Nocturnal blood pressure (BP) is associated with cardiovascular events independently of daytime BP. Isolated nocturnal hypertension (INH), defined by elevated nocturnal BP with normal daytime BP, increases cardiovascular risk. However, its underlying; mechanisms remain unclear. This study aims to assess the association between nocturnal BP and INH with sleep quality and duration. This cross-sectional study analyzed 2297 individuals (57% women, 49.5 ± 15 years) using ambulatory blood pressure monitoring (ABPM) to evaluate the relationship between INH and sleep quality. Individuals with secondary hypertension and sleep disorders were excluded. Sleep quality and duration were primarily assessed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG score. Results showed that 64% had poor sleep quality (PSQI > 5), and 18.7% slept less than 6 h. No significant differences in sleep quality were found among hypertensive phenotypes. INH was associated with older age, diabetes, and waist circumference; however, sleep quality and duration were not independent factors in its development. Nonetheless, nocturnal BP exhibited a slight association with sleep quality and disturbances of mild clinical significance.

Dietary interventions are recommended as part of hypertension (HTN) treatment. Sodium reduction has proven effective, however supplements of potassium and/or nitrate are likely also of importance. We aimed to test how these three dietary components affect blood pressure (BP) individually and in combination in patients with HTN. A double-blind randomized controlled trial of 90 participants with HTN was conducted. Participants were randomized to eight groups receiving a hand-out diet and different combinations of supplementation of sodium chloride (130 mmol/day), potassium chloride (40 mmol/day) and beetroot juice (BRJ) with nitrate (13 mmol/day) or for each a matching placebo. The intervention lasted one week. 24 h BP, blood samples and 24 h urine collection were conducted before and after. We found a strong association between change in BP and sodium reduction (p < 0.0001). The change in systolic BP in the low-sodium groups was -7 mmHg (95% CI -9;-5) and no change was found in the high-sodium groups. We found a BP reduction in the low-potassium vs. the high-potassium groups (p = 0.03). Nitrate supplementation was not related to change in BP (p = 0.31). Plasma aldosterone and aldosterone-to-renin ratio (ARR) were associated to the change in BP in the low-sodium groups. In conclusion, in this one week intervention we found sodium reduction to be the important dietary alteration in matters of lowering BP. BRJ with nitrate and potassium chloride supplements did not assist in decreasing BP during this short-time intervention. Measuring ARR might be relevant in a clinical setting to predict the BP effect of sodium reduction. URL: https://www.clinicaltrialsregister.eu . Unique identifier: 2021-003407-17.

Apparent treatment-resistant hypertension (aTRH) is linked to significantly elevated cardiovascular risk and unfavorable long-term outcomes. Despite guideline recommendations to screen for primary aldosteronism (PA) in patients with aTRH, the prevalence of screening in Asian ambulatory care settings remains unknown. This cross-sectional study evaluated hypertensive adults who were managed in the ambulatory clinics of a tertiary hospital in Thailand between January 2020 and May 2023. aTRH was defined by: (1)uncontrolled office blood pressure (BP ≥ 140/90 mmHg) despite maximally tolerated doses of three antihypertensive drug classes, including a diuretic, or (2)use of four or more antihypertensive classes regardless of BP control. PA screening was performed using plasma aldosterone concentration and plasma renin activity measurements. Among 3207 hypertensive patients identified via ICD-10 (I10) coding, 2047 met inclusion criteria after excluding 1160 based on the exclusion criteria; the prevalence of aTRH was 9.4%. The mean age of the aTRH group was 74 ± 10 years, 59% were female, and the average number of antihypertensive agents was 3.8 ± 0.7. PA screening was conducted in only 3.1% of patients with aTRH and 17.9% of hypokalemia, with a median delay of 9.5 (21.25) months from the detection of hypokalemia to PA testing. Among 20 screened patients, five were diagnosed with PA, leading to improved BP control with targeted therapy. This study represents the first real-world analysis of PA screening practices in an Asian ambulatory care population. Strategies to enhance PA screening and address barriers to its implementation are warranted to improve clinical outcomes.

We aimed to assess trends in elevated blood pressure (EBP) and hypertension among US children and adolescents before and after the COVID-19 pandemic using data from 25,916 participants aged 8-19 years in NHANES 1999-2023. Survey-weighted multinomial logistic regression was used to examine associations of sociodemographic, nutritional and other factors with EBP and hypertension overall and across subgroups during the pre-pandemic cycles (2015-2020) and post-pandemic cycles (2021-2023). Among children (n = 10,616), EBP prevalence decreased from 4.3% in 1999-2002 to 3.5% in 2021-2023 (P = 0.36), and hypertension declined from 3.3% to 2.3% (P = 0.025). Among adolescents (n = 15,300), EBP declined from 10.0% to 9.4% (P = 0.46), and hypertension prevalence fell from 8.3% to 5.1% (P < 0.001). From 2015-2023, obesity was strongly associated with both EBP and hypertension in children (odds ratio [OR] 1.78, 95% CI 1.02-3.10) and adolescents (OR 1.89, 95% CI 1.30-2.74). In children, higher dietary fat intake was associated with greater odds of EBP, and higher sodium intake with greater odds of hypertension. In adolescents, older age, male sex and non-Hispanic Black race were additional risk factors. Comparing pre-pandemic (2015-2020) with post-pandemic (2021-2023) cycles, EBP prevalence in adolescents decreased (11.6% vs 9.42%, P = 0.46) and hypertension prevalence in children changed modestly (2.53% vs 2.26%, P = 0.025). Despite concerns about pandemic-related increases in obesity, pediatric EBP and hypertension prevalence remained stable or declined from 2015 to 2023, with adiposity remaining the dominant modifiable correlate.

While elevated arterial stiffness is recognized as a predictor of atrial fibrillation (AF), the relationship between long-term pulse pressure (PP) and the incidence of AF remains to be fully elucidated. We assessed the influence of time-averaged cumulative PP in midlife on incident AF. The analysis included 9150 adults from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of AF at visit 4. The time-averaged cumulative blood pressure (BP) was calculated as the sum of the averaged BPs from the adjacent consecutive visits (visits 1-4), with the values being indexed to the total exposure time. At visit 4, the mean age of the study population was 62.9 years, with 4045 (44.2%) of the population being male. In 1455 individuals (15.9%) with a median follow-up of 16 years, incident AF was seen. The greatest predictor of incident AF, as indicated by the decline in the -2 Log likelihood statistic, was time-averaged cumulative PP, which was linked to an elevated risk for AF (HR = 1.20 (1.13-1.27)) in adjusted Cox models (per 1-SD increment). The correlation between incident AF and time-averaged cumulative systolic blood pressure (SBP) was 1.14 (1.07-1.22). In contrast, the diastolic relation tended to be opposite (HR = 0.94 (0.88-1.00)). Moreover, among persons aged < 65 years, without hypertension or antihypertensive treatment, these associations were even more remarkable (P < 0.05 for all interactions). Time-averaged cumulative PP in midlife was an important risk factor for incident AF with the strongest predictive effect, especially in persons who were younger, normotensive, or without antihypertensive treatment.

H-type hypertension, characterized by concomitant hypertension and hyperhomocysteinemia (HHcy), is associated with heightened cardiovascular risk. Despite emerging evidence implicating apolipoprotein A1 (APOA1) in atherosclerotic processes, its prognostic value in acute myocardial infarction (AMI) patients with H-type hypertension remains underexplored.We conducted multivariable-adjusted cox regression analyses to investigate major adverse cardiovascular events (MACES) associations. Non-linear relationships were explored using restricted cubic spline (RCS) and threshold effect analyses. Survival disparities were quantified through Kaplan-Meier estimates. Stratification analyses were used to demonstrate the stability of the relationship between APOA1 and MACES. A total of 581 participants were included, with a median follow-up time of 34.00 ± 1.21 months, and 134 MACES occurred, with higher tertiles of the APOA1 associated with a lower cumulative risk of MACEs (log-rank, P < 0.001). After adjusting for confounders, the fully adjusted HRs (95% CI) for Q3 and Q4 of the APOA1, with the lowest tertile as reference, were 0.46 (0.23,0.92) and 0.42 (0.19,0.93), respectively. RCS analysis showed that APOA1 had a linear relationship with MACES. Subgroup analyses and interaction tests revealed that the association between APOA1 and MACES was negative association at most subgroup (Pinteraction >0.05). However, with the negative association observed in participants with hs-CRP > 3(mg/L), but not in those with hs-CRP ≤ 3(mg/L). In conclusion,emerging evidence demonstrates an inverse association between APOA1 and MACES risk in H-type hypertension with AMI.

During graded exercise, systolic blood pressure (SBP) is expected to increase linearly, but other responses are observed. To date, a framework for algorithmic assessment of the shape of the SBP response is lacking, making its physiological and clinical relevance poorly understood. We aimed to algorithmically identify distinct SBP response shapes and analyze their association with clinical factors and all-cause mortality. We retrospectively analyzed SBP recordings from a cohort of 5633 patients (mean age, 55.1 years; 43% female) undergoing maximal cycle ergometry, who met strict quality criteria, including ≥30 mmHg increase in SBP during exercise. Per patient, test duration and SBP values were rescaled (0-100%) to retrieve the SBP response shape. Group-based trajectory modelling (GBTM) was used to classify SBP shapes by sex. Associations with clinical factors and all-cause mortality were evaluated using multinomial logistic regression and Cox survival analysis. In both sexes, GBTM identified three SBP response shapes: early, linear and late rise in SBP. Late rise was associated with higher resting SBP, lower peak SBP and smaller increases in SBP during exercise (P < 0.05). A late SBP rise related independently to older age, higher body mass index, beta blocker use and lower exercise capacity. A late SBP rise predicted increased all-cause mortality in men (HR versus early SBP rise: 1.66, 95% CI: 1.10-2.50; P = 0.015) but not in women (1.06, 0.60-1.90; P = 0.84). In conclusion, a late SBP response was linked to a worse risk profile and independently predicted all-cause mortality in men, suggesting clinical relevance for SBP shape assessment during exercise.

Hypertension (HTN) is a mitochondrial and metabolic disease. However, cause-effect connections between mitochondrial dysfunction and HTN remains uncharted. we focused on mitochondria-related genes, identifying potential causal-genes-relevant blood pressure (BP) using mitochondria-related genome-wide Mendelian randomization (MR). Through the summary statistics from cis-expression quantitative trait loci (cis-eQTL) datasets (human blood and artery), mitochondrial transcription factor A (TFAM), and genome-wide association studies (GWAS) datasets of BP indices (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and mean arterial pressure [MAP]) and HTN. we conducted a MR analysis to explore the potential causal relationship between mitochondrial-related genes and the BP indices, HTN. Sensitivity analysis and Bayesian colocalization were employed to validate this causal relationship. In aorta, HIBCH expression was negatively associated with SBP; OCIAD1 expression was positively associated with MAP. In tibial artery, HIBCH expression was negatively associated with SBP; OCIAD1 expression was positively associated with SBP, PP, and MAP; SLC25A37 was positively associated with MAP. In blood, LACTB expression was negatively associated with SBP, PP, and MAP; OCIAD1 expression was negatively associated with SBP and PP; and MTX1 expression was negatively associated with MAP. HARS2 expression was positively associated with SBP and PP; RAB24 and PRELID1 expression was positively associated with DBP; and NME6 expression was positively associated with SBP and DBP. In conclusion, the regulation of blood pressure correlates with mitochondria-related genes (HIBCH, SLC25A37 and OCIAD1 in artery; LACTB, OCIAD1, MTX1, HARS2, RAB24, PRELID1 and NME6 in blood). This study provides scientific evidence for specifically regulating BP phenotypes.

This pilot study investigated the effects of dynamic power training (PT) with elastic bands (EB) on arterial stiffness and hemodynamic parameters in older adults. Twenty-six older adults were randomly assigned to the control group and the intervention group (IG). IG participants performed PT with EB twice a week for 12 weeks. Pulse wave velocity (PWV), pulse pressure (PP), central pulse pressure, systolic blood pressure (SBP), diastolic blood pressure (DBP), central SBP, and central DBP were assessed before and after 12 weeks. PWV, PP, and SBP significantly improved after 12 weeks of intervention (p < 0.05). These findings indicate that 12 weeks of PT with EB reduces AS and significantly improves systolic blood pressure in older adults. Given the pilot nature of this work, larger randomized controlled trials are essential to confirm these benefits and further establish the safety of the protocol.

We conducted a prospective study in consecutive high-risk pregnant women with 8 to 34 weeks of gestation to evaluate the relationship between PWV and the subsequent development of early- and late- onset preeclampsia (PE). The cohort was divided in high PWV (defined by the top tertile) and normal PWV (the remaining two tertiles). PE were classified as late-onset PE and early- onset PE using a cut-point of 34 weeks of gestation. The risk of women with high PWV for early- and late-onset PE was compared with women with normal PWV using multinomial regression. Two hundred and sixty-three high-risk pregnant women (mean age 30 ± 7 years, with 26 ± 7 weeks of gestation at the evaluation) were included in the study; 7.4%, 22.6%, 1.2%, 3.1% and 0.8% had antecedents of diabetes, chronic hypertension, chronic renal disease, collagen diseases and antiphospholipid syndrome, respectively. In previous pregnancies, 11.3% had had gestational diabetes and 22,6% hypertensive disorders of pregnancy. Forty-six pregnant women (17.9%) developed PE, of which 31 (12.1%) were late-onset and 15 (5.8%) early-onset. Women with high PWV more frequently developed early-onset than late-onset PE (14.0% vs 11.8% p = 0.509). Unadjusted and adjusted OR for early-onset PE were 9.61 (95%CI 2.62-35.25) and 7.13 (1.89-26.71), respectively. In conclusion, in high-risk pregnant women, a high PWV value was related with ~7 times more risk for development of early-onset PE.

Accurately estimating childhood hypertension prevalence is challenging due to blood pressure variability and the need for confirmation across multiple measurements. This study assessed prevalence of hypertension status, stages, and phenotypes among Chinese children on three visits and explored their associations with healthy lifestyles. A school-based cross-sectional survey conducted in Pinghu, Zhejiang province, in September 2022 included 2538 children aged 8-14 years. Elevated blood pressure was defined as blood pressure ≥95th percentile for age, sex, and height in a single measurement, while hypertension required confirmation across three occasions. A healthy lifestyle score was developed based on normal weight, ≥60 min/day of moderate-to-vigorous physical activity, <2 h/day of screen time, adequate sleep, dietary diversity. Multivariable logistic regression assessed associations between healthy lifestyles and hypertension status, stages (stage 1 and stage 2) and phenotypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], systolic diastolic hypertension [SDH]). Elevated blood pressure prevalence decreased from 16.9% to 4.4% across visits. Prevalence rates were 3.2% for stage 1 hypertension, 1.2% for stage 2 hypertension, 2.5% for ISH, 0.4% for IDH, and 1.4% for SDH. Each 1-point increase in healthy lifestyle score, the odds of children being hypertension, stage1 hypertension, stage 2 hypertension, ISH, IDH and SDH decreased by 43% (odds ratio 0.57, 95% confidence interval 0.46-0.70), 44% (0.56, 0.44-0.71), 40% (0.60, 0.41-0.86), 39% (0.61, 0.47-0.80), 49% (0.51, 0.27-0.98) and 48% (0.52, 0.36-0.74), respectively. Prevalence of childhood hypertension among those aged 8-14 years in Pinghu was 4.4%. Adherence to multiple healthy lifestyles was associated with hypertension status, stages, and phenotypes.

Despite consistent evidence of the cardioprotective benefits of reduced-sodium salt, it remains an underutilised intervention. Understanding how reduced-sodium salt is perceived is required to scale-up its use. This review summarises end user and healthcare professional knowledge, attitudes, and behaviours about reduced-sodium salt. We systematically searched four databases (inception to February 2024) and identified studies reporting knowledge, attitudes and behaviours towards reduced-sodium salt. Twenty-nine studies from 11 countries were included, 18 of which were intervention studies involving reduced-sodium salt and 11 were descriptive studies examining perceptions among the general community and healthcare professionals. Among intervention studies, there was high overall acceptability but mixed findings on taste. Outcomes related to use or willingness to use were mostly positive especially following cost-subsidisation. Among descriptive studies, there was low awareness (ranging from 0-32%) and reported use (10-16%) of reduced-sodium salt among the general community. Barriers to use included low availability and higher costs compared to regular salt. Awareness was higher among healthcare professionals (71%). Overall, most studies found high acceptability and willingness to use following exposure to reduced-sodium salt, despite some detecting taste differences. Greater awareness coupled with strategies to improve availability and affordability are important to scale-up the use of reduced-sodium salt.

Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians' routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.

In Latin America, hypertension prevalence varies widely, and control rates remain low, particularly in low-income communities, despite the proven efficacy of recommended interventions. We aimed to describe baseline characteristics and identify individual factors associated with uncontrolled hypertension in participants of the RE-HOPE study in Santander, Colombia. A cross-sectional analysis was conducted including participants ≥18 years old with hypertension, defined by self-reported history, antihypertensive use, or systolic BP ≥ 140 and/or diastolic BP ≥ 90 mmHg. Descriptive statistics were used for baseline characteristics. Mixed-effects logistic regression models stratified by sex were applied to identify factors associated with uncontrolled hypertension, adjusting for age, diabetes, obesity, medication intake, physical activity, and smoking. A total of 3 481 participants were included, with a mean age of 60.2 years (SD 13.7); 62% were female. Mean systolic and diastolic BP were 144 ± 16 mmHg and 86 ± 10 mmHg, respectively. Despite high levels of awareness (81%) and medication use (76%), only 26% of participants had controlled hypertension ( < 140/90 mmHg), and 9.6% met the target below 130/80 mmHg. Control rates were higher in the capital city compared to peripheral and rural provinces. Being female was inversely associated with uncontrolled hypertension (OR = 0.62; 95% CI: 0.52-0.75). In contrast, age ≥ 60 years (OR = 2.19; 95% CI: 1.84-2.61) and current smoking (OR = 2.48; 95% CI: 1.54-4.00) were positively associated with poor control. This study highlights significant challenges in hypertension management, particularly early diagnosis and the identification of priority groups, and emphasizes the need for targeted public health initiatives and policy actions to enhance hypertension control.

In 19 114 community-dwelling older adults enrolled in the ASPREE trial, high late-life visit-to-visit blood pressure variability (BPV) was associated with increased risks of incident dementia and cognitive decline during the median 4.7 year trial period. Whether sex or apolipoprotein E (ApoE) affect these associations over longer-term follow-up is unknown. We investigated the association between BPV and long term risks of dementia and cognitive decline using data from the ASPREE-eXTension (ASPREE-XT) study (median 8.3 year follow-up for dementia, 7.3 years for cognitive decline, after BPV estimation). Long-term BPV was estimated using standard deviation (SD) of the mean systolic BPs measured at ASPREE baseline, year 1 and 2 visits. Incident dementia was an adjudicated secondary endpoint and cognitive decline was defined as ≥1.5 SD decline in score from baseline sustained on the same of one, or more, standardized cognitive tests administered annually/biennially throughout ASPREE/ASPREE-XT. Analyses were stratified a priori by sex, using sex-specific SD tertiles of systolic BPV. Multivariable Cox proportional hazards regression comparing the highest BPV tertile to the lowest showed increased risk of dementia (HR = 1.33, 1.10-1.61) and cognitive decline (HR = 1.17, 1.06-1.30) in males, and cognitive decline in females (HR = 1.17, 1.07-1.28). In ApoE genotyped participants (81%), females in the highest BPV tertile lacking the ɛ4 allele had increased risk of dementia (HR = 1.39; 1.04-1.84), while risk of cognitive decline was increased in both sexes lacking the ɛ4 allele (males HR = 1.25; 1.09-1.43; females HR = 1.14; 1.01-1.29). These findings suggest both sex and ApoE impact the association of high BPV with long-term cognitive changes.

Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24-58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBP) using published cut-offs; SBP ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBP/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden's Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBP was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP > 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBP/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBP thresholds. Graphical Abstract - Created in BioRender. La Gerche, A. (2025) https://BioRender.com/undefined Abbreviations: SBP, systolic blood pressure; ABPM, ambulatory blood pressure monitoring.

There had been no previous study that evaluated the prevalence of masked hypertension (MH), its determinants, and ambulatory blood pressure patterns among patients with type 2 diabetes mellitus (DM) in Nigeria. Among 222 individuals living with type 2 DM with normal clinic blood pressure (SBP < 140 mm Hg and DBP < 90 mm Hg), we obtained 24 h ambulatory blood pressure measurements. Patients were either untreated (77) or treated (145) with antihypertensive medications. The prevalence of MH among the normotensive (untreated) and hypertensive subgroups (treated) was 32.5 and 60% respectively. The prevalence of nocturnal hypertension among all patients was 71.6%, and was significantly higher among patients with masked phenomenon (98.2 vs 46.2%, p < 0.0001) compared to true normotension. The determinants of MH were 5 years or more duration of type 2 DM (odds ratio 2.71, 95% CI 1.21-6.27) and increasing clinic SBP (odds ratio 2.19, 95% CI 1.51-3.36). Masked hypertension is common among patients with type 2 DM. Higher clinic SBP and 5 years or more duration of type 2 DM are the risk factors.

Although central wave reflections are critical for aortic pressure regulation, the control mechanisms involved in humans are understudied. This study investigated the impact of upper- and lower-limb high-flexion postures on central arterial wave reflections. Twenty-two healthy adults (11 females, aged 25 ±  3 years) underwent three randomized and counter-balanced positions to evaluate the effect on central wave reflection: supine legs and arms in the anatomical position; supine two legs bent and arms straight; and supine two arms bent and legs straight. Characteristic impedance, forward and backward pressure waves, and pulse characteristics were measured via the central pressure-flow relationship in the frequency domain at the end of each posture hold. Central diastolic blood pressure increased during arm flexion only (67 ± 9 mmHg vs. 62 ± 9 mmHg; p < 0.01). Central systolic blood pressure, augmentation index, forward wave amplitude, reflected wave amplitude, central wave reflection magnitude, and characteristic impedance were unaffected by varying limb flexion positions (all p > 0.05). Acutely bending the arms and legs did not influence central wave reflections, likely related to a minimal effect of conduit artery bending, versus microvascular involvement, as suggested in previous studies. These findings underscore the importance of identifying the specific vascular regions responsible for wave reflection generation and support the need to refine central pressure augmentation models to accurately localize the dominant sources of wave reflection in humans.