Current Hypertension Reports

Bothe, Tomas L.; Melloy, Abigail E.; Patzak, Andreas; Pilz, Niklas

doi: 10.1007/s11906-025-01346-3pmid: 41118028

Purpose of ReviewIn clinical practice, the diagnosis of hypertension is based on non-invasive upper-arm cuff blood pressure (BP) measurement. Most measurements are performed seated, although evidence indicates that supine BP may provide additional information. This review summarises recent findings on the influence of body posture on BP readings and cardiovascular (CV) risk prediction across office, ambulatory, and home BP monitoring (OBPM, ABPM, HBPM), their clinical implications and future research directions.Recent FindingsIn OBPM, patients with supine-only hypertension demonstrated CV risk comparable to patients with hypertensive BP in both positions, and a higher risk than seated-only hypertensives. Supine hypertension was particularly predictive in individuals under 65 years of age. In ABPM, the strongest predictors of CV events are nocturnal hypertension and abnormal dipping patterns, particularly when patients are truly asleep, whereas supine nocturnal HBPM has been less extensively investigated.SummaryCurrent clinical practice remains primarily based on seated BP measurements. Recent trials have highlighted that supine OBPM may provide additional predictive power in the assessment of CV risk. These findings offer a partial explanation for the residual high predictive value of nocturnal BP values which can be derived from ABPM or specialised HBPM devices that goes beyond the correlation of breathing related sleep disorders Research should focus on homogenising supine risk data into composite risk scores combining seated and supine BP while new outcome studies should consider including supine BP measurement. Future guideline committees should consider recommending the structured clinical application of supine BP, given its demonstrated prognostic benefits.Graphical Abstract[graphic not available: see fulltext]

Stephens, Jacqueline; Grande, Eleonora Dal; Roberts, Tayla; Kerr, Marianne; Northcott, Celine; Johnson, Tahlia; Sleep, Jessie; Ryder, Courtney

doi: 10.1007/s11906-025-01327-6pmid: 39976766

Purpose of the ReviewPreeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing. To understand factors associated with increased risk for Indigenous women a systematic review and meta-analysis was conducted. The PRISMA guidelines were adhered to, and the review protocol was registered on PROSPERO (Registration CRD42023381847). EndNote, Covidence and Excel were used to screen and extract data, with studies assessed using JBI critical appraisal tools.Recent FindingsSeven studies from Canada, Australia, and the United States (none from New Zealand) were included in this review. Meta-analysis showed women classified as overweight (OR 1.32, 95% CI: 1.09–1.60), obese (OR 1.88, 95% CI: 1.57–2.25), or having high mean BMI (MD 3.02 95% CI: 1.72–4.31), high mean systolic blood pressure (MD 15.19 95% CI: 12.83–17.541), or high mean diastolic blood pressure (MD 15.26 95% CI: 13.05–17.47), pre-pregnancy diabetes (OR 3.63, 95% CI: 1.66–17.94), or high microalbuminuria (OR 2.76, 95% CI: 1.40–5.43) were more likely to be diagnosed with preeclampsia. Smoking (OR 0.77, 95% CI: 0.58–1.03), alcohol consumption (OR 1.70, 95% CI: 0.76–3.81), and gestational diabetes (OR 1.74, 95% CI: 0.90–3.37) were not associated with preeclampsia.SummaryUnderstanding factors associated with increased preeclampsia/HDP risk amongst Indigenous women is important to minimising adverse perinatal events and future health complications. This review demonstrates current gaps in the evidence, specifically in relation to social, economic, and environmental factors.

Williams, Rebecca; Gloston, Gabrielle; Ward, Katherine C.; Jain, Shubhi; Hays, Kristen; Ensor, Annie; Patel, Samarth; Patel, Neel; Hogue, Mackenzie; Thomas, S. Justin; Polanka, Brittanny M.

doi: 10.1007/s11906-025-01345-4pmid: 41118090

Sleep is recognized in Life’s Essential 8™ as an important behavioral factor for improving and maintaining cardiovascular health. While sleep duration is currently the focus in Life’s Essential 8™, sleep health is multidimensional and encompasses regularity, satisfaction, next-day alertness, timing, efficiency, and duration. In addition to sleep, circadian factors have also been implicated in cardiovascular health. For example, shift work, which results in significant circadian misalignment, is associated with poor cardiovascular health. This review will describe methods for measuring, analyzing, and interpreting sleep and circadian rhythms in humans. Subjective and objective measurements of sleep are not always concordant and may reflect distinct constructs. Therefore, both subjective and objective sleep measurements are discussed. Assessment of the circadian system in humans typically relies on the measurement of circadian biomarkers (i.e., melatonin, core body temperature, and/or cortisol) during rigorous and burdensome research protocols. However, novel approaches are being developed to estimate circadian parameters with lower cost and participant burden. This review aims to inform cardiovascular scientists and clinicians of common practices in the assessment of sleep and circadian rhythms.

Ye, Yuyang; Wang, Junwen; Peng, Yong

doi: 10.1007/s11906-025-01336-5pmid: 40555927

Purpose of ReviewSince the FDA approved transcatheter renal denervation (RDN) for the treatment of uncontrolled hypertension in 2023, cardiologists have sought to answer a critical question: "Who benefits from RDN?" The blood pressure-lowering effect of RDN varies considerably among individuals, with some showing little to no response. Predicting individual response remains challenging due to the lack of reliable biomarkers. This review summarizes potential biomarkers for predicting the antihypertensive response to RDN, with a focus on their pathophysiological mechanisms.Recent FindingsBiomarkers reflecting renal efferent nerve activity, rather than afferent nerve activity, may serve as more reliable predictors of RDN response. Additionally, biomarkers linked to renin–angiotensin–aldosterone system (RAAS) activation, such as plasma renin activity and miR-133a, have shown promising predictive value. Further research is needed to validate these findings and identify novel biomarkers to optimize patient selection for RDN.

Siddiqi, Ahmed Kamal; Khan, Muhammad Shahzeb; Kulkarni, Anandita; Hall, Michael E.; Böhm, Michael; Díez, Javier; Butler, Javed

doi: 10.1007/s11906-025-01342-7pmid: 41324724

Purpose of ReviewHypertension is the leading modifiable risk factor for cardiovascular disease. Despite multiple antihypertensive therapies, blood pressure (BP) control remains suboptimal in many individuals with persistent cardiovascular risk. This review evaluates the antihypertensive potential of sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), particularly in patients with comorbid diabetes, HF, CKD or resistant hypertension.Recent FindingsSGLT2-i consistently lower office SBP/DBP (2.5–4.0/1.5–2.0 mmHg) and 24-hour ambulatory BP (3.8/1.8 mmHg). GLP-1RAs show modest SBP reductions (1.8–5.1 mmHg) and minimal DBP effects (~ 0.5 mmHg), though tirzepatide shows greater efficacy (~ 10.6 mmHg) in select populations. Both classes have demonstrated cardio-renal benefits, favorable safety profiles, and reduced polypharmacy.SummarySGLT2-i exert more consistent BP-lowering effects than GLP-1RA, largely due to their diuretic-like action. While not first-line therapies, both drug classes show promise as adjuncts in high-risk populations. Future research should further define their role in comprehensive hypertension management.

Ding, Fang Chao Linda; Sandery, Blake J.

doi: 10.1007/s11906-025-01333-8pmid: 40448860

Purpose of ReviewWe aim to review the most recent literature on demographic features and diagnostic workup of children with secondary hypertension, in order to provide a framework for health providers to determine which hypertensive pediatric patients warrant further investigation for secondary causes. By highlighting the utility of various diagnostic investigations, we aim to minimize unnecessary testing burden.Recent FindingsA recent meta-analysis revealed that hypertensive children and adolescents with any of the following features were at increased risk of secondary hypertension: < 6 years of age, history of prematurity, family history of secondary hypertension, body mass index (BMI) < 10th percentile.SummaryBased on available evidence, we suggest a testing schema that is stratified by both age and BMI. Limited evidence suggest renal ultrasound may be one of the most useful initial investigations for secondary causes in asymptomatic hypertensive children. Lipid profile in overweight/obese children, and echocardiogram for end organ involvement may have high yield of abnormal results. Further studies on the diagnostic utility of tests for secondary hypertension are required, as the current body of evidence is limited.

Xiao, Lu; Yang, Sicong; Song, Yali; Xiao, Jia

doi: 10.1007/s11906-025-01334-7pmid: 40493257

Purpose of ReviewThis review provides a critical examination of the sex-specific impact of alcohol consumption on the development and progression of hypertension. Specifically, it elucidates the differential roles of alcohol metabolism and blood pressure regulatory mechanisms in men and women. Finally, it explores promising sex-specific therapeutic strategies for the management of alcoholic hypertension.Recent FindingsEmerging evidence indicates significant sex-based disparities in alcohol pharmacokinetics and pharmacodynamics, with women exhibiting heightened susceptibility to alcohol-induced cardiovascular sequelae. Crucially, key mechanistic insights reveal the differential modulation of the renin-angiotensin-aldosterone system (RAAS), oxidative stress pathways, and the intricate interplay of sex hormones, including the protective effects of estrogen and the potential pro-hypertensive effects of testosterone. Consequently, contemporary therapeutic avenues are increasingly focusing on targeting these sex-specific pathophysiological mechanisms.SummaryAlcoholic hypertension manifests with distinct sex-related etiologies and underlying mechanisms, necessitating the development of tailored therapeutic interventions. Effective management strategies should prioritize addressing sex-specific differences in oxidative stress, RAAS activation, and the implementation of personalized lifestyle modifications.

Borozan, Sanja; Kamrul-Hasan, A. B. M.; Shetty, Sahana; Pappachan, Joseph M.

doi: 10.1007/s11906-025-01323-wpmid: 39821533

Purpose of ReviewHypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managing the high incidence of cardiovascular disease (CVD) complications and mortality because of elevated blood pressure (BP). However, evaluation and management of endocrine hypertension are not optimal in clinical practice. With three unique clinical case scenarios, we update the evidence base for diagnostic evaluation and management of endocrine hypertension in this review to inform appropriate day-to-day clinical practice decisions.Recent FindingsAlthough most individuals with high BP suffer from essential hypertension (≈85%), some patients may have a clear underlying etiology (termed secondary hypertension), and a significant proportion of these patients have endocrine hypertension (≈10%) consequent to hormone excess from dysfunction of one or more endocrine glands. Even if a relatively common disease in the general population, the correct diagnosis and appropriate treatment of endocrine hypertension is often delayed because of poor awareness among clinicians, including primary care providers and physicians in the secondary care settings.SummaryAn accurate and timely diagnosis of endocrine hypertension is crucial to potentially cure or at least properly manage these patients because the consequences of delays in diagnosis can be catastrophic, with markedly higher end-organ complications such as CVD, chronic kidney disease, and even premature mortality among sufferers.

Mahgoup, Elsayed M.

doi: 10.1007/s11906-025-01331-wpmid: 40261509

Purpose of ReviewSystemic hypertension is a major risk factor for cardiovascular disease and remains challenging to manage despite the widespread use of antihypertensive medications and lifestyle modifications. This review explores the role of gut microbiota in hypertension development and regulation, highlighting key mechanisms such as inflammation, gut-brain axis modulation, and bioactive metabolite production. We also assess the potential of microbiota-targeted therapies for hypertension management.Recent FindingsEmerging evidence indicates that microbial dysbiosis, high-salt diets, and gut-derived metabolites such as short-chain fatty acids (SCFAs) and bile acids significantly influence blood pressure regulation. Preclinical and early clinical studies suggest that interventions targeting gut microbiota, including probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and dietary modifications, may help modulate hypertension. However, variability in gut microbiota composition among individuals and limited human trial data pose challenges to translating these findings into clinical practice.SummaryWhile microbiota-based therapies show promise for hypertension management, further research is needed to establish their efficacy and long-term effects. Large-scale, standardized clinical trials are crucial for understanding the therapeutic potential and limitations of gut microbiota interventions. A deeper understanding of the gut-hypertension axis could lead to novel, personalized treatment strategies for hypertension.Graphical abstract[graphic not available: see fulltext]

Tran, Andrew H.; Walsh, Aaron; Urbina, Elaine M.

doi: 10.1007/s11906-025-01329-4pmid: 40014185

Purpose of ReviewTo review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood obesity on target organ damage.Recent FindingsThe prevalence of hypertension and obesity are rising in children despite efforts to address these risk factors. Health disparities play a role in contributing to the rise in prevalence. Hypertension and obesity promote pro-inflammatory cytokines that activate the renin-angiotensin-aldosterone system and sympathetic nervous system which result in adverse effects on blood pressure regulation and renal function. Adverse cardiac, vascular, renal, neurocognitive, and retinal changes can be seen with elevated blood pressure. Recent intervention studies are few, but adequate treatment of hypertension and obesity can result in improvement in target organ damage.SummaryHypertension and obesity have significant impacts upon target organs. Interventions to decrease blood pressure and treat obesity are associated with reductions in left ventricular hypertrophy, improvement in measures of systolic and diastolic function, and improvement in renal outcomes. Appropriate screening and management of these conditions can lessen potential future cardiovascular impact.