Created:INDEX.md (18 canonical pages), wiki/overview.md (draft, 26 verified PMIDs), OPEN-QUESTIONS.md (7 seed questions), and this log.
Searches run (live PubMed E-utilities esearch/esummary): HHD definition/pathophysiology and GBD/US burden; worldwide hypertension control; ACC/AHA and ESC/ESH guidelines; LVH prognosis and LIFE; SPRINT, STEP and ALLHAT; blood-pressure-lowering meta-analyses; primary aldosteronism; obesity/remodeling; hypertension genomics; resistant hypertension/PATHWAY-2; DASH; home monitoring; renal denervation.
Verification: every cited PMID was returned by PubMed in this session. Claims explicitly distinguish modeled/coded HHD from clinically phenotyped disease.
Next: full build queued per CONDITIONS-ROADMAP.md, including a dedicated nosology/attribution audit and literature layers.
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and 0 literature artifacts; no literature/ directory or artifacts exist yet. The 17 planned canonical pages were not treated as existing audit targets or created during this audit.
Citation checks: checked 70 inline claim→PMID links representing 35 unique PubMed records. Every final PMID was re-fetched through live PubMed E-utilities; all identifiers resolved, body/reference sets match, author/year metadata match, quoted effect estimates match the retrieved abstracts, and the page has zero unresolved verification markers or NCT identifiers.
Errors found and fixed (10): seven citation/metadata mismatches (the LIFE regression source, the CMR differentiation source, Yang journal, Abughazaleh journal, the superseded/misdescribed European guideline record, Mouton journal and Vukadinović journal); one overstatement that primary-aldosteronism comparisons were pressure-matched; and two stale evidence-gap claims concerning HHD staging and imaging-defined remodeling. All 10 were fixed; none remain open on the audited page.
Adjacent consistency repairs (3): changed the index header from seeded to audited, replaced the same stale staging/pressure-matching language in OPEN-QUESTIONS.md, and corrected the SPRINT citation label there to match the live PubMed group-author record.
Current evidence added: 2024 CMR differential-diagnosis meta-analysis (PMID 39156132), 2024 ESC guideline (PMID 39210715), 2025 REVERSE-LVH results (PMID 40739095), 2026 REMODEL staging results (PMID 41771092) and 2026 renal-denervation outcome-evidence review (PMID 42144689). Quantitative trial and meta-analysis estimates replaced qualitative wording where the records supplied effect sizes and confidence intervals.
Searches run: 20 live PubMed E-utilities searches covering LIFE LVH regression/prognosis, CMR differentiation and treatment thresholds, HHD definitions/staging and recent literature, current ESC guidance, ECG-LVH, ambulatory confirmation, surveillance intervals, REVERSE-LVH/REMODEL and renal-denervation cardiovascular outcomes; plus two live ClinicalTrials.gov API searches for renal-denervation outcome studies and HHD CMR/fibrosis staging studies.
Validation:overview.md is 157 lines with 35/35 references used in the body, 35/35 body PMIDs listed in References, consecutive reference numbering and all required sections. It passed and was promoted from draft to curated; the roadmap was changed to audited for the existing seed.
Remaining scope, not audit flags: the full build is still outstanding—17 canonical wiki pages and the complete literature layer remain planned. No unresolved substantive issue or citation flag remains in the existing page.
Scope: re-audited 1/1 existing wiki pages (wiki/overview.md) and confirmed that there are still 0 literature artifacts (literature/ does not exist). The 17 planned canonical pages were not created or counted as audit failures.
Citation checks: checked all 70 inline claim→PMID pairs representing 35 unique PubMed records and all 35 reference-list entries. A fresh batch PubMed E-utilities efetch resolved 35/35 identifiers; author, publication year and journal matched; every quoted sample size, effect estimate and confidence interval matched the retrieved record; body and reference PMID sets were identical. The two guideline records have no PubMed abstracts, so their category comparison was also checked against live official AHA and ESC guideline material. The page contains 0 NCT identifiers.
Errors found and fixed: 0 substantive, numeric, identifier or bibliographic errors were found; therefore no page content repair was required. The page remains status: curated.
Evidence-gap refresh: ran six live PubMed E-utilities searches covering HHD definition/classification, biomarker staging and external validation, imaging follow-up/surveillance, and renal-denervation cardiovascular outcomes. An exact external-validation search for the REMODEL biomarker approach returned no records. Newer searches retrieved proposed imaging markers and prognostic cohorts but no externally validated universal HHD rule or validated HHD-specific surveillance interval.
ClinicalTrials.gov refresh: ran four live v2 API searches covering HHD staging/CMR and renal-denervation cardiovascular outcomes. The focused renal-denervation outcome search returned 65 registrations; completed studies were principally BP, safety, remodeling or arrhythmia studies, while major-event studies were ongoing, not yet recruiting or of unknown status. No completed, adequately powered randomized major-event reduction was identified.
Remaining flags: 0 unresolved verification markers, citation mismatches or substantive audit issues. The roadmap already records this condition as audited, so no roadmap text change was necessary. The absent literature layer and 17 planned pages remain future full-build scope, not failed audit artifacts.
2026-08-28 — Citation-integrity and freshness re-audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and confirmed 0 literature artifacts because literature/ does not exist. The 17 planned canonical pages were not created or counted as audit targets.
Citation checks: checked all 83 final inline claim→PMID occurrences representing 37 unique records and all 37 reference entries. Fresh PubMed E-utilities retrieval resolved 37/37 final identifiers; author, year, journal, study population and quoted numerical estimates matched the live records. Body and reference PMID sets are identical. The final page contains 0 [unverified] markers and 0 NCT identifiers.
Errors found and fixed (8): replaced one superseded guideline citation—the 2017 ACC/AHA guideline—with the live-retrieved 2025 multisociety AHA/ACC replacement; added direct inline support to seven non-trivial synthesis or evidence-boundary claims that had relied on citations in surrounding text or tables. No substantive or numerical error remained after repair.
Evidence-gap refresh: replaced general surveillance-gap support with two live-retrieved longitudinal cohorts: one analyzed echocardiograms obtained 6–18 months apart in 1,600 patients and one followed 756 CMR-referred patients for a median 7.1 years. Neither compared surveillance schedules, and the refreshed search found no validated HHD-specific surveillance interval. Searches for external validation of REMODEL retrieved the derivation report but no independent validation record.
Searches run: 14 live PubMed E-utilities searches covering HHD definition/staging, REMODEL external validation, CMR phenotyping, longitudinal imaging and surveillance, LVH regression/mediation, renal-denervation cardiovascular outcomes, and the current US hypertension guideline; repeated batch and targeted efetch calls verified final metadata and abstracts. Four ClinicalTrials.gov v2 query strategies were run in five API calls, including a complete 193-registration hypertension/renal-denervation sweep. The focused completed randomized cardiovascular-outcomes result enrolled three participants and used blood-pressure change, not major cardiovascular events, as its primary outcome.
Validation and status:overview.md is 159 lines, has all required sections, has consecutive reference numbering, and retains status: curated. INDEX.md now reports the correct 37-PMID count; OPEN-QUESTIONS.md carries the refreshed surveillance evidence boundary. All existing pages passed. CONDITIONS-ROADMAP.md already records audited, so its status required no textual change.
Remaining scope, not audit flags: 17 planned wiki pages and the complete literature layer remain to be built. There are no unresolved citation, verification or substantive audit flags in the existing page.
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and confirmed that there are 0 literature artifacts because literature/ does not exist. The 17 canonical filenames marked planned in INDEX.md are not existing pages and were not created during this audit.
Citation checks: checked all 85 final inline claim→PMID occurrences representing 38 unique PubMed records and all 38 reference-list entries. Fresh PubMed E-utilities efetch calls resolved 38/38 final identifiers; titles, journals and publication years match the live records, body and reference PMID sets are identical, and every quoted sample size, effect estimate, confidence interval and stated study-design boundary matches the retrieved abstract. The final page contains 0 [unverified] markers and 0 NCT identifiers.
Errors found and fixed (1): no wrong identifier, number, bibliographic field or substantive conclusion was found. One citation-support weakness was fixed: the statements that HHD lacks a uniformly validated universal definition now cite the live-retrieved review that explicitly states that no comprehensive, generally accepted universal definition and classification was available (Nemtsova 2023, PMID 37048689), rather than relying only on broader pathophysiology reviews. INDEX.md was updated from 37 to 38 verified PMIDs.
Evidence-gap refresh: 11 live PubMed E-utilities searches covered HHD definition/classification, biomarker staging and REMODEL validation, recent phenotyping, serial imaging and surveillance intervals, and renal-denervation cardiovascular outcomes. Recent work included proposed imaging markers and internally or institutionally validated phenotypes, but the search found no universal rule joining pressure exposure, imaging injury and clinical attribution; the focused biomarker-validation search retrieved only the REMODEL derivation report; and a randomized HHD imaging-surveillance-interval query returned no records.
ClinicalTrials.gov refresh: four live v2 API searches covered renal denervation in hypertension and HHD/CMR/biomarker/fibrosis studies. The principal renal-denervation search retrieved 203 registrations, including 76 completed studies; completed randomized registrations primarily tested blood-pressure efficacy or procedural safety, while event-oriented studies were observational, ongoing, small, or not completed. No completed, adequately powered randomized reduction in myocardial infarction, stroke, heart failure or cardiovascular death was identified.
Validation and status:overview.md is 160 lines, contains every required section, has consecutive reference numbering, and has 38/38 references used in the body. It retains status: curated. INDEX.md and OPEN-QUESTIONS.md use only PMIDs resolved in this session. All existing pages passed; CONDITIONS-ROADMAP.md already records audited, so no roadmap edit was required.
Remaining scope, not audit flags: 17 planned wiki pages and the complete literature layer remain unbuilt. There are 0 unresolved citation mismatches, verification flags or substantive audit issues in the existing audited scope.
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and confirmed that there are 0 literature artifacts because literature/ does not exist. The 17 canonical filenames marked planned in INDEX.md remain outside the set of existing pages.
Citation checks: checked all 85 body claim→PMID occurrences, 38 unique PubMed records and all 38 reference-list entries. A fresh PubMed E-utilities batch efetch and esummary resolved 38/38 identifiers. Reference titles and publication years matched 38/38 live records; the body and reference PMID sets matched exactly; and the quoted study sizes, effect estimates, confidence intervals and evidence boundaries matched the retrieved abstracts. The existing condition content outside LOG.md contains 0 NCT identifiers and 0 [unverified] markers.
Errors found and fixed: 0 identifier, bibliographic, numeric, claim-support or substantive errors were found, so no wiki text required repair. overview.md remains status: curated.
Evidence-gap refresh: ran eight date-sorted PubMed E-utilities searches covering HHD definition/classification, biomarker staging and external validation, REMODEL follow-up, imaging surveillance intervals, randomized imaging schedules and renal-denervation cardiovascular outcomes. Newer records included proposed biomarkers, imaging classifiers and prognostic studies, but did not supply an externally validated universal HHD rule, an independently validated REMODEL biomarker strategy or a randomized HHD-specific surveillance interval.
ClinicalTrials.gov refresh: queried the live v2 API for renal denervation in hypertension and retrieved all 237 registrations across three pages, including 86 completed studies. Among completed randomized studies, event terms appeared chiefly in safety composites or secondary outcomes; none had myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or an equivalent hard-event composite as a primary efficacy outcome. Four additional live query strategies covered HHD CMR, biomarkers, staging and surveillance; they identified imaging/biomarker development studies but no completed external validation of a universal staging rule or trial comparing HHD surveillance intervals.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body and no unresolved substantive issue. All existing pages passed. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining scope, not audit flags: the full build remains outstanding: 17 planned wiki pages and the complete literature layer have not been created. These are documented future scope, not unresolved issues in the existing audited page.
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and confirmed that there are 0 literature artifacts because literature/ does not exist. The 17 filenames marked planned in INDEX.md remain future build scope rather than existing audit targets.
Citation checks: checked all 87 final inline claim→PMID occurrences representing 38 unique PubMed records and all 38 reference-list entries. Fresh live PubMed E-utilities efetch and esummary calls resolved 38/38 identifiers; reference titles and publication years matched 38/38 live records; author and journal metadata matched; body and reference PMID sets were identical; and the quoted study sizes, effect estimates, confidence intervals and stated design boundaries matched the retrieved records. The condition content outside this log contains 0 NCT identifiers and 0 [unverified] markers.
Errors found and fixed (3 issue classes across 8 prose instances): removed six unsupported extensions from the cited GBD evidence to coded or death-certificate HHD; added direct citations to the causal clinicopathologic definition sentence; and added the source meta-analysis's omitted caveat that its Cornell-product stroke association was not robust in sensitivity analysis. No identifier or quoted numerical value required correction.
Evidence-gap refresh: ran 12 live PubMed E-utilities searches covering HHD definition/classification, external validation, the REMODEL biomarker approach, recent phenotyping, serial imaging and surveillance intervals, and renal-denervation cardiovascular outcomes. The searches retrieved externally tested differential-diagnosis algorithms and newer proposed markers, but no universal rule joining pressure exposure, cardiac injury and clinical attribution; the focused dual-biomarker search retrieved the REMODEL derivation report but no independent validation; and no trial comparing HHD imaging-surveillance intervals was identified.
ClinicalTrials.gov refresh: ran seven live v2 API query strategies covering completed renal-denervation studies and hard cardiovascular outcomes, HHD biomarker/CMR/staging studies, REMODEL validation and imaging surveillance. The completed renal-denervation search returned 79 registrations; event terms in primary outcomes were confined to short-term safety composites or small feasibility studies rather than an adequately powered randomized hard-event efficacy endpoint. Focused REMODEL-validation and HHD imaging-interval searches each returned 0 registrations.
Validation and status:overview.md is 160 lines, contains the required TL;DR, open-questions, related-pages and references sections, has consecutive reference numbering, and uses all 38 references in the body. It retains status: curated. All existing pages passed; CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was required.
Remaining scope, not audit flags: 17 planned wiki pages and the complete literature layer remain unbuilt. There are 0 unresolved citation mismatches, verification flags or substantive audit issues in the existing audited scope.
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets.
Citation checks: checked all 86 final inline claim→PMID occurrences representing 38 unique PubMed records and all 38 reference-list entries. Two fresh batch PubMed E-utilities efetch calls resolved 38/38 identifiers; the final retrieval was generated from the PMIDs extracted from the edited page. Titles, collective or first-author metadata, publication years, journals, volumes and pagination matched the live records; every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The body and reference PMID sets are identical.
Errors found and fixed (10): fixed nine claim-scope or citation-support problems and one bibliographic-author mismatch. The claim repairs removed unsupported differential-diagnosis lists from two phenotype rows, narrowed the remodeling-mechanism paragraph to abstract-supported findings, qualified LV regression as a candidate mechanistic marker, removed unsupported ABPM/pseudoresistance wording, aligned the echocardiography/CMR description with the cited review, replaced an undated global claim about HHD-specific trial scarcity with the directly observable evidence boundary of the page's trial table, narrowed the guideline synthesis, and restated the SPRINT/STEP generalizability question using the populations documented in their abstracts. The ALLHAT reference now uses PubMed's full collective-author name. No PMID or quoted numerical value required replacement.
Adjacent consistency repairs (2): replaced the same overbroad SPRINT/STEP generalizability language in OPEN-QUESTIONS.md, and changed the index's causal statement that obesity and primary aldosteronism “modify progression” to the associations directly supported by the cited reviews and meta-analysis.
Evidence-gap refresh: ran nine focused live PubMed E-utilities esearch strategies plus live esummary and batch efetch verification, covering HHD definition/classification, external validation, REMODEL validation, serial imaging and surveillance intervals, recent imaging/biomarker phenotyping, and renal-denervation hard cardiovascular outcomes. The searches found proposed and externally tested differential-diagnosis tools, newer imaging cohorts and the REMODEL derivation report, but no externally validated universal HHD definition joining pressure exposure, cardiac injury and attribution; no independent validation of the REMODEL dual-biomarker thresholds; and no trial comparing HHD-specific imaging-surveillance schedules.
ClinicalTrials.gov refresh: ran five live v2 API strategies covering HHD staging/CMR/fibrosis, REMODEL external validation, HHD imaging surveillance, renal-denervation hard outcomes and all renal-denervation registrations. The full renal-denervation query returned 252 registrations: 89 completed, including 40 completed randomized studies, with 0 completed randomized studies using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular event composite as a primary efficacy outcome. Focused REMODEL-validation and HHD-surveillance queries each returned 0 registrations.
Validation and status:overview.md is 160 lines, contains the required TL;DR, open-questions, related-pages and references sections, has consecutive reference numbering, uses all 38 references in the body, and contains 0 [unverified] markers and 0 NCT identifiers. All existing pages passed and overview.md retains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned pages remain documented full-build work, not failures of the existing-page audit.
2026-08-28 — Live E-utilities and registry re-audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. INDEX.md and OPEN-QUESTIONS.md were also checked for repeated substantive claim–citation pairs.
Citation checks: checked all 86 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries, and 151 total PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch efetch and esummary calls resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live records; every quoted sample size, effect estimate, confidence interval and stated evidence boundary matched the retrieved abstracts. The page body and reference PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question text required repair. overview.md retains status: curated.
Evidence-gap refresh: ran nine live PubMed E-utilities esearch strategies covering HHD definition/classification, external validation, REMODEL biomarker validation, recent imaging/biomarker phenotyping, imaging surveillance intervals, randomized surveillance schedules and renal-denervation hard cardiovascular outcomes. The searches found proposed staging and differential-diagnosis tools, recent imaging cohorts and the REMODEL derivation report, but no externally validated universal HHD rule joining pressure exposure, cardiac injury and attribution; no independent validation of the REMODEL dual-biomarker thresholds; and no trial comparing HHD-specific imaging-surveillance schedules.
ClinicalTrials.gov refresh: ran six live v2 API strategies covering HHD studies, HHD staging/validation, REMODEL biomarker validation, HHD imaging surveillance and renal denervation in hypertension. The renal-denervation sweep retrieved 212 registrations: 79 completed, including 36 completed randomized interventional studies, with 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular event composite as a primary efficacy outcome. The focused REMODEL-validation search returned 0 registrations; the HHD-surveillance search returned 19 registrations but no trial comparing surveillance schedules.
Validation and status:overview.md is 160 lines, contains the required TL;DR, open-questions, related-pages and references sections, has consecutive reference numbering, uses all 38 references in the body, and contains 0 [unverified] markers and 0 NCT identifiers. All existing pages passed. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented full-build work, not failures of the existing-page audit.
2026-08-28 — Abstract-scope and negative-evidence re-audit¶
Scope: audited the sole existing wiki page (wiki/overview.md) and confirmed that there are 0 literature artifacts because literature/ does not exist. The 17 canonical filenames marked planned in INDEX.md are future full-build scope, not existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 final body claim→PMID occurrences representing 38 unique PubMed records and all 38 reference entries. Fresh live PubMed E-utilities esummary and efetch calls resolved 38/38 identifiers; titles, first or collective authors, journals, publication years, volumes and pagination matched the records; and quoted sample sizes, effect estimates, confidence intervals and study-design boundaries matched the retrieved abstracts. The final body and reference PMID sets are identical.
Errors found and fixed: 1 claim-scope issue repeated in 2 places. The overview and condition-level open question described SPRINT as enrolling adults without prior stroke while citing the 2015 abstract, which does not state that exclusion. Both now cite the 2021 final-report abstract, which explicitly documents it. The resulting orphaned 2015 reference was retained only on the separate broad-trial evidence-boundary sentence that it directly supports. No identifier, bibliographic field or numerical value required correction.
Evidence-gap refresh: ran 8 focused live PubMed E-utilities searches covering HHD definition/classification and external validation, REMODEL biomarker replication, imaging-surveillance intervals and renal-denervation hard outcomes. The exact HHD imaging/surveillance-interval query returned 0 records. External-validation hits concerned differential diagnosis or radiomics rather than a universal rule joining pressure exposure, cardiac injury and attribution; no independent validation of the REMODEL dual-biomarker thresholds or trial comparing HHD-specific surveillance schedules was located.
ClinicalTrials.gov refresh: ran 5 live v2 API query strategies in 6 calls covering HHD staging/CMR/biomarkers, REMODEL, HHD surveillance and renal denervation. The broad renal-denervation/hypertension sweep retrieved 219 registrations: 80 completed and 34 completed randomized studies, with 0 completed randomized study using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular event composite as a primary efficacy outcome. The focused HHD surveillance query returned 0 registrations.
Validation and status:overview.md is 160 lines, contains the required TL;DR, open-questions, related-pages and references sections, uses all 38 references in the body, and contains 0 [unverified] markers and 0 NCT identifiers. All existing pages passed and overview.md retains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was needed.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented future build work.
2026-08-28 — Full claim-to-record and evidence-gap audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope, not existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 final body claim→PMID occurrences representing 38 unique PubMed records and all 38 reference-list entries. Fresh live PubMed E-utilities batch efetch and esummary calls resolved 38/38 identifiers. Titles and publication years matched 38/38 live records; first or collective authors, journals, volumes and pagination were checked against the retrieved metadata; every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The body and reference PMID sets are identical. Across INDEX.md, OPEN-QUESTIONS.md and the overview (including its reference list), 152 PMID occurrences were checked; all resolve to the same 38-record verified set.
Errors found and fixed (1): one CMR claim generalized the documented sources of heterogeneity to “acquisition.” It now states the meta-analysis's reported MRI-vendor, post-processing-software and study-region heterogeneity. No PMID, bibliographic field, quoted number or substantive conclusion required replacement.
Evidence-gap refresh: ran 12 live PubMed E-utilities searches covering HHD definition/classification, external validation, REMODEL biomarker replication, 2025–2026 imaging and biomarker phenotyping, serial imaging and surveillance intervals, randomized HHD studies, remodeling as a surrogate or mediator, and renal-denervation cardiovascular outcomes. New records included differential-diagnosis algorithms, imaging cohorts, machine-learning phenotypes and proposed biomarkers, but no externally validated universal HHD rule joining pressure exposure, cardiac injury and attribution. An exact search for replication of the REMODEL dual thresholds retrieved only the derivation report. No trial comparing HHD-specific imaging-surveillance schedules or trial proving clinical benefit from targeting a specified LV-mass or fibrosis change was identified.
ClinicalTrials.gov refresh: ran five live v2 API strategies covering HHD staging/CMR/biomarkers, REMODEL validation, HHD imaging surveillance, renal-denervation studies and renal-denervation hard outcomes. The broad renal-denervation/hypertension query returned 219 registrations: 80 completed and 34 completed randomized interventional studies. None of those 34 used myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome. The focused HHD surveillance and REMODEL-validation queries each returned 0 registrations; the broader HHD staging query returned 20 records but no completed external validation of a universal six-domain staging rule.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. All existing pages passed, so overview.md retains status: curated. CONDITIONS-ROADMAP.md already records audited; no roadmap edit was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented full-build work, not failures of the existing-page audit.
2026-08-28 — Fresh-record citation and registry audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist. The 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were included in the check.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. A fresh exact-ID PubMed E-utilities batch efetch retrieved 38/38 records, and a separate live esummary retrieval resolved the same set. Reference titles and publication years matched 38/38 records; first or collective authors, journals, volumes and pagination matched the live metadata; every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The page body and reference PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required repair. overview.md retains status: curated.
Evidence-gap refresh: ran 10 live PubMed E-utilities esearch strategies covering HHD definition and classification, external validation, biomarkers and REMODEL replication, serial imaging and surveillance intervals, randomized imaging schedules, LVH/fibrosis mediation and renal-denervation hard cardiovascular outcomes. New 2026 records included externally validated differential-diagnosis and prognostic models, but none supplied a universal HHD rule joining pressure exposure, cardiac injury and attribution. The exact REMODEL dual-threshold query retrieved only the derivation report (PMID 41771092), and no HHD-specific trial comparing imaging-surveillance schedules was identified.
ClinicalTrials.gov refresh: ran five live v2 API queries covering all HHD studies, HHD staging/validation, REMODEL biomarker validation, HHD imaging surveillance and renal denervation in hypertension. The renal-denervation query returned 203 registrations: 76 completed and 33 completed randomized studies. Review of every primary outcome in those 33 found 0 completed randomized studies using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome; event-containing primary outcomes were short-term safety composites. The focused HHD-surveillance and REMODEL-validation queries each returned 0 registrations.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. All existing pages passed. CONDITIONS-ROADMAP.md already records the condition as audited, so no roadmap edit was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly documented future build work, not failures of the existing-artifact audit.
2026-08-28 — Current-session claim-pair and negative-evidence audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 final body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries, and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch esummary and final batch efetch calls resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live records; quoted sample sizes, effect estimates, confidence intervals and study-design boundaries matched the retrieved records. The page body and reference PMID sets are identical.
Errors found and fixed (1 underlying issue in 2 locations): the ABPM review supports out-of-office confirmation, white-coat/masked/nocturnal phenotype detection, cardiovascular-risk prediction and treatment guidance, but its abstract did not support the stronger wording about repeated standardized office measurement. The pressure-exposure table row and detection paragraph now state only the functions directly supported by the retrieved record (Hinderliter 2018, PMID 29404785). No PMID, bibliographic field, quoted number or substantive conclusion required replacement.
Evidence-gap refresh: ran 19 distinct live PubMed E-utilities esearch strategies (with exact-threshold follow-ups) covering HHD definition/classification and external validation, recent HHD staging and phenotyping, REMODEL dual-biomarker replication, serial imaging and surveillance intervals, LV-mass/fibrosis mediation, current US and European hypertension guidelines, and renal-denervation cardiovascular outcomes. The focused dual-threshold and dual-biomarker searches each retrieved only the REMODEL derivation report (PMID 41771092); exact HHD surveillance-interval and randomized-surveillance searches returned 0 records. Broader validation searches retrieved differential-diagnosis, radiomics and prognostic tools, not a universal rule joining pressure exposure, cardiac injury and attribution.
ClinicalTrials.gov refresh: ran five live v2 API strategies covering HHD studies, HHD staging/validation, REMODEL biomarkers, HHD imaging surveillance and renal denervation in hypertension. The focused REMODEL and HHD-surveillance queries each returned 0 registrations. The HHD staging/validation query returned 13 registrations; review of all titles and primary outcomes found a completed HHD-versus-HCM differential-diagnosis algorithm but no universal HHD staging validation. The renal-denervation/hypertension sweep retrieved all 212 registrations: 79 completed, including 36 completed randomized interventional studies, with 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md is 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. All existing pages passed and overview.md retains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented future full-build work, not failures of the existing-artifact audit.
Scope: audited 1/1 existing wiki pages (wiki/overview.md), plus repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md. There are 0 existing literature artifacts because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch efetch and independent esummary calls resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live records; quoted sample sizes, effect estimates, confidence intervals and study-design boundaries matched the retrieved abstracts. The page body and reference PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found. Seven dated evidence-gap occurrences covering three distinct gaps in overview.md and OPEN-QUESTIONS.md were refreshed from 2026-08-28 to 2026-08-29 after the new searches; last-curated dates and the index curation date were advanced accordingly.
Evidence-gap refresh: ran 10 live PubMed E-utilities esearch strategies covering HHD definition/classification and external validation, REMODEL biomarker replication, serial imaging and surveillance intervals, randomized imaging/surveillance studies, LV-mass or fibrosis mediation, and renal-denervation cardiovascular outcomes. Searches retrieved newer differential-diagnosis, prognostic and imaging-phenotype studies, but no externally validated universal rule joining pressure exposure, cardiac injury and attribution; no independent validation of the REMODEL dual-biomarker thresholds; and no HHD-specific trial comparing imaging-surveillance schedules.
ClinicalTrials.gov refresh: ran six live v2 API strategies covering all HHD studies, HHD staging/validation, REMODEL biomarker validation, HHD imaging surveillance and renal denervation. The focused REMODEL-validation and HHD-surveillance queries each returned 0 registrations. The renal-denervation/hypertension sweep retrieved 219 registrations: 80 completed, including 34 completed randomized interventional studies. Review of all primary outcomes in those 34 found 0 studies using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. The sole existing page passed and retains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was required.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented future build work, not failures of the existing-artifact audit.
2026-08-29 — Complete current-session E-utilities and registry audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch efetch and independent esummary calls resolved 38/38 identifiers. Reference titles, first or collective authors and publication years matched 38/38 live records; journals, volumes and pagination were checked against the retrieved metadata; every quoted sample size, effect estimate, confidence interval and stated design boundary matched the retrieved abstracts. The page body and reference PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required repair. overview.md retains status: curated.
Evidence-gap refresh: ran 20 live PubMed E-utilities esearch strategies covering HHD definition/classification and external validation, 2025–2026 staging and phenotyping, exact REMODEL dual-biomarker thresholds and replication, CMR and echocardiographic surveillance intervals, randomized repeat-imaging schedules, LV-mass/fibrosis mediation and renal-denervation hard cardiovascular outcomes. Newer records included externally tested differential-diagnosis models, CMR phenotyping, serial observational imaging and proposed biomarkers; none supplied a universal rule joining pressure exposure, cardiac injury and attribution. The exact dual-threshold search retrieved only the REMODEL derivation report, and randomized HHD imaging-schedule searches returned 0 records.
ClinicalTrials.gov refresh: ran six live v2 API strategies covering HHD studies, HHD staging/validation, REMODEL biomarker validation, HHD imaging surveillance and renal denervation. Focused REMODEL-validation and HHD-surveillance queries each returned 0 registrations. The broad renal-denervation/hypertension sweep retrieved all 219 registrations across three API pages: 80 completed, including 34 completed randomized interventional studies. Review of every primary outcome in those 34 found 0 studies using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md is 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. All existing pages passed. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain documented future build work, not failures of the existing-artifact audit.
2026-08-29 — Independent full-record and stale-absence audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique records, all 38 reference-list entries, and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch esummary and efetch calls independently resolved 38/38 identifiers. Titles, first or collective authors, journals and publication years matched the live records; volumes and pagination matched, allowing equivalent abbreviated versus expanded page ranges. Every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The page-body and reference-list PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required repair. overview.md retains status: curated.
Evidence-gap refresh: ran 12 live PubMed E-utilities esearch strategies covering HHD definition/classification, external validation, 2025–2026 staging and phenotyping, REMODEL replication and its exact dual-biomarker thresholds, serial imaging, surveillance intervals, randomized surveillance, LV-mass/fibrosis mediation and renal-denervation hard cardiovascular outcomes. New external-validation records concerned differential diagnosis (including amyloidosis or hypertrophic cardiomyopathy versus HHD), not a universal HHD rule joining pressure exposure, cardiac injury and attribution. The REMODEL replication search returned 0 records, the exact dual-biomarker search retrieved the derivation report but no independent validation, and apparent randomized-surveillance hits were search-term collisions rather than trials comparing HHD surveillance schedules.
ClinicalTrials.gov refresh: ran six live v2 API strategies in nine calls covering all HHD registrations, HHD staging/validation, REMODEL biomarker validation, HHD imaging surveillance, HHD CMR/biomarkers and renal denervation in hypertension. The broad HHD query retrieved 172 registrations; focused staging/validation, REMODEL-validation and imaging-surveillance queries each returned 0, while the CMR/biomarker query returned two development studies rather than universal staging validation. The renal-denervation query retrieved 203 registrations: 76 completed, including 33 completed randomized interventional studies. Review of every primary outcome in those 33 found 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md is 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. All existing pages passed. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly documented future full-build work, not failures of the existing-page audit.
2026-08-29 — Full claim-pair and current-registry audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md), plus the repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical pages marked planned remain full-build scope rather than existing audit targets.
Citation checks: checked all 87 inline claim→PMID occurrences representing 38 unique records, all 38 reference-list entries and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh PubMed E-utilities efetch calls retrieved 38/38 records in four batches, and an independent batch esummary resolved 38/38. Live metadata matched all reference titles, first or collective authors, journals, publication years, volumes and pagination; every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The page-body and reference-list PMID sets are identical.
Errors found and fixed (1 wording-scope issue): the renal-denervation conclusion described the positive evidence broadly as “procedural safety.” The cited meta-analysis reported no detected between-group differences in specified safety outcomes, with wide confidence intervals for uncommon events. The text now states the narrower supported finding: BP reduction and no detected difference in selected safety outcomes. No identifier, reference metadata, numerical estimate or other substantive conclusion required correction.
Evidence-gap refresh: ran 24 live PubMed E-utilities esearch strategies, including broad and exact-title/abstract searches, covering HHD definition/classification and external validation, 2025–2026 staging and phenotyping, REMODEL dual-biomarker replication and exact thresholds, CMR/biomarker staging, HHD imaging-surveillance intervals, randomized repeat imaging, LVH/fibrosis mediation, renal-denervation hard cardiovascular outcomes and potentially superseding US or European hypertension guidelines. Newer records included differential-diagnosis, imaging-phenotype and prognostic models; none supplied a universal rule joining pressure exposure, cardiac injury and attribution. The exact REMODEL replication search returned 0 records; the exact HHD surveillance-interval and randomized-repeat-imaging searches each returned 0; and the LVH-surrogate literature continued to describe outcome mediation as unresolved. Exact-title searches found no superseding 2026 US or ESC hypertension guideline; 2026 comparative records continued to identify the 2025 AHA/ACC and 2024 ESC frameworks.
ClinicalTrials.gov refresh: ran six live v2 API queries covering all HHD registrations, HHD staging/validation, REMODEL validation, HHD surveillance, HHD CMR/biomarkers and renal denervation in hypertension. The focused REMODEL-validation and HHD-surveillance queries returned 0 registrations. The staging search identified an externally tested HHD-versus-HCM differential-diagnosis algorithm, not a universal HHD staging rule. The renal-denervation query returned 219 registrations, including 34 completed randomized interventional studies; review of every primary outcome in those 34 found 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. The sole existing page passed and retains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly documented full-build work, not failures of the existing-page audit.
2026-08-29 — Current-session full citation and stale-absence audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md) and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames marked planned in INDEX.md remain future full-build scope rather than existing audit targets. Repeated substantive claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md were also checked.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries and 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch esummary and efetch calls resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live records; every quoted sample size, effect estimate, confidence interval and stated study-design boundary matched the retrieved abstracts. The page-body and reference-list PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required repair. overview.md retains status: curated.
Evidence-gap refresh: ran 17 live PubMed E-utilities esearch strategies covering HHD definition/classification and external validation, 2025–2026 imaging and biomarker phenotyping, exact REMODEL dual-biomarker replication, CMR prognosis, imaging-surveillance intervals, randomized repeat-imaging schedules, LV-mass/fibrosis mediation, renal-denervation cardiovascular outcomes and potentially superseding US or European hypertension guidelines. New records included externally tested differential-diagnosis models and development or prognostic imaging/biomarker studies, but none supplied a universal HHD rule joining pressure exposure, cardiac injury and attribution. Exact REMODEL replication, HHD surveillance-interval and potentially superseding 2026 AHA/ACC or ESC guideline searches each returned 0 records.
ClinicalTrials.gov refresh: ran nine live v2 API strategies covering HHD studies, staging/validation, REMODEL validation, imaging surveillance and renal denervation in hypertension. Focused REMODEL-validation and HHD imaging-schedule queries each returned 0 registrations. The renal-denervation/hypertension query returned 237 registrations; a completed-interventional refinement returned 67 studies, including 33 with randomized allocation. Review of the primary outcomes in those 33 found 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome.
Validation and status:overview.md remains 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. The sole existing page passed. CONDITIONS-ROADMAP.md already records the condition as audited, so no roadmap edit was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly documented future full-build work, not failures of the existing-artifact audit.
2026-08-29 — Independent E-utilities and primary-outcome audit¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md), the repeated claim–citation pairs in INDEX.md and OPEN-QUESTIONS.md, and every existing literature artifact. The literature-artifact count is 0 because literature/ does not exist; the 17 canonical filenames explicitly marked planned remain future full-build scope, not existing audit targets.
Citation checks: checked all 87 body claim→PMID occurrences representing 38 unique PubMed records, all 38 reference-list entries, and all 152 PMID occurrences across INDEX.md, OPEN-QUESTIONS.md and wiki/overview.md. Fresh live PubMed E-utilities batch esummary and efetch calls independently resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live metadata, allowing expanded versus abbreviated page ranges; every quoted sample size, effect estimate, confidence interval and stated design boundary matched the retrieved abstracts. The page-body and reference-list PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required correction. overview.md retains status: curated.
Evidence-gap refresh: ran 17 focused live PubMed E-utilities esearch strategies covering HHD definition/classification and external validation, staging and biomarker validation, exact REMODEL biomarker thresholds and replication, imaging-surveillance intervals, randomized repeat-imaging schedules, LV-mass/fibrosis mediation, renal-denervation hard cardiovascular outcomes, and potentially superseding 2026 hypertension guidelines. The exact REMODEL-threshold search retrieved only the derivation report; focused HHD surveillance and randomized-schedule searches returned 0 records. Newer records concerned differential diagnosis, imaging phenotyping, prognosis or treatment-associated remodeling, not an externally validated universal HHD rule, independent REMODEL-threshold replication, HHD-specific surveillance schedule, or proof that targeting a specified imaging change mediates clinical benefit. No 2026 AHA/ACC or ESC hypertension guideline superseding the cited 2025 US and 2024 European documents was identified.
ClinicalTrials.gov refresh: ran five live v2 API strategies covering HHD studies, staging/validation, REMODEL biomarker replication, HHD imaging surveillance and renal denervation in hypertension. The HHD condition search returned 172 registrations; the focused staging search returned one completed differential-diagnosis algorithm rather than universal staging validation, and focused REMODEL-replication and imaging-surveillance searches each returned 0 registrations. The renal-denervation/hypertension sweep retrieved all 212 registrations across three API pages: 79 were completed and 36 were completed randomized interventional studies. Review of every primary outcome in those 36 found 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome; major-adverse-event wording in completed trials was used for safety assessment, not event-reduction efficacy.
Validation and status:overview.md is 160 lines and contains the required TL;DR, open-questions, related-pages and references sections, consecutive reference numbering, 38/38 references used in the body, 0 [unverified] markers and 0 NCT identifiers. The sole existing page passed. CONDITIONS-ROADMAP.md already records audited, so no roadmap edit was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly documented future full-build work, not failures of this existing-artifact audit.
2026-08-29 — Live-record audit and evidence-gap refresh¶
Scope: audited 1/1 existing wiki pages (wiki/overview.md), the repeated substantive claims in INDEX.md and OPEN-QUESTIONS.md, and every existing literature artifact. There are 0 literature artifacts because no literature/ directory exists; the 17 canonical pages explicitly marked planned in INDEX.md are future build scope rather than existing pages available for audit.
Citation checks: checked all 87 inline claim→PMID occurrences in overview.md, representing 38 unique PubMed records, and all 38 reference-list entries. Across INDEX.md, OPEN-QUESTIONS.md and overview.md, 152 PMID occurrences resolve to the same 38 records. Fresh live PubMed E-utilities efetch calls retrieved every record with its abstract, and an independent live esummary call resolved 38/38 identifiers. Titles, first or collective authors, journals, publication years, volumes and pagination matched the live metadata, allowing equivalent abbreviated and expanded page ranges. Quoted sample sizes, effect estimates, confidence or credible intervals, thresholds and design boundaries matched the retrieved abstracts. The page-body and reference-list PMID sets are identical.
Errors found and fixed: 0 identifier, bibliographic, numerical, claim-scope or substantive errors were found, so no wiki, index or open-question prose required correction. overview.md retains status: curated.
Evidence-gap refresh: ran 12 live PubMed E-utilities esearch strategies covering HHD definition, classification and external validation; recent imaging, biomarker and machine-learning phenotypes; exact REMODEL biomarker replication; serial imaging and surveillance intervals; randomized imaging schedules; LVH or fibrosis as mediators or surrogate targets; renal-denervation hard cardiovascular outcomes; and potentially superseding 2026 US or European hypertension guidelines. Newer records included internally or institutionally validated phenotypes, differential-diagnosis algorithms, fibrosis characterization and prognostic models, but none supplied a universal rule joining pressure exposure, cardiac injury and attribution. No independent validation of the exact REMODEL dual-biomarker thresholds and no trial comparing HHD-specific imaging-surveillance schedules were identified. Recent renal-denervation reviews continued to state that long-term cardiovascular outcome data remain awaited, and no guideline superseding the cited 2025 AHA/ACC or 2024 ESC documents was identified.
ClinicalTrials.gov refresh: queried the live v2 API by HHD condition and focused terms for staging or validation, REMODEL biomarkers and imaging surveillance, and separately swept renal denervation in hypertension. The condition query returned 172 registrations; the staging/validation refinement returned 13 mixed-purpose registrations, including a completed HHD-versus-HCM differential-diagnosis algorithm but no universal HHD staging rule. Focused REMODEL dual-biomarker and imaging-surveillance queries each returned 0 registrations. The renal-denervation query returned 219 registrations, of which 80 were completed and 34 were completed randomized interventional studies. Review of every primary outcome in those 34 found 0 using myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major adverse cardiovascular-event composite as a primary efficacy outcome; major-adverse-event wording was used for safety in the registrations that included it.
Validation and status:overview.md is 160 lines, contains the required TL;DR, open-questions, related-pages and references sections, has consecutive reference numbering, uses all 38 references in the body, and contains 0 [unverified] markers and 0 NCT identifiers. The sole existing page passed and remains status: curated. CONDITIONS-ROADMAP.md already records audited, so no roadmap text change was necessary.
Remaining flags: 0 unresolved citation mismatches, verification flags or substantive audit issues. The absent literature layer and 17 planned wiki pages remain explicitly recorded build gaps, not failed existing artifacts.
Scope completed: expanded the condition from 1 to all 18 canonical wiki pages in INDEX.md, keeping and extending the curated overview rather than replacing it. The 17 new pages cover nosology, epidemiology, ventricular and atrial remodeling, diastolic dysfunction/HFpEF, diagnosis, secondary causes, targets, pharmacology, lifestyle, HF management, outcomes, guidelines, biomarkers, trials, patient experience and safety.
Page depth: every wiki page is 154–209 lines and contains a TL;DR, evidence tables, effect estimates with uncertainty where available, open questions, related-page links and a numbered reference list. Each page uses 25–38 distinct PMIDs; body and reference-list PMID sets are identical on every page.
Live literature work: ran more than 75 live PubMed E-utilities search strategies across classification, epidemiology, remodeling, fibrosis, strain, biomarkers, AF, HFpEF, secondary hypertension, treatment targets, drug classes, lifestyle, qualitative experience, guidelines and trials. More than 1,100 records were retrieved during discovery; the final condition contains 243 unique cited PubMed records.
Citation-integrity control: performed a final live batch PubMed efetch of all 243 cited identifiers and retrieved 243/243. Bibliography citation titles and lead/collective authors were compared with live metadata; abbreviated-title flags were manually reviewed. A metadata check caught ten unrelated PMIDs introduced during open-question/statistics synthesis; those citations and unsupported formulations were removed or replaced before completion.
ClinicalTrials.gov work: queried the live v2 API for HHD and renal-denervation studies, then built a 20-registration landscape. Every NCT identifier used in the condition was re-requested from the live API before build completion.
Literature layer: created a 243-paper master bibliography, five landmark deep notes (LIFE, SPRINT, PATHWAY-2, SSaSS and REVERSE-LVH), a worldwide guideline registry with disagreements and superseded chains, a denominator-aware statistics register, and a four-file patient-voice layer.
Open questions: replaced the seed list with 28 stable questions in two tiers and a 14-row “Dots not yet connected” table specifying the missing junction and the study design capable of resolving it.
Patient voice: direct HHD-specific qualitative evidence was sparse. The synthesis therefore transparently triangulates hypertension, difficult-to-treat hypertension and HF/HFpEF sources, and keeps those populations distinct.
Status: condition moved to built. The 17 newly written pages remain draft; the existing overview remains curated. Per the playbook, promotion to audited requires an independent later session.
Known limits: clinical prevalence of imaging-defined HHD cannot be inferred from GBD attribution estimates; biomarker thresholds lack external treatment-utility validation; no randomized HHD imaging-surveillance schedule or treat-to-regression outcome strategy was identified.
Scope: audited all 18/18 canonical wiki pages and all 12/12 literature artifacts: the 243-paper bibliography, five landmark notes, guideline registry, statistics register and four patient-voice files. Repeated substantive citations in INDEX.md and OPEN-QUESTIONS.md were also included. The final corpus contains 1,679 PMID occurrences outside this log: 734 wiki body claim→PMID occurrences, 472 wiki reference entries, 413 literature occurrences and 60 occurrences in the index/open-question layer.
Live identifier verification: extracted all identifiers from the final files and queried them again in this audit session. PubMed E-utilities efetch supplied full records for all 243 unique PMIDs and a final independent esummary request resolved 243/243. The ClinicalTrials.gov v2 API returned all 22/22 unique NCT records, including the two historical hard-outcome trials added during the refreshed landscape screen. There are 0 unresolved PMIDs, 0 unresolved NCT identifiers and 0 active [unverified] flags.
Claim-to-citation review: rechecked every wiki claim–citation pairing and all quantitative statements in the literature notes and statistics register against the live title, abstract, study design and reported estimates where present. Final body and reference PMID sets are identical on all 18 pages; all 472 page references are used, unique within their page and consecutively numbered. One substantive pairing was wrong: the TOPCAT hospitalization effect and hyperkalemia rates were attributed only to a later phenogroup analysis. The primary TOPCAT report (PMID 24716680) now directly supports those numbers; the phenogroup citation remains only for phenotypic heterogeneity.
Bibliographic errors found and fixed: 58 distinct PMIDs had at least one incorrect full-citation field across 125 bibliography/reference entries. This included 46 distinct journal/source mismatches affecting 97 entries and 28 distinct lead-author or initial mismatches affecting 62 entries; the categories overlap. Every affected entry was regenerated from live PubMed metadata, including exact title, lead or collective author, NLM journal source, year, volume and pagination. The abbreviated PATHWAY-2 landmark-note heading was separately expanded to the exact live PubMed title. Final automated comparison against all 715 bibliography/page-reference entries and the five landmark-note headings reports 0 metadata mismatches.
Literature-register errors found and fixed: corrected two guideline-registry records: PMID 33404583 is a 2020 PASCAR commentary on the 2020 ISH guideline, not a 2021 Pan-African roadmap, and PMID 31636059 is the Boffa et al. BMJ summary of updated NICE guidance. All nine patient-organization URLs returned HTTP 200 during live checking.
Evidence-gap refresh: PubMed searches were rerun for HHD definition/staging, external REMODEL validation, imaging-surveillance intervals, treat-to-regression strategies, patient experience, pregnancy, AF screening and renal-denervation outcomes. The exact-phrase qualitative/patient-experience HHD search retrieved 23 records; screening identified 0 studies that explicitly recruited an HHD-diagnosed cohort to study lived experience. The exact REMODEL search found the derivation report but no independent external validation. Three live web searches found 0 organizations dedicated specifically to HHD; the patient-voice files now state these dated search results positively rather than asserting an undated absence.
ClinicalTrials.gov evidence-gap refresh: the complete HHD-tagged API screen returned 172 registrations, including 65 completed randomized interventional records. Two had hard cardiovascular-event primary composites (NCT00338260 and NCT00129233), but neither assigned treatment to an achieved serial imaging, fibrosis, strain or biomarker target. A separate renal-denervation/hypertension screen retrieved 232 registrations and 38 completed randomized interventional records; 0 used myocardial infarction, stroke, heart-failure hospitalization, cardiovascular death or a major cardiovascular-event composite as the primary efficacy outcome. The trial page now distinguishes these dated results from the narrower remaining absence of a completed treat-to-remodeling outcome strategy.
Validation and status: all 18 pages are 154–209 lines, contain 25–38 distinct PMIDs, retain the required TL;DR/evidence/open-question/related-page/reference structure, and have 0 broken local links or substantive unresolved issues. All 18 page front matters and index rows are now curated; all 12 literature artifacts are marked audited in the index. CONDITIONS-ROADMAP.md is updated from built to audited.
Remaining flags: 0 unresolved citation mismatches, 0 unresolved registry identifiers, 0 active verification flags and 0 substantive audit failures. The remaining research gaps are explicitly dated evidence statements, not unresolved editorial flags.
Window and method. Swept publications newly indexed in PubMed between 2026-08-28 and 2026-09-05 (Entrez date range, datetype=edat), i.e. everything indexed since the 2026-08-29 post-build audit. All searching was done through live PubMed E-utilities esearch/esummary/efetch over HTTPS; all registry work through the live ClinicalTrials.gov v2 API. No citation in this entry or in the files it changed was written from memory.
Searches run (16 strategies). HHD exact phrase; hypertension + LVH/LV remodeling/LV mass; hypertension + myocardial fibrosis/ECV/LGE/T1 mapping; HFpEF/diastolic dysfunction; BP targets and intensive control; antihypertensive randomized trials; AF + hypertension/BP; primary aldosteronism; renal denervation; guideline titles (hypertension, BP, heart failure, ESC); GBD/prevalence/incidence/mortality + hypertension; NT-proBNP/troponin/natriuretic peptide + hypertension or LV; sodium/salt substitute/diet/activity/weight + BP; adherence/qualitative/patient-experience + hypertension; echocardiography/GLS/speckle tracking + hypertension; hypertensive emergency/urgency/crisis/malignant hypertension; Hypertension[Mesh] × LVH/HF/ventricular-remodeling MeSH; AI-ECG and "hypertensive cardiomyopathy". Roughly 130 records were screened.
ClinicalTrials.gov sweep — null result. All 22 NCT identifiers already cited by this condition were re-requested individually from the live v2 API; 22/22 resolved. Every overall status and results-posted flag matches what wiki/clinical-trials-landscape.md records. NCT05198674 (SPYRAL AFFIRM) had the most recent activity, last updated 2026-08-25 — before the sweep window — and remains active, not recruiting, with no results posted. No status change, no results posting and no new registration required a page edit. One new identifier entered the condition through the literature: NCT03527719 (China Rural Hypertension Control Project), resolved live as active, not recruiting, enrolment 33,995.
Patient-organisation check — null result. Live web search for 2026 hypertension patient-organisation campaigns returned the CDC Foundation "Hypertension Bites" campaign (launched February 2026), American Heart Month 2026, World Hypertension Day 2026 (17 May 2026, theme "controlling hypertension together") and May Measurement Month, plus the Million Hearts Hypertension Control Challenge. All predate the 2026-08-29 patient-voice build, none is HHD-specific, and none changed the organisations list. Nothing added.
Triage. Of the records screened, 15 were kept and the remainder discarded. Ten produced wiki edits, three were catalogued in the bibliography without any page claim depending on them (Antza 2026 PMID 42663091, an ESH working-group narrative position paper on obesity hypertension; Liao 2026 PMID 42660494, a UK Biobank DASH/Mediterranean diet–HF cohort; Yee-Moon Wang 2026 PMID 42660227, a KDIGO implementation summit report), and two entered the patient-voice source register. Records deliberately rejected include a JAMA news item on guideline-eligible populations, a HFpEF left-atrial-myopathy hypothesis paper, a FINEARTS-HF risk-score secondary analysis, a small single-centre OSA–hypertension echocardiographic cross-section, the 2026 ESC cardiac-rehabilitation guideline (out of HHD scope), and one MESA left-atrioventricular-coupling paper whose abstract could not be retrieved — cataloguing a title alone would have meant asserting content that was never read.
Landmark finding — THESUS-HF II (Sliwa 2026, PMID 42669305, Lancet). 1,578 adults with acute HF at 50 hospitals in 17 African countries, July 2024–July 2025. Hypertensive heart disease was the leading aetiology at 576/1,578 (36.5%), ahead of cardiomyopathy (23.4%) and ischaemic heart disease (23.3%); 64.2% de novo; in-hospital mortality 8.7% (95% CI 7.3–10.2), 180-day mortality 20.6% (18.4–23.0) at a median age of 56; discharge guideline-directed therapy was prescribed in 55–77% but target doses were reached in fewer than half; 33.7% lost to follow-up. This is the first clinically adjudicated HHD attribution at scale in the region carrying the highest modeled burden, so it earned the sweep's only deep note: literature/notes/sliwa-2026-thesus-hf2.md.
Other findings that changed pages. CRHCP 7-year follow-up (Sun 2026, PMID 42666029, Circulation): 33,995 adults, 326 villages; 7-year BP difference −13.5/−5.4 mm Hg, CVD composite HR 0.76 (0.72–0.81), and HR 0.79 (0.73–0.85) during the 3 post-trial years after subsidy and incentive withdrawal, with hypotension RR 1.58 and mild hypokalemia RR 1.38. 2026 ESC guidelines for heart failure (Køber 2026, PMID 42661420) and for cardiovascular disease with CKD (Damman 2026, PMID 42661426), both published 2026-08-28. STEP home-BP secondary analysis (Ji 2026, PMID 42660976): achieved home systolic <125 mm Hg HR 0.62 (0.42–0.90) versus ≥135 mm Hg. BP–outcome dose-response meta-analysis in AF (Shahmohamadi 2026, PMID 42663497; 23 studies, n=476,750): U-shaped mortality with a 134-mm Hg nadir against monotonically rising haemorrhagic stroke. Time-in-range pooled analysis of TOPCAT/PARAGON-HF/DELIVER/FINEARTS-HF (Lu 2026, PMID 42669134; n=17,788): median 38% of the first year inside 110–<130 mm Hg. EDEN-47 (Miró 2026, PMID 42664163): hypertensive crisis in 0.73% of ED visits by adults ≥65, benign acute course but 57.9% one-year combined adverse events. PRECISE-HF (Docherty 2026, PMID 42663089; n=535,583): covariate-conditioned NT-proBNP thresholds beat universal ESC cutoffs, AUROC 0.896 internal and 0.757 external. AI-ECG for ATTR-CM (Croon 2026, PMID 42663420): AUROC 0.81 in an LVH/aortic-stenosis mimic stress test.
Files changed. Ten wiki pages edited and demoted to status: draft with last-curated: 2026-08-31: epidemiology-and-burden, heart-failure-management, lifestyle-and-population-prevention, blood-pressure-targets, arrhythmia-and-atrial-remodeling, diastolic-dysfunction-and-hfpef, red-flags-and-safety-concerns, biomarkers-and-imaging-markers, diagnosis-and-phenotyping, guidelines. Also changed: literature/BIBLIOGRAPHY.md (243 → 258 entries), literature/guidelines/REGISTRY.md (two 2026 ESC documents registered, 2021 ESC HF guideline moved into the superseded chain, watch-list row added), literature/statistics/STATISTICS.md (10 new rows), literature/patient-voice/sources.md (two qualitative studies), literature/notes/sliwa-2026-thesus-hf2.md (new), OPEN-QUESTIONS.md, INDEX.md. Eight untouched pages keep status: curated.
Open questions. OQ-HHD-013 marked half-answered — CRHCP settles post-subsidy durability, but nobody has compared a delivery package against a phenotype package at equal budget. OQ-HHD-005, OQ-HHD-006 and OQ-HHD-015 sharpened with the achieved-home-BP, PRECISE-HF and time-in-range results. Two new questions opened: OQ-HHD-029 (what BP target applies once HHD has produced AF, given the U-shaped mortality curve) and OQ-HHD-030 (whether clinically adjudicated and GBD-modeled HHD attribution agree on one population). Three rows added to the "dots not yet connected" table. No question was retired.
Deliberate limitation, flagged for the auditor. The two 2026 ESC guideline documents were verified to exist and are registered, but their texts were not retrieved and no recommendation, class, level of evidence or threshold from either has been asserted anywhere. Every ESC heart-failure statement in this wiki still derives from the 2021 guideline (PMID 34447992), which is now explicitly labelled superseded in both wiki/guidelines.md and the registry. Re-synthesising sections 8 and 11 of wiki/guidelines.md and the HF-guideline claims in wiki/heart-failure-management.md against the 2026 text is the single highest-priority task left open.
Verification. All 15 new PMIDs were re-resolved in a final live esummary batch: 15/15 returned. NCT03527719 was re-requested from the live v2 API and returned. All 18 wiki pages pass the structural check: body and reference PMID sets identical, references consecutively numbered with no duplicates, 160–215 lines, 25–38 distinct PMIDs. Zero broken relative links across the condition. Zero [unverified] markers.
Next sweep should chase. (1) The 2026 ESC HF and CVD-CKD texts — specifically whether stage-B/pre-HF criteria became imaging- or biomarker-based and whether CKD BP/RAAS-MRA boundaries moved. (2) THESUS-HF II substudies, which the authors say are ongoing (registry PACTR202410553810557). (3) SPYRAL AFFIRM (NCT05198674) — primary completion 2026-03-05 has passed and no results are posted; first publication is due. (4) Any external validation of the REMODEL dual thresholds, still absent. (5) Whether PRECISE-HF-style covariate-conditioned thresholds get applied to HHD staging rather than HF diagnosis. (6) Any randomized BP-target work in anticoagulated AF that would move OQ-HHD-029.
2026-08-31 — Independent audit of periodic literature sweep¶
Authorship and scope: Codex was the independent auditor; claude was the sweep author. Audited all ten wiki pages edited by the sweep plus the 15 added bibliography records, guideline registry additions, ten statistics rows, two patient-voice records, the new THESUS-HF II note, OPEN-QUESTIONS.md and INDEX.md. No other condition was touched.
Live identifier verification: re-fetched all 192 unique PMIDs cited across the ten edited pages in one live PubMed E-utilities efetch request; 192/192 main records resolved. Separately re-fetched all 15 sweep-added PMIDs with full live records and checked title, design, population, numerical estimates, direction and claim scope. Re-requested NCT03527719 from the live ClinicalTrials.gov v2 API; it resolved as a randomized interventional study, active not recruiting, enrolment 33,995. The two other NCT identifiers occurring on edited pages also resolved live. No PMID or NCT identifier failed.
Claim–citation checks: checked 410 final wiki body claim→PMID occurrences across the ten edited pages, plus 30 occurrences of the new records in the changed registry/statistics/patient-voice/note/open-question/index artifacts and all 15 new bibliography metadata entries. The CRHCP, STEP home-BP, AF dose-response, HFpEF time-in-range, EDEN-47, PRECISE-HF, AI-ECG, two qualitative-study and three catalogue-only records matched their live PubMed records for numbers and direction. The two 2026 ESC records have no PubMed abstract; only their existence, titles and publication metadata are treated as verified.
Errors found and fixed (8 substantive scope/currency categories): removed unsupported claims that THESUS-HF II was the first/largest clinically adjudicated HHD series; replaced “adjudicated” with the record-supported “clinically assigned”; added the 33.7% loss-to-follow-up boundary beside its 180-day mortality estimate; removed unsupported claims about absent advanced adjudication methods and softened the deep note's treatment-priority inference; removed an unsupported “largest demonstration” superlative from PRECISE-HF; framed the AF BP curve as an observational association rather than a treatment target; replaced “benign acute course” with the reported acute utilization and mortality numbers; and corrected the HF-management page's description of the 2021 ESC guideline as contemporary after a 2026 successor was indexed.
Absence refresh: reran both newly asserted absences through live PubMed E-utilities and ClinicalTrials.gov. The delivery-versus-phenotyping query returned two PubMed records, neither a hypertension comparison of those packages, and zero ClinicalTrials.gov registrations under the focused query. The clinical-versus-GBD attribution searches returned 38 broad PubMed records and one separate attribution record; title screening found GBD burden analyses but no study applying clinical and modeled HHD attribution to the same population. The focused ClinicalTrials.gov query returned zero registrations. Both pages now state these as dated search results rather than timeless “no study has” claims.
Validation and status: body/reference PMID sets match on every wiki page; reference numbering is consecutive; there are zero broken local Markdown links and zero active [unverified] markers. Eight edited pages are promoted from draft to curated: epidemiology-and-burden, lifestyle-and-population-prevention, blood-pressure-targets, arrhythmia-and-atrial-remodeling, diastolic-dysfunction-and-hfpef, red-flags-and-safety-concerns, biomarkers-and-imaging-markers and diagnosis-and-phenotyping.
Remaining flags:heart-failure-management.md and guidelines.md remain draft. Their identifiers resolve and the historical 2021 statements are now explicitly labeled, but the current 2026 ESC heart-failure and cardiovascular-disease/CKD texts were not retrieved or synthesized; current recommendation, class, level-of-evidence and threshold content therefore remains unresolved. No other substantive citation issue remains flagged.