Background: Hypertension remains the leading global risk factor for cardiovascular morbidity and mortality, with suboptimal control rates despite guideline-directed therapies. Digital health and artificial intelligence (AI) technologies offer novel approaches for improving diagnosis, monitoring, and individualized treatment of hypertension. Objectives: To critically review the current landscape of AI-enabled digital tools for hypertension management, including emerging applications, implementation challenges, and future directions. Methods: A narrative review of recent PubMed-indexed studies (2019–2024) was conducted, focusing on clinical applications of AI and digital health technologies in hypertension. Emphasis was placed on real-world deployment, algorithmic explainability, digital biomarkers, and ethical/regulatory frameworks. Priority was given to high-quality randomized trials, systematic reviews, and expert consensus statements. Results: AI-supported platforms—including remote blood pressure monitoring, machine learning titration algorithms, and digital twins—have demonstrated early promise in improving hypertension control. Explainable AI (XAI) is critical for clinician trust and integration into decision-making. Equity-focused design and regulatory oversight are essential to prevent exacerbation of health disparities. Emerging implementation strategies, such as federated learning and co-design frameworks, may enhance scalability and generalizability across diverse care settings. Conclusions: AI-guided titration and digital twin approaches appear most promising for reducing therapeutic inertia, whereas cuffless blood pressure monitoring remains the least mature. Future work should prioritize pragmatic trials with equity and cost-effectiveness endpoints, supported by safeguards against bias, accountability gaps, and privacy risks.

The study investigated gender bias in GPT-4’s assessment of coronary artery disease risk by presenting identical clinical vignettes of men and women with and without psychiatric comorbidities. Results suggest that psychiatric conditions may influence GPT-4’s coronary artery disease risk assessment among men and women.

The transcaval (TCv) vascular approach is increasingly utilized in transcatheter aortic valve replacement (TAVR), in patients unsuitable for the gold-standard transfemoral approach. We aimed to evaluate the efficacy, safety, and clinical outcomes associated with TCv-TAVR. A systematic review and meta-analysis was conducted by searching PubMed/MEDLINE, EMBASE and the Cochrane Library for all articles assessing the TCv approach published until December 2023. Outcomes included 30-day and 1-year all-cause mortality (ACM), 30-day rehospitalization, peri-operative and post-operative complications at 30 days. The meta-analysis was registered on the PROSPERO database with the identifier CRD42024501921. A total of eight studies with 467 patients were included. TCv-TAVR procedures achieved a success rate of 98.5%. TCv-TAVR was associated with a 30-day ACM rate of 6.4% (95% confidence interval [CI]: 3.9-8.2%), a one-year ACM rate of 14.4% (95% CI: 2.3- 27.6%) and a 30-day rehospitalization rate at of 4.4% (95% CI: 2.2-10.6%). Postoperative stroke or transient ischemic attack, major vascular complications and major or life-threatening bleeding occurred in 3.9%, 8.5% and 10.1% of cases, respectively. Cumulative meta-analyses showed a trend of decreasing rates of vascular complications. The TCv approach in TAVR demonstrated a reassuring efficacy and safety profile, with mortality and post-operative complication rates comparable to those reported for supra-aortic alternative TAVR access routes. The temporal decrease in vascular complications suggests potential improvements in procedural techniques and device technology. These findings further support the TCv approach as a viable option in patients ineligible for the transfemoral access.

Background: A considerable number of patients with angina undergo invasive coronary angiography, which might reveal non-obstructive coronary arteries (ANOCA). In this setting, they might have coronary microvascular disease (CMD). Its prevalence significantly varies in the literature. This systematic review aims to document the prevalence of CMD over time according to the diagnostic modalities. Methods: A systematic literature review was conducted using PubMed, the Cochrane Library, and Embase, covering publications from inception to 1 May 2024. Among 1471 identified articles, 297 full-text articles were assessed for eligibility. All studies reporting the prevalence of CMD in ANOCA patients based on invasive coronary artery (ICA), positron emission tomography–computed tomography (PET-CT), transthoracic echocardiography (TTE), or cardiac magnetic resonance (CMR) were included. Results: The review included 53 studies (published between 1998 and 2024), encompassing a total of 16,602 patients. Of these studies, 23 used ICA, 15 used PET-CT, 8 used TTE, and 7 used CMR. A statistically significant increase in CMD prevalence over time was observed across all diagnostic modalities (p < 0.05), except for PET-CT, which showed a consistent and stable prevalence over time. Notably, the prevalence rates from all of the diagnostic methods converged towards the 50% prevalence detected by PET-CT. Conclusions: The prevalence of CMD in patients with ANOCA is subject to debate. However, the current data suggest that regardless of the diagnostic method used, the most recent studies tend to converge towards a prevalence value of 50%, which has been consistently reported by PET-CT from the beginning.

Introduction: The use of esophageal temperature monitoring (ETM) for the prevention of esophageal injury during atrial fibrillation (AF) ablation is often advocated. However, evidence supporting its use is scarce and controversial. We therefore aimed to review the evidence assessing the efficacy of ETM for the prevention of esophageal injury. Methods: We performed a meta‐analysis and systematic review of the available literature from inception to December 31, 2022. All studies comparing the use of ETM, versus no ETM, during radiofrequency (RF) AF ablation and which reported the incidence of endoscopically detected esophageal lesions (EDELs) were included. Results: Eleven studies with a total of 1112 patients undergoing RF AF ablation were identified. Of those patients, 627 were assigned to ETM (56%). The overall incidence of EDELs was 9.8%. The use of ETM during AF ablation was associated with a non significant increase in the incidence of EDELs (12.3% with ETM, vs. 6.6 % without ETM, odds ratio, 1.44, 95%CI, 0.49, 4.22, p  = .51, I ²  = 72%). The use of ETM was associated with a significant increase in the energy delivered specifically on the posterior wall compared to patients without ETM (mean power difference: 5.13 Watts, 95% CI, 1.52, 8.74, p  = .005). Conclusions: The use of ETM does not reduce the incidence of EDELs during RF AF ablation. The higher energy delivered on the posterior wall is likely attributable to a false sense of safety that may explain the lack of benefit of ETM. Further randomized controlled trials are needed to provide conclusive results.

Background: Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta‐analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction. Methods: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study‐specific results in meta‐analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction. Results: We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta‐analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78–1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (−1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11–1.13). Conclusion: Our meta‐analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465 ; Unique identifier: CRD42024595465.