Elevated childhood blood pressure (BP) is associated with adulthood cardiovascular mortality. However, evidence of an association between maternal and perinatal factors and standardized childhood BP percentiles in Japan remains limited. In this study, we examined this association by using data from the BOSHI study, which included children's home BP measurements. Among 175 mother-offspring pairs, the mean maternal age and children's birth weight were 32.4 years and 3031 g, respectively; the median age of the children at follow-up was 7 years; and hypertensive disorders of pregnancy occurred in 43 mothers. Multivariable analyses showed that higher birth weight was associated with lower diastolic BP percentiles (-0.87 percentile per 100-g increase; p = 0.03). Given previous evidence linking elevated childhood BP to subsequent cardiovascular risk later in life, our findings warrant further investigation in diverse populations.

Digital health technologies (DHTs) offer opportunities to support poststroke self-management and rehabilitation, but their implementation may be hindered by mismatches between technological design, stakeholder needs, and care contexts. Synthesizing stakeholder perspectives can clarify implementation priorities and gaps in the evidence.

This study aimed to synthesize stakeholders' perceptions, experiences, and recommendations regarding DHT implementation in poststroke self-management and rehabilitation and to map the findings to the NASSS (Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability) framework.

Six databases (PubMed, MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched from inception through October 2025. Eligible studies were English-language, peer-reviewed primary studies using qualitative, quantitative, or mixed methods designs to report stakeholder perspectives on DHTs in poststroke care. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). A convergent integrated synthesis was conducted: quantitative findings were transformed into textual descriptors, combined with qualitative findings, coded inductively, and subsequently mapped deductively to NASSS domains and subdomains. Disagreements were resolved through consensus or by third-reviewer adjudication.

Of 15,262 records identified, 42 studies published between 2019 and 2025 were included: 24 qualitative, 8 quantitative, and 10 mixed methods studies. Patients, health care professionals, caregivers, and members of the public were represented in 32, 19, 8, and 3 studies, respectively, with some studies including multiple groups. Evidence concentrated on the condition, technology, value proposition, and adopter-system domains. Stakeholders valued personalized functions, intuitive interfaces, timely feedback, and digital support that complemented human care. Barriers included stroke-related motor, cognitive, communication, and sensory impairments; unequal digital access and literacy; caregiver demands; staff workload and training needs; and poor integration with clinical routines. Data privacy and unclear payment arrangements also raised concerns. Evidence on organizational readiness and wider-system determinants was limited, and no eligible study directly examined interaction and adaptation over time. Methodological concerns included nonresponse bias and insufficient interpretation of integrated findings in mixed methods studies.

Stakeholder perspectives indicate that DHT implementation in poststroke care should combine accessible, personalized design with support for patients, caregivers, and health care professionals, alongside integration into clinical workflows and clear data governance and financing arrangements. The NASSS mapping identified priorities beyond usability, but current evidence does not establish sustained adoption, scale-up, or spread. Longitudinal studies in routine care are needed to evaluate adaptation and sustainability.

Cardiorespiratory fitness (CRF) is a powerful predictor of cardiovascular morbidity and mortality. The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing CRF. Patients with myocarditis are recommended to abstain from exercise because of the risk of sudden cardiac death (SCD). Therefore, the clinical benefit of exercise-based cardiac rehabilitation (CR) has not been previously established in this population.

The aim of this study is to assess the CRF of myocarditis and the safety and effectiveness of an exercise-based CR program in these populations.

A total of 70 consecutive patients with a diagnosis of myocarditis admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between October 2021 and December 2024 were enrolled in the current study. CPET was performed within 3-6 months of hospital discharge. The exercise-based CR program was performed for 3 months. The protocol included biomarker analysis, CPET, and standard-of-care echocardiography (including resting left ventricular ejection fraction and global longitudinal strain [GLS]). Data were collected at admission and 3 months after discharge.

A total of 70 patients with myocarditis were enrolled. Among them, 47 patients completed the rehabilitation program and had complete follow-up assessments, including cardiopulmonary exercise testing, and were included in the final analysis. In comparison with NFM, patients with FM were more often female, and had higher levels of creatine kinase (CK), lactate dehydrogenase (LDH), urea nitrogen (UN), N-terminus probrain natriuretic peptide (NT-proBNP), fasting blood glucose (FBG), and white blood cell (WBC). For FM, echocardiography revealed more frequently signs of left ventricular (LV) dysfunction in the form of a reduced ejection fraction (p < 0.01), and lower GLS (p < 0.01) in contrast to NFM. CPET results showed that FM patients had markedly lower exercise capacity, impaired ventilatory efficiency, and pulmonary function (p < 0.05). After the 3-month exercise-based CR program, both groups demonstrated significant improvements in peak VO₂, peak workload, and MVV. However, no significant between-group differences were observed in the magnitude of improvement in CRF.

CRF was substantially impaired in patients recovering from myocarditis, particularly among those with fulminant presentations. Participation in a structured 3-month exercise-based CR program was feasible and was associated with favorable changes in exercise capacity and cardiopulmonary performance.

Chinese Clinical Trial Registry: ChiCTR2400088436.

This is a protocol for a Cochrane review (intervention). The objectives are as follows: Primary objective To evaluate the benefits and harms of lower targets of blood pressure (BP; i.e. BP ≤ 135/85 mmHg) versus standard targets (i.e. BP ≤ 140 to 160/90 to 100 mmHg) for total mortality and morbidity in people 18 years or older, with elevated BP. Secondary objectives To evaluate the benefits and harms of lower targets versus standard targets for achieved systolic and diastolic BP in people 18 years or older, with elevated BP. To evaluate the benefits and harms of lower targets versus standard targets for withdrawals due to adverse events in people 18 years or older with elevated BP. To assess whether the effects of lower targets versus standard targets differ according to prespecified equity-related characteristics (e.g. place of residence, race/ethnicity/culture/ancestry, sex, socioeconomic status, and social capital, plus other context-specific factors, including comorbidity burden) in people 18 years or older, with elevated BP.

Ventricular Arrhythmias (VA) associated with Cardiomyopathy (CM) continues to be the major cause of death. However, a national longitudinal study examining mortality trends from these conditions is still lacking. This study assessed mortality trends due to these conditions among U.S. adults aged ≥ 25 years from 1999 to 2024.

An observational analysis of U.S. mortalities due to VA in patients with CM (ICD-10 I47.2, I49.0 and I25.5, I42 respectively), was conducted using CDC WONDER. Adjusted Mortality Rates (AAMR) per 100,000 calculated and trends were assessed by calculating Average and Annual Percent Change (AAPC, APC), using joinpoint regression stratified by year, sex, race, and region.

From 1999 to 2024, 81,204 VA with CM-related deaths occurred with the overall AAMR declined from 2.54 in 1999 to 1.01 in 2024 (AAPC: -3.55%; p < 0.000001). AAMRs decreased from 1999 to 2007 (APC: -7.93), remained stable till 2022 (APC: -0.66), and dropped by 2024 (APC: -6.87). Men exhibited greater AAMRs (2.42) than women (0.68). Racially, the AAMRs were most pronounced in Non-Hispanic (NH) Blacks (1.97), followed by NH Whites (1.42), whereas Hispanics and NH Others experienced similar AAMRs of 0.97. Geographically, Delaware and the Western regions experienced the highest rates of mortality (2.2 and 1.53, respectively). Urban areas had higher AAMRs than rural settings (1.45 vs. 1.4) CONCLUSION: Although VA-CM mortality has declined over the past two decades, differences by race, sex, and geography remain, underscoring the need for targeted healthcare strategies.

There is evidence that patients with immune thrombocytopenia (ITP) are at increased risk of thrombosis. The associations of clinical and comorbid factors with thrombosis in ITP remain unclear.

This study aimed to investigate the incidence rate and risk factors of arterial and venous thrombosis among patients with primary ITP.

A retrospective cohort study was conducted, enrolling adult patients diagnosed with ITP at Qilu Hospital between January 1, 2014, and December 31, 2025. Thrombosis incidence was calculated using person-years of follow-up, and multivariable-adjusted Cox regression was used to identify independent risk factors. Sensitivity analyses were also conducted using Fine-Gray subdistribution hazard model regression, with death as a competing event.

Among 764 patients with ITP with 3540.8 person-years of follow-up, the incidence was 5.7 (95% CI, 4.9-6.5) per 100 person-years for arterial thrombosis and 2.1 (95% CI, 2.1 1.6-2.6) for venous thrombosis. The median age at thrombosis onset and the interval from ITP diagnosis to the index thrombotic event were 67.5 years and 2.4 years for arterial thrombosis and 62.0 years and 1.2 years for venous thrombosis, respectively. Recent 3-month exposure to all 3 ITP-targeted therapies increased the risk of both arterial and venous thrombosis.

Advanced age, prior thromboembolism, comorbidities, recent exposure to ITP-targeted therapies, and cardiovascular risk factors were independent risk factors for thrombosis in ITP. Thromboembolism in ITP mostly occurred in the presence of multiple thrombotic risk factors. Continuous risk assessment and optimized management are essential throughout the clinical course of ITP.

Cardiovascular disease remains a significant cause of morbidity and mortality in Canada, and early detection and intervention programs have the potential to improve outcomes for patients. This review aims to outline the importance of early detection and intervention for various cardiac diseases, outline barriers that exist to early detection in Canada, identify the system-level benefits to improving early detection and intervention, and ultimately help policymakers and other stakeholders identify new opportunities for intervention. Various data show that early detection and intervention in coronary artery disease, arrhythmias, valvular heart disease, and heart failure are feasible and are associated with better outcomes for patients. Recognizing the unique barriers that exist in Canada, we must work toward creating innovative solutions aimed at helping patients access care. Several innovative collaborative models of care and programs have been piloted around the world, allowing us to learn from different jurisdictions and begin work locally to help improve early detection of cardiovascular diseases in Canada. Canadian stakeholders including health leaders, policymakers, and other health advocates must continue to work with physician leaders to create robust, comprehensive, and cost-effective early detection and intervention programs to improve cardiac care nationally.

Systemic hypertension is a global non-communicable disease that creates an essential need for alternate forms of lifestyle modifications, including exercise, to lower elevated blood pressure. Mat Pilates, a feasible form of mind-body coordinated exercise, may provide benefits with limited resources.

This randomized controlled trial aims to assess the efficacy of Mat Pilates on resting blood pressure and health-related quality of life in individuals with systemic hypertension.

A two-arm, single-blinded, block randomized controlled trial will be recruited with a total of 120 participants into control and experimental groups 60 participants in each group (1:1 ratio). Mat Pilates will be administered to the experimental group and standard care to the control group for 12 weeks. Resting and central blood pressure, health-related quality of life, and echocardiographic parameters will be measured before and after the trial. We hypothesized that Pilates may not be beneficial in lowering resting blood pressure in hypertensive patients. A repeated-measures analysis of variance (ANOVA) will test the within- and between-group effects of Mat Pilates on various outcomes.

The trial was approved by the Institutional Research Committee, Manipal College of Health Professions, Manipal Academy of Higher Education, Kasturba Medical College, and Kasturba Hospital Institutional Ethics Committee, Manipal. Written informed consent will be obtained from all the participants. All stakeholders and committees will communicate key findings regarding the implementation of mind-body association exercises as a measure of lifestyle modification in individuals with systemic hypertension.

Clinical Trials Registry of India: CTRI/2021/07/035002. Registered on July 20, 2021, http://ctri.nic.in.

Cardiovascular safety of methylphenidate remains a matter of debate.

To evaluate the long-term cardiovascular risk associated with methylphenidate use, a cohort study was conducted using the French National Health Data System. New users were defined by a first methylphenidate dispensation (index date) between January 1, 2014, and December 31, 2023. Each new user was matched with three nonusers by sex and by month and year of birth. Individuals with prior cardiovascular disease or relevant cardiovascular comorbidities were excluded. The primary outcome was cardiovascular disease, defined by International Classification of Diseases codes or antihypertensive drug use. Cox proportional hazards models estimated adjusted hazard ratios (HRs), accounting for demographic and clinical covariates. Negative control outcomes were used to assess residual confounding, allowing the derivation of calibrated HRs and confidence intervals.

A total of 212 216 new users and 636 648 matching nonusers were included. Mean age was 13.7 years and 72% were males. Over a follow-up of ~4 years, 3858 cardiovascular diseases occurred (0.45%): 1960 in new users (9.2 per 1000) and 1898 in nonusers (3 per 1000). The adjusted HR was 2.37 (95% CI [2.21; 2.54]), with a calibrated HR of 1.85 (95% CI [1.55; 2.21]).

The results suggest that methylphenidate use may be associated with an increased risk of cardiovascular diseases. Although the calibrated estimates indicate attenuation due to residual confounding, the association remained statistically significant. This supports recommendations for cardiovascular monitoring during treatment.

To describe temporal trends in the clinical landscape of vitamin K antagonist (VKA) treatment in the Netherlands, after the introduction of a lower international normalized ratio (INR) target range in 2016 and direct oral anticoagulants.

Data from 17 Dutch anticoagulation clinics between 2014 and 2022 were individually linked to nationwide healthcare data. Prevalent VKA users were identified on January 1 of each year, forming nine annual cohorts. We assessed baseline patient characteristics, anticoagulation treatment quality (using time in/above/below therapeutic range [TTR/ATR/BTR]), and annual odds ratios of major bleeding and thromboembolism for each cohort.

The number of patients treated with VKAs increased from 101 090 in 2014 to 121 916 in 2017, followed by a decline to 73 649 in 2022. Over time, cohorts were characterized by increasing age and a higher prevalence of comorbidities, with a doubling of kidney disease. After the introduction of the lower INR target range, mean BTR decreased (~30% in 2014 to ~15% in 2022), while mean TTR increased (~54% in 2014 to ~67% in 2022), with stable mean ATR. Across calendar years, the 1-year odds ratio of major bleeding decreased from 1.71% (95% CI 1.63-1.79) in 2014 to 1.52% (95% CI 1.44-1.61) in 2022, whereas the odds ratio of ischemic stroke/transient ischemic attack/systemic thromboembolism increased from 1.14% (95% CI 1.08-1.21) in 2014 to 1.32% (95% CI 1.24-1.40) in 2022. The 1-year odds ratio of mortality increased from 5.09 (95% CI 4.95-5.22) to 8.55 (95% CI 8.35-8.75), with an OR of 1.74 (95% CI 1.68-1.81).

VKA users declined between 2014 and 2022. The remaining patients using VKA became older and more comorbid. During this period, INR target ranges were lowered, while temporal changes were observed with decreasing odds ratio of major bleeding and increasing odds ratio of thromboembolism and mortality.