Depression is often accompanied by multisystem comorbidities, but the time trajectories of these comorbidities remain unclear.

We aimed to define the temporal sequence of comorbidity accrual relative to depression diagnosis, and examine how this trajectory differs in recurrent depression.

A total of 32 953 individuals with depression were identified in the UK Biobank cohort, including 2402 with recurrent depression. The time between diagnosis of depression or recurrent depression and ten common comorbidities was established to determine the temporal order and rate of comorbidity diagnosis in relation to depression, based on the sequence of recorded diagnostic events. We further stratified the cohort by polygenic risk score, gender, age and history of antidepressant or antihypertensive medication use.

The study included 32 953 participants (mean age at diagnosis 52.6 years; 63.1% female). Hypertension and dorsopathies preceded depression diagnosis by a median of 2.6 years (interquartile range (IQR) −7.0 to 0.0) and 1.0 year (IQR −5.0 to 2.0), respectively. Alzheimer’s disease and obesity emerged after diagnosis at medians of 2.5 years (IQR 0.0–5.0) and 0.8 years (IQR −2.0 to 3.0). High genetic risk was associated with an earlier onset of pre-depression cardiometabolic conditions, with hypertension occurring 2.8 years before diagnosis in individuals with a high polygenic risk score compared with 2.3 years in individuals with a low polygenic risk score. Crucially, individuals with recurrent depression exhibited a profoundly different trajectory, with most comorbidities manifesting many years after the index diagnosis. Stratification by medication history indicated that antihypertensive drug use was associated with an earlier recorded diagnosis of cardiometabolic conditions, whereas antidepressant use was linked to a later diagnosis of neurodegenerative diseases.

These findings identify three critical windows for intervention and reveal a distinct, delayed comorbidity trajectory in recurrent depression. This underscores the need for long-term, integrated surveillance strategies tailored to depression subtype and treatment history.

Systemic inflammation plays an important role in the pathophysiology of hypertension, contributing to endothelial dysfunction and target organ damage. This study aimed to evaluate the diagnostic and predictive value of the systemic immune inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-albumin ratio in children with primary hypertension by comparing them with healthy controls, assessing their association with disease severity, and examining changes after treatment.

This retrospective study included 49 paediatric patients with newly diagnosed primary hypertension and 50 age- and gender-matched healthy controls. Complete blood count derived indices and biochemical markers were analysed. Patients were stratified by hypertension stage, and post-treatment changes in inflammatory indices were evaluated.

The mean age was 16.3 ± 1.9 years in the hypertension group and 15.8 ± 1.3 years in the control group. Systemic immune inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-albumin ratio were significantly higher in children with hypertension than in controls (p < 0.05). Systemic immune inflammation index was markedly higher in stage 2 compared with stage 1 hypertension (p = 0.003) and decreased significantly after treatment (p < 0.001). Neutrophil-to-lymphocyte ratio and C-reactive protein-albumin ratio emerged as strong diagnostic markers, while systemic immune inflammation index, although less discriminative, was associated with disease severity and decreased significantly after treatment.

Neutrophil-to-lymphocyte ratio and C-reactive protein-albumin ratio provide robust diagnostic value in paediatric hypertension. Systemic immune-inflammation index, despite modest diagnostic accuracy, has prognostic significance by indicating disease severity and monitoring treatment effects. Collectively, these markers may serve as cheap and accessible tools for early diagnosis, risk stratification, and follow-up in children with hypertension.

The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework.

We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence.

Hypertension prevalence was 12.6% (95% CI: 11.7–13.4) in Tanzania, 46.7% (95% CI: 45.0–48.4) in South Africa, and 15.4% (95% CI: 13.8–17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8–10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania −0.19, South Africa −0.17, Lesotho hypertension −0.15, Lesotho diabetes −0.24; all p < 0.01), with poor men experiencing the most disparities.

Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.

This study is the first study in Middle Eastern population that aimed to investigate the association between global diet quality score (GDQS) and risk of hypertension (HTN) in Iranian adults.

This population-based cohort study was conducted on 5718 individuals aged ≥ 18 years from the third and fourth Tehran Lipid and Glucose Study surveys, who were followed until the sixth survey (mean follow-up: 7·8 years). Dietary data were collected using a validated FFQ to calculate GDQS as a novel food-based metric designed to assess diet quality across diverse populations. It evaluates the adequacy of healthy food groups (e.g. fruits, vegetables and whole grains) while monitoring the moderation of unhealthy or excessive intake (e.g. refined grains, processed meats and sugary foods).

Tehran Lipid and Glucose Study.

Iranian men and women.

Participants had a mean (sd) age of 37·7 (sd 12·8) years, BMI of 26·6 (sd 4·7) kg/m2 and GDQS of 25·3 (sd 4·4). During the 7·8-year follow-up, 1302 (18 %) new cases of HTN were identified. Higher GDQS and its healthy components were associated with reduced HTN risk (hazard ratio (HR): 0·83; 95 % CI: 0·70, 0·98; Ptrend = 0·034 and HR: 0·78; 95 % CI: 0·65, 0·92; Ptrend = 0·005, respectively), while unhealthy components of GDQS showed no association with HTN risk (HR: 1·14; 95 % CI: 0·98, 1·33; Ptrend = 0·059). These protective associations were observed across all weight categories and both genders, with stronger effects among obese individuals (for GDQS: HR: 0·75; 95 % CI: 0·58, 0·98; P = 0·041; for healthy components: HR: 0·75; 95 % CI: 0·57, 0·99; P = 0·044) and females (for GDQS: HR: 0·77; 95 % CI: 0·62, 0·97; P = 0·028; for healthy components: HR: 0·76; 95 % CI: 0·60, 0·96; P = 0·023).

A higher GDQS was associated with a reduced risk of incident HTN among Iranian adults. Adherence to a high-quality diet, particularly focusing on the healthy dietary components of GDQS, may serve as an effective strategy for preventing HTN, especially among obese individuals and women.

There is limited knowledge on titration, optimal dosing, and efficacy of angiotensin-converting enzyme inhibitors in paediatric patients following cardiac surgery.

Patients after cardiac surgery to repair ventricular septal defect or coarctation of the aorta from 01/2017 to 12/2019 were eligible for a retrospective single-centre study. Medical records were reviewed for patient characteristics and outcomes. Mean arterial pressure response and angiotensin-converting enzyme inhibitor dosage were collected. Controls were patients not receiving angiotensin-converting enzyme inhibitor postoperatively. Appropriate statistics were used for analysis.

Among a total of 286 patients [n = 188 (66%) ventricular septal defect; n = 98 (34%) coarctation of the aorta], 170 (59%) received angiotensin-converting enzyme inhibitor on any postoperative day 1 to 5. The median age was 4.9 months (IQR 1.2–14.4) and weight 5.5 kg (IQR 3.7–9.2). The most common angiotensin-converting enzyme inhibitor was captopril on day 1 [n = 117 (69%)] and lisinopril at discharge [n = 86 (51%)]. Patients in treatment group were shown to have higher median mean arterial pressure at baseline and at time 1, compared with controls (mean difference 3.57 (95% CI: 1.85, 5.35) and 3.46 (95% CI: 1.41, 5.50), respectively. Median mean arterial pressure among controls significantly increased over time with a slope of 0.97 (95% CI: 0.2, 1.74), while median mean arterial pressure among treatment group decreased with a slope of −0.31 (−0.93,0.31). Patients who received high and medium doses of angiotensin-converting enzyme inhibitor showed significantly decreasing median mean arterial pressure over time with a slope of −2.85 (−5.14, −0.56) and −1.25 (−2.4, −0.11), respectively.

High and medium dose angiotensin-converting enzyme inhibitor therapy had a greater effect in decreasing mean arterial pressure when compared to low dose.

The impact of arch anatomy on the prognosis of aortic coarctation of the aorta (COA) is not well established. We aim to assess the relationship between arch anatomy and the short- and long-term prognosis after surgical repair.

Patients with COA operated on the period between 11/2007 and 03/2016 were retrospectively recruited. Anatomical analysis of the aortic arch was done using Multidetector CT with measurement of the inter-branch distances between left common carotid artery, innominate artery, and left subclavian. We classified patients into group I, whose distance ratio (LCCA- IA)/(LSCA-IA) is short and less than 50%, and group II with such ratio ≥ 50%.

Seventy-three patients were recruited. The distance (LCCA-IA) had a range of Zero (common origin) to 22.3 mm. The distance ratio (LCCA-IA)/(LSCA-IA) ranged between Zero and 89%. Group I had a significantly higher incidence of adverse outcomes, including recoarctation, re-elevation of blood pressure, and re-elevation of pressure gradient, compared to Group II (p = 0.0001, 0.011, and 0.014, respectively). A positive correlation exists between the distance ratio and the residual SPG across the repaired segment (P = 0.0001). Only the anatomical distance ratio (LCCA-IA)/(LSCA-IA) can independently predict recoarctation in the long term.

There is a strong association between the anatomical distance LCCA-IA and recoarctation. This novel parameter is the only anatomical independent predictor of recoarctation.

Patients diagnosed with hypertension (HT) are at high risk for end-organ damage. With changing living conditions and access to healthcare facilities worldwide, the rate of diagnosis in childhood is increasing. In this study, healthy children were compared with a group of pediatric patients diagnosed with hypertension. Cardiac findings in the hypertensive group were compared at presentation and at six months. We aimed to determine the discriminatory value of epicardial adipose tissue (EAT) measurements as an early imaging marker for cardiac involvement in children with HT compared to healthy children and to determine its prognostic feature for HT treatment response.

Fifty-nine primary hypertension patients and 76 control patients aged 0-18 years were compared. EAT values measured between the healthy group and the patient group and at the beginning of treatment and subsequent follow-ups in the patient group were evaluated with M-mode measurements.

There was no difference between the groups in terms of sex, and age. EAT was found to be significantly higher in the patient group than in the healthy group. There was a statistically significant difference between the EAT measurements evaluated before and after treatment in the patient group.

Hypertension is an important cause of morbidity and mortality. Using EAT measurements as a noninvasive parameter may provide information about early cardiac involvement due to HT. EAT is promising as an imaging marker that can be used in diagnosis and follow-up.

Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.

We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.

We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (n = 100, mean ± s.d. age 43 ± 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.

Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each P < 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 ± 21% v. 47.1 ± 30% increases for mental stress and 3.7 ± 21% v. 18.6 ± 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each P ≤ 0.01).

A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.