Global reporting of obesity is commonly based on comparisons over multiple decades

In their recent Viewpoint, Frieden and colleagues argue that mass blood pressure screening diverts resources from improving hypertension care. We present a counterargument that community-based blood pressure screening can complement health-care services by increasing hypertension detection, particularly in populations with limited access to health care. Opportunistic community-based screening can be delivered at relatively low cost and reach individuals who might not otherwise engage with health-care systems. In settings where access to health-care facilities is constrained, such approaches provide an additional route to identifying raised blood pressure and initiating further assessment. When implemented using validated blood pressure devices and standardised protocols, community-based screening can support accurate measurement, although confirmatory diagnosis and long-term management require linkage to health-care facilities. In addition to case detection, screening initiatives contribute to improved awareness of hypertension through community engagement and public health messaging. Increasing detection of raised blood pressure will be essential to improving population-level control. Community-based screening, alongside strengthened primary care, could form part of a broader strategy to address the global burden of hypertension.

Hypertension in children and adolescents is an increasingly prevalent global health concern and a strong predictor of adult cardiovascular and kidney disease. Variability in existing guidelines and limited applicability in low-resource settings hinder effective identification and management. This International Society of Hypertension (ISH) position paper provides practical, harmonized guidance for clinicians globally. To develop evidence-based, clinically relevant recommendations for the evaluation, diagnosis, and management of hypertension in youth, informed by multidisciplinary expertise from 12 countries. An expert panel undertook an iterative, consensus-driven synthesis of current evidence covering epidemiology, risk factors, blood pressure measurement, diagnostic evaluation, target organ injury, lifestyle therapy, pharmacological treatment, and long-term monitoring. Youth hypertension is driven by obesity, adverse childhood experiences, unhealthy lifestyle behaviors, and socioecological factors, with a disproportionately higher burden in low and middle-income countries. Accurate diagnosis requires standardized measurement using validated devices, proper cuff sizing, and out-of-office monitoring, particularly ambulatory blood pressure monitoring. Targeted investigations help distinguish primary from secondary hypertension and identify early organ injury. Lifestyle modification forms the foundation of treatment, while pharmacotherapy is indicated for persistent stage 2 hypertension, comorbid conditions, or evidence of organ damage. Structured transition to adult care is essential to improve long-term adherence and outcomes. Timely recognition and individualized management of youth hypertension are critical for reducing lifelong cardiovascular risk. This ISH position paper offers pragmatic, globally adaptable recommendations to enhance early detection, treatment, and continuity of care for children and adolescents with elevated blood pressure.

This study evaluated the accuracy of the automated oscillometric upper-arm cuff blood pressure (BP) measuring device Prolife PA5 Comfort AF (BP 136A) for home use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2 : 2018) and its amendments (1 : 2020 and 2 : 2024). The requirements of the Universal Standardand its amendments for a validation study in a general population using the same arm sequential measurement method were applied. Participants were recruited to fulfill the age, sex, BP level, arm circumference, and cuff size distribution criteria. The test device measures BP during inflation and uses a wide-range cuff for arm circumference 22-42 cm. One-hundred-twenty-eight individuals were recruited and 85 were analyzed [mean age: 54.9 ± 15.0 (SD) years, 36 (42%) men, arm circumference: 31.7 ± 5.4 cm, range: 22.5-41.9 cm). For validation Criterion 1, the mean difference ± SD between the test device and reference BP readings ( N  = 255) was -2.1 ± 7.5/-0.3 ± 5.3 mmHg (systolic/diastolic; threshold: ≤5 ± 8 mmHg). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per individual ( N  = 85) were 6.44/5.07 mmHg (systolic/diastolic; threshold: ≤6.62/6.95 mmHg). The automated oscillometric home BP monitor Prolife PA5 Comfort AF (BP 136A) fulfills all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2 : 2018) and its amendments (1 : 2020 and 2 : 2024) for a general population and can be recommended for clinical use.

Growing evidence on the long-term efficacy and safety of sympathetic renal denervation (RDN) has established this neuromodulatory interventional therapy as the third therapeutic pillar for hypertension management, alongside lifestyle modification and pharmacotherapy. Accordingly, recent European and American guidelines have upgraded the role of RDN, recommending its consideration as an additional treatment option for selected patients with resistant or uncontrolled hypertension-particularly, for those at high cardiovascular risk-when performed in experienced centers with appropriate training and within a shared decision-making framework that respects patients' preferences. This consensus document, jointly developed by the Hellenic Society of Hypertension (Hellenic Excellence Centers of Hypertension), the Hellenic Society of Cardiology (Working Groups "Hypertension and Heart" and "Interventional Cardiology"), the Hellenic Society of Nephrology, and the Hellenic Academy of General Practice/Family Medicine and Primary Health Care, aims to provide a structured referral pathway for the clinical use of RDN in Greece. The proposed pathway integrates all contemporary therapeutic options in alignment with current hypertension guidelines and takes into account the structure of the Greek health care system. Ongoing and future research regarding antihypertensive therapies, including novel device-based and pharmacological interventions, is anticipated to further refine patient selection, procedural techniques, and long-term strategies to optimize cardiometabolic outcomes.

The automated cuff-oscillometric blood pressure (BP) measurement currently is the standard method for evaluating hypertension using office, home and ambulatory measurements. It eliminated observer-related issues of the auscultatory method and made out-of-office BP monitoring feasible. But there are issues with this method, mainly due to the limited BP information they provide, the use of an inflatable cuff, and because measurements are provided only in static conditions. Cuffless wearable devices can provide complete information of the individual's BP profile and behavior, for days, weeks, months, unobtrusively, during all routine daily activities and during sleep. However, at the present time there is no convincing evidence that any cuffless BP technology has adequate accuracy as required for clinical use, and scientific societies do not recommend them. Novel tools implemented in smartwatches, such as the Apple 'Hypertension Notification Feature', can be useful in detecting undiagnosed hypertension in the general population, but require confirmation by cuff BP measurement and are not intended for monitoring treated hypertensives. Novel smartwatch-type cuff-oscillometric (not cuffless) BP monitors can be used for self-measurement at home, at work and other settings, and also for ambulatory monitoring including nighttime sleep. Some successful validation studies, mainly on static validation, have been reported, but more research is needed in ambulatory conditions involving motion and position and in clinical use. While continuing to pursue cuffless wearable BP technologies, smartwatch-type cuff-oscillometric devices deserve our close attention for establishing their optimal use.

The measurement of blood pressure remains the cornerstone for diagnosing and managing individuals with hypertension. Today, there is international consensus on the optimal technology and methodology for reliable evaluation of blood pressure. Automated oscillometric upper-arm cuff blood pressure devices which have been properly validated are recommended for all measurement methods. Office blood pressure measurement remains an essential method, yet as much as possible, treatment decisions should be primarily based on out-of-office blood pressure monitoring at home or with 24-h ambulatory monitoring. It is important that established protocols are applied to standardize each of these methods in clinical practice, to exhaust their potential in diagnosing hypertension and guiding treatment-induced blood pressure decline. Despite the wide use of blood pressure measurement methods for too long time, there are still research questions regarding their optimal clinical implementation, which need to be addressed in future studies.

Carotid-femoral pulse wave velocity (cfPWV) is the reference method for measuring large artery stiffness. Automated brachial-ankle pulse wave velocity (baPWV) is an alternative method for assessing medium-to-large artery stiffness. A systematic review/meta-analysis was performed to investigate the relationship of cfPWV and baPWV measurements regarding their difference and association, and their relationship with indices of subclinical target organ damage (TOD) and cardiovascular outcomes. Among 1000 records initially retrieved, 51 were included ( n  = 36 126). Meta-analysis of 46 studies [ n  = 32 426, weighted mean age 61 years, men 49%, BMI 25.1 kg/m 2 , SBP/DBP 129/75 mmHg, hypertension 58%, diabetes 23%, smokers 17%, baPWV 15.82 m/s, cfPWV 9.47 m/s] indicated a pooled baPWV-cfPWV mean difference 5.03 m/s [95% confidence intervals (4.34-5.72)]. Meta-analysis of 23 studies ( n  = 10 880, age 58 years, men 58%, BMI 26.2 kg/m 2 , BP 126/74 mmHg, hypertension 41%, diabetes 16%, smokers 13%) indicated a pooled baPWV vs. cfPWV Pearson correlation coefficient 0.68 (0.61, 0.74). Similar correlations of baPWV/cfPWV with left ventricular mass index, carotid intima-media thickness and urine albumin-to-creatinine ratio were found. Limited data indicated a slightly higher predictive value of cfPWV for cardiovascular outcomes. Sensitivity and multivariable meta-regression analyses indicated significant associations of pooled baPWV-cfPWV mean difference with the distance used for cfPWV calculation and baPWV/cfPWV devices. baPWV and cfPWV are strongly correlated to each other and similarly to subclinical TOD, but baPWV gives higher values. There is considerable heterogeneity among the available studies and standardized design and methodology is needed in future research.

Hypertension remains a major public health challenge with inadequate control globally. The May Measurement Month (MMM) global survey initiated by the International Society of Hypertension was implemented in Greece in 2022 aiming to raise hypertension awareness and control. Adult volunteers were recruited through opportunistic screening in 11 urban areas. Information on medical history and three sitting blood pressure (BP) measurements were obtained using validated automated upper-arm devices, and the data were submitted online through a custom-designed app of the global MMM survey. Hypertension was defined as average systolic BP at least 140 mmHg and/or diastolic 90 mmHg, and/or self-reported use of drugs for hypertension. A total of 6353 individuals were included (mean age 54.8 ± 16.2 years, 49% men, 30.5% current smokers, 11.5% had diabetes, 5.1% cardiovascular disease). The prevalence of hypertension (42.6%) was higher in men (48.8%) and in older individuals (74%). Among individuals with hypertension, 27.5% were unaware of their diagnosis, 22.2% were treated but uncontrolled (≥140 mmHg systolic and/or ≥90 mmHg diastolic BP), and 47.9% were treated and controlled. Among treated hypertensives, 58.2% were on monotherapy and at least one-third of them were uncontrolled. The prevalence of hypertension in Greece seems to be high and is often undiagnosed, untreated, and uncontrolled. Public health initiatives and campaigns aiming at improving hypertension diagnosis and control need to be implemented.