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Article History

Received: 17 March 2026

Revised: 24 March 2026

Accepted: 24 March 2026

First Online: 20 April 2026

Compliance with ethical standards

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: Kario K received grants from A&D, Omron Healthcare, Fukuda Denshi, CureApp; Honoraria from Daichi Sankyo, Viatris, Novartis, Otsuka Pharmaceuticals, Medtronic, Otsuka Medical device, Omron Healthcare. Kai H received honoraria from Daiichi Sankyo, Novartis and Otsuka Medical Device. Rakugi H received honoraria from Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., and Otsuka Pharmaceutical Co., Ltd.; research funding from Novartis Pharma K.K.; scholarship from Daiichi Sankyo Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd.Takeda Pharmaceutical Company Ltd., and Sumitomo Pharma, Co.,Ltd. Hoshide S received honoraria from Novartis. Node K received research grants from Otsuka Medical Devices, Medtronic, Astellas, Bayer Yakuhin, Boehringer Ingelheim Japan, Fujiyakuhin, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Novartis Pharma; Scholarship from Abbott, Boehringer Ingelheim Japan, Daiichi Sankyo, Mitsubishi Tanabe Pharma, Teijin Pharma; Honoraria from AstraZeneca, Bayer Yakuhin, Boehringer Ingelheim Japan, Daiichi Sankyo, Eli Lilly Japan, Kowa, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical,MSD, Novartis Pharma, Novo Nordisk Pharma, Ono Pharmaceutical, Otsuka, Tsumura & Co. Katsurada K received honoraria from Otsuka Medical Device and Medtronic. Shinohara K received grants from Otsuka Medical Devices. Maekawa Y received scholarship funds from Abbott Medical Japan LLC, Medtronic Japan Co., Ltd., and BIOTRONIK JAPAN; and honoraria from Bristol-Myers Squibb Co., Ltd. Sakata Y received grants from Abbott Medical Japan, Otsuka Pharmaceutical, Nippon Boehringer Ingelheim, Boston Scientific Japan, BIOTRONIK JAPAN; Honoraria from AstraZeneca, Otsuka Pharmaceutical, Nippon Boehringer Ingelheim, Novartis Pharma and Bayer Yakuhin. Matsue Y received honoraria from Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., AstraZeneca K.K., Nippon Boehringer Ingelheim Co., Ltd., Bayer Yakuhin, Ltd., Kyowa Kirin Co., Ltd., Pfizer Japan Inc., and Alnylam Japan K.K. He also received collaborative research funding from Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., Nippon Boehringer Ingelheim Co., Ltd., AstraZeneca K.K., Roche Diagnostics K.K., Grace Imaging Inc., and Omron Healthcare Co., Ltd. Yamaki M declares no conflict of interest. Fujihara M received consultation fees from Abbott, Philips, Cordis, Kaneka, and BD, as well as honoraria from Boston Scientific, Medtronic, Gore, and Terumo. Kobayashi Y received lecture fees from Amgen, Novartis Japan, Medtronic, and Diichi-Sankyo and research grants from Nipro, Kaneka Medical Products, OrbusNeich Medical, Win International, and Abbott Medical Japan. Kozuma K received remuneration for lecture from Boston Scientific, Abbott Medical, Medtronic, Otsuka Pharmaceutical and Medical Devices, Daiichi-Sankyo, Amgen, Novartis, Novo Nordisk, Shockwave medical, Research fund from Abbott Medical. Aoki J received Honoraria from Medtronic, Otsuka Medical Device, Otsuka Pharmaceutical, Daiichi Sankyo, Nippon Boehringer Ingelheim, and Novartis Pharma. Role of Clinical Trials: Kario K is an Executive Committee Principal Investigator for the Spyral OFF MED, the Spyral ON MED, the DUO and the REQUIRE; a Coordinating investigator for the TCD-16164 study; a Site Principal Investigator for the HTN-J, the Spyral OFF MED, the Spyral ON MED, the DUO, the REQUIRE and the TCD-16164 study. Kai H is a Site Sub-Investigator for the HTN-J; a medical expert for the DUO and the REQUIRE. Rakugi H is a Site Sub-Investigator for the HTN-J, the DUO and the REQUIRE. Hoshide S is a Site Sub-Investigator for the HTN-J, the Spyral OFF MED, the Spyral ON MED, the DUO, the REQUIRE and the TCD-16164 study; a medical expert for the REQUIRE. Node K is a Site Sub-Investigator for the REQUIRE. Katsurada K is a Site-sub-Investigator for the DUO. Shinohara K is a Site Principal Investigator for the DUO and the REQUIRE. Maekawa Y is a Site Principal Investigator for the DUO. Sakata Y is a Principal Investigator for the DUO and the REQUIRE; a Site Sub-Investigator for the HTN-J. Matsue Y has no role. Yamaki M is a Site Principal Investigator for the DUO and the REQUIRE. Fujihara M is a Site Principal Investigator for the REQUIRE. Kobayashi Y has no role. Aoki J is a Site Sub-Investigator for the HTN-J; a Site Principal Investigator for the Spyral OFF MED, the Spyral ON MED studies, the DUO and the REQUIRE.

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