Clinical Hypertension最新文献

{"title":"To be (IIb), or not to be (IIb) - That is the current status of cuffless blood pressure monitoring device.","authors":"Hae-Young Lee, Jeong-Hun Shin, Eun Mi Lee, Sang-Hyun Ihm","doi":"10.5646/ch.2026.32.e40","DOIUrl":"10.5646/ch.2026.32.e40","url":null,"abstract":"<p><p>Cuffless blood pressure (BP) monitoring devices have attracted extraordinary scientific and commercial attention, yet their clinical status remains deeply contested. Major international guidelines from the American Heart Association/American College of Cardiology (2025), the European Society of Cardiology (2024), and the European Society of Hypertension (ESH, 2023) uniformly assign a Class III recommendation (not recommended for diagnostic use) to cuffless devices due to insufficient validation and calibration drift. However, the Korean Society of Hypertension has recently updated its guidelines to include cuffless BP monitors as a Class IIb recommendation for out-of-office BP measurement. This review explores the rationale behind this divergence, largely based on the acclumulating validation of a domestic ring-type cuffless device, CART BP (Sky Labs), currently the world's only nationally insured cuffless monitor. We analyze the historical landscape of international validation, detail the sequential fulfillment of ESH criteria, and delineate future research imperatives-emphasizing calibration practicality, transient BP changes, and cardiovascular outcome validation-to pave the way for universal clinical adoption.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e40"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuffless 24-hour ambulatory blood pressure monitoring-guided antihypertensive titration in real-world clinical practice: a prospective non-randomized study.","authors":"Jung-Joon Cha, Mi-Na Kim, So Ree Kim, Jae Hyoung Park, Hyung Joon Joo, Cheol Woong Yu","doi":"10.5646/ch.2026.32.e42","DOIUrl":"10.5646/ch.2026.32.e42","url":null,"abstract":"<p><strong>Background: </strong>Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is the reference standard for diagnosing hypertension and assessing treatment response, but routine use remains limited by conventional cuff-based devices. We compared 6-month ambulatory blood pressure (BP) between cuffless 24-hour ABPM-guided titration and usual care in outpatient hypertension management.</p><p><strong>Methods: </strong>We conducted a single-center, open-label, non-randomized prospective study of adults with uncontrolled hypertension between March and November 2025. Participants were assigned by the treating physician, without randomization, to CART BP pro-guided titration (CART BP arm, <i>n</i> = 67) or usual care (Control arm, <i>n</i> = 179). The primary endpoint was 24-hour mean systolic BP at 6 months, analyzed using analysis of covariance with 10 prespecified covariates. Sensitivity analyses addressed measured confounding, missing outcomes, and visit frequency.</p><p><strong>Results: </strong>Among 162 participants with a valid 6-month ABPM recording, the adjusted between-group difference in 24-hour systolic BP was -7.35 mmHg (95% confidence interval [CI], -12.03 to -2.67 mmHg; <i>P</i> < 0.01), favoring the CART BP arm. Sensitivity analyses for measured confounding, missing outcomes, and visit frequency yielded similar estimates. In exploratory phenotype-specific comparisons, the controlled-BP phenotype was more prevalent in the CART BP arm (65.8% vs. 36.3%; <i>P</i> < 0.01), and masked hypertension was less prevalent (5.3% vs. 20.2%; <i>P</i> = 0.04). Adjusted office systolic BP differed by -3.14 mmHg (95% CI, -9.25 to 2.96; <i>P</i> = 0.31). Adverse events were more frequent per participant (20.0% vs. 8.1%; <i>P</i> = 0.02); exposure-adjusted incidence rate ratios were 1.78 (95% CI, 0.87 to 3.65) per participant-visit and 2.75 (95% CI, 1.35 to 5.61) per person-year.</p><p><strong>Conclusions: </strong>In this non-randomized study, a care pathway incorporating cuffless 24-hour ABPM was associated with lower 24-hour ambulatory systolic BP at 6 months compared with usual care, whereas office systolic BP did not differ significantly between arms. Given the non-randomized design, these findings are hypothesis-generating and require confirmation in a randomized trial.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT07454148.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e42"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing renal denervation: from blood pressure reduction to autonomic disease modification-a state-of-the-art review.","authors":"Ehsan Shahverdi, Sendooran Shahi, Carsten Schneider, Mathias Lange","doi":"10.5646/ch.2026.32.e39","DOIUrl":"10.5646/ch.2026.32.e39","url":null,"abstract":"<p><strong>Background: </strong>Renal denervation (RDN) has re-emerged as an evidence-based treatment for uncontrolled and resistant hypertension following consistent findings from contemporary sham-controlled randomized trials. Because renal sympathetic signaling plays a central role in cardiovascular (CV), renal, and metabolic homeostasis, the therapeutic effects of RDN may extend beyond blood pressure (BP) reduction. This review reframes RDN within a precision autonomic medicine framework by integrating contemporary mechanistic evidence, phenotype-guided patient selection, and future directions for outcome-oriented clinical trials.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed/MEDLINE for studies published between January 2009 and 30 June 2026. Randomized controlled trials, observational studies, mechanistic investigations, systematic reviews, consensus statements, and major international guidelines evaluating the mechanisms, clinical effects, procedural aspects, and emerging applications of RDN were reviewed. Evidence was synthesized narratively with emphasis on autonomic modulation, target-organ protection, precision phenotyping, and future trial design.</p><p><strong>Results: </strong>Contemporary evidence demonstrates that RDN provides durable reductions in ambulatory BP with an acceptable long-term safety profile. Experimental and clinical studies further suggest favorable effects on sympathetic activity, neurohumoral activation, inflammation, oxidative stress, endothelial function, and cardiac, renal, and metabolic remodeling. We propose an autonomic responder phenotype integrating ambulatory BP characteristics, autonomic biomarkers, target-organ involvement, and anatomical suitability to facilitate precision-guided patient selection. We also outline a framework for phenotype-enriched clinical trials incorporating standardized procedural verification and clinically meaningful CV and renal outcomes beyond BP reduction. However, evidence supporting autonomic disease modification remains preliminary, with most studies relying on surrogate endpoints.</p><p><strong>Conclusions: </strong>RDN is an established therapy for appropriately selected patients with hypertension, whereas its broader role as a precision-guided autonomic disease-modifying intervention remains investigational. Future progress requires validated responder phenotypes, objective confirmation of successful denervation, standardized procedural methodologies, and adequately powered randomized outcome trials.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e39"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world performance of a ring-type cuffless blood pressure device compared with ambulatory blood pressure monitoring.","authors":"Hyun-Jin Kim, Byung Sik Kim, Jeong-Hun Shin, Jinho Shin","doi":"10.5646/ch.2026.32.e41","DOIUrl":"10.5646/ch.2026.32.e41","url":null,"abstract":"<p><strong>Background: </strong>Cuffless blood pressure (BP) monitoring devices are convenient alternatives to conventional ambulatory blood pressure monitoring (ABPM). We evaluated the real-world agreement between a ring-type cuffless BP device (continuous ambulatory ring-type blood pressure monitor, CART BP pro) and ABPM and identified the clinical and physiological factors associated with measurement discrepancies.</p><p><strong>Methods: </strong>This real-world observational study included 154 adults (mean age, 62.1 ± 14.2 years; 41.6% men) who underwent simultaneous 24-hour ABPM and CART BP pro after exclusion of predefined clinical conditions and insufficient recordings. CART BP pro measurements were calibrated at baseline to ABPM in the contralateral arm. BP values from the 2 devices were compared for 24-hour, daytime, and nighttime periods, as well as for the classification of nocturnal hypertension and dipping status. Predictors of close systolic agreement (|24-hour systolic blood pressure [SBP] difference| ≤ 5 mmHg) were identified using multivariable logistic regression.</p><p><strong>Results: </strong>CART BP pro-derived period summaries were lower than ABPM for systolic BP (-7.1 mmHg for 24-hour SBP) and showed a modest positive bias for diastolic BP. Only 33.1% of measurements met the ≤ 5 mmHg accuracy criterion. Daytime SBP showed a similar bias (-7.8 mmHg), whereas nighttime SBP differences were smaller (-1.7 mmHg). By contrast, diastolic BP was consistently higher with the CART BP pro, particularly at night (+4.8 mmHg). Older age, male sex, lower body mass index, and higher heart rate independently predicted a closer systolic agreement. The agreement for nocturnal hypertension was moderate (κ = 0.516), with an overall concordance of 76.0%. However, dipping concordance was limited, with the CART BP pro showing blunted nocturnal dipping compared with ABPM (mean, 3.7% vs. 7.8%).</p><p><strong>Conclusions: </strong>This exploratory, real-world study found that CART BP pro-derived period summaries showed lower SBP values and smaller nocturnal BP declines than ABPM. Because period-level aggregates were compared rather than simultaneous point-to-point measurements, these findings should not be interpreted as a formal accuracy validation of the device. Further studies are needed to establish device-specific diagnostic thresholds and prospectively validate the clinical interpretation of CART BP pro-derived period summaries for hypertension diagnosis and circadian BP phenotyping.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e41"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning-based retinal risk stratification for 10-year atherosclerotic cardiovascular mortality in patients with hypertension and diabetes: a retrospective cohort study.","authors":"Dongjin Nam, Jaewon Seo, Sahil Thakur, Simon Nusinovici, Tae Keun Yoo, Miso Jang, Byung Hyun Joe, Tyler Hyungtaek Rim, Hae Kyung Kim, Minyoung Lee, Sunjin Hwang, Yong-Ho Lee, Chan Joo Lee, Heesuk Kim, Sungha Park","doi":"10.5646/ch.2026.32.e38","DOIUrl":"10.5646/ch.2026.32.e38","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular risk stratification in patients with hypertension and diabetes remains suboptimal. We evaluated the prognostic and incremental value of Dr. Noon CVD, a deep learning (DL)-based retinal biomarker, for 10-year atherosclerotic cardiovascular (ASCVD) mortality.</p><p><strong>Methods: </strong>This retrospective, single-center, primary prevention cohort study included 7,832 Korean patients with hypertension or diabetes diagnosed on or before retinal fundus photography (2005 to 2022). Patients with prior cardiovascular disease were excluded. The primary outcome of 10-year ASCVD mortality and a sensitivity analysis of 5-year mortality were stratified using 4-tier and 3-tier Dr. Noon CVD systems, respectively. Multivariable Cox proportional hazards models were adjusted for traditional risk factors and chronic kidney disease (CKD), and incremental predictive value was assessed using the change in the C-index (ΔC-index) and net reclassification improvement (NRI).</p><p><strong>Results: </strong>In the overall population, the Dr. Noon CVD score was independently associated with 10-year ASCVD mortality (hazard ratio [HR] trend, 1.49; 95% confidence interval [CI], 1.21 to 1.85; <i>P</i> < 0.001) after full adjustment for traditional factors and CKD. Adding Dr. Noon CVD to the clinical model significantly improved discrimination (ΔC-index, 0.030; <i>P</i> = 0.001) and risk reclassification (NRI, 0.484; 95% CI, 0.233 to 0.666; <i>P</i> < 0.001). This independent prognostic value was consistent in both hypertension (10-year HR trend, 1.48; <i>P</i> = 0.006) and diabetes (10-year HR trend, 1.42; <i>P</i> = 0.003) subgroups. The reclassification improvement was greater in the diabetes than the hypertension subgroup (10-year NRI, 0.481 vs. 0.413). The score's prognostic value was independent of diabetic retinopathy status.</p><p><strong>Conclusions: </strong>DL-based retinal imaging provides prognostic value for 10-year ASCVD mortality independent of the available clinical risk factors (age, sex, hypertension, diabetes, and CKD) and consistent under adjustment for available laboratory measures, supporting its role as an accessible opportunistic screening tool for long-term primary prevention in cardiometabolic clinics.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e38"},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent update on renal denervation: where do we stand now?","authors":"Jonghu Shin, Young-Won Yoon","doi":"10.5646/ch.2026.32.e26","DOIUrl":"10.5646/ch.2026.32.e26","url":null,"abstract":"<p><p>Renal denervation (RDN) has re-emerged as a potential adjunctive therapy for hypertension following advances in device technology, trial design, and patient selection. Early enthusiasm for RDN declined after neutral findings from initial sham-controlled trials; however, subsequent randomized studies have consistently demonstrated modest but significant reductions in blood pressure (BP) across a range of clinical settings. Contemporary sham-controlled trials using radiofrequency-, ultrasound-, and alcohol-mediated approaches have shown that RDN lowers office and ambulatory BP both in the presence and absence of background antihypertensive therapy. Long-term follow-up data extending up to 3 years suggest that BP-lowering effects can be sustained, with no consistent signal of late-emerging safety concerns. Recent meta-analyses further support these findings, reporting modest but consistent reductions in systolic BP compared with sham procedures. Despite these advances, several limitations remain. The magnitude of BP reduction is modest, treatment response is heterogeneous, and definitive evidence for cardiovascular outcome benefit is lacking. Current international guidelines therefore position RDN as an adjunctive, rather than replacement, therapy for carefully selected patients with uncontrolled or resistant hypertension. This review summarizes the mechanistic rationale, key clinical trial evidence, long-term durability, safety considerations, and current guideline recommendations for RDN, and discusses future directions to better define its role in hypertension management.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e26"},"PeriodicalIF":6.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of weekend warrior and regular physical activity patterns with prevalence of hypertension by socioeconomic status in Korean adults.","authors":"Tae Gu Choi, Sangshin Park, Setor K Kunutsor, Sae Young Jae","doi":"10.5646/ch.2026.32.e36","DOIUrl":"10.5646/ch.2026.32.e36","url":null,"abstract":"<p><strong>Background: </strong>Evidence shows that the weekend warrior physical activity (PA) pattern (1-2 days/week) is associated with a lower risk of hypertension, but it is unclear whether this association differs by socioeconomic status (SES). This study aimed to examine whether the association between the weekend warrior PA pattern and prevalent hypertension differs according to SES in Korean adults.</p><p><strong>Methods: </strong>We analyzed 28,039 adults (aged ≥ 19 years) from the 2018-2023 Korea National Health and Nutrition Examination Survey. PA patterns were categorized as inactive, insufficiently active, weekend warrior, or regularly active. Educational attainment (high school or less vs. college or higher) and household income (Q1-Q2 vs. Q3-Q4) were used as proxies of SES. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, a physician diagnosis, or use of antihypertensive medication. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent hypertension across PA patterns, stratified by educational attainment and household income level.</p><p><strong>Results: </strong>Among 28,039 adults, 8,842 (31.5%) had hypertension. In multivariable-adjusted models, compared with inactive participants, insufficiently active (OR, 0.85; 95% CI, 0.77-0.93), weekend warrior (OR, 0.74; 95% CI, 0.59-0.92), and regularly active (OR, 0.84; 95% CI, 0.77-0.91) PA patterns were each associated with lower odds of prevalent hypertension. There was no significant educational attainment-by-weekend warrior interaction for prevalent hypertension (<i>P</i> for interaction = 0.349), whereas a significant household income-by- weekend warrior interaction was observed (<i>P</i> for interaction = 0.049), with a more pronounced inverse association among lower-income adults.</p><p><strong>Conclusions: </strong>PA patterns, including the weekend warrior pattern, were associated with lower odds of prevalent hypertension among Korean adults. The inverse association between the weekend warrior pattern and hypertension appeared to differ by household income level, with a more pronounced inverse association among lower-income adults. Further studies in large longitudinal cohorts are warranted to confirm these findings.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e36"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of adherence to antihypertensive treatment: a comparison of drug biochemical analysis and the self-report scale.","authors":"Mayra Cristina da Luz Pádua Guimarães, Juliana Chaves Coelho, Juliano Dos Santos, Karina Cardoso Meira, Maria de Fátima Fernandes Vattimo, Elisio Costa, Giovanio Vieira da Silva, Luciano Ferreira Drager, Angela Maria Geraldo Pierin","doi":"10.5646/ch.2026.32.e37","DOIUrl":"10.5646/ch.2026.32.e37","url":null,"abstract":"<p><strong>Background: </strong>Assessing adherence to antihypertensive medication remains a major challenge for healthcare professionals. The objective of this study was to compare the evaluation of adherence to antihypertensive medication between direct and indirect methods, and to identify variables associated with nonadherence.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 253 persons with hypertension followed at a hypertension unit of a tertiary teaching hospital. Participants aged over 18 years and under antihypertensive drug treatment were included. Persons with secondary hypertension, end-stage chronic kidney disease, or pregnancy were excluded. Biopsychosocial, anthropometric, lifestyle, comorbidity, and medication data were collected. Indirect assessment of treatment adherence was performed using the 4-item Morisky-Green Medication Adherence Scale, while direct assessment was based on urine analysis using high-performance liquid chromatography coupled with mass spectrometry. Variables with <i>P</i> < 0.20 in the bivariate analysis were included in the multiple logistic regression model. The significance level was set at 5%. Cohen's Kappa coefficient (CKC) was used to assess agreement between the methods.</p><p><strong>Results: </strong>The sample consisted predominantly of women (61.7%), white individuals (63.2%), and married participants (52.8%), with a mean age of 65 ± 13.3 years and median education of 12.0 (7-12) years. Participants were using an average of 3.2 ± 1.3 antihypertensive drugs, and 69.2% had controlled blood pressure (BP). The prevalence of adherence according to the direct method was 32.4%, while 90.1% were adherent according to the indirect method. Agreement between the direct and indirect methods was low (CKC = 0.014). Variables independently associated with nonadherence according to the direct method were regular physical activity (odds ratio [OR], 0.370; 95% confidence interval [CI], 0.158-0.853), proteinuria (OR, 2.406; 95% CI, 1.066-5.751), number of antihypertensive medications (OR, 1.570; 95% CI, 1.127-2.225), and systolic BP (OR, 1.051; 95% CI, 1.010-1.097). Indirect adherence assessment was associated only with the presence of common mental disorders (OR, 1.163; 95% CI, 1.035-1.307).</p><p><strong>Conclusions: </strong>The prevalence of adherence to antihypertensive drug treatment assessed by the indirect method was substantially higher than that observed with the direct method. The results were inconsistent between the 2 approaches. Moreover, the direct method identified a broader range of variables associated with nonadherence.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e37"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic changes in right ventricular free wall strain during hemodialysis identify patients at risk for intradialytic hypotension.","authors":"Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Jung-Ho Heo, Ye Na Kim, Ho Sik Shin, Yeonsoon Jung, Hark Rim, James D Thomas","doi":"10.5646/ch.2026.32.e35","DOIUrl":"10.5646/ch.2026.32.e35","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypotension (IDH) is a frequent complication of hemodialysis that is associated with adverse cardiovascular consequences. The contribution of right ventricular (RV) functional reserve to hemodynamic stability during dialysis remains unclear. We investigated whether dynamic changes in RV strain are associated with IDH.</p><p><strong>Methods: </strong>In this prospective single-center study, 50 patients with end-stage renal disease undergoing maintenance hemodialysis underwent comprehensive echocardiography with speckle-tracking analysis immediately before and after dialysis. IDH was defined as a decrease in systolic blood pressure (SBP) of ≥ 20 mmHg from pre- to post-dialysis. Right ventricular free wall strain (RVFWS) was analyzed offline by a blinded specialist. Changes in RVFWS were compared between patients with and without IDH, and correlations between SBP change and RVFWS change were assessed.</p><p><strong>Results: </strong>In the analyzed 33 patients, 15 patients (45%) developed IDH. Baseline clinical characteristics, ultrafiltration volume (mean, 2.9 L), and pre-dialysis SBP were comparable between groups. Left ventricular ejection fraction was preserved in most patients, and baseline RVFWS did not differ significantly. However, the IDH group showed a significantly greater post-dialysis reduction in RVFWS than the non-IDH group (-7.0 ± 7.2% vs. -1.7 ± 4.6%, <i>P</i> = 0.017). Moreover, the magnitude of SBP decline correlated moderately with the decrease in RVFWS (<i>r</i> = 0.50, <i>P</i> = 0.003). Receiver operating characteristic analysis suggested a modest discriminatory ability of dialysis-induced changes in RVFWS for IDH (area under the curve, 0.74; 95% confidence interval, 0.56-0.92).</p><p><strong>Conclusions: </strong>IDH was associated with a greater dialysis-induced decline in RVFWS despite similar baseline RV function, suggesting that acute volume unloading may unmask impaired RV contractile reserve. These findings provide preliminary evidence that dynamic RV strain assessment could help identify patients vulnerable to intradialytic hemodynamic instability, warranting further validation in larger studies.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e35"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension in chronic kidney disease: where do international guidelines converge and diverge?","authors":"Emelina Stambolliu, Elpiniki Stathopoulou, Margarita Bora, Aikaterini Damianaki","doi":"10.5646/ch.2026.32.e32","DOIUrl":"10.5646/ch.2026.32.e32","url":null,"abstract":"<p><p>In recent years, major scientific societies have updated their hypertension guidelines, each incorporating specific recommendations for patients with chronic kidney disease (CKD). Across societies, there is strong consensus on standardized office and out-of-office blood pressure (BP) measurement, as well as systematic assessment of estimated glomerular filtration rate and albuminuria, with confirmation of abnormalities and regular monitoring. Moderate-to-severe CKD is universally recognized as a major determinant of cardiovascular (CV) risk and is frequently considered equivalent to established CV disease, thereby supporting earlier and more intensive BP treatment. Although BP thresholds for treatment initiation and on-treatment BP targets remain debated, there is broad agreement on the preferential use of dual-agent combination therapy, including surely renin-angiotensin system inhibitors in patients with albuminuric CKD-together with calcium-channel blockers or diuretics, with diuretic selection largely guided by renal function. Moreover, contemporary guidelines increasingly emphasize disease-modifying strategies, including sodium-glucose cotransporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists in selected patients, to improve cardio-renal outcomes. Despite differences in definitions, targets, and treatment algorithms, all guidelines converge on a patient-centered approach prioritizing cardio-renal protection, adherence, and individualized care. With this review, we summarize and compare key recommendations for patients with CKD from the 2023 European Society of Hypertension (ESH), the 2024 European Society of Cardiology, the 2021 Kidney Disease: Improving Global Outcomes, and the 2025 American Heart Association/American College of Cardiology guidelines, with the aim of supporting clinicians in navigating guideline complexity and optimizing hypertension management in CKD.</p>","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"32 ","pages":"e32"},"PeriodicalIF":6.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}