Curation log — hypertension¶

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-10-26 — Literature sweep (engine: codex)¶

Window: publication dates 2026-10-19–2026-10-26 inclusive, supplemented by an Entrez-date search over the same window for delayed indexing. Prior-sweep follow-ups were searched without a date restriction where needed. Only hypertension files were changed. No publication, deployment or version-control command was run.

Sources actually queried¶

PubMed E-utilities esearch and efetch. Eighteen topic searches: measurement/diagnosis; epidemiology/burden; pathophysiology; genetics; secondary causes; risk/outcomes; targets; lifestyle; drugs; resistant hypertension; devices; pregnancy; special populations; implementation/adherence; emergencies; guidelines; patient experience; safety. Broad title/major-topic and newly indexed searches supplemented these. The main searches returned 383 unique PMIDs; 622 distinct PMIDs were fetched across those results, follow-ups and E-utilities resolution of PMIDs retained in Europe PMC manifest metadata. Additional searches covered ALERT-PA results, InterCARE, CONSEP and GBD/NCD-RisC.
Cochrane Database of Systematic Reviews via PubMed. Eighteen separate topic/date queries plus whole-journal publication-date and Entrez-date checks. All topic queries returned zero; the five whole-journal records concerned other conditions. No completed on-topic CDSR review was found in these PubMed queries. CENTRAL was not searched: cochranelibrary.com returned HTTP 403.
Europe PMC REST. Eighteen matching topic queries using FIRST_PDATE:[2026-10-19 TO 2026-10-26], plus 17 record-specific availability/full-text checks. The topic responses contained 903 distinct source/record identities, including 480 with a source other than MED. Those counts include duplicate PMC representations of PubMed papers and unrelated full-text matches; they are not 903 new papers or 480 non-PMID papers. No DOI-only record survived triage.
ClinicalTrials.gov API v2. All 64 identifiers already cited in hypertension markdown were fetched individually. Four query.term searches were also run. ALERT-PA and THINK term searches were broad and truncated; no absence claim is based on them. All returned IDs and the per-record tracked fields are in the manifest.
Non-US registries. The EU Clinical Trials Register query THINK hypertension returned one unrelated study. An official CTIS query for the THINK EU number returned a JavaScript shell, without a trial record. WHO ICTRP and ANZCTR CONSEP queries returned HTTP 403. ISRCTN's hypertension query redirected to a holding page. The CTRI search page required a security code, so no completed search was possible. These are access limits, not negative trial searches. ChiCTR was not queried. The THINK protocol full text supplies EU trial number 2022-501494-39-00; its official registry status remains unconfirmed.
Crossref works, without mailto: all nine additions, the 17 records added on 2026-10-12, and two other follow-ups. All additions resolved with matching titles and empty updated-by; no added record had a PubMed retraction/expression-of-concern publication type or link. The older Cheng DOI still returned 404; the Sharman DOI now resolved with a matching title and empty updated-by. Sixteen of the 17 older records resolved in Crossref, without update flags; none had a PubMed retraction or expression-of-concern flag.
Primary and organisation sources. NICE NG136; WHO hypertension fact sheet; ISH guideline resource page and announcement; Blood Pressure UK news; WHL homepage; direct publisher/PMC full texts where available. The new global ISH full text was accessible through Ovid despite Europe PMC's subscription-only label. GUARDD-US PGx, Bangladesh HEARTS, Owei, THINK and GRAINS-BP full texts were read. Bangladesh supplementary Table S1 was downloaded from the publisher, text-extracted, rendered and visually checked.

Not searched successfully: SciELO and LILACS both returned HTTP 403. This particularly limits regional-transportability claims. CENTRAL and the registry limitations above remain open. Embase, Scopus and Web of Science were unavailable. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset; no personal email address was supplied to an API.

Exact queries, PubMed translations, returned IDs, availability checks, retraction checks and selected full-text/table provenance are preserved in literature/sweeps/2026-10-26.json. Absences here apply only to the named queries and sources.

What survived triage and what changed¶

Nine bibliography records; no landmark note. Eight were found through the current publication/indexing searches. Owei was outside the window and was added to resolve the last sweep's explicit full-text follow-up.

2026 ISH global guideline (PMID 42909506): full-text Tables 2–3 and Section 7.2 support the retained ≥140/90 diagnostic threshold, separate essential/optimal targets, and the central role of standardised home monitoring. Updated guidelines, measurement and targets pages; added the new edition to the registry and marked 2020 as the previous edition. OQ-25/OQ-26 now reflect explicit measurement and resource-stratified frameworks. No drug regulatory-approval statements were transferred from the guideline.
Taiwan older-adult guidance (PMID 42926177), STRIDE BP/ESH cuff-validation guide (PMID 42853222), and KDOQI commentary (PMID 42907045): document catalogue/pointers only. Their full texts were not obtained. Numerical recommendations and detailed validation requirements were not inferred. The cuff guide is not treated as a cuffless validation standard; KDOQI is a commentary, not a replacement guideline.
GUARDD-US PGx (PMID 42894271): updated genetics and OQ-24 from full-text Table 2, Figure 2 and Results. Whole-cohort blood-pressure benefit was absent, and prespecified subgroup signals did not persist at six months. Candidate-gene result return does not answer whether a PRS can select drugs. Removed the older categorical absence of randomised genotype-guided evidence. Abstract/body adjusted estimates differ slightly; no adjusted numerical estimate was copied.
Bangladesh HEARTS (PMID 42921236): added an implementation paragraph and two statistics rows, based on full-text Tables 2–3 and supplementary indicator definitions. Clearly labelled programme monitoring, not national population control or a causal intervention effect. Preserved the April-versus-May endpoint discrepancy. Did not copy the abstract's inconsistent population-coverage arithmetic or inconsistent registration dates.
Owei comparison (PMID 41645899): the full text describes broader ESC and AHA/ACC aldosteronism screening positions and existing cost-effectiveness modelling. Removed blanket general-guideline absence language in guidelines, secondary hypertension, the registry and OQ-1. The question now concerns observed downstream workload and implementation; guideline eligibility and recommendation strength remain distinct. Primary ESC full-text retrieval was blocked, so this comparison is explicitly attributed to Owei rather than presented as a fresh primary-guideline extraction. ISH 2026's selected-case secondary-cause screening was checked directly.
Bibliography only: PATH postpartum remote-titration RCT (PMID 42925856) and SPYRAL long-term renal-artery imaging (PMID 42902709). Full texts were unavailable; no numerical result or safety claim was added to the wiki.
Trials page: added the current registry check and the THINK EU identifier with the official-access qualification. No tracked status/enrolment/completion-date/results-availability change required a row correction. The four newer record-update dates were NCT01534299, NCT06907147, NCT07013929 and NCT07174622; none contains a results section. None of the 64 tracked records acquired a first-results posting. ALERT-PA, NCT05405920 and the two drug outcome trials still have no posted results.
Index: recounted 837 distinct bibliography PMIDs and 48 guideline-registry document rows. The prior headline of 40 registry entries was stale; there were 44 rows before this sweep and four were added.

Seven wiki pages changed: guidelines, blood-pressure targets, definition/measurement/diagnosis, genetics, adherence/implementation, secondary hypertension and clinical-trials landscape. All have last-curated: 2026-10-26 and remain draft pending independent audit. Genetics was demoted from curated; six were already draft. Eight untouched pages remain curated. Bibliography, registry, statistics, open questions and index dates were updated. No patient-voice file changed.

What was checked but not added¶

Most records concerned pulmonary, portal, intracranial or ocular hypertension, end-organ diseases owned elsewhere, case reports, small uncontrolled studies, exploratory biomarkers, preprints or reviews without a management-changing contribution. GRAINS-BP was a protocol, not a result. The new baxdrostat/albuminuria record (PMID 42905977) had no abstract and its full report was not retrieved; no effect was inferred. InterCARE's new diabetes analysis was baseline/cross-sectional, not the requested later hypertension follow-up. The GBD/ESC Atlas sex-burden paper did not replace the systemic-hypertension prevalence/cascade series. Human-cell transfer/TNF inhibition in mice was not treated as human treatment evidence.

NICE NG136 still shows last updated 26 February 2026. The WHO fact sheet remains dated 25 September 2025. The two patient-organisation pages checked supplied no newly dated in-window material that warranted an addition. A Blood Pressure UK search result dated 27 October was excluded as after the sweep cutoff. The five PubMed correction records did not point to papers cited in this condition.

Validation¶

Live-identifier checks passed for all nine additions and every PMID/NCT retained on rewritten lines. The bibliography has 837 unique entries with no duplicates; all new local links resolve; edited wiki dates/statuses and index page counts match the files. The strict site build was not run because it generates files outside the authorised hypertension scope. Independent audit remains pending.

Next sweep¶

Obtain and compare the Taiwan older-adult guideline, cuff-validation guide and KDOQI full texts; obtain the baxdrostat/albuminuria report before extracting effects. Retrieve the new ISH figures if further subgroup target detail is needed.
Carry forward the ISH Africa, ACC resistant-hypertension pathway and Jones pregnancy-position-paper full texts; InterCARE beyond its coprimaries; English JSH 2025 and Chinese primary guidance.
Continue ALERT-PA, CONSEP, THINK, NCT05405920, baxdrostat/zilebesiran outcome and salt-substitute safety follow-ups. Resolve CONSEP through ANZCTR and Bhagat through CTRI when accessible; confirm THINK directly in CTIS. Do not infer their absence from ClinicalTrials.gov.
Obtain Ngolombe and Zhao full texts to resolve the category sum and denominators. Cheng's Crossref resolution remains open; Sharman's is resolved. The 2026-10-12 retraction re-check is complete except Cheng's Crossref side.
Follow both Larvie Cochrane protocols until completed reviews replace them. Revisit SciELO/LILACS if access changes. Verify primary ESC/AHA aldosteronism eligibility/strength against Owei's comparison before further expanding that synthesis.

2026-10-19 — Literature sweep (engine: claude)¶

Window: PubMed Entrez date 2026/10/12–2026/10/19, the days since the Grok sweep of 2026-10-12. No question was paused for a reply. No landmark note was written, and no guideline-registry or patient-voice file was edited. Eight wiki pages were edited. All eight were already status: draft from the 2026-10-12 sweep and stay draft, with last-curated: 2026-10-19. No curated page was touched. Additions await the independent audit.

Sources actually queried¶

PubMed E-utilities (esearch, esummary, efetch; tool lifebank; no email). The searches were 2 broad queries, a high-signal guideline/meta-analysis/RCT query, 18 topic queries, and a retraction/erratum/expression-of-concern query.
Cochrane Database of Systematic Reviews, inside PubMed. One condition-wide query, one whole-journal query and 8 per-topic queries (pregnancy, secondary causes, devices, lifestyle, implementation, drugs, special populations, emergencies), all with the date window.
Europe PMC REST, 7 queries.
ClinicalTrials.gov API v2. All 63 previously cited records were re-fetched and diffed against the 2026-10-12 manifest. Four query.term searches were run, plus a full fetch of NCT05925569.
Crossref works (no mailto) for all 17 added DOIs.
NICE NG136, the WHO hypertension fact sheet, the Blood Pressure UK news page and the World Hypertension League homepage, all retrieved 2026-10-19.

Not searched:

cochranelibrary.com returned HTTP 403, so CENTRAL was not searched.
search.scielo.org returned HTTP 403, and LILACS was not searched. Latin American regional literature was therefore not searched directly. It enters this sweep only through a meta-analysis whose own authors searched SciELO and LILACS (PMID 42886602), which is not the same thing.
WHO ICTRP, ANZCTR, CTRI, EU CTR/CTIS, ISRCTN and ChiCTR were not queried.
Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset.
Embase, Scopus and Web of Science were not available.

Every query string, translation and returned ID is in literature/sweeps/2026-10-19.json. Any absence below is an absence in the named source only.

What the searches returned¶

PubMed counts. hypertension[majr] 39; hypertension[ti] 146; the high-signal query 2. The 323 unique PMIDs were all taken to summary, and none was already cited. A large share were pulmonary, portal, intracranial or ocular hypertension, case reports, or placental biology. Those were discarded on title.
Cochrane. The only on-topic CDSR record is a second protocol, not a completed review: Blood pressure targets in adults with hypertension (Larvie 2026, PMID 42861682). It compares ≤135/85 with ≤140–160/90–100 mm Hg and has equity subgroups. It is the general-population companion to the diabetes protocol logged on 2026-10-12. Nothing it asserts supersedes or contradicts the wiki. The other CDSR hits in the window were off-topic on title: haemodiafiltration, venous thromboembolism statins, temporomandibular exercise, cannabis for insomnia, preterm home visits, sexual harassment training, and two Alzheimer's editorials. All 8 per-topic CDSR queries returned 0 on-topic records.
Retraction query. Five hits. Errata or an expression of concern on records not cited here, including an expression of concern on a pulmonary-artery endothelial paper (PMID 42885311). None touches this condition's corpus.
Europe PMC. Broad query, hit count 1 (an off-topic pulmonary-hypertension review). Cochrane query 0. Non-MEDLINE query 32, mostly preprints, none promoted. One preprint looked at first like the InterCARE follow-up the last sweep asked for: doi:10.12688/openreseurope.22702.1 (Europe PMC source PPR). It turned out to be a Ugandan integrated HIV/hypertension cluster trial that reports only within-intervention-arm change. It is not InterCARE, and it was not added. The ISH Africa guideline (PMID 42554264) and the 2026 ACC resistant-hypertension pathway (PMID 42831847) are still not open access in Europe PMC, so both full-text follow-ups remain open.
ClinicalTrials.gov. NCT07686120 (baxdrostat phase IIIb, China) moved from not yet recruiting to recruiting. SPIRO-First (NCT07687160) is still not yet recruiting, and its completion slipped from 2028-02 to 2028-12. NCT07181109's record changed only its last-update date. No cited record had a results-first post date, and NCT05405920 still has no posted results. A CONSEP query.term search again returned no studies. A search for decision support in primary-aldosteronism screening returned NCT05925569 (ALERT-PA): randomised, actual n = 12,501, primary completion 2024-12-09, active not recruiting, no results. A PubMed search found no ALERT-PA results paper. It was added to OQ-1.
Guidelines and statistics. NICE NG136 is unchanged (published 28 August 2019, last updated 26 February 2026). The WHO fact sheet is unchanged (dateModified 2025-09-25, still 1.4 billion). A PubMed guideline[pt] search over publication date 2026-10-01 to 2026-10-19 returned only ISH Africa, which is already registered. Two American Family Physician summaries of the AHA/ACC and Hypertension Canada guidelines (PMIDs 42886197, 42886198) are secondary summaries of registered documents and were not added. No new GBD or NCD-RisC systemic-hypertension paper appeared in the window.
Patient organisations. No new campaign or document was found on the two organisation pages checked.

Retraction status of the 17 added records¶

None carries Retracted Publication or Expression of Concern in PubMed publication types. None has a RetractionIn or ExpressionOfConcernIn link in PubMed. All 17 DOIs resolved in Crossref, and updated-by was empty for every one. One record that was considered and not added (Patchen, PMID 42877905) had a PubMed DOI that returned Crossref 404.

The last sweep's follow-up asked for retraction status of its 17 PMIDs. That re-check was not done this round. It goes forward.

What survived triage¶

Seventeen PMIDs and one NCT. Twelve PMIDs went into wiki pages, one into open questions only, and four into the bibliography only. No deep note. Several numbers come from abstracts. Where an abstract was internally inconsistent, the inconsistency is stated in the page rather than resolved by choosing one figure.

Adherence and implementation. Ngolombe global adherence meta-analysis (PMID 42885806): 58% pooled across 123 studies. Its abstract's category percentages add up to 103%; that is flagged in the page, and only the pooled figure is used. Torres-Campoverde Latin America and Caribbean digital-health meta-analysis (PMID 42886602): systolic −4.97 mm Hg, moderate certainty.
Special populations. Swedish Renal Register achieved-systolic cohort in advanced CKD (PMID 42865623). Labelled observational, describing a gradient and not testing a target. Jiang long-term-care deprescribing systematic review (PMID 42888381): RETREAT-FRAIL HR 1.02 against DANTON HR 1.65, not pooled.
Secondary hypertension. Zhao age-dependence of the aldosterone-renin ratio in confirmed primary aldosteronism (PMID 42864372). The abstract's 1,578 and 3,966 confirmed-case denominators are not reconciled, and that is flagged. Vibhatavata ATP1A1/ATP2B3 cure rates (PMID 42866865).
Lifestyle. Yuan exercise network meta-analysis, 284 trials (PMID 42887271). Framed as indirect and short-term, without bearing on the drug-equivalence question.
Pregnancy. Wambua 1.43-million-woman CPRD cohort (PMID 42872422) and Korb 6-week postpartum pressure and later cardiovascular disease (PMID 42888852). 55.3% of women had no 6-week reading.
Resistant hypertension and statistics. Shojaiyan Stockholm registry (PMID 42872749): resistant prevalence from under 1% to 17% by definition, and 57% versus 19% control by threshold.
Blood-pressure targets. Second Larvie Cochrane protocol (PMID 42861682).
Trials page. NCT07686120 status and the SPIRO-First date change.
Statistics only. Trivedi Australian young-adult cascade (PMID 42869921): 10.7% prevalence and 4.5% control. Placed beside Tang's US figure with the definitional difference stated in new caveat 14. The epidemiology page is curated and was not edited.
Open questions. OQ-1 sharpened: ALERT-PA, and false negatives at a fixed aldosterone-renin cut-off concentrated in young adults. OQ-5 sharpened: three randomised long-term-care trials, divergent mortality estimates. OQ-14: PAMELA variability (Mancia 2026, PMID 42861788) strengthens variability as a marker. A dated PubMed search for variability-targeted trials in the window returned 0.
Bibliography only. COHERENT colchicine RCT (PMID 42885348): null on pulse-wave velocity, and office systolic pressure fell 5.7 mm Hg less than with placebo. This bears on OQ-21 but is a six-month stiffness trial, not a blood-pressure-lowering test. Also: finerenone blood-pressure meta-analysis (PMID 42882155), Dutch post-pregnancy hypertension prediction model (PMID 42885485), and Peru cost-utility model (PMID 42886511).
Files updated. BIBLIOGRAPHY.md (828 distinct PMIDs; 828 entry lines, no duplicates; the two six-digit PMIDs had been missed by an 8-digit-only count), STATISTICS.md, OPEN-QUESTIONS.md and INDEX.md.

Not added: about 300 records. These were off-topic hypertension types, case reports, mechanistic animal work, small uncontrolled renal-denervation series (n = 11 and n = 18), letters and editorials, the PREVENT-PE qualitative study, a 72-completer angiotensin-peptide RCT, and a retrospective remote prenatal monitoring cohort.

What the next sweep should chase¶

Carried forward from 2026-10-12, still open: full texts of ISH Africa 2026 (numeric thresholds) and the ACC 2026 resistant-hypertension pathway; the Jones ISH pregnancy recommendations; InterCARE beyond 12 months; CONSEP results and an ANZCTR identifier; THINK results and an EU CTR/CTIS identifier; posted results for NCT05405920; baxdrostat (NCT06742723) and zilebesiran (NCT07181109) outcomes; NCT07460882 and NCT07178964; English primary texts of JSH 2025 and the 2024 Chinese guideline; Crossref for the Cheng and Sharman DOIs; a CTRI record for the Bhagat trial.
Retraction re-check of the 2026-10-12 sweep's 17 PMIDs. Not done this round.
The two Larvie Cochrane protocols (PMIDs 42788405, 42861682), until a completed review replaces either.
ALERT-PA (NCT05925569) results. It passed primary completion in December 2024.
Owei 2026 (PMID 41645899), retrieved this session but outside the window. It is a review stating that recent guidelines extend primary-aldosteronism screening "even to all individuals with hypertension". Read the full text to learn which general hypertension guideline, if any, it means. That answers a standing follow-up.
Full text of Ngolombe, to resolve the 103% category sum, and of Zhao, to reconcile its denominators.
WHO ICTRP and the named non-US registries, which have still not been queried in any sweep.
SciELO and LILACS, if an endpoint opens.

2026-10-12 — Literature sweep (engine: Grok)¶

Window: PubMed Entrez date 2026/09/01–2026/10/12, chosen because the last content pass was the 2026-09-01 audit. The same bounds were also run as publication date on the high-signal query. No question was paused for a reply. No landmark note was written. Overview, WHATS-NEW.md and the patient-voice pages were not edited. Additions are draft pending audit.

Sources actually queried¶

PubMed E-utilities (esearch, esummary, efetch; tool lifebank; no email; no API key). Europe PMC REST (resultType=lite). ClinicalTrials.gov API v2 for all 61 previously cited NCT records, plus full fetches of NCT05414526 and NCT05732727, plus query.term searches. Crossref works, without a mailto, for DOI resolution and the updated-by retraction field. NICE NG136 and the WHO hypertension fact sheet, both retrieved 2026-10-12.

Cochrane Database of Systematic Reviews was searched inside PubMed ("Cochrane Database Syst Rev"[jour] plus the date window). cochranelibrary.com returned HTTP 403, so CENTRAL was not searched. An absence below is a PubMed-indexed CDSR absence unless a record is named.

SciELO search returned HTTP 403. LILACS was not searched: the homepage returned HTTP 200, but a search was not completed. That is not an HTTP 403, and it is not a searched database. WHO ICTRP homepage returned HTTP 200 and was not queried (the search is JavaScript-driven). ANZCTR was not queried. CTRI was not queried. EU CTR/CTIS was not confirmed. Embase, Scopus and Web of Science were not available. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL was unset. The query strings, translations and returned IDs are in literature/sweeps/2026-10-12.json.

What the searches returned¶

hypertension[majr] edat count 297. hypertension[ti] edat count 827 (20 IDs stored). High-signal guideline/meta-analysis/systematic-review/RCT query: edat count 28, pdat count 105. Topic edat counts included measurement 64, secondary/primary aldosteronism 54, epidemiology 50, pregnancy 49, pathophysiology 34, new drugs 23, resistant 22, implementation 21, special populations 20, devices 17, emergencies 14, patient-experience 12, targets 9, genetics 8, guidelines 5, lifestyle 5. Unique PMIDs taken to summary: 460.

PubMed-indexed CDSR hits in the window: 3. The only on-topic record is a protocol, not a completed review (Larvie 2026, PMID 42788405), comparing ≤130/85 mm Hg with ≤140–160/90–100 mm Hg in elevated blood pressure plus diabetes. It does not supersede ESPRIT or BPROAD. The other two are off-topic on title: dialysis neuromuscular stimulation (PMID 42757634) and cardiorespiratory training after stroke (PMID 42742033). Per-topic CDSR queries for devices, pregnancy, secondary hypertension, implementation, frailty and emergencies returned 0 in PubMed in this window.

Europe PMC, first publication date 2026-09-01 to 2026-10-12: broad title query hit count 32; Cochrane journal filter hit count 1; NOT SRC:MED hit count 131, none promoted. NOT HAS_PMID:Y did not filter (hit count stayed 698, the same as the title-hypertension count) and is not an absence of non-PMID records. ISH Africa was in Europe PMC, not open access, not in full text. The ACC resistant-hypertension pathway title search returned hit count 0.

Retraction query: 1 hit, PMID 42719959, an expression of concern about a Toll-like-receptor paper in spontaneously hypertensive rats. The original paper is not cited here. Not added. The 17 added records had neither Retracted Publication nor Expression of Concern in PubMed publication types. Crossref updated-by was empty where the DOI resolved. The PubMed DOI strings for Cheng (PMID 42780603) and Sharman (PMID 42849428) returned Crossref 404, so those two retraction checks are PubMed-only and both papers are cited by PMID. Several other PubMed ArticleId DOIs pointed at different papers (Larvie, Adegoke, Su, CONSEP, DiPette, THINK) and were not used.

ClinicalTrials.gov: none of the 61 previously cited records had a results-first post date on or after 2026-09-01. Three changed status or enrolment. NCT07222917 is now active, not recruiting, actual n=222, completion 2026-12-10 (was recruiting, n=218, completion 2027-05). NCT07679828 is now recruiting, n=8,252 (was not yet recruiting). NCT05405920 is now completed, actual n=1,706, completion 2026-09-09, no results posted (was active, not recruiting, n=1,280). NCT05414526 (InterCARE) is completed, actual enrolment 4,655, hasResults false. NCT05732727 (THINK) is recruiting, estimated n=720. A query.term search for CONSEP returned no studies. A query.term search for the Bhagat postpartum comparison returned no studies. A query.term search for lorundrostat and CKD returned NCT06150924, which matches the published Explore-CKD design (completed, actual n=60, results posted 2026-06-03, acronym field empty). The paper reports 59 participants.

NICE NG136, retrieved 2026-10-12, still says published 28 August 2019 and last updated 26 February 2026. Not superseded. The WHO fact sheet, retrieved 2026-10-12, has dateModified 2025-09-25 and still states 1.4 billion adults. It has no PMID and was not added. The wiki prevalence headline remains NCD-RisC 2019. No new GBD or NCD-RisC systemic-hypertension prevalence paper was in the PubMed window. Patient-voice pages were not edited; no new patient-organisation document was cited.

What survived triage¶

Seventeen PMIDs. No deep note. The rest of the 460 were not added: small trials, narrative reviews, letters, case reports, stroke blood-pressure papers (owned by the stroke condition), pulmonary hypertension, and secondary meta-analyses of baxdrostat, lorundrostat and zilebesiran that re-summarise trials already in the wiki. A QUADRO correction was not added because QUADRO is not cited here.

Pages edited, all demoted to status: draft, last-curated: 2026-10-12:

Guidelines: 2026 ISH Africa (PMID 42554264; thresholds not in the abstract), Jian reclassification (PMID 42858041; 13.84% and 0.42 million quoted and not reconciled), Adegoke Lagos survey (PMID 42688995), DiPette HEARTS 2.0 comparison (PMID 42756877), ACC pathway pointer (PMID 42831847), Larvie protocol pointer.
Pharmacological therapy and the trials page: Explore-CKD lorundrostat (PMID 42778148; NCT06150924; 59 in the paper, 60 on the registry).
Adherence, special populations, statistics, and OQ-10: InterCARE (PMID 42586107; paper 4,654, registry 4,655) and the Salam mean-pressure meta-regression (PMID 42605672). Australian general-practice interviews (PMID 42693929) are on the adherence page only.
Trials page: the three status changes above, plus THINK (PMID 42754276; NCT05732727).
Resistant hypertension: the ACC pathway is indexed and not summarised.
Secondary hypertension: pentixafor meta-analysis (PMID 42687933) and the CONSEP protocol (PMID 42697927). OQ-1 notes that CONSEP tests screening uptake, not the false-positive burden.
Blood-pressure targets and special populations: the Larvie protocol does not change the diabetes-target conclusion.
Definition and measurement, and OQ-25: Tasmanian co-design study (PMID 42849428). It does not settle the mapping question.
Lifestyle: Taiwan sodium consensus recommendations only (PMID 42780603). Dose–response figures the consensus restates were not copied in as new evidence.
Pregnancy: ISH position paper (PMID 42695459; recommendations not in the abstract; Europe PMC not open access) and one open-label postpartum nifedipine versus enalapril-hydrochlorothiazide trial (PMID 42767560). The primary sustained-control contrast was not significant. It does not replace the labetalol comparison.
Registry, statistics (caveat 13), open questions OQ-1, OQ-10, OQ-25 and OQ-26, bibliography (811 distinct PMIDs after recount), and this index. Nine wiki pages were not edited and stay curated.

What the next sweep should chase¶

Full text of the 2026 ISH Africa guideline for numeric thresholds. Full text of the 2026 ACC resistant-hypertension decision pathway. Jones position-paper recommendations, which are not in the abstract. Larvie, when a completed Cochrane review replaces the protocol. InterCARE outcomes past the 12-month coprimaries. CONSEP results and any ANZCTR identifier. THINK results and an EU CTR/CTIS identifier. Posted results for NCT05405920. Outcome reads for baxdrostat (NCT06742723) and zilebesiran (NCT07181109), both still recruiting. Salt-substitute safety trials NCT07460882 and NCT07178964. Whether any general hypertension guideline adopts universal primary-aldosteronism screening. English primary texts of JSH 2025 and the 2024 Chinese guideline. Crossref resolution for the Cheng and Sharman DOIs. Retraction status of the 17 new PMIDs. The WHO fact sheet's 1.4 billion (page dated 2025-09-25, no PMID) against the NCD-RisC 2019 headline, if a citable update appears. A CTRI record for the Bhagat trial. LILACS and SciELO, if a search endpoint opens. Latin American regional literature was not searched this round.

2026-09-01 — Independent audit (auditor: codex; author: claude)¶

Audited every one of the 20 canonical wiki pages and all 14 literature artifacts. This was an independent audit: claude authored the material and codex audited it. The audit checked 1,872 claim–citation pairs (body citations, excluding each page's reference list and the bibliography), 3,728 PMID mentions representing 794 unique PubMed records, and 84 NCT mentions representing 61 unique ClinicalTrials.gov records. Every unique PMID was fetched live from PubMed E-utilities in this audit session; every unique NCT identifier was fetched live from the ClinicalTrials.gov v2 API. All 794 PubMed records and all 61 trial records resolved. The 1,062 wiki reference-list entries (768 unique records) were also checked for closure and identity; every PMID used in a page body appears in that page's References section. The bibliography contains all 794 records exactly once. Eighteen unique external literature URLs were checked: 16 resolved directly, and two official organisation pages that rejected automated retrieval with HTTP 403 were confirmed through live indexed-web results.

Errors found and fixed¶

Area	Error in authored material	Correction made
NICE thresholds and targets	The NICE values carried an unresolved verification flag, and the build log said the full guidance had not been retrieved.	Retrieved the current NG136 recommendations live and replaced the flag with the supported paired clinic/out-of-office diagnostic thresholds and the under-80/80-plus clinic and out-of-office treatment targets; added the indexed NICE record to the page references and bibliography.
Pregnancy treatment targets	The page said no randomized trial had tested a target below 140/90 mm Hg.	Added CHIPS (randomized diastolic target 85 versus 100 mm Hg), narrowed the remaining gap to a systolic target below 140 mm Hg, and recorded the live GOALPOST trial.
Labetalol versus nifedipine in pregnancy	The page said no adequately powered direct trial existed.	Added the 894-participant severe-hypertension trial (primary-control success 84% versus 77%; p=0.05) and the 323-participant postpartum trial (readmission 1.2% versus 8.1%; adjusted odds ratio 0.12), with the claim limited to each study's population and endpoint.
Renin-guided treatment	Several pages said it had never been randomized.	Added the 44-person comparative randomized pilot (similar pressure change, control 62.5% versus 25%, fewer medications), the RETAME-PA protocol and live trial record, and the live SPIRO-First record; narrowed the open question to definitive outcome-scale evidence.
Deprescribing in frail older adults	The pages said the strategy had never been randomized.	Added RETREAT-FRAIL (1,048 participants; death 61.7% versus 60.2%, hazard ratio 1.02, 95% CI 0.86–1.21; systolic pressure 4.1 mm Hg higher after deprescribing) and the completed 522-participant OptimizeBP registry record, for which no indexed results publication was found at the audit date.
Absolute-risk communication	The patient-experience material said absolute-risk framing had never been tested in hypertension.	Added the 210-person randomized decision-aid study (medication use 65.0% versus 57.9%, odds ratio 1.35, 95% CI 0.77–2.36; adherence 43.7% versus 40.2%, odds ratio 1.15, 95% CI 0.67–2.00) and the 159-person EFFRICO trial, which did not significantly change the risk score; narrowed the evidence gap to isolated absolute-versus-relative framing.
Community health-worker outcomes	The CRHCP landmark note and implementation page stopped at early blood-pressure outcomes and said outcome follow-up was awaited.	Added the three-year cardiovascular result (1.62% versus 2.40% per year; hazard ratio 0.67, 95% CI 0.61–0.73) and seven-year result (2.4% versus 3.0% per year; hazard ratio 0.76, 95% CI 0.72–0.81), including the reported hypotension and mild-hypokalaemia signals, and corrected the landmark note and statistics table.
Salt-substitution characterization	The SSaSS note called it the only lifestyle intervention with outcome evidence.	Replaced the absolute claim with the supported, narrower statement that it is one of few hypertension-focused environmental interventions with hard cardiovascular outcomes.
Trial-registry drift	Eleven completion dates and two enrolment values were stale.	Re-fetched every registry record and corrected the displayed completion dates; corrected OptimizeBP enrolment to 522 and SPIRO-First enrolment to 30.
Unsupported absence claims	Multiple pages used undated, categorical “no trial/no study” language.	Re-ran targeted PubMed and ClinicalTrials.gov searches and replaced the surviving gaps with positively stated, search-dated formulations. These now cover inpatient noncardiac treatment outcomes, diagnostic-threshold outcome trials, intensive targets in frailty, deliberate variability reduction, implementation-model head-to-head trials, a diastolic floor, young low-risk stage-1 event trials, ACCOMPLISH replication with chlorthalidone, sex-specific thresholds, nocturnal targets, processed-food salt substitution, randomized hypertension definitions, adherence testing before devices, resistant-hypertension cardiovascular outcomes, measurement-quality clinical endpoints, and validated treatment-burden instruments.
Citation metadata introduced during correction	Initial draft corrections carried incorrect author/journal metadata for four newly located records.	Re-fetched their PubMed summaries and corrected author, journal, year, volume and page/article strings everywhere before promotion.

Closure and disposition¶

No unresolved verification marker remains. All evidence gaps are positively stated and dated 2026-09-01 rather than asserted as timeless absences.
The retracted ambulatory-monitoring paper and the chronotherapy paper carrying an expression of concern remain present only in explicit publication-status warnings; neither is used as affirmative evidence. Their PubMed publication-status records were re-fetched during this audit.
No unresolved substantive claim–citation mismatch remains. Local links resolve, all body citations close to page reference lists, all bibliography entries are unique, and every cited PMID and NCT record exists and matches the work or trial described.
20/20 pages promoted from draft to curated. The condition status in CONDITIONS-ROADMAP.md was advanced to audited.

2026-09-01 — Full build (engine: claude)¶

Built all 20 canonical pages, the complete literature layer, a tiered open-questions agenda and this index update, from live literature searches run in this session. Every one of the 785 distinct PMIDs cited anywhere in this condition was resolved by a live PubMed E-utilities query during this session, and all 56 ClinicalTrials.gov identifiers were resolved by live v2 API queries. No identifier was written from memory. Both sets were re-verified programmatically at the end of the build: the cited-PMID list was diffed against the session's retrieval log with zero unmatched identifiers, and each NCT ID was fetched individually and confirmed to resolve.

What was built¶

20/20 wiki pages, 2,855 lines total, 37–79 cited PMIDs per page (median ~49), all left at status: draft.
literature/BIBLIOGRAPHY.md — 785 records in 19 domain sections, cross-indexed to every file that cites them. Metadata was regenerated programmatically from live esummary output rather than transcribed, so author/journal/year/volume/pages strings match the database exactly.
literature/notes/ — 7 landmark deep notes: NCD-RisC 2021, BPLTTC 2021, SPRINT 2015, Brown 2020 (primary aldosteronism prevalence), SYMPLICITY HTN-3, SSaSS, CRHCP. Choice recorded: the playbook suggests 3–6; I wrote 7 because the seed identified implementation as this condition's defining problem, and CRHCP is the strongest single demonstration of it.
literature/guidelines/REGISTRY.md — 40 documents with supersession chains (JNC7 → JNC8 → 2017 ACC/AHA → 2025 AHA/ACC; ESH/ESC 2013 → ESC/ESH 2018 → the 2023/2024 European split; JSH 2004 → 2014 → 2019 → 2025; NICE CG127 → NG136; Hypertension Canada 2020 → 2025; ISSHP 2014 → 2018), per-document notes, a numerically stated disagreements table and a watch list.
literature/statistics/STATISTICS.md — 15 tables, every figure carrying source, year, population and method, with a 12-point known-conflicts section.
literature/patient-voice/ — README (method and ethics), organizations.md (18 organisations, each verified by retrieving its site on 2026-09-01), themes.md (9 themes, each with ≥2 independent sources, plus 3 sub-threshold observations recorded honestly), sources.md (annotated, with an 8-point coverage-limits section).
OPEN-QUESTIONS.md — replaced the seed set with 27 questions (12 Tier 1, 15 Tier 2) and a 16-row "Dots not yet connected" table.
INDEX.md — rewritten with at-a-glance counts, six reading paths, page statuses and citation counts, and the anchor-record re-verification table.

Anchor re-verification¶

All five seed anchors were re-fetched and confirmed before use: 34450083 (NCD-RisC, Lancet 2021;398:957-980), 33933205 (BPLTTC, Lancet 2021;397:1625-1636), 26551272 (SPRINT, N Engl J Med 2015;373:2103-16), 32449886 (Brown, Ann Intern Med 2020;173:10-20), 39210715 (McEvoy, Eur Heart J 2024;45:3912-4018). Author, journal, year, volume and pages matched the seed's record in every case. As the seed instructed, they were treated as orientation only; every topic was searched afresh.

What the seed questions became¶

Seed	Outcome
SQ-1 (why control stays low)	Became the spine of adherence-and-implementation.md and OQ-10/OQ-18. The implementation trials (CRHCP, barbershop, HOPE 4, Kaiser) were assembled as instructed; the finding that none has been compared with another is now OQ-10.
SQ-2 (how low, in whom, at what cost)	Became blood-pressure-targets.md. The seed asked for the trials side by side with populations, methods and harms rather than a winner; that is the seven-row table. The benefit–harm ledger (NNT 58 vs NNH 55) is the honest answer.
SQ-3 (universal PA screening)	Answered, and the answer had moved. The 2025 Endocrine Society guideline (PMID 40658480) now suggests screening all hypertensive people — published after the seed was written. The question was re-cast as OQ-1 (the false-positive burden nobody has modelled) and OQ-2 (whether subclinical disease should be treated, now testable via NCT07727252).
SQ-4 (does measurement change who is treated)	Became OQ-3 and the measurement section of definition-measurement-and-diagnosis.md. The seed asked for offsets; the honest finding is that pooled attended-vs-unattended heterogeneity (I² 97%) makes a conversion factor unusable, which is a stronger result than a number would have been.
SQ-5 (lifestyle evidence that survives real life)	Became lifestyle-and-dietary-management.md. Salt-substitute outcome trials were retrieved as instructed. The organising finding — environment-level interventions outlast behaviour-level ones — is stated explicitly and carried into the patient-voice layer.
SQ-6 (did renal denervation fail)	Became device-and-interventional-therapy.md, with the trial sequence in chronological order including every negative result, and both errors named: over-claiming from unblinded data, and over-generalising from one negative trial.

Searches run¶

Approximately 75 PubMed E-utilities searches and about 30 targeted efetch abstract retrievals across: measurement and device validation; ambulatory/home/nocturnal prognosis; white-coat and masked phenotypes; global and national epidemiology; care cascades; sex differences and life-course tracking; sub-Saharan African burden; GBD attributable burden; dose–response and variability; J-curve; pressure natriuresis and its critics; RAAS, sympathetic, immune, microbiome, tissue-sodium and obesity mechanisms; GWAS, rare variants, PRS, monogenic forms and pharmacogenomics; primary aldosteronism prevalence/outcomes/subtyping/surgery; renovascular disease; OSA and CPAP; phaeochromocytoma, coarctation, fibromuscular dysplasia, drug-induced hypertension; every major target trial and its subgroup analyses; first-line drug classes and Cochrane reviews; ALLHAT/ACCOMPLISH/LIFE/VALUE/ONTARGET/DCP; combination-first strategies; chronotherapy; aldosterone synthase inhibitors, endothelin antagonism and siRNA; PATHWAY-2 and resistant-hypertension epidemiology; the full renal-denervation sequence plus baroreflex and AV-anastomosis devices; pregnancy (CHAP, CHIPS, ASPRE, POP-HT, BUMP 2) and long-term maternal risk; CKD/dialysis/transplant, diabetes, frailty, deprescribing, ethnicity, HIV, paediatrics; adherence measurement and implementation trials; hypertensive emergency and inpatient over-treatment; guidelines from 12 bodies including historical ones; and qualitative patient-experience literature. Plus about 10 ClinicalTrials.gov v2 queries and 30 organisation-website retrievals.

Judgement calls, recorded¶

Seven landmark notes rather than six, for the reason above.
PMID 29669232 (Banegas, N Engl J Med 2018, Spanish ambulatory registry) was deliberately not used anywhere as evidence: PubMed flags it as a retracted publication. The 2023 Lancet analysis of the same registry (PMID 37156250) is used instead, and the exclusion is stated in definition-measurement-and-diagnosis.md and in the statistics caveats so a later reader does not "restore" it.
The Hygia Chronotherapy Trial (PMID 31641769) is presented as a contested claim, not as evidence. Its journal Expression of Concern (PMID 32318736), the investigators' rebuttals, and the neutral TIME trial (PMID 36240838) are all cited so the reader can see the shape of the dispute.
Three organisations could not be described from their own websites — the American Heart Association and US CDC returned HTTP 403 access-control responses, and the Japanese Society of Hypertension's English page redirected to a Japanese error page. Rather than describe them from memory, they are listed in a separate "referenced but not directly verifiable" table with the limitation stated. One candidate organisation (a national heart foundation in India) resolved to an unrelated NGO consultancy and was dropped entirely.
The 36-month SYMPLICITY HTN-3 result is not presented alongside the 6-month randomised figure in the statistics tables, because unblinding and crossover with imputation mean it is not the same kind of estimate. This is stated in both the wiki page and the statistics caveats.
literature/BIBLIOGRAPHY.md topic assignment is algorithmic — each record is filed under the earliest-in-sequence domain among the pages that cite it. A record cited by several pages therefore appears once, under one heading, with all citing files listed. This is deliberate: one record, one line.
Where a guideline's primary document is not indexed in English (2024 Chinese guidelines; JSH 2025), it is catalogued through the indexed highlights or comparative papers and flagged on the registry watch list rather than cited as if the primary text had been read.

Could not be verified / deliberately omitted¶

No NICE guideline full text was retrieved. NG136 is catalogued via its PubMed guideline record (PMID 31577399) and the update summary (PMID 32001477); its specific numeric recommendations are described only to the extent those indexed sources support them.
JNC 8's non-endorsement by NHLBI is stated in the registry as a fact about its status; it rests on the guideline's own published account (PMID 24352797) and general knowledge of the episode, and an auditor may wish to source it more tightly or soften it.
No non-English database was searched for the patient-voice layer; this is stated as a coverage limit in literature/patient-voice/sources.md.
The May Measurement Month campaign's published results papers were not retrieved — a title-word search returned unrelated records and the campaign is cited only via its verified website. An auditor should search for the ISH-authored MMM results series by author or journal rather than by campaign name.
No figure in this build was taken from a source's abstract-free record. Where only title-level metadata was available, the record is used for existence and attribution, not for a number.

Follow-ups for the auditor, in priority order¶

Re-fetch and check every numeric claim in the statistics tables and the TL;DRs. These carry the highest density of extracted numbers and the highest cost if wrong.
Re-run the searches behind every asserted absence. The pages state a number of "no trial has ever…" claims — inpatient BP targets (OQ-4), renal denervation outcome trials (OQ-9), variability-reduction strategies (OQ-14), renin-guided treatment (OQ-12), sex-specific thresholds (OQ-19), absolute-risk communication (OQ-11). Stale absences are the commonest real error, and these are the load-bearing ones.
Confirm the ClinicalTrials.gov statuses, which drift. All 56 were live at 2026-09-01; the phase 3 outcome trials (NCT06742723, NCT07181109) are the ones most likely to have moved.
Check the guideline registry's supersession chains, particularly the JSH sequence and the 2018→2023/2024 European split, which is described from the guideline documents rather than from a source that states the split explicitly.
Check the ALLHAT race-interaction description in special-populations.md — the point that the interaction exists for lisinopril but not amlodipine is doing real interpretive work and should be read against PMID 15811979 directly.
Verify the three unverifiable-website organisations from a different network position; if they resolve, they should be described properly.
Promote nothing without checking the two flagged publications (PMID 29669232 retracted, PMID 31641769 expression of concern) are still handled correctly.

Next: independent audit by an engine other than claude, then publication. Status set to built in CONDITIONS-ROADMAP.md.

2026-09-01 — Seeded¶

Created the condition scaffold per CLAUDE.md's add-a-new-condition workflow, and registered it in CONDITIONS-ROADMAP.md under Cardiovascular.
Ran live PubMed scoping searches and recorded five resolved anchor records. Every PMID came from a live query in this session; none was written from memory.
Measured the literature first, as with uterine adenosarcoma, and got the opposite answer: 724,578 records, the largest in this repository and roughly 2,800 times the size of the adenosarcoma corpus. The failure mode here is sprawl, not thinness.

The scoping decision. Hypertension borders four conditions already curated, so the seed defines the border explicitly in INDEX.md: this condition owns the exposure and its management — measurement, diagnosis, epidemiology, mechanism, secondary causes, targets, drug and lifestyle therapy, resistant disease, devices, pregnancy, implementation, emergencies — and does not own the end-organ diseases. Cardiac end-organ damage stays in hypertensive-heart-disease; stroke in stroke; coronary disease in ischemic-heart-disease; blood-pressure lowering as dementia prevention in vascular-dementia, which already carries SPRINT MIND. The rule given to the build is cross-link, never restate: where a trial matters to two conditions, each cites it for its own endpoint.

A framing instruction for the build. With three-quarters of a million records, almost any loosely phrased question has already been studied. "Open" must mean a decision that specific retrievable evidence leaves unresolved, not a topic nobody has written about; questions failing that test should be dropped rather than dressed up. The seed anchors are orientation points only and explicitly not a foundation — the build should search each topic afresh rather than building outward from five papers.

Next: full build from live literature, then an independent audit by a different model than the one that wrote the pages.