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High BP in PH, HF AMS Flaws, and Deafening Diuretics
By Viktor Zarev, Virginia Hunt
November 2, 2026
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Together with
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“I believe firmly that AI manuscript review will make science better. Often, low-quality papers slip through and get published, even in high impact journals, because they somehow escaped review by a high-quality human. It’s the variance of review quality, not the median, that remains the largest problem with human manuscript review.”
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Mintu Turakhia, MD, MS
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ICYMI: Why misunderstand the cardiovascular nuance of half your patients when you can watch the latest Cardiac Wire webinar here?
And more specifically, nuance is key in cardiology because sometimes even high blood pressure can have its nuances as you’ll read in today’s Top Story.
Did I write the word “nuance” enough?
Vik
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Systemic hypertension is often cast as a cardiovascular villain, but what if it could serve a different purpose? New research suggests that may be the case, with hypertension acting as a sign of resilience and better survival odds in patients living with pulmonary hypertension.
- As the name suggests, pulmonary hypertension (PH) is high blood pressure that occurs in the arteries that supply the lungs.
- There are five different groups of PH causes, and it often coexists with systemic hypertension.
- However, the overlap between pulmonary BP and systemic BP and how it affects disease prognosis is poorly understood.
Searching for the link between these two types of hypertension, researchers examined a cohort of 12.8k patients with incident PH from the PVRI GoDeep meta-registry, which pools both retrospective and prospective PH patient data from five continents.
- All patients analyzed had been diagnosed from 1980 to 2020, and covered all five groupings of PH causes.
A counterintuitive trend emerged upon analyzing this cohort.
- Patients with preexisting hypertension had a 26% lower mortality risk than those without it (HR: 0.74).
- In fact, hypertension’s survival benefit rose steadily when patients’ systolic systemic arterial pressure (sSAP) stayed in the 80–180 mmHg range
- The benefit was also observed regardless of whether or not patients were taking antihypertensive or PH-specific drugs, so it’s likely not a treatment effect.
So why would high systemic pressure help? It comes down to hemodynamics in the heart.
- Higher sSAP means better cardiac index (the heart’s pumping volume relative to body surface area) and TAPSE (Tricuspid Annular Plane Systolic Excursion).
- That suggests high BP partly reflects a right ventricle that can still pump effectively.
So if systemic hypertension is a good sign in PH patients, what are the warning signs?
- In this case, elevated baseline heart rate was the datapoint linked to higher mortality.
Now here’s the part where I remind you, this is an observational data analysis across four decades of PH patients.
- Since hypertension diagnoses were independently reported by each medical center in the registry, residual confounding can’t be ruled out.
- The study doesn’t also can’t define a target BP for PH patients, it just tells us not to panic when a PH patient is generally hypertensive.
The Takeaway
Though it may seem like backwards logic, this study suggests that overall hypertension can be a sign of a cardiovascular system that is resisting pulmonary hypertension well. On the other hand, an elevated heart rate and slipping systolic systemic arterial pressure are cause for alarm.
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- Impella Controller Alert Becomes Class I: In a now-excessively-repetitive story, J&J MedTech’s Impella controllers landed another Class I recall. The FDA wrapped its earlier investigation into a September alert covering 900 units across three controller models that need hardware, firmware, or software fixes for problems like missed purge cassette recognition and a sticky button. No injuries or deaths are linked, and units can still be used when necessary. It’s the latest chapter for Impella, which saw eight recalls from July 2025 through September 2026.
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- Silencing Angiotensinogen for BP Control: New data in JAMA Cardiology suggests that a single injection of Arnatar Therapeutics’ angiotensin-targeting siRNA ART101 could lower BP for six months. In a two-part Phase I trial, researchers first randomized 40 patients to either ART101 (25, 75, 150, 300, or 600mg injections) or placebo. This was followed by a single open-label 600mg injection in eight different patients. The randomized results suggest that ART101 is generally safe at all doses, while the second patient group saw their 24-hour systolic BP drop by 12.9 mmHg on average at 24 weeks post-injection.
- StimCardio Raises $30M for AFib Wearable: StimCardio closed a $30M Series A financing round to fund its NeuroPulse 2 pivotal study and a planned De Novo submission for its Rhyvive device. A wrist-worn device, Rhyvive delivers closed-loop, non-invasive electrical stimulation to the median nerve (the one at your palm-wrist connection) that is designed to reduce AFib recurrence after catheter ablation. While it’s a fascinating implant-free approach to neuromodulation for a population where post-ablation recurrence remains common, we have yet to see efficacy data backing it.
- Cleerly’s Plaque AI Gets Broader Training: Any AI plaque algorithm is only as good as the patient data it’s trained on. That’s why Cleerly landed FDA clearance for an updated version of its LABS analysis software and the latest generation of its PLAQUE algorithm, since both are now trained on its exceptionally comprehensive CONFIRM2 Registry data that covers 6.5k people from 46 countries, about half of whom are women. Both updates roll out automatically to customers in November 2026.
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