Michael Mayr

Background: Elevated blood pressure (BP) is common during hospitalization. Despite recommendations to avoid routine changes in antihypertensive therapy, clinical practice remains variable. Prospective data on whether elevated in-hospital BP identifies patients with hypertension after discharge are limited. Methods: Adults hospitalized for non-cardiac conditions with asymptomatic routine in-hospital BP ≥140 and/or ≥90 mmHg on at least two occasions separated by ≥24 hours were prospectively enrolled. Antihypertensive therapy was managed at the discretion of treating physicians. Routine in-hospital BP, standardized research BP, and changes in antihypertensive therapy were recorded. Four weeks after discharge, participants underwent 24-hour ambulatory BP monitoring (ABPM). Results: Among 50 participants, 42 (84%; 95% CI, 70.9 – 92.8) had hypertension on follow-up ABPM. Among 21 participants without known hypertension, 18 (86%) had previously unrecognized hypertension on follow-up ABPM; among 29 participants with known hypertension, 24 (83%) had uncontrolled hypertension. Antihypertensive therapy was changed during hospitalization in 26 participants (52%), with de-escalation more frequent than intensification. Hypertension on follow-up ABPM was present in 88.5% of participants with and 79.2% without in-hospital therapy changes. Standardized research BP, but not routine in-hospital BP, correlated with follow-up ABPM. Conclusion: Asymptomatic elevated routine in-hospital BP identified a population with a high prevalence of hypertension four weeks after discharge, including patients with and without previously diagnosed hypertension. These findings support structured post-discharge BP reassessment rather than assuming that elevated in-hospital BP is transient. URL: www.ClinicalTrials.gov ; Unique identifier: NCT06132451 Abstract Figure:

UNSTRUCTURED Background: There is a lack of clear recommendation on how to manage elevated blood pressure (BP) values in hospitalized patients, largely due to the absence of prospective data. Retrospective studies suggest that initiation or intensification of antihypertensive therapy during hospitalization may not improve outcomes and may even be associated with increased risk of adverse events. Methods: This is a single-centre, open-label, prospective study comprising two consecutive phases: an observational phase followed by an intervention phase. All patients hospitalized for non-cardiovascular reasons will be screened for asymptomatic elevated BP values (defined as 140–180 mmHg systolic and/or 90–110 mmHg diastolic on at least two occasions). During the observational phase, patients will be managed according to usual clinical practice. During the intervention phase, a standardized management strategy will be applied, consisting of no initiation or modification of antihypertensive therapy during hospitalization. All participants will undergo 24-hour ambulatory BP monitoring (ABPM) four weeks after hospital discharge. The primary endpoint is the prevalence of persisting new or uncontrolled hypertension on ABPM. Primary safety endpoints include the prevalence of combined hypertensive and hypotensive complications. Discussion: This study aims to provide prospective data on the clinical relevance of elevated BP values in hospitalized patients. By assessing both the persistence of hypertension and the occurrence of adverse events, the study will help to inform future strategies regarding the management of elevated BP in the inpatient setting.

Before the American Heart Association introduced the cardiovascular–kidney–metabolic (CKM) syndrome concept in 2023, clinical care was largely organ-specific. This retrospective study analyzed diagnostic patterns and gaps in 406 patients with hypertension referred to and evaluated at the University Hospital Basel Hypertension Centre in 2017, 2019, or 2022 to identify blind spots in the assessment of cardio–kidney–liver–metabolic health. Electronic health records were used to assess CKM-relevant diagnostics, including lipid profiles, N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, kidney function (estimated glomerular filtration rate: eGFR, urinary albumin-to-creatinine ratio: uACR), and hepatic assessment (Fib-4 score, abdominal ultrasound). Previously undetected conditions were identified according to contemporary criteria for dyslipidemia, chronic kidney disease (CKD), suspected heart failure (HF), diabetes, and suspected metabolic dysfunction-associated steatotic liver disease (MASLD). Although 94% of participants had laboratory data, key CKM parameters were inconsistently assessed. Of the participants, 39% had neither NT-proBNP measurement nor echocardiography, and 27% lacked hepatic ultrasound or sufficient data for Fib-4 calculation. Previously unrecognized comorbidities were common (suspected HF 21%, CKD 6%, suspected MASLD 3%). Lipoprotein(a) testing increased from 0% in 2017 to 23.7% in 2022, indicating growing awareness. Despite specialized care, diagnostic fragmentation persisted, underlining the need for systematic, interdisciplinary screening and informing the design of prospective registries such as the Swiss CKLM Registry to integrate patient-centered cardio–kidney–liver–metabolic care.

Background and Aims: Non-adherence to antihypertensive therapy is a major contributor to poor blood pressure (BP) control, increased cardiovascular risk, and higher healthcare costs. Behavioral economics suggests that financial incentives and mobile-based interventions may support behavior change, yet evidence for such strategies in central Europe is limited. Objective: The BEHAVE-HTN study evaluates whether a multi-faceted medication adherence mobile application (mApp) with behavioral economic principles—including reminders, gamification, and financial incentives—improves medication adherence in patients with hypertension compared to standard of care. Methods: This multi-center, randomized, open-label trial will include 180 outpatients with hypertension taking four or more pills daily. Participants will be randomized into three groups (n = 60 per group): (A) mApp with contingent financial incentives, (B) mApp without incentives, and (C) standard of care. All participants will receive a Medication Event Monitoring System (MEMS) dispenser to objectively track adherence. The primary endpoint is the difference in mean MEMS adherence between group A and the control group at 90 days. A co-primary endpoint compares MEMS adherence in the final vs. initial month of the intervention. Secondary outcomes include changes in BP, app-reported adherence, and patient-reported feedback on the mApp. Results: Currently, participant inclusion has been nearly completed. We are undergoing data clearing and are planning data analysis. These steps are planned for autumn 2025. Conclusion: This study will provide evidence on whether a multi-faceted medication adherence mobile App — with or without financial incentives—can improve medication adherence in hypertensive patients. The findings may support the implementation of mobile health strategies in routine hypertension care. Trial Registration: SNCTP000004345; ClinicalTrials.gov Identifier: NCT04708756

BACKGROUND Non-adherence to antihypertensive therapy is a major contributor to poor blood pressure control, increased cardiovascular risk, and higher healthcare costs. Behavioral economics suggests that financial incentives and mobile-based interventions may support behavior change, yet evidence for such strategies in Central Europe is limited. OBJECTIVE The COLLABREE study evaluates whether a multi-faceted mobile application with behavioral economic principles—including reminders, gamification, and financial incentives—improves medication adherence in patients with hypertension compared to standard of care. METHODS This multi-center, randomized, open-label trial will include 180 outpatients with hypertension taking four or more pills daily. Participants will be randomized into three groups (n = 60 per group): (A) Collabree app with contingent financial incentives, (B) Collabree app without incentives, and (C) standard of care. All participants will receive a Medication Event Monitoring System (MEMS) to objectively track adherence. The primary endpoint is the difference in mean adherence between Group A and the control group at 90 days. A co-primary endpoint compares adherence in the final vs. initial month of the intervention. Secondary outcomes include changes in blood pressure, self-reported adherence, and patient-reported feedback on the app. RESULTS Currently, participant inclusion has been nearly completed. We are undergoing data clearing and are planning data analysis. These steps are planned for autumn 2025. CONCLUSIONS This study will provide evidence on whether a multi-faceted digital intervention—with or without financial incentives—can improve medication adherence in hypertensive patients. The findings may support the implementation of mobile health strategies in routine hypertension care. CLINICALTRIAL SNCTP000004345; ClinicalTrials.gov Identifier: NCT04708756

Introduction The recent pandemic caused by SARS-CoV-2 had a profound global impact. While many individuals recovered from COVID-19, some developed long-lasting symptoms that significantly disrupted daily life. The WHO defines this condition as post-COVID-19 condition (PCC). Common symptoms include fatigue, dyspnoea, sleep disturbances and cognitive difficulties. Increasing evidence suggests that PCC is a multifactorial condition, shaped not only by biomedical but also psychological and social factors. This article presents the protocol of the Basel Long COVID Cohort Study (BALCoS), which aims to improve understanding of PCC by capturing clinical, functional and psychosocial aspects through repeated assessments over the course of 1 year. Methods and analysis BALCoS is a prospective, single-site cohort study. Inclusion criteria include either a probable or confirmed history of SARS-CoV-2 infection with persistent symptoms consistent with the WHO definition of PCC, sufficient German language skills and age ≥18 years. At baseline, we collected detailed information on previous SARS-CoV-2 infections, symptom history, reinfections, COVID-19 vaccination status and pre-existing medical conditions. The study includes standardised psychometric assessments, physical performance tests, ecological momentary assessments (EMAs), neurocognitive testing and blood sample collection. Assessments are scheduled at baseline and at 3-month, 6-month and 12-month follow-up. All participants complete psychometric assessments at each time point. Blood samples are only collected at baseline. Neurocognitive testing and physical performance measures are collected at baseline and 12-month follow-up for in-person participants only. Participants who are unable to attend in person complete a remote version of the study, excluding these in-clinic assessments. EMAs are initiated the day after each time point and consist of eight questions over 10 consecutive days. The study is exploratory in nature, with a target sample size of 120 participants. BALCoS is part of the Horizon Europe Long COVID project, a multinational interdisciplinary research consortium integrating mechanistic, clinical and interventional studies. Ethics and dissemination The study was approved by the Ethics Commission of Northwest and Central Switzerland (BASEC-ID: 2023–00359) and is registered at ClinicalTrials.gov (ID: NCT05781893). All participants provide written informed consent. Study findings will be disseminated through peer-reviewed publications. Trial registeration number NCT05781893.

Introduction: Four different antihypertensive drug classes are equivalently recommended in the previous guidelines for first-line treatment of arterial hypertension (HTN). However, it is unclear, whether one of these drugs is more capable than the others to reach blood pressure (BP) control. We sought to compare response rates and BP control in these 4 classes. Methods: Patients with newly diagnosed mild to moderate HTN on 24-h BP measurements (ABPM) were randomized in a 1:1:1:1 fashion to either perindopril, olmesartan, amlodipine, or hydrochlorothiazide (HCT). ABPM was completed at baseline (BL) and after 4 weeks of half dose (treatment period 1 [TP1]). If BP control was not reached after TP1, drug dose was doubled and another ABPM completed after 4 weeks (treatment period 2 [TP2]). Patients were classified as controlled if 24-h mean BP was <130/80 mm Hg, awake BP <135/85 mm Hg, and night BP <120/70 mm Hg, and as optimal if 24-h mean BP was 115–124/65–74 mm Hg. Results: 88 patients were randomized: 20 (23%) to perindopril, 23 (26%) to olmesartan, 24 (27%) to amlodipine, and 21 (24%) to HCT. Median 24-h mean BP reduction from BL to TP1 was −11/−6 mm Hg and from TP1 to TP2 −4/−2 mm Hg. The highest BP reduction was reached with olmesartan (−15/−10 mm Hg), particularly for diastolic values, the lowest with HCT (−8/−1 mm Hg). 27% of patients reached systo-diastolic BP control, with the best control rate with perindopril and olmesartan (40 and 39%), the lowest with HCT (5%), and 21%/18% reached an optimal treatment goal for systolic/diastolic 24-h mean values, respectively, after TP1. Three additional participants (4%) reached BP control after TP2. Conclusion: Initial antihypertensive monotherapy failed in most patients (73% uncontrolled, 21%/18% reached optimal treatment goal at TP1) even in low-risk patients, with efficacy varying by drug class (inhibitors of the renin-angiotensin-aldosterone system best, HCT least). These findings support guideline-recommended combination therapy.

Introduction The recent severe acute respiratory syndrome coronavirus type 2 (SARS–CoV–2) pandemic had a devasting global impact. Many people suffered from coronavirus disease 2019 (COVID–19) and some experienced persistent symptoms interrupting their lives even further. The World Health Organization (WHO) defined the condition of these persistent symptoms as post–COVID–19 condition (PCC). The most prevalent PCC symptoms are fatigue, dyspnea, sleep disturbances, coughing, anosmia and ageusia, chest pain, and headaches. This article describes the protocol of the Basel Long COVID Cohort Study (BALCoS), which aims at fostering understanding of PCC and investigating underlying mechanisms for the development and course of the condition by focusing on participants′ health status and symptoms with repeated measures over one year. Methods and analysis BALCoS is a prospective single site cohort study. Inclusion criteria are a confirmed PCC diagnosis according to WHO or a subjective attribution of persistent symptoms to PCC, proficiency in German to follow study procedures, and at least 18 years of age. It comprises blood sample collections, standardized neurocognitive and psychometric tests, physical performance measures, and ecological momentary assessments (EMAs). Standardized tests and EMAs are administered at baseline (BL), and at 3–, 6–, and 12–months follow–up. At BL and 12–month follow–up, physical performance and neurocognitive abilities are assessed. Participants provide blood samples at BL. The study is exploratory in nature and a sample size of at least 120 participants is targeted. The study is part of a larger Horizon Europe Long COVID project combining mechanistic, clinical, and intervention studies within an interdisciplinary European research consortium. Ethics and dissemination The Ethics Commission of Northwest and Central Switzerland approved the study (BASEC–ID: 2023–00359), which is registered at ClinicalTrial.gov (ID: NCT05781893). All participants provide written informed consent. Key results from the study will be published in peer–reviewed journals. Funding Details BALCoS is primarily funded by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 22.00094 in the context of the European Union′s Horizon Europe research and innovation program under grant agreement No. 101057553.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided.