New perspective of diagnosis and treatment of hypertension: fusion analysis of TCM syndrome and SPECT kidney dynamic imaging technology.

Hypertension is a major global public health burden, with unsatisfactory blood pressure control rates and insufficient attention to early renal hemodynamic impairment. Traditional Chinese Medicine (TCM) syndrome differentiation provides holistic and individualized insights into disease pathogenesis, while single-photon emission computed tomography (SPECT) renal dynamic imaging enables sensitive, quantitative assessment of early renal perfusion and glomerular filtration rate (GFR) abnormalities. This study explicitly positions the TCM-SPECT fusion model as an early functional screening tool for hypertensive renal damage, complementary to-but not a replacement for-standard structural imaging (CT/MRI) and routine nephrological workup. We aimed to explore the correlation between TCM syndromes and SPECT renal parameters and propose an integrated screening framework for hypertension. A retrospective observational study was conducted on 33 primary hypertensive patients who underwent standardized TCM syndrome differentiation and 99mTc-DTPA SPECT renal dynamic imaging. Renal perfusion peak time, split and total GFR were analyzed across syndromes. Twenty-five patients had complete GFR data; 8 patients were excluded due to motion artifact or suboptimal radiotracer uptake, with sensitivity analysis confirming no systematic bias. Different TCM syndromes exhibited distinct renal functional profiles: Kidney Yang Deficiency (KYD) showed the most severe impairment, with total GFR of 81.6 ± 12.5 mL/min/1.73 m2 and delayed perfusion; Liver Yang Hyperactivity (LYH, n = 2) showed preserved renal function, but this subgroup was underpowered for definitive inference. After 3 months of individualized TCM treatment plus conventional antihypertensive therapy and lifestyle modification, total GFR improved significantly from 89.2 ± 11.5 to 94.5 ± 10.2 mL/min/1.73 m2 (p < 0.001). Systolic blood pressure (SBP) decreased from 152.3 ± 11.4 to 136.8 ± 9.7 mmHg, diastolic blood pressure (DBP) from 94.6 ± 7.8 to 82.1 ± 6.5 mmHg (both p < 0.001). We propose a four-step integrated framework combining TCM syndrome differentiation with SPECT functional assessment for early screening and risk stratification. This framework is not intended to replace established structural imaging or standard nephrological evaluation but to enhance early detection of subclinical renal hemodynamic injury. Our findings support the feasibility of TCM-SPECT fusion for precision hypertension care, though larger prospective validation is needed.