Black women in the United States experience disproportionately high breast cancer mortality and have high rates of comorbid hypertension; however, the associations of hypertension and antihypertensive medication use with breast cancer survival are unclear. We examined these associations among 2474 Black Women's Health Study participants with invasive breast cancer. Hypertension and antihypertensive medication use were assessed biennially, and breast cancer diagnoses were confirmed through medical records and cancer registries. We used Cox proportional hazards models, adjusted for clinical and lifestyle factors and cancer treatment, to estimate hazard ratios (HR) for breast cancer-specific death. In the full study population, the HR for untreated hypertension compared to no hypertension was 1.17 (95% CI = 0.75-1.82), while the HR for treated hypertension compared to no hypertension was 0.81 (95% CI = 0.60-1.10). For ER+ cases, there was no association between untreated hypertension and breast cancer specific-death (HR = 0.96, 95% CI = 0.50-1.82), but a strong inverse association between treated hypertension and breast cancer-specific death (HR = 0.53, 95% CI = 0.34-0.83). In contrast, for ER- cases, we observed an increased risk of breast cancer specific death among those with untreated hypertension (HR = 2.19, 95% CI = 1.09-4.39), but there was little evidence of an association with treated hypertension (HR = 1.32, 95% CI = 0.80-2.19). Overall, our findings indicate that Black breast cancer patients with hypertension have better survival when their hypertension is treated, possibly due to regular healthcare engagement or the tumor suppressing actions of antihypertensive medications. Randomized trials are needed to establish causality and inform optimal cardiovascular management in oncology.

Substantial evidence supports an association between physical exercises and hypertension. However, the role of muscle strength, such as hand grip strength (HGS) and back muscle strength (BMS), remains unclear in this relationship. This study investigated whether low BMS and HGS accelerated incident hypertension in a population-based prospective study. A total 3,038 non-hypertensive subjects aged 40-69 years were followed-up for 18 years. In the analysis, the relationships between absolute and relative-muscle strength (relative-body mass index (BMI), weight, weight2/3, and waist circumference (WC)), and incident hypertension were analyzed using the Cox proportional hazards model. In multivariate analysis, weak strength of below -1.5 SD BMI and WC relative-BMS (BMI-BMS and WC-BMS), except absolute BMS, weight-, and weight2/3 relative-BMS, was associated with higher risk of incident hypertension (HR = 1.264, P = 0.050 and HR = 1.405, P = 0.003, respectively). Relative-BMS quartiles, except absolute-BMS quartiles, showed a significant trend of increased risk of incident hypertension as BMS decreased (Trend P < 0.05). Weak HGS, based Asian Working Group for Sarcopenia (AWGS) and Korea National Health and Nutrition Examination Survey (KNHNES) criteria, was also associated with higher risk of incident hypertension (HR = 1.679, P = 0.002 and HR = 1.515, P = 0.004, respectively). Weak HGS below -1.5 SD was associated with higher risk of incident hypertension in absolute HGS, BMI-, and WC relative-HGS (HR = 1.476, P = 0.001, HR = 1.374, P = 0.008, and HR = 1.530, P < 0.001, respectively). Relative-HGS quartiles, except absolute HGS, showed similar significant trend (Trend P < 0.001). In this study, we found that the BMS and HGS were an independent risk factor for the incident hypertension.

Patients with chronic kidney disease (CKD) are at increased risk for masked and nocturnal hypertension, conditions best identified through ambulatory blood pressure (BP) monitoring (ABPM) and associated with adverse cardiovascular outcomes. We evaluated associations between antihypertensive medication classes and ABPM profiles by conducting a cross-sectional analysis of participants from the Chronic Renal Insufficiency Cohort (CRIC) with ABPM data. Antihypertensive medications were categorized as renin-angiotensin system inhibitors (RASis), beta-blockers, calcium channel blockers (CCBs), and thiazide/loop diuretics. We used multinomial logistic regression to evaluate the independent association between each medication class (accounting for simultaneous use of multiple classes) and ABPM phenotype: controlled hypertension, white coat effect, sustained hypertension, and masked uncontrolled hypertension (MUCH). Secondary outcomes included nocturnal hypertension, nocturnal non-dipping, and BP variability. Analyses were Bonferroni-corrected for multiple comparisons. Among 1499 eligible participants, 66% used RASis, 52% beta-blockers, 43% CCBs, and 50% thiazide/loop diuretics. RASi use was associated with lower odds of sustained hypertension (OR 0.60, 95% CI 0.42 to 0.84), while beta-blocker use was positively associated with MUCH (OR 1.48, 95% CI: 1.12 to 1.96). For secondary outcomes, RASi use was associated with lower odds of nocturnal hypertension (OR 0.71, 95% CI: 0.55 to 0.91), whereas beta-blocker and CCB use were both associated with nocturnal hypertension (OR for beta-blockers 1.33, 95% CI 1.04 to 1.70; OR for CCBs 1.36, 95% CI 1.07 to 1.73). Overall, we identified several associations between specific antihypertensive classes and abnormal ABPM profiles. Longitudinal studies are needed to evaluate reproducibility and potential mechanisms of these findings.

We aimed to examine the prevalence of frailty in older adults with hypertension and its association with suboptimal blood pressure (BP), with a particular focus on differences by sex. The study was conducted at two major hospitals in Vietnam from 2023 to 2024. Frailty was defined by a Clinical Frailty Scale of ≥ 4. Suboptimal BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. There were 1038 participants (326 female, mean age 73 years). The prevalence of frailty was 28.6%, higher in female (35.3%) than male participants (25.6%). The overall rate of suboptimal BP was 26.7%. In female participants, the frail had a significantly higher rate of suboptimal BP (33.9%) compared to the non-frail (20.9%), but no significant differences among male. In the logistic model adjusted for age, education, marital status, physical exercise, falls, coronary heart disease, diabetes, chronic kidney disease, osteoarthritis, heart failure, stroke, atrial fibrillation, osteoporosis, chronic obstructive pulmonary disease, duration of hypertension, monotherapy/combination therapy, and medication adherence score, the odds ratios of frailty on suboptimal BP were 2.01 (95% CI 1.08-3.76) in female participants, 0.92 (95% CI 0.59-1.44) in male, female-to-male ratio of odds ratios 2.18 (95% CI 1.01-4.70). These findings highlight the need for sex-specific approaches in managing hypertension in older populations.

Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. Atherosclerosis is a chronic disease which can lead to peripheral vascular occlusion causing cardiovascular, cerebrovascular, and peripheral artery diseases (PAD). Key contributors to PAD include ageing, classical cardiovascular risk factors, diabetes mellitus, and hypertension. For decades, these factors have also been related to arterial tortuosity, potentially indicating vascular fragility or arteriopathies. We aimed to evaluate the association between abdominal aortic tortuosity (AAT) and arteriopathies from other vascular beds and to assess its potential role as a subclinical marker of peripheral vascular disease. We included individuals aged ≥ 50 years and excluded those with dorsolumbar scoliosis. We built a multivariate log-linear regression model to identify factors associated with AAT. The model was adjusted by carotid calcification, stiffness, and stenosis as well as individual clinical characteristics and previously registered vascular diseases. A total of 490 individuals (mean age, 66.92 years; range, 50-98 years; 44.29% of women) from the Ageing Imageomics Study were included in this analysis. We observed that the AAT index was strongly dependent on age and also with diastolic blood pressure and estimated glomerular filtration rate (eGFR), but to a lesser extent. In contrast, other classical cardiovascular risk factors like diabetes mellitus, hypertension, smoking, aortic stiffness, and calcification did not play a significant role. Our results do not support the AAT index as a subclinical marker of cardiac, cerebrovascular, or peripheral vascular disease. AAT was not associated with classical cardiovascular risk factors and comorbidities.

The comparative superiority among the triglyceride-glucose (TyG) index and its obesity-related composite indicators in identifying hypertension and carotid atherosclerosis (CAS) remains unknown. This study aims to evaluate and compare the discriminative ability of these indices in a large-scale population to identify the optimal marker for cardiovascular risk assessment. This cross-sectional study included 154,873 participants who underwent routine physical examinations and carotid ultrasonography. Binary logistic regression, restricted cubic spline (RCS), receiver operating characteristic (ROC) analyses, and mediation analyses were used to evaluate the associations of TyG, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and TyG-body mass index (TyG-BMI) with hypertension and CAS. The mean age of participants was 45.7 ± 12.5 years, with 42.1% being female and 91.0% being married. A total of 16,235(10.5%) participants had hypertension, and 81,337 (52.5%) had CAS. Comparing the highest to the lowest quartile, TyG-WHtR demonstrated the strongest association with hypertension (OR = 8.644, 95% CI: 7.927-9.426) and CAS (OR = 2.173, 95% CI: 2.086-2.263). RCS analyses revealed monotonic increases for hypertension and complex nonlinear patterns for CAS. Stratified analyses revealed distinct phenotypic signatures. For hypertension, risk magnitudes were markedly amplified in younger adults (≤ 60 years) (P for interaction < 0.001 for all indices). For CAS, a significant interaction between sex and the indices was observed (P for interaction < 0.05 for TyG, TyG-WHtR, and TyG-BMI): TyG-WHtR exhibited the strongest association in women (OR = 1.504), whereas in men, the isolated TyG index was inversely associated with CAS, and only TyG-BMI showed a significant positive association (OR = 1.091). Mediation analyses revealed that obesity indicators (WHtR, BMI) demonstrated substantial direct associations with on outcomes, with TyG providing negligible or partial mediation, which may account for the stronger associations observed with composite indices. TyG-obesity composite indices are strongly associated with hypertension and CAS, particularly in younger adults. TyG-WHtR is optimal for women and the general population, while TyG-BMI is superior for men. These easily accessible and cost-effective metrics can serve as practical tools for early cardiovascular risk screening in primary care. Implementing such age-targeted and sex-specific risk stratification could facilitate more precise and timely preventive interventions.

The 2025 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults introduces important updates to the classification, risk assessment, and treatment of hypertension. Notable changes include adoption of the Predicting Risk of Cardiovascular Disease EVENTs risk calculator, revised criteria for initiating pharmacotherapy, and a shift toward lower treated blood pressure targets. Yet these updates have limited direct application to the perioperative setting. Recommendations for surgical patients remain largely unchanged from prior iterations, with continued dependency on expert opinion and low-certainty evidence. Anesthesiologists are left to reconcile evolving outpatient management paradigms with conflicting perioperative data, including recent trials demonstrating no benefit from preoperative blood pressure optimization in noncardiac surgery. This narrative review examines the key updates from the 2025 Hypertension Guideline and their implications for perioperative care, identifies persistent knowledge gaps, and advocates for a multidisciplinary, individualized approach in which anesthesiologists assume active leadership in integrating evidence-based care across the surgical continuum.