Hypertension Research最新文献

{"title":"Long-term outcomes associated with continued use of ARBs versus CCBs in older adults: a landmark cohort study.","authors":"Hisashi Noma, Hiroshi Sunada, Hajime Yamazaki, Futoshi Oda, Megumi Maeda, Haruhisa Fukuda","doi":"10.1038/s41440-026-02793-4","DOIUrl":"https://doi.org/10.1038/s41440-026-02793-4","url":null,"abstract":"<p><p>Evidence guiding treatment selection for patients already receiving long-term antihypertensive therapy remains uncertain, particularly in older adults. We compared long-term outcomes associated with continued use of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) among older adults receiving sustained antihypertensive therapy. Using linked administrative claims and health examination data from Japan, we conducted a retrospective cohort study of individuals aged ≥65 years who had continuously received either ARBs or CCBs for at least 12 months, with this time point defined as the landmark for follow-up. Discrete-time proportional hazards models with inverse probability of treatment and censoring weights were used to account for confounding and informative censoring. A total of 59,558 individuals (20,028 ARB users and 39,530 CCB users) were included, with a median follow-up of 4.75 years. Sustained ARB use was associated with a lower risk of heart failure hospitalization (hazard ratio [HR] 0.817, 95% confidence interval [CI] 0.758-0.882) and end-stage renal disease (HR 0.162, 95% CI 0.089-0.295). Risks of myocardial infarction and major adverse cardiovascular events were similar between groups, and stroke risk did not differ meaningfully. Blood pressure levels were comparable throughout follow-up. Among older adults receiving long-term antihypertensive therapy, continued use of ARBs was associated with lower risks of heart failure hospitalization and ESRD/dialysis compared with CCBs, despite similar blood pressure control. These findings may inform treatment selection in patients already established on antihypertensive therapy.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of intensive blood pressure control on cardio-kidney outcomes by KDIGO risk categories: a Post Hoc analysis of ACCORD-BP and SPRINT trials.","authors":"Xi Meng, Yueyue Wang, Yu Xiang, Xiaoli Xu, Xiaoyun Zhang, Siyu Wang, Zhiping Tan, Xuan Zhao, Kan Wang, Mian Li, Tiange Wang, Zhiyun Zhao, Jieli Lu, Min Xu, Jie Zheng, Weiqing Wang, Guang Ning, Yufang Bi, Yu Xu","doi":"10.1038/s41440-026-02792-5","DOIUrl":"https://doi.org/10.1038/s41440-026-02792-5","url":null,"abstract":"<p><p>The effects of intensive systolic blood pressure (SBP) control on cardiovascular (CV) and kidney outcomes across different Kidney Disease Improving Global Outcomes (KDIGO) risk categories remain unclear. We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) and the SPRINT-eligible Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trial. Participants were categorized into low, moderate, and high/very-high KDIGO risk groups. The primary outcomes were composite adverse CV events (defined as nonfatal myocardial infarction (MI), nonfatal stroke, fatal or hospitalized heart failure (HF), and CV mortality) and composite adverse kidney events (defined as a sustained decline in eGFR of ≥ 40% and end-stage kidney disease (ESKD)). We found that intensive BP control reduced the risk of composite CV events (HR 0.68; 95% CI 0.59-0.78), with attenuated benefits in higher KDIGO risk categories (P for interaction = 0.055). This interaction was mainly driven by nonfatal MI and fatal or hospitalized HF (both P for interaction < 0.05). Intensive BP control increased the risk of composite kidney events (HR 1.88; 95% CI 1.52-2.33), mainly in low- and moderate-risk groups rather than in high/very-high risk groups (P for interaction = 0.04). Similar patterns were observed for sustained eGFR decline (P for interaction = 0.03), but not for ESKD (HR 1.05; 95% CI 0.74-1.48; P for interaction = 0.71). The KDIGO risk classification modified the effects of intensive BP control. Balancing CV benefits against potential kidney impacts in patients with different KDIGO risks during intensive BP treatment is recommended. Trial Registration: ClinicalTrials.gov Identifiers: NCT01206062 (SPRINT) and NCT00000620 (ACCORD).</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep quality and hypertension: a counterfactual mediation analysis of the role of depressive symptoms.","authors":"Pil Kyung Yun, Young Dae Kwon","doi":"10.1038/s41440-026-02799-y","DOIUrl":"https://doi.org/10.1038/s41440-026-02799-y","url":null,"abstract":"<p><p>Poor subjective sleep quality and moderate-to-severe depressive symptoms have both been associated with hypertension, but the extent to which depressive symptoms account for the sleep quality-hypertension association remains uncertain, particularly in community-based populations. This cross-sectional study analyzed data from 210,925 adults in the 2018 Korea Community Health Survey. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and categorized as good or poor, while depressive symptoms were measured with the Patient Health Questionnaire-9 and dichotomized at a score of 10 to indicate moderate-to-severe depressive symptoms. Hypertension was defined as a self-reported physician diagnosis. Logistic regression models estimated associations between sleep quality, depressive symptoms, and hypertension, and counterfactual mediation analysis decomposed the association between poor sleep quality and hypertension into direct and indirect components, adjusting for sociodemographic, behavioral, and clinical factors. Poor sleep quality was associated with higher odds of hypertension (total effect odds ratio [OR], 1.119; 95% confidence interval [CI], 1.091-1.146). The natural direct effect remained significant after accounting for depressive symptoms (OR 1.106, 95% CI 1.078-1.133), whereas the natural indirect effect was statistically significant but small (OR 1.012, 95% CI 1.007-1.016), corresponding to a mediation proportion of 10.8% and 14.6% among non-employed participants. These findings suggest that poor subjective sleep quality was associated with hypertension and that moderate-to-severe depressive symptoms statistically accounted for only a modest proportion of the observed association. Because of the cross-sectional design, these findings should be interpreted as exploratory and hypothesis-generating rather than as evidence of temporal or causal relationships.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sacubitril/valsartan on serum uric acid and blood pressure in patients with hypertension and asymptomatic hyperuricemia: A randomized clinical trial.","authors":"Meng-Bo Wu, Jiao Yang, Cong-Cong Ding, Hong-Liang Xiong, Wei-Tong Hu, Jia-Bing Huang, Bi-Ming Zhan, Yan Xu, Xing-Hua Jiang, Yi-Fei Dong","doi":"10.1038/s41440-026-02802-6","DOIUrl":"https://doi.org/10.1038/s41440-026-02802-6","url":null,"abstract":"<p><p>Hyperuricemia commonly coexists with hypertension and is associated with increased renal and cardiovascular risk, yet few antihypertensive agents lower serum uric acid. This study compared the urate-lowering effects of sacubitril/valsartan versus valsartan in adults with primary hypertension and asymptomatic hyperuricemia. This single-center, prospective, randomized, open-label clinical trial enrolled adults with mild-to-moderate primary hypertension and fasting serum uric acid ≥ 420 μmol/L from September 2021 to December 2024, with 12 weeks of follow-up. Participants were randomized 1:1 to sacubitril/valsartan 200 mg once daily or valsartan 160 mg once daily. A standardized stepwise add-on protocol with amlodipine was used to achieve blood pressure control. The primary outcome was the change in fasting serum uric acid from baseline to week 12. In the primary intention-to-treat analysis using multiple imputation, treatment-effect estimates were pooled across imputed datasets using Rubin's rules. In the fully adjusted model, sacubitril/valsartan was associated with a greater reduction in serum uric acid at week 12 than valsartan (β = 30.13 μmol/L; 95% CI, 4.33-55.92; P = 0.022). Similar findings were observed in the per-protocol analysis. Blood pressure control at week 12 was comparable between treatment groups, although more participants assigned to valsartan required escalation to amlodipine 10 mg than those assigned to sacubitril/valsartan (17/75 [22.67%] vs. 4/75 [5.33%]; P = 0.008). In adults with primary hypertension and asymptomatic hyperuricemia, sacubitril/valsartan was associated with greater serum uric acid reduction than valsartan over 12 weeks while achieving comparable blood pressure control. These findings suggest that sacubitril/valsartan may have a favorable uric acid profile among hypertensive patients with asymptomatic hyperuricemia. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100050320 ( https://www.chictr.org.cn ). Date of Registration: September 1, 2021.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, clinical features and emergency department blood pressure management of hypertensive emergencies and uncontrolled hypertension: a retrospective multi-centre study.","authors":"Alessandro Maloberti, Giulia Capitoli, Tommaso Valobra, Paola Rebora, Nicolas Mavreas, Silvia Vergani, Valentina Giani, Chiara Tognola, Nicolò Capsoni, Michele Galasso, Lorenzo De Censi, Cecilia Ferretti, Andrea Sultana, Gabriele Peraro, Martina Morelli, Annalisa Giacalone, Ilaria Garofani, Filippo Galbiati, Michele Bombelli, Cristina Giannattasio","doi":"10.1038/s41440-026-02788-1","DOIUrl":"https://doi.org/10.1038/s41440-026-02788-1","url":null,"abstract":"<p><p>Very heterogeneous data have been published concerning prevalence and clinical management of Hypertensive Emergencies (HE) and Uncontrolled Hypertension (UH). The aim of our study was to characterize HE and UH patients evaluating: (i) Blood Pressure (BP) management in Emergency Department (ED), the pharmacological treatment and its adherence to guidelines recommendation; (ii) variables associated with the presence of organ damage; and (iii), as an exploratory analysis, the impact of BP on in-hospital mortality. We performed a multicentre (Niguarda Hospital - Milan and Pio XI Hospital - Desio) retrospective study evaluating patients admitted to ED with BP values ≥ 180/120 mmHg during 2017 and 2019. 1838 patients were admitted to the ED with a BP ≥ 180/120 mmHg (0.95% of total admissions) of whom 37.7% were HE and the remaining (62.3%) were UH. The reduction in Systolic and Diastolic BP (SBP/DBP respectively) was similar in HE (40.6/16.9 ± 26.3/17.7 mmHg) and UH (39.3/15.5 ± 22.4/16.0 mmHg). The most used drugs were intravenous furosemide, nitroglycerin, clonidine and labetalol for HE. Age, smoking, heart failure, previous acute coronary syndrome, chronic kidney disease and diabetes mellitus present a positive association HEs while female sex and chronic anti-hypertensive therapies with 2 or more drugs results as protective variables. Finally, regarding the exploratory analysis, BP at ED admission and its management didn't present significant association with in-hospital mortality. In conclusions, our study demonstrated that adherence to guidelines in the management of HE/UH could be further improved.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycoside fraction from pear seed functionally antagonizes sFLT-1 and restores angiogenic signaling in preeclampsia.","authors":"Peter U Amadi, Justice O Osuoha, Atieme J Ogbolosingha, Govind S Gill, Suha J Jarad, Prince C Odika, Esienanwan E Efiong, Sayem A Ahmed, Emmanuel N Agomuo, Queendarlyn Agbagwara, Chiamaka W Amadi, Joy A Amadi, Celestine N Ekweogu, Hong-Mei Gu, Da-Wei Zhang","doi":"10.1038/s41440-026-02770-x","DOIUrl":"https://doi.org/10.1038/s41440-026-02770-x","url":null,"abstract":"<p><p>Preeclampsia is characterized by endothelial dysfunction and angiogenic imbalance driven, in part, by excess soluble fms-like tyrosine kinase-1 (sFLT-1). Building on previous findings demonstrating vascular modulatory effects of cardiac and quercetin glycosides from Dacryodes edulis seeds during L-NAME-induced vascular perturbation, we investigated whether pear seed glycosides (PSG) modulate sFLT-1-mediated endothelial injury in preeclampsia. Endothelial, preclinical, biophysical, pharmacodynamic, and exploratory clinical approaches were integrated to evaluate PSG activity. TGFβ-stimulated HUVECs, an L-NAME-induced rat model of preeclampsia, orthogonal binding assays (SPR/BLI and MST), ligand competition assays, and a multicenter double-blind phase 1-2a exploratory clinical trial were employed. PSG reduced endothelial migration and suppressed αSMA, TNFα, and fibronectin expression in stimulated HUVECs. In preeclamptic rats, PSG attenuated systolic and diastolic blood pressure elevation, reduced inflammatory and cardiovascular injury markers, restored VEGF and placental growth factor (PlGF), and reduced circulating sFLT-1 and the sFLT-1/PlGF ratio. Bioactivity-guided fractionation identified glycosides as the principal active fraction and improved mean birth weight from 2.7 g in untreated preeclamptic dams to 3.5 g, approaching normotensive controls (3.7 g). Orthogonal SPR/BLI and MST assays demonstrated concentration-dependent PSG-sFLT-1 interactions, while competitive ELISA and BLI assays showed inhibition of sFLT-1-mediated sequestration of VEGF and PlGF. PSG additionally restored VEGFR2/KDR, AKT, and ERK signaling in sFLT-1-exposed endothelial cells. In the exploratory clinical trial, 83 participants were randomized following screening of 125 women, with approximately 80% completing follow-up. PSG administration alongside standard care did not reveal major treatment-emergent safety concerns. These findings support further investigation of PSG as a candidate adjunctive strategy targeting angiogenic dysfunction in preeclampsia.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body mass index modifies cardiovascular risk across blood pressure categories, particularly among underweight adults with hypertension: a 6.3 million‑person nationwide Japanese cohort study.","authors":"Takahisa Kawano, Tomohisa Seki, Hiroaki Araie, Akiko Matsunaga, Naohiro Konoshita, Osamu Yamamura, Masamichi Ikawa","doi":"10.1038/s41440-026-02781-8","DOIUrl":"https://doi.org/10.1038/s41440-026-02781-8","url":null,"abstract":"<p><p>Co-occurring obesity and hypertension is associated with high cardiovascular risk, whereas the prognostic significance of underweight in the presence of hypertension remains uncertain. We examined whether the association between body mass index category and 10-year risk of major adverse cardiovascular events differed across blood pressure categories. Using the Japan Medical Claims Database from 2005 to 2023, we analyzed 6,262,298 adults without prior cardiovascular disease, chronic renal failure, dialysis, or antihypertensive medication use at baseline. Blood pressure was classified as normal (<120 and <80 mmHg), high-normal (120-129 and <80 mmHg), elevated (130-139 and/or 80-89 mmHg), stage 1 hypertension (140-159 and/or 90-99 mmHg), or stage 2/3 hypertension (≥160 and/or ≥100 mmHg). Body mass index was classified as underweight (<18.5 kg/m²), normal weight (18.5-24.9), overweight (25.0-29.9), or obesity (≥30.0). The primary outcome was major adverse cardiovascular events within 10 years. Multivariable Cox proportional hazards models estimated hazard ratios for combined blood pressure and body mass index categories, using normal blood pressure with normal weight as the reference. During a median follow-up of 1,183 days, 34,034 participants experienced major adverse cardiovascular events. Underweight showed a marked blood pressure-dependent increase in risk, with the hazard ratio rising from 1.14 (95% confidence interval, 1.07-1.22) in normal blood pressure to 5.01 (4.23-5.93) in stage 2/3 hypertension. The interaction between blood pressure category and body mass index category was significant. These findings suggest that higher blood pressure may amplify the adverse prognostic significance of underweight.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant zoster vaccine and risk of kidney failure, cardiovascular, and mortality in patients with chronic kidney disease.","authors":"Chung-An Wang, Wei-Jie Wang, Hung-Wei Liao, Zheng-Hong Jiang, Chung-Yi Cheng, Jui-Yi Chen, Vin-Cent Wu","doi":"10.1038/s41440-026-02786-3","DOIUrl":"https://doi.org/10.1038/s41440-026-02786-3","url":null,"abstract":"<p><p>Individuals with chronic kidney disease are at increased risk for herpes zoster, cardiovascular events, kidney failure, and premature mortality. Although the recombinant zoster vaccine effectively prevents herpes zoster, its broader systemic effects in this population remain unclear. We conducted a retrospective cohort study of adults aged 50 years or older with incident chronic kidney disease using the U.S.-based TriNetX network from 2017 to 2024. A total of 13,218 vaccine recipients were propensity score-matched to 13,218 unvaccinated controls. The primary outcome was a kidney event, defined as progression to end-stage kidney disease or initiation of dialysis. Secondary outcomes included cardiovascular events and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios, with additional analyses of restricted mean survival time over five years and incidence rate differences. After a median follow-up of 3.0 years (IQR, 1.5-4.9), recombinant zoster vaccination was associated with significantly lower risks of kidney events (hazard ratio, 0.63; 95% CI, 0.57-0.70), cardiovascular events (hazard ratio, 0.74; 95% CI, 0.68-0.80), and all-cause mortality (hazard ratio, 0.51; 95% CI, 0.48-0.54). Greater risk reductions were observed among individuals who completed the two-dose series. These findings suggest that recombinant zoster vaccination in patients with chronic kidney disease is associated with substantial and sustained reductions in kidney disease progression, cardiovascular events, and mortality, supporting a potential role for vaccination in long-term cardiorenal protection.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antihypertensive therapy tailored to the circadian blood pressure profile as precision medicine.","authors":"Francesca Coccina, Chiara Cuccurullo, Rosa Scurti, Sante D Pierdomenico","doi":"10.1038/s41440-026-02789-0","DOIUrl":"https://doi.org/10.1038/s41440-026-02789-0","url":null,"abstract":"<p><p>Circadian blood pressure (BP) values may be different from clinic BP values. Thus, antihypertensive therapy guided solely by clinic BP might not prove appropriate. Moreover, ambulatory BP parameters are superior to clinic BP in predicting outcomes, indicating they should receive more attention as therapeutic targets. Among all relevant 24-h BP parameters, in both untreated and treated patients, two clinically unpredictable windows with proven prognostic relevance deserve attention: the period after awakening and the nighttime one. Some patients exhibit higher BP after awakening, which is associated with increased risk. In untreated patients, underdosed therapy could be started. In treated ones, most likely the drug taken the previous morning could not provide adequate duration of action. In this context, a medication with delayed onset of action and peak effect after several hours added in the evening could be of benefit to blunt morning BP rise. Others show high nighttime BP, which is associated with increased risk. In untreated patients, this can lead to prescribe underdosed therapy. In treated patients, most likely antihypertensive therapy in the morning does not cover the 24-h period. In this context, a drug with rapid onset of action and peak effect after few hours added in the evening could reduce high nighttime BP. Globally, evening therapy must be tailored to nighttime BP pattern to achieve the desired effect in the early morning or during the night. Future studies in which antihypertensive therapy is tailored to circadian BP profile, a more physiological definition of chronotherapy, should be scheduled.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure management for stroke patients beyond the JSH 2025 guidelines.","authors":"Kazunori Toyoda","doi":"10.1038/s41440-026-02765-8","DOIUrl":"https://doi.org/10.1038/s41440-026-02765-8","url":null,"abstract":"<p><p>As scientific evidence on blood pressure reduction in patients with chronic stroke accumulates year by year, target blood pressure levels recommended in guidelines, both in Japan and internationally, have tended to become lower. In addition, with respect to antihypertensive strategies, the Japanese Society of Hypertension Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (JSH2025) assign a higher level of recommendation to the angiotensin receptor-neprilysin inhibitor and mineralocorticoid receptor antagonist, in addition to the conventional first-line major drugs. In patients with resistant hypertension, renal denervation can be clinically used in Japan from 2026. However, the effect of stroke prevention in these newer drugs or renal denervation remains unclear and should be further elucidated. Recommendations for blood pressure management in acute-phase stroke, particularly ischemic stroke without receiving reperfusion therapy, remain unsettled, despite the fact that the validity of relatively strict blood pressure targets has been examined in multiple clinical trials to date. Target blood pressure for stroke patients and stepwise approach to blood pressure-lowering treatment.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}