Summary : This diagram illustrates the protocol for diagnosing hypertension using home blood pressure monitoring (HBPM), specifying the threshold for hypertension and the recommended measurement procedure. flowchart: # Nodes : • "Hypertension: average HBPM ≥135/85 mmHg" (hexagon) • House icon (represents home measurement) • "3" (circle, step number) • "2X" stopwatch icon (indicates two readings) • "Obtain two readings on each occasion, 1–2 min apart" (text) # Connectors : • Implied sequential flow from hypertension definition → home measurement → step 3 (obtain two readings). # Layout : • Left-to-right arrangement: hypertension threshold (left), home icon (center), step 3 instructions (right). • Visual icons supplement text for clarity. # Analysis : • The figure communicates that hypertension is defined as an average HBPM of ≥135/85 mmHg. • It instructs users to take two blood pressure readings at home on each occasion, spaced 1–2 minutes apart, as part of the diagnostic protocol. • The use of icons and step numbering enhances clarity and guides the user through the recommended measurement process.

Summary : This figure presents a comprehensive overview of the multifactorial causes and mechanisms underlying blood pressure (BP) elevation and hypertension, organised as overlapping Venn diagrams. It categorises risk factors into genetic, behavioural, environmental, and socio-economic/psychosocial domains, and details the physiological mechanisms (renal, hormonal, neural, vascular) that mediate BP regulation. venn diagram / conceptual illustration: # Main Domains : • Genetic factors: Biological sex, BP-associated SNPs, monogenic forms of hypertension, epigenetic and foetal programming. • Behavioural factors: Physical activity, sedentary behaviour, sleep quality/quantity, dietary patterns, sodium and potassium intake, obesity, alcohol consumption, drugs/substances that increase BP. • Environmental factors: Geopolitical status, noise pollution, air pollution, climate. • Socio-economic and psychosocial factors: Stress, low socio-economic status, social deprivation, healthcare access, gender identity/roles/norms, gender-based violence, discrimination. # Physiological Mechanisms (Central Overlapping Circles) : ## Renal mechanisms : • Salt sensitivity • Pressure-natriuresis • RAAS (Renin-Angiotensin-Aldosterone System) • Renal ischaemia ## Hormonal mechanisms : • RAAS • Endothelin system • Sex hormones ## Neural mechanisms : • Autonomic nervous system (SNS/PNS) • Baroreceptor reflex ## Vascular mechanisms : • Endothelial dysfunction • Small artery remodelling • Large artery stiffness # Central Illustration : • At the centre, a cartoon of a man and woman symbolises the affected population. # Design Encodings : • Each domain is represented by a large, coloured circle with overlapping regions for mechanisms. • Mechanisms are shown as smaller, darker circles overlapping the main domains. • Bulleted lists within each circle detail specific factors/mechanisms. • ESC logo at bottom right. # Analysis : • The figure visually emphasises that hypertension is a complex, multifactorial condition resulting from the interplay of genetic, behavioural, environmental, and socio-economic/psychosocial factors. • Physiological mechanisms (renal, hormonal, neural, vascular) are central and overlap with all domains, indicating their integrative role in BP regulation. • The central placement of the affected individuals highlights the human impact and the need for a holistic approach to hypertension prevention and management. • No quantitative data or statistical relationships are presented; the figure is conceptual and descriptive.

A pathophysiology diagram titled 'Impact of hypertension on viral immunity' comparing cellular immune responses under normal and hypertensive conditions. The top panel, 'Normal blood pressure,' illustrates a dendritic cell presenting antigens to a T cell via receptor-ligand interactions and cytokine release. This stimulation leads to robust T-cell activation and proliferation, resulting in a large cluster of effector T cells essential for viral clearance. The bottom panel, 'Hypertension,' depicts the same initial dendritic cell-T cell interaction but highlights the presence of elevated Angiotensin II. Angiotensin II binds to Angiotensin II receptors expressed on the activated T cell. This signaling inhibits sustained proliferation and instead promotes a T-cell contraction phase, resulting in a significantly reduced population of T cells. The diagram indicates that this hypertensive state leads to an impaired effector response and delayed viral clearance. Key components labeled include dendritic cells, T cells, cytokines, Angiotensin II, and Angiotensin II receptors.