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Background: Hypertension is a major risk factor for cardiovascular disease, yet nearly 46% of adults with hypertension remain undiagnosed. Without timely intervention, it can lead to severe complications, including stroke, heart failure, and kidney disease. In sub-Saharan Africa (SSA), hypertension prevalence varies widely from 19.3% in Eritrea to 39.6% in Seychelles. Urbanization has played a key role in increasing hypertension rates through its impact on diet, physical activity, and obesity. Still, urban-rural differences remain modest. Understanding demographic and lifestyle predictors is crucial for SSA's targeted prevention and control efforts. Methods: We conducted a cross-sectional analysis using nationally representative, de-identified data from the Demographic and Health Surveys (2016–2024) in five SSA countries: Lesotho, Tanzania, Gabon, Benin, and South Africa. Adults aged ≥18 years with valid blood pressure and covariate data were included (N=38,085). Blood pressure was measured three times, and the average of the second and third readings was used when available. Hypertension was defined per the 2017 ACC/AHA guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg). Independent variables included age, sex, BMI, education, wealth index, smoking status, and recent caffeine intake. Results: Urban residents (n=20,773) had a higher hypertension prevalence than rural residents (n=17,312) (44.8% vs. 36.7%, p<0.001), along with higher median BMI (24.9 vs. 22.3 kg/m 2 ) and obesity rates (23.5% vs. 11.3%). South Africa exhibited the highest rates (urban 68%, rural 61%), while Tanzania and Lesotho had the lowest (~39–40%). In pooled multivariable analysis, hypertension odds increased steadily with age (OR 4.57 for ≥60 vs 18–24, p<0.001). Obesity demonstrated a dose–response relationship: Class III obesity was associated with a fivefold increase in risk (OR 5.38, p<0.001). Men had higher odds than women (OR 1.65, p<0.001). Secondary education and middle wealth status conferred modest increases in risk. Caffeine use was marginally significant; smoking was not. Predictor importance ranked: age > BMI > sex > wealth > education > smoking > caffeine. Conclusion: Hypertension is highly prevalent in both urban and rural SSA, with age and obesity emerging as the most powerful predictors. South Africa stands out with younger adults most affected. Early detection, awareness campaigns, and obesity-focused interventions are needed to mitigate the growing burden of hypertension in SSA.

Introduction: Excess sodium intake is strongly linked with hypertension and cardiovascular disease (CVD); people with narcolepsy (PwN) have increased CV risk. Hypothesis: Switching from high-sodium oxybate (SXB; Xyrem ® ; 6–9 g for ≥6 wks) to low-sodium oxybate (LXB; Xywav ® ; same regimen) reduces mean 24-hr ambulatory systolic blood pressure (ASBP) after ≈6 wks in PwN, regardless of antihypertensive (anti-HTN) use and site type. Methods: XYLO, an open-label, single-arm study (NCT05869773), assessed PwN aged 18−70 y with office SBPs of 130−155 mmHg. The primary and key secondary endpoints were changes from baseline (BL) to end-of treatment (EOT) in mean 24-hr ASBP and seated resting (“office”) SBP (OSBP), respectively; exploratory endpoints were diastolic BP (DBP) changes. Changes are baseline adjusted. Prespecified subgroup analyses explored BL anti-HTN use and participation site (ie, site-based [at study site] vs decentralized [at-home]). Results: In 43 PwN (mean age, 45 y; female, 65%; anti-HTN, 33%), mean±SD BL OSBP and DBP were 138.0±5.7 and 85.2±6.6 mmHg, respectively. Mean±SD total SXB vs LXB dosages were 8.0±1.1 vs 8.1±1.1 g/night, reflecting 1457±206 vs 118±16 mg sodium (difference: ≈1339 mg); median 24-hr urinary sodium was 4232 mg/d at BL and 2703 mg/d at EOT (median change: 1288 mg/d). Mean change in 24-hr ASBP (least squares mean [95% CI]) was −4.1 (−6.9, −1.4; 1-sided P =0.0019) mmHg (Fig 1) ; mean change in OSBP was −9.2 (−11.9, −6.5; 1-sided P <0.0001). Mean changes in 24-hr ambulatory and office DBP were −2.3 (−4.1, −0.5; 2-sided P =0.0118; nominal) and −3.8 (−6.0, −1.6; 2-sided P =0.0014; nominal) mmHg, respectively. In subgroups, mean change in 24-hr ASBP was −4.6 (−9.6, 0.3) mmHg with BL anti-HTN use and −3.9 (−7.3, −0.5) mmHg without BL anti-HTN use; changes in OSBP were −11.8 (−16.5, −7.1) and −7.9 (−11.1, −4.6) mmHg. Mean change in 24-hr ASBP was −3.6 (−8.0, 0.9) mmHg for site-based and −4.5 (−8.1, −1.0) mmHg for decentralized participation. Corresponding changes in OSBP were −9.0 (−13.3, −4.6; site-based) and −9.3 (−12.8, −5.8; decentralized) mmHg with a downward trend over 6 wks ( Fig 2 ). Treatment-emergent adverse events (all mild/moderate) occurred in 40% of PwN (N=67). Conclusions: Switching from SXB to LXB reduced daily medication-related sodium intake in PwN and was associated with clinically meaningful BP reductions overall and across subgroups, consistent with evidence on dietary and medication-related sodium effects.

Background: Supine hypertension, or elevated blood pressure while lying down, is often underrecognized in clinical settings. Though more common in older adults and those with autonomic dysfunction, its long-term cardiovascular impact remains unclear. Growing evidence suggests it may contribute to higher risks of cardiovascular disease (CVD), stroke, heart failure, and mortality. Methods: A meta-analysis evaluated the association between supine hypertension and primary cardiovascular outcomes were searched using standard electronic databases. MeSh term including “supine hypertension” and “cardiovascular outcomes” were used for Search. Studies reporting hazard ratios for CVD events, stroke, heart failure, cardiovascular, and all-cause mortality were included. Random-effect models were used for pooled analysis, with heterogeneity assessed using the I2 statistic and p value <0.05 considered significant. Results: A total of 13 studies were included in the analysis, comprising a combined study population of 241,765 individuals with a mean age of 59 years and follow up for 12.4 years. Cardiovascular Events: Six studies showed a significant association between supine hypertension and increased CVD events (HR = 1.41, 95% CI: 1.28–1.55, p<0.05). Cardiovascular Mortality: Five studies indicated elevated supine systolic BP was linked to higher cardiovascular mortality (HR = 1.57, 95% CI: 1.40–1.75, p<0.05). Heart Failure: Three studies demonstrated a strong, consistent association between supine hypertension and heart failure (HR = 1.83, 95% CI: 1.72–1.95, p<0.05). Mortality: Eight studies showed a modest but significant increase in all-cause mortality (HR = 1.23, 95% CI: 1.02–1.45, p<0.05). Stroke: Three studies revealed significantly increased stroke risk in individuals with supine hypertension versus standing hypotension (HR = 1.69, 95% CI: 1.41–1.97, p<0.05). Conclusion: Supine hypertension was significantly associated with increased risks of CVD events, cardiovascular mortality, stroke, heart failure, and all-cause mortality. These findings highlight the need to consider supine blood pressure patterns in clinical evaluations to improve risk detection and guide preventive care strategies.

Background: Hypertension is a major contributor to global cardiovascular morbidity and mortality. Despite a wide range of pharmacologic treatments, many patients continue to have uncontrolled blood pressure. Recent research highlights the gut microbiota as a modifiable factor in blood pressure regulation through mechanisms involving systemic inflammation, microbial metabolites such as short-chain fatty acids, and angiotensin-converting enzyme modulation. Probiotic and prebiotic supplementation has gained interest as an adjunct strategy, yet existing reviews are limited in scope and often lack robust subgroup analysis. Objective: To systematically evaluate the effect of probiotic and prebiotic supplementation on blood pressure in adults with hypertension or elevated blood pressure, with an emphasis on gut microbiota modulation. Methods: We conducted a systematic search of PubMed, Scopus, Cochrane CENTRAL, and ScienceDirect for articles published from May 1, 2015, to April 30, 2025. ClinicalTrials.gov and PROSPERO were also searched. Eligible studies were randomized controlled trials in English involving adults 19-44 years with hypertension or pre-hypertension, comparing probiotic or prebiotic interventions with placebo, no treatment, or standard care. The primary outcome were changes in systolic and diastolic blood pressure; secondary outcomes included gut microbiota composition, inflammatory markers, endothelial function, and adverse effects. Two independent reviewers screened studies and assessed quality using the Cochrane Risk of Bias Tool 2.0. Results: Of 601 records screened, 23 trials met inclusion criteria. Most studies showed modest reductions in systolic and diastolic blood pressure with probiotic or prebiotic use. Mechanistic insights included improved gut barrier integrity, reduced inflammation, and increased beneficial metabolites. Subgroup analyses suggested efficacy varied by strain type, dosage, duration, and delivery method. Secondary outcomes showed improvements in lipid profiles, insulin resistance, and abundance of Bifidobacterium. Conclusion: Modulation of gut microbiota shows potential as an adjunct approach in managing hypertension.. While short-term benefits are observed, variability across studies limits generalizability. Larger trials with standardized methods are needed to confirm long-term clinical relevance. Keywords: Hypertension, Blood Pressure, Gut Microbiota, Probiotics, Prebiotics, Randomized Controlled Trials, Systematic Review

Background: Early detection and prediction of arterial hypertension (HTN) are vital to reduce cardiovascular morbidity and mortality. AI has enhanced ECG diagnostic capabilities, enabling detection of latent cardiovascular abnormalities. Aims: This systematic review evaluates current evidence on AI-enhanced ECG for detection and prediction of HTN in in both clinical and subclinical populations. Methods: A search was conducted on April 28, 2025, in PubMed, Scopus, and Web of Science. Gray literature and study reference lists, plus the first 10 pages of Google Scholar, were screened. The review followed PRISMA 2020 guidelines. Bias risk was assessed using PROBAST (for prediction models) and QUADAS-2 (for diagnostic studies). Two reviewers independently performed study selection and data extraction after pilot training. Results: A total of 26 studies were included: 16 focused on detection and 10 on prediction of HTN using AI-enhanced ECG. Overall, 96% reported successful outcomes, underscoring the strong diagnostic and prognostic potential of this approach. Among detection studies, 94% successfully identified hypertensive individuals, classified blood pressure (BP) levels, or evaluated cardiovascular risk. Most were retrospective in design (75%), with internal validation in 44% and external validation in 19%. Sample sizes ranged from 100 to over 120,000, including healthy and cardiovascular patients. Commonly used algorithms included deep Learning, random forest, and ensemble methods, often using single-lead ECG data, highlighting the feasibility of wearable technologies. QUADAS-2 identified 56% of studies had low risk of bias. All prediction studies achieved accurate estimation of systolic/diastolic BP or predicted future HTN onset. Designs were 40% experimental and 50% retrospective. All studies reported internal validation, and 50% included external validation. AI models such as CNNs, ResNet-LSTM, and U-Net were used across clinical and community-based populations, with follow-up periods of up to 6.8 years. Populations were predominantly normotensive or mixed. PROBAST assessments showed 60% low and 40% moderate risk of bias. Conclusion: AI-enhanced ECG is a promising, non-invasive tool for early detection and prediction of HTN. However, external validation and clinical trials are needed to support integration and generalizability.

Abstract Aims Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment, and outcome of patients presenting with IE-related EE. Methods and results Cases recorded from 2014 to 2023 in nine centres in Europe and the United States were collected. Results were compared to a matched control group. Conclusion Sixty-six patients with EE were reported, mean age of 65.2 ± 14.9 years, 71% (n = 47) male. Blood cultures were positive in 97% (64 cases) of patients, with a predominance of streptococci (46%, n = 30). As compared with the control group (n = 264), the EE group presented with more frequent diabetes (35% vs. 21%, P = 0.02), history of cirrhosis (9% vs. 3%, P = 0.04), glomerulonephritis (15% vs. 0.4%, P &lt; 0.001), embolism before admission (92% vs. 55%, P &lt; 0.001), and Janeway lesions (9% vs. 1%, P = 0.002). Streptococcal infection (46% vs. 26%, P = 0.001) was more frequent and Enterococcal infection (0% vs. 18%, P &lt; 0.001) less frequent in the EE group. The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%), and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients. Conclusion EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.

Abstract Toxicology testing for drugs associated with scenarios such as recreational use or substance use disorder can be performed in support of the emergency department (ED) for specific patient populations such as pediatrics and trauma. These compounds were historically referred to as drugs of abuse (DOA); although the word “abuse” is recognized as potentially stigmatizing, no replacement terminology for DOA has emerged in current guidelines. This document refers to these compounds as drugs or substances of misuse, and acknowledges the need for less-stigmatizing language that more fully encompasses the range of uses for these drugs. This literature-driven, consensus guidance document provides recommendations primarily targeted to US hospital-based laboratories performing urine drug testing (UDT) in support of the ED. Indications for ordering UDT and related testing in both pediatric and adult populations are summarized. Further, recommendations are made for testing that should be available at all facilities with rapid turnaround, and how to perform and report testing. The advantages and disadvantages of immunoassays and mass spectrometry, as well as common challenges, are reviewed. Indications for mass-spectrometry assays and more extensive testing (e.g., novel psychoactive substances) are also provided. Future directions for improvements in laboratory technology to improve the utility of this testing are outlined. All laboratories should collaborate with ED leadership, medical toxicologists and poison control centers to optimize and update test menus to reflect local drug use patterns, ensure test methodologies and results meet clinical needs, and educate clinical staff regarding assay limitations and accurate test interpretation.