This session at ESC 2025 highlighted advances in hypertension treatment exhibiting quadpill efficacy, stroke risk reduction, dapagliflozin benefits, telemonitoring, spironolactone’s mortality impact, & effect of RAAS drug on brain health.

The session highlights the latest research on efficacy and safety of glucagon like peptide-1agonists and sodium-glucose cotransporter-2 inhibitors in various disease including atrial fibrillation and high-risk diabetes.

In 137,859 UK Biobank patients, MASLD was linked to a higher risk of 128 diseases. Obesity (HR 8.77), diabetes (HR 4.34), and sleep disorders (HR 3.21) were most pronounced. Disease trajectories were clustered into metabolic, inflammatory, and cardiovascular pathways, with hypertension, diabetes, and inflammatory arthritis as intermediates leading to late-stage conditions like electrolyte imbalance and sepsis.

The Million Women Study spanning over two decades confirmed that midlife hypertension heightened the risk of dementia (HR 1.17), especially vascular dementia (HR 1.50), while its association with Alzheimer's disease was minimal (HR 1.01). Hypertension in pregnancy showed a modest effect (HR 1.04). Early detection and control of midlife hypertension could help mitigate long-term cognitive decline.

Patients initiating anti-osteoporotic medication (AOM) following a hip fracture halved the risk of periprosthetic fractures (PPFs, HR 0.50) and reduced contralateral second hip fractures (2HFs, HR 0.85). Ages 60 to 69 were at higher risk of PPFs. Mortality over 5 years was similar between PPF and 2HF groups (33% vs. 30%), but PPF patients faced a higher rate of subsequent major osteoporotic fractures (7.5% vs 3.7%).

Bariatric surgery reduced the risk of metabolic diseases in obese adults compared with weight management programs. 5-year incidence rates per 1000 person-years were strikingly lower for T2D (1.06 vs 4.29), hypertension (3.35 vs 8.89), hyperlipidemia (4.85 vs 9.67), OSA (3.43 vs 3.99) & MASLD (2.01 vs 2.44), with a risk reduction of 40–79%. The findings reinforce bariatric surgery as an effective preventive strategy.