Taiwan, in common with other high-income East Asian societies, is experiencing rapid demographic aging. Hypertension is present in the majority of older adults and remains the leading modifiable determinant of cardiovascular morbidity and mortality in this population. Yet managing blood pressure (BP) in older adults differs qualitatively from managing it in younger patients: arterial stiffening, salt sensitivity, orthostatic BP dysregulation, atrial fibrillation, frailty, cognitive vulnerability, and multimorbidity collectively alter the benefit-harm balance in ways that conventional guidelines-designed predominantly around middle-aged trial populations-do not adequately capture. To address this gap, the Taiwan Hypertension Society (THS) published the 2026 Guidelines for the Management of Hypertension in Older Adults, endorsed by the Taiwan Society of Cardiology (TSOC), the Taiwan Association of Gerontology and Geriatrics (TAGG), and the Taiwan Society of Family Medicine (TSFM). The guideline comprises 63 actionable recommendations developed through PICO-formulated clinical questions, systematic evidence appraisal, and the GRADE approach, with structured expert consensus for areas of limited evidence. Key updates include a measurement-first framework centered on validated oscillometric devices and the 7-2-2 home BP monitoring (HBPM) protocol; age- and comorbidity-stratified systolic BP (SBP) targets with frailty-sensitive safeguards; structured lifestyle prescriptions packaged as the SP-ABCDE mnemonic; individualized pharmacological management with explicit deprescribing considerations; and dedicated sections on orthostatic hypotension, atrial fibrillation, cognitive impairment, and resistant hypertension. This article summarizes the major highlights and clinical implications of the 2026 THS Hypertension guideline for older adults. Key components of the 2026 Taiwan Hypertension Society (THS) Guidelines for the Management of Hypertension in Older Adults. The upper panels summarize the diagnostic and lifestyle foundations-including the 7-2-2 home blood pressure monitoring (HBPM) protocol and the SP-ABCDE lifestyle prescription-together with the age- and risk-stratified systolic blood pressure (SBP) targets. For the intensive-versus-standard target comparison, an SBP target of <130 mmHg is a Strong recommendation for general older adults aged 65-79 years but a Conditional recommendation for those aged ≥80 years; a more intensive target of <120 mmHg may be considered (Conditional recommendation) in high-risk older adults with two or more additional cardiovascular risk factors. The lower panels summarize precision targets and frailty safeguards-including individualized targets and deprescribing considerations in frail older adults-and emphasize accurate BP measurement as a patient-safety strategy, including screening for orthostatic hypotension to prevent falls and syncope. HBPM home blood pressure monitoring, OH orthostatic hypotension SBP systolic blood pressure.

Cold indoor temperatures acutely raise blood pressure, but their long-term effects remain uncertain. We investigated whether winter indoor-temperature levels and temporal variability were associated with 5-year changes in home blood pressure. This nationwide cohort included 700 adults from 483 households with complete data. Living-room temperature was measured at 10-min intervals, and home blood pressure was measured twice each morning and evening for 2 weeks in winter at baseline and at the 5-year follow-up. Linear mixed-effects models with household random intercepts were adjusted for baseline blood pressure, individual covariates, and mean indoor temperature in analyses of variability. Mean and minimum indoor temperatures were not associated with 5-year changes in systolic or diastolic home blood pressure. In contrast, a 10 °C/day higher cumulative indoor-temperature variation was associated with 0.42 mmHg (95% confidence interval, 0.04-0.80) and 0.27 mmHg (0.01-0.54) greater increases in systolic and diastolic home blood pressure, respectively. Each additional daily indoor-temperature swing ≥3 °C and ≥5 °C was associated with 0.32 mmHg (0.004-0.636) and 0.49 mmHg (0.04-0.93) greater increases in systolic blood pressure, respectively. A model-based comparison of cumulative indoor-temperature variation values 1 standard deviation above versus below the mean yielded an estimated difference of 1.47 mmHg (0.13-2.81) in the 5-year change in home systolic blood pressure. The sensitivity analysis yielded broadly consistent results. Greater winter indoor-temperature variability was associated with larger 5-year increases in home blood pressure independently of mean indoor temperature. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index.htm . UMIN Clinical Trials Registry, Trial No. UMIN000042196.

Excessive sympathetic activity may contribute to orthostatic hypertension and nocturnal hypertension. However, evidence on associations between skin sympathetic nerve activity (SKNA), assessed noninvasively using neuECG, and these hypertension phenotypes is limited. In this cross-sectional observational study, simultaneous SKNA and supine-to-standing blood pressure (BP) measurements were performed among outpatients with hypertension to examine these associations. Average SKNA (aSKNA) during supine and standing periods, and the percentage change in aSKNA from supine to standing (aSKNA%-changesupine-to-standing) were calculated. Orthostatic hypertension was defined as a supine-to-standing BP increase ≥20/10 mm Hg or conversion from <140/90 mm Hg to ≥140/90 mm Hg. Nighttime home BP was measured for 7 consecutive days; nocturnal hypertension was defined as nighttime BP ≥ 120/70 mm Hg. Associations of SKNA measures with orthostatic and nocturnal hypertension were examined using logistic regression analyses. A total of 141 participants (mean age, 67.6 years; 53.9% men) were included in the analyses. aSKNA%-changesupine-to-standing was correlated with standing SBP (rs = 0.221) and nighttime SBP (rs = 0.280). The adjusted odds ratio (OR) (95% CI) for orthostatic hypertension comparing the highest with the lowest tertile of aSKNA%-changesupine-to-standing was 2.18 (0.89-5.35). The corresponding OR for nocturnal hypertension was 2.74 (1.01-7.41) after adjustment for age and sex, and the corresponding OR for nondipping and riser patterns was 3.70 (1.38-9.90). In the current analysis, greater standing-induced increases in aSKNA tended to be associated with orthostatic and nocturnal hypertension, suggesting the potential role of SKNA in characterizing hypertension phenotypes associated with excessive sympathetic activity.

We investigated cross-sectional associations between body mass index (BMI) and brachial-ankle pulse wave velocity (baPWV) and longitudinal associations between body weight change and baPWV over 3 years in 874 patients with treated hypertension or diabetes mellitus without coronary artery disease (475 men; mean age, 61.9 ± 9.5 years). baPWV was measured at baseline, 1.5 years, and 3 years. At baseline, BMI was inversely correlated with baPWV (r = -0.14, P < 0.001), and multivariate analysis confirmed this association (β = -12.5, P < 0.001). In generalized linear mixed-effects models adjusted for concurrent systolic blood pressure, heart rate, and other covariates, neither continuous percentage change in body weight (β = -1.2, P = 0.08) nor categorical body weight change (≥5% increase: β = -10.6, P = 0.45; ≥5% decrease: β = 18.0, P = 0.15) was associated with longitudinal changes in baPWV, with no interaction across baseline BMI categories. The modest body weight changes observed in this cohort were not significantly associated with longitudinal changes in baPWV.

Accurate projections of future hypertension prevalence are essential for planning effective public health strategies to prevent cardiovascular mortality. This study aimed to project the future prevalence of hypertension in Japan through 2040. Prevalence estimates of hypertension and untreated/uncontrolled hypertension stratified by sex and age groups were obtained from the National Health and Nutrition Survey from 1986 to 2019. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication, and untreated/uncontrolled hypertension as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Three approaches were compared: a Bayesian Lee-Carter model, a model assuming monotonic prevalence change, and a constant-prevalence model. The projected prevalence estimates were applied to the population projections from the Vital Statistics of Japan. The Bayesian Lee-Carter model demonstrated the best predictive accuracy among the three models. The model projected that hypertension prevalence remained stable among men from 47.1% (95% credible interval [CI], 45.6-48.6%) in 2020 to 48.2% (44.6-52.4%) in 2040, and among women from 36.7% (35.5-37.8%) to 35.6% (32.8-38.3%). In contrast, untreated/uncontrolled hypertension prevalence would decline among men from 31.9% (28.6-34.6%) to 26.7% (18.0-38.4%), and among women from 23.1% (21.3-24.8%) to 17.2% (13.1-22.6%). The prevalence of hypertension in Japan is projected to remain largely unchanged through 2040, while the prevalence of untreated/uncontrolled hypertension is projected to decline. The findings suggest that public health policies and clinical efforts for BP control should be maintained and further strengthened to sustain and accelerate the trend.

Streptomyces aureofaciens (S. aureofaciens) Tü117 and its metabolite α-lipomycin have been implicated in high-salt-induced hypertension. Previous studies showed that high-salt intake increases gut Tü117 abundance and circulating α-lipomycin levels. Mechanistically, α-lipomycin acts as a TRPV4 antagonist, impairing nitric oxide (NO)- and endothelium-derived hyperpolarizing factor (EDHF)- mediated endothelium-dependent vasodilation and thereby promoting vascular dysfunction and blood pressure (BP) elevation. However, whether hypertension is driven by Tü117 itself or specifically by α-lipomycin production remains unclear. Here, we generated a LipReg4 deletion mutant strain (ΔTü117) using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 genome editing to selectively abolish α-lipomycin biosynthesis. Deletion of LipReg4 did not markedly affect bacterial growth but completely abolished α-lipomycin production. Compared with Tü117, ΔTü117 failed to increase circulating α-lipomycin levels or induce a sustained elevation in BP. These findings identify α-lipomycin as the key metabolite mediating Tü117-induced hypertension. They further support a direct role of gut microbial metabolites in host BP regulation.