grouped by AI task, and a thematic qualitative analysis per-task was conducted to evaluate organ-specific findings, AI methodologies, and research gaps. For quantitative synthesis, the I2 statistic derived from Cochran's Q test was used to assess heterogeneity, and forest plots were generated to visualize effect sizes. The review was registered with PROSPERO (CRD42023427430). The search strategy yielded 48 studies. Thematic analysis categorized the studies into five major tasks, with the majority employing supervised learning for classification processes. Nearly half of the studies focused on the heart. However, paucity of studies performed multi-organ assessment, external validation, and phenotyping or predicting future risk. AI and computational approaches in imaging achieved an overall sensitivity of 0.84 [0.69-0.93] in identifying hypertension from normotension, highest with brain imaging. Sensitivity reached 0.92 [0.90-0.94] in discriminating hypertension from hypertrophic cardiomyopathy. Current research focusses primarily on hypertension prediction using single organ information. While results are promising, datasets remain small with limited external validation. There remains a need for discovery-oriented research to uncover disease heterogeneity, multi-organ phenotypes, and support personalized and targeted interventions.