Current hypertension epidemiology and contemporary approaches using the “Real-World Evidence Cycle” framework

Hypertension is a major contributor to the global disease burden, affecting more than one billion individuals worldwide. Despite decades of recognition of its adverse health effects, hypertension control rates remain suboptimal. Epidemiology provides essential knowledge for understanding disease distribution and identifying risk factors at the individual, social, and environmental levels. Recent evidence emphasizes both traditional lifestyle determinants, including excess sodium intake, low potassium intake, obesity, physical inactivity, smoking, and alcohol consumption, and emerging contributors, such as gut microbiota dysregulation and infectious diseases. Among those, the urinary sodium-to-potassium ratio has gained attention as an important factor associated with hypertension risk. Additionally, social determinants of health, including socioeconomic disparities, neighborhood deprivation, and structural racism, exacerbate the risk of hypertension and impede its effective control. Environmental factors such as air pollution, extreme temperatures, and occupational stress further contribute to the complexity of hypertension epidemiology. Regarding contemporary epidemiological methodology, our proposed concepts of the "Bench and Real-World Cycle" and "Real-World Evidence Cycle" highlight the necessity of continuously integrating real-world evidence into practice. In addition to classical cohort studies, real-world data derived from electronic health records including health checkups and insurance claims data are indispensable tools for addressing previous research limitations. This multifaceted perspective will accelerate evidence-based epidemiological approaches for preventing and treating hypertension.