Humberto Muzi-Filho1,2*
Adalberto Vieyra1,2,3*- 1Center for Research in Precision Medicine, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- 2National Center for Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- 3Graduate Program in Translational Biomedicine/BIOTRANS, Grande Rio University/UNIGRANRIO, Duque de Caxias, Brazil
Hypertension and cardiorenal syndrome are two risk factors in elderly populations (Jarocki et al., 2025), reflecting the dual nature of friends and foes. As a friend, in the early stages of life, adaptive mechanisms in the cardiovascular system compensate for initial hemodynamic stress. However, prolonged stimulation of the Renin-Angiotensin-Aldosterone System and the autonomic nervous system can transform this “friend” into a severe “foe”, provoking deleterious effects on multiple organs, such as the heart and the kidneys, establishing the basis for hypertension and cardiorenal syndrome (Ziegler et al., 2025). In this Research Topic, recently published studies have broadened the understanding of how physiological, psychological, and behavioral factors converge to interact with hypertension and cardiorenal syndrome in hypertensive patients, highlighting the interaction between aging, vascular remodeling, and changes at the renal level, and demonstrating that their consequences go far beyond the numbers expressed on the sphygmomanometer (Kebede et al., 2024; Shangguan et al., 2024; Dai et al., 2025; Du et al., 2025; Fang et al., 2025; Wang et al., 2025; Zeng et al., 2025) (Figure 1).
Figure 1. Beyond the numbers expressed on the sphygmomanometer.
Cardiorenal syndrome involves a bidirectional interaction between the heart and kidneys, in which dysfunction in one organ accelerates impairment in the other (Ronco, 2011). Aging can amplify the pathogenesis of cardiorenal syndrome by promoting vascular stiffening, endothelial dysfunction, and impaired maintenance of body homeostasis. In this context, the usefulness of new non-invasive markers, such as estimated pulse wave velocity (ePWV) and shear wave elastography (SWE), is increasingly recognized for early detection of subclinical renal lesions (Dai et al., 2025; Zeng et al., 2025). In the published manuscript on this Research Topic, the increase in ePWV correlates with albuminuria in hypertensive patients, indicating that arterial stiffness contributes to glomerular microvascular stress and early renal impairment, even before changes in renal biomarkers such as serum creatinine (Zeng et al., 2025). Similarly, the SWE study revealed that renal cortical stiffness increases with the progression of hypertension, correlating with the progressive and silent nature of hypertensive nephropathy (Dai et al., 2025). These two studies highlight the importance of studying vascular and renal imaging methods in routine geriatric cardiovascular assessment.
Another element of interest in monitoring hypertensive patients is the assessment of metabolic markers. The manuscript by Du et al. (2025) showed, in a 7-year longitudinal study, that sarcopenia, by itself, is not significantly associated with the development of hypertension in middle-aged and elderly adults. However, obesity associated with sarcopenia significantly increases the risk of developing hypertension, deserving attention in public health strategies aimed at the elderly population. Furthermore, Du et al. (2025) also discuss that obesity leads to increased chronic inflammation, activating the Renin-Angiotensin-Aldosterone System and oxidative stress pathways, culminating in the onset of hypertension, and that sarcopenia not associated with obesity would not trigger these mechanisms. In another study, the Hemoglobin Glycation Index (HGI) is proposed as a biomarker of cardiovascular mortality in hypertensive patients, reflecting data beyond average blood glucose levels (Shangguan et al., 2024). This study also suggests that states of hypoglycation and hyperglycation can confer an elevated cardiovascular risk, correlating with metabolic impairment in older adults. Additionally, lifestyle elements such as diet, physical activity, and adherence to pharmacological treatment are central to the results obtained (Shangguan et al., 2024). In another study, more than 50% of Ethiopian patients reported incorrectly practicing self-care, being influenced by educational issues, little knowledge about hypertension and stress handling, and social inequalities (Kebede et al., 2024). Thus, the study suggested that psychosocial behavioral factors act in conjunction with physiological stressors in the course of arterial hypertension, with particular attention to elderly patients.
Another important issue in the management of hypertension is mental health. A meta-analysis demonstrated that depression in elderly hypertensive patients is associated with a 30%–40% increase in mortality, with increased prevalence mainly among women (Fang et al., 2025). The interaction between mental health and cardiovascular compromise can be assessed through neurohumoral activation, systemic inflammation, endothelial dysfunction, and low adherence to pharmacological treatment. Furthermore, the study by Wang et al. (2025) showed that life satisfaction correlates with subjective perception of health, economic situation, sleep quality, diet, and social interactions in elderly patients, indicating that social and subjective perceptions may have a critical influence on the clinical management of hypertension.
The clinical message is clear: treating hypertension and cardiorenal syndrome alone is insufficient. In this context, the articles published in this Research Topic contribute to understanding the pathophysiology of hypertension and cardiorenal syndrome in aging, encompassing underlying aspects such as metabolic changes, mental health, and behaviors related to personal health (Figure 1). Given that the kidney-heart axis is sensitive to arterial stiffening and age-related metabolic changes, the early identification of susceptible patients through imaging (SWE, ePWV) and biochemical markers (HGI, albuminuria) is fundamental, potentially mitigating progression to chronic renal and cardiac diseases. In this context, the evaluation of the development of obesity and metabolic syndrome, associated or not with sarcopenia, is also an important field in understanding the progression of hypertension. Furthermore, behavioral and psychological interventions, including the diagnosis of depression and the promotion of personal life satisfaction, can be helpful in the therapy of hypertension. Thus, the understanding of these interactions is essential as population aging and the prevalence of chronic multimorbidities increase (Figure 1). In conclusion, integrating these assessments into population screening can contribute to early detection in adults and the elderly, support public health policies to prevent and treat hypertension and cardiorenal syndrome, and improve the quality of life of populations. In other words, this new knowledge should act as a true “friend,” not a “foe”.
Author contributions
HM-F: Writing – original draft, Writing – review and editing. AV: Writing – original draft, Writing – review and editing.
Funding
The author(s) declared that financial support was received for this work and/or its publication. HM-F receives funding from the Carlos Chagas Filho Foundation for Research Support from the State of Rio de Janeiro (FAPERJ, E-26/210.441/2024 and E-26/203.661/2025). AV receives funding from the Brazilian National Research Council (CNPq, 409690/2023-6 and 302878/2025-4) and FAPERJ (E-26/211.276/2021 and E-26/204.079/2024).
Acknowledgements
We gratefully acknowledge the invaluable efforts of the authors and reviewers of the publications in this Research Topic. Our thanks also go to the Editorial Board members and Support Staff of the journal for their dedication and support during the preparation of this Research Topic.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
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References
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Keywords: aging, cardiorenal syndrome, hypertension, mental health, metabolic biomarkers, non-invasive markers, self-care practices
Citation: Muzi-Filho H and Vieyra A (2025) Editorial: Hypertension and cardiorenal syndrome and their relationship with aging: friends and foes. Front. Aging 6:1760202. doi: 10.3389/fragi.2025.1760202
Received: 03 December 2025; Accepted: 08 December 2025;
Published: 15 December 2025.
Edited and reviewed by:
Jianhua Zhang, University of Alabama at Birmingham, United StatesCopyright © 2025 Muzi-Filho and Vieyra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Humberto Muzi-Filho, aHVtYmVydG9tdXppQGJpb2YudWZyai5icg==; Adalberto Vieyra, YXZpZXlyYUBiaW9mLnVmcmouYnI=
Editorial on the Research Topic Hypertension and cardiorenal syndrome and their relationship with aging: friends and foes