Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts

Time Spent on the Internet and Adolescent Blood Pressure

Internet use is nearly ubiquitous among adolescents. Growing evidence suggests heavy Internet use negatively impacts health, yet the relationship between time spent on the Internet and adolescent blood pressure (BP) is unknown. We examined the association between Internet use and elevated BP in a racially diverse cross-sectional sample of 331 healthy adolescents (ages 14–17 years). Heavy Internet use was defined as ≥2 hr/day, moderate use as <2 hr/day and ≥5 days/week, and light use as <2 hr/day and ≤4 days/week. Elevated BP was defined as systolic or diastolic BP ≥90th percentile. Heavy Internet users had statistically significantly higher odds of elevated BP compared to light Internet users. School nurses can play an important role in preventing high BP through assessment of BP and other health behaviors including Internet use, and health teaching to individuals, student groups, faculty, and parents to increase awareness of the relationship between Internet use and health.

Long-term predictors of blood pressure among adolescents during an 18-month school-based obesity prevention intervention

PURPOSE

To evaluate the effectiveness of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) initiative, a multicomponent school-based obesity prevention intervention based on the Centers for Disease Control and Prevention's coordinated school health approach, on the improvement of blood pressure (BP) and to determine long-term predictors of systolic and diastolic BP changes among high school students who were exposed to the intervention.

METHODS

Biometric and behavioral data from high school students were analyzed at baseline, 6, 12, and 18 months (N = 847, three schools). The attrition rate at 18 months was 26.1%. Sequential generalized estimating equation models were fit to the data using SAS 9.3, taking into account clustering effects within the same school and correlations within repeated measures.

RESULTS

A significant downward trend was observed in systolic BP (p = .0006) and diastolic BP (p < .0001) among the students who were exposed to the HEROES initiative. The prevalence of hypertension decreased from 17.1% at baseline to 12.8% at 6 months (p < .0001), 12.0% at 12 months (p < .0001), and 15.0% (p = .0024) at 18 months. Baseline body mass index, increases in body mass index percentiles, and increases of television-viewing hours were associated with BP increases. Increases in frequencies of eating french fries or chips, skipping breakfast, and consuming supersize meals when eating fast food were predictive of systolic BP changes, not of diastolic BP changes.

CONCLUSIONS

An 18-month multicomponent school-based obesity intervention program may be effectively used to decrease rates of high BP among adolescents.

The effects of repeated administration of camphor-crataegus berry extract combination on blood pressure and on attentional performance - a randomized, placebo-controlled, double-blind study

The present study investigated the effects of repeated administration of Korodin(®), a combination of camphor and crataegus berry extract, on blood pressure and attentional functioning. This study was conducted based on a randomized, placebo-controlled, double-blind design. 54 persons participated (33 female, 21 male) with a mean age of 24.3 years. Blood pressure and body mass index were in the normal range. Participants received 20 drops of either Korodin(®) or a placebo for four times with interjacent time intervals of about 10 min. Blood pressure was measured sphygmomanometrically before and after each administration. Attentional performance was quantified by using two paper-and-pencil tests, the d2 Test of Attention and Digit Symbol Test. Greater increases in blood pressure occurred after the four Korodin(®) administrations in comparison to the four placebo administrations. The performance in two parameters of d2 Test of Attention was consistently superior after the intake of Korodin(®). The excellent tolerability and safety of Korodin(®), even after a total consumption of 80 drops, was confirmed.

Commentary on the 2014 BP guidelines from the panel appointed to the Eighth Joint National Committee (JNC 8)

The recently published article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) has generated considerable controversy. In this commentary, we evaluate the document and compare the recommendations contained within it with those of the JNC 7 and other national and international guidelines. The evidence quality rating approach followed by the article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) disqualified nearly 98% of previous studies from review; as a result, some of the key recommendations were on the basis of expert opinion alone. We are especially concerned that the recommendation to raise the systolic/diastolic BP levels at which treatment is initiated to ≥150/≥90 mmHg in adults≥60 years old may affect cardiovascular and renal health in these patients. Additionally, we recommend that hypertension guidelines should be updated every 3-4 years with a fresh approach to the definition of target BP levels, the use of modern technology in the diagnosis of hypertension, and the treatment of hypertension in special populations not addressed in earlier guidelines.

Beyond birth-weight: early growth and adolescent blood pressure in a Peruvian population

Background. Longitudinal investigations into the origins of adult essential hypertension have found elevated blood pressure in children to accurately track into adulthood, however the direct causes of essential hypertension in adolescence and adulthood remains unclear.

Methods. We revisited 152 Peruvian adolescents from a birth cohort tracked from 0 to 30 months of age, and evaluated growth via monthly anthropometric measurements between 1995 and 1998, and obtained anthropometric and blood pressure measurements 11–14 years later. We used multivariable regression models to study the effects of infantile and childhood growth trends on blood pressure and central obesity in early adolescence.

Results. In regression models adjusted for interim changes in weight and height, each 0.1 SD increase in weight for length from 0 to 5 months of age, and 1 SD increase from 6 to 30 months of age, was associated with decreased adolescent systolic blood pressure by 1.3 mm Hg (95% CI −2.4 to −0.1) and 2.5 mm Hg (95% CI −4.9 to 0.0), and decreased waist circumference by 0.6 (95% CI −1.1 to 0.0) and 1.2 cm (95% CI −2.3 to −0.1), respectively. Growth in infancy and early childhood was not significantly associated with adolescent waist-to-hip ratio.

Conclusions. Rapid compensatory growth in early life has been posited to increase the risk of long-term cardiovascular morbidities such that nutritional interventions may do more harm than good. However, we found increased weight growth during infancy and early childhood to be associated with decreased systolic blood pressure and central adiposity in adolescence.

Clinical predictors and impact of ambulatory blood pressure monitoring in pediatric hypertension referrals

Elevated blood pressure (BP) is rising in children. Significant proportions of children have reactive hypertension or masked hypertension, making ambulatory BP monitoring (ABPM) a valuable tool, although with potential economic implications. In youth referred for elevated BP, we sought clinic BP combinations that obviated the need for ABPM and to specify the economic role of ABPM. In a retrospective pediatric referral cohort (N = 170), we examine clinic systolic BP (SBP) predictors of components of ABPM hypertension and their combination. In economic analyses, we compared effectiveness and charges of three diagnostic pathways: (1) clinic BP alone; (2) abnormal clinic BP prompting ABPM; or (3) universal ABPM. ABPM hypertension occurred in 55 (32.4%) and reactive hypertension in 37 (21.8%), average automated (β = 0.208; 95% confidence interval, 0.027, 0.389; P = .03) and maximum auscultatory clinic SBP (β = 0.160; 95% confidence interval 0.022, 0.299; P = .02) were associated with ABPM SBP mean, but none predicted SBP load. No clinic SBP combination was associated with ABPM hypertension. Universal ABPM accrued the lowest average charge per hypertensive youth identified ($10,948). We did not identify a clinic SBP combination that predicted ABPM hypertension in youth referred for elevated BP. Universal ABPM, in this context, may be the most economically and clinically efficient diagnostic strategy.

Pulsatile and Steady-State Pressure Trends in Children: A Window into the Future?

The aorta has limited ability to accommodate increasing body size by remodeling. The dramatic rise in pediatric obesity threatens to overwhelm this intrinsic remodeling program and lead to abnormal aortic function. As hypothesized, pulse pressure, as an index of aortic function, has indeed risen dramatically in parallel with the rise of pediatric obesity, while at the same time mean arterial pressure, as an index of small resistance artery function, has fallen. These divergent large-artery-versus-small-artery indices may combine to explain the counterintuitive decrease in systolic blood pressure in children and adults during the global obesity pandemic. The pathophysiologic mechanisms underpinning these contrasting trends are not yet known.

Hypertension and its correlates among school adolescents in delhi

BACKGROUND

Hypertension is fast emerging as a major health problem amongst all school adolescents, particularly in urban areas. Regular screening of the students for this is required for preventing the emergence of complications later in life. Therefore, the present study was undertaken with the objective to determine the prevalence of hypertension amongst urban school adolescents and its correlation with anthropometric measurements.

METHODS

A cross-sectional study was conducted in a school in Central Delhi involving all 315 students of 9(th) and 11(th) standard. A preforma was filled by the students and anthropometric measurements along with blood pressure (BP) measurements were taken for each student. Data was analyzed using Epi-info 2005 and SPSS 16.0.

RESULTS

Out of the total 315 students, 208 (66%) were boys and 107 (34%) were girls and the mean age was 14.31 ± 0.96 years. Overall prevalence of malnutrition was 24% and boys were found to be more obese as compared to girls. There were 5 students (1.6%) who were found to have systolic hypertension while 17 (5.4%) were found to have diastolic hypertension while 4.1% (n = 13) of the participants were systolic pre-hypertensive and 26% (n = 82) were in stage of diastolic pre-hypertension. Body mass index and gender were found to be independent predictor for systolic hypertension.

CONCLUSIONS

Prevalence of hypertension and pre-hypertension was high amongst the school children. BP check-up for children and adolescents is thus recommended to take remedial action on time.

Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis

BACKGROUND

Childhood overweight and obesity are associated with elevated blood pressure (BP). However, little is known about how childhood obesity lifestyle prevention programs affect BP. We assessed the effects of childhood obesity prevention programs on BP in children in developed countries.

METHODS AND RESULTS

We searched databases up to April 22, 2013, for relevant randomized, controlled trials, quasi-experimental studies, and natural experiments. Studies were included if they applied a diet or physical activity intervention(s) and were followed for ≥ 1 year (or ≥ 6 months for school-based intervention studies); they were excluded if they targeted only overweight/obese subjects or those with a medical condition. In our meta-analysis, intervention effects were calculated for systolic BP and diastolic BP with the use of weighted random-effects models. Of the 23 included intervention studies (involving 18 925 participants), 21 involved a school setting. Our meta-analysis included 19 studies reporting on systolic BP and 18 on diastolic BP. The pooled intervention effect was -1.64 mm Hg (95% confidence interval, -2.56 to -0.71; P=0.001) for systolic BP and -1.44 mm Hg (95% confidence interval, -2.28 to -0.60; P=0.001) for diastolic BP. The combined diet and physical activity interventions led to a significantly greater reduction in both systolic BP and diastolic BP than the diet-only or physical activity-only intervention. Thirteen interventions (46%) had a similar effect on both adiposity-related outcomes and BP, whereas 11 interventions (39%) showed a significant desirable effect on BP but not on adiposity-related outcomes.

CONCLUSIONS

Obesity prevention programs have a moderate effect on reducing BP, and those targeting both diet and physical activity seem to be more effective.

Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes: cohort study of 34 009 primary care patients

OBJECTIVE

The optimal blood pressure (BP) in persons with type-2 diabetes is debated. We investigated shapes of the associations of SBP and DBP levels with risk of cardiovascular events and mortality in a large primary care-based sample of diabetic patients.

METHODS

We investigated all 34 009 consecutive cardiovascular disease-free type-2 diabetes patients aged 35 years or older (mean age 64 years) at 84 primary care centers in central Sweden between 1999 and 2008. We followed this cohort until the end of 2009 in national registries for the incidence of major cardiovascular events (a composite endpoint of myocardial infarction, stroke, heart failure, or cardiovascular mortality) or total mortality.

RESULTS

During up to 11 years of follow-up, 6344 patients (18.7%) had a first cardiovascular event, and 6235 died (18.3%). The associations of annually updated SBP and DBP with risk of major cardiovascular events were U-shaped. The lowest risk of cardiovascular events was observed at a SBP of 135-139 mmHg and a DBP of 74-76 mmHg, and the lowest mortality risk at a SBP of 142-150 mmHg and a DBP of 78-79 mmHg, in both antihypertensive drug-untreated and drug-treated persons.

CONCLUSION

In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.

Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility

BACKGROUND

Depression, anxiety, and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders.

METHODS AND RESULTS

Participants were 1 107 524 Swedish men conscripted at a mean age of 18.3 years. Mental disorders were assessed by psychiatric interview on conscription, and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. An increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.62) (depressive disorders) to 1.90 (1.58, 2.38) (alcohol-related disorders). [corrected]. The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24-1.80) (schizophrenia) to 2.82 (2.53-3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes mellitus, and blood pressure measured at conscription, but they were partially attenuated by the adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position.

CONCLUSIONS

Increased risk of incident CHD is present across a range of mental disorders and is observable when the disorders are diagnosed at a young age.

Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium

BACKGROUND

Elevated blood pressure (BP) levels in childhood have been associated with subsequent atherosclerosis. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on carotid artery intima-media thickness (IMT) in adulthood.

METHODS AND RESULTS

The cohort consisted of 4210 participants from 4 prospective studies (mean follow-up, 23 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood, BP was classified as elevated for individuals with systolic BP ≥120 mm Hg, diastolic BP ≥80 mm Hg or with self-reported use of antihypertensive medications. Carotid artery IMT was measured in the left common carotid artery. High IMT was defined as an IMT ≥90th percentile according to age-, sex-, race-, and cohort-specific levels. Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of high carotid artery IMT (relative risk [95% confidence interval]) 1.82[1.47-2.38] and 1.57[1.22-2.02], respectively) in comparison with individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk (1.24[0.92-1.67]). In addition, these individuals had a lower risk of increased carotid artery IMT (0.66[0.50-0.88]) in compared with those with persistently elevated BP. The results were consistent when controlling for age, sex, and adiposity and when different BP definitions were applied.

CONCLUSIONS

Individuals with persistently elevated BP from childhood to adulthood had increased risk of carotid atherosclerosis. This risk was reduced if elevated BP during childhood resolved by adulthood.

Association of birth order with cardiovascular disease risk factors in young adulthood: a study of one million Swedish men

Background

Birth order has been suggested to be linked to several cardiovascular disease (CVD) risk factors, but the evidence is still inconsistent. We aim to determine the associations of birth order with body mass index (BMI), muscle strength and blood pressure. Further we will analyse whether these relationships are affected by family characteristics.

Methods

BMI, elbow flexion, hand grip and knee extension strength and systolic and diastolic blood pressure were measured at conscription examination in 1 065 710 Swedish young men born between 1951 and 1975. The data were analysed using linear multivariate and fixed effects regression models; the latter compare siblings and account for genetic and social factors shared by brothers.

Results

Fixed effect regression analysis showed that birth order was inversely associated with BMI: second and third born had 0.8% and 1.1% (p<0.001) lower BMI than first-born, respectively. The association pattern differed among muscle strengths. After adjustment for BMI, first-born presented lower elbow flexion and hand grip strength than second-born (−5.9 N and −3.8 N, respectively, p<0.001). Knee extension strength was inversely related to birth order though not always significantly. The association between birth order and blood pressure was not significant.

Conclusions

Birth order is negatively associated with BMI and knee extension strength, positively with elbow flexion and hand grip strength, and is not associated with blood pressure among young men. Although the effects are small, the link between birth order and some CVD risk factors is already detectable in young adulthood.

Habitual exercise and blood pressure: age dependency and underlying mechanisms

BACKGROUND

Regular exercise is associated with a reduction in cardiovascular risk, but the precise mechanisms responsible are unknown. The aim of the current study was to examine the relationship between regular exercise, aortic stiffness, and wave reflections, and to determine whether this relationship differs by age.

METHODS

Younger (<30 years) and older (>50 years) individuals, who were either sedentary or undertook regular aerobic exercise, were drawn from the Anglo-Cardiff Collaborative Trial population. This yielded 1,036 individuals, all of whom were nonsmokers, and were free of cardiovascular disease and medication. All individuals undertook a detailed lifestyle and medical history questionnaire including details of physical activity. Brachial and central blood pressure, together with aortic stiffness, wave reflections, cardiac output, and peripheral vascular resistance were assessed in all individuals.

RESULTS

In younger individuals, regular exercise was associated with lower diastolic blood pressure but elevated pulse pressure. In contrast, both systolic and pulse pressure were lower in older active individuals, compared with their sedentary counterparts. Moreover, regular exercise was associated with lower wave reflections and peripheral vascular resistance in younger individuals, but lower large artery stiffness in older individuals.

CONCLUSIONS

These data suggest that regular exercise is associated with a beneficial vascular profile. However, this differs between younger and older individuals such that the smaller preresistance and resistance vessels are involved in younger individuals whereas the large elastic arteries are involved in older individuals. Despite these differential findings, the current data provide support for strategies that increase habitual physical activity levels in the general population.

Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality

OBJECTIVE

To determine the risk of mortality associated with cardiometabolic risk factors in a national sample of adolescents and young adults.

METHODS

Prospective study of participants in the third NHANES (1988-1994), aged 12 to 39 years at the time of the survey (n = 9245). Risk factors included 3 measures of adiposity, glycated hemoglobin (HbA1c) level, cholesterol levels, blood pressure, self-reported smoking status, and cotinine level. Death before age 55 (n = 298) was determined by linkage to the National Death Index through 2006. Proportional hazards models, with age as the time scale, were used to determine the risk of death before age 55 years after adjusting for gender, race/ethnicity, and presence of comorbid conditions.

RESULTS

After adjusting for age, gender, and race/ethnicity, results of categorical analyses showed that current smokers were at 86% greater risk for early death than those classified as never smokers; that those with a waist-to-height ratio >0.65 were at 139% greater risk than those with a WHR <0.5; and that those with an HbA1c level >6.5% were at 281% greater risk than those with an HbA1c level <5.7%. Neither high-density lipoprotein nor non-high-density lipoprotein cholesterol measures were associated with risk for early death.

CONCLUSIONS

Our finding that risk for death before age 55 among US adolescents and young adults was associated with central obesity, smoking, and hyperglycemia supports reducing the prevalence of these risk factors among younger US residents.

Mortality following unemployment during an economic downturn: Swedish register-based cohort study

OBJECTIVE

To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment.

DESIGN

Longitudinal register-based cohort study.

SETTING

Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction.

PARTICIPANTS

A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded.

MAIN OUTCOME MEASURE

All-cause mortality.

RESULTS

Unemployment compared with employment in 1991 (ages 34-38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45-49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004).

CONCLUSIONS

Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.

Muscular strength in male adolescents and premature death: cohort study of one million participants

OBJECTIVES

To explore the extent to which muscular strength in adolescence is associated with all cause and cause specific premature mortality (<55 years).

DESIGN

Prospective cohort study.

SETTING

Sweden.

PARTICIPANTS

1,142,599 Swedish male adolescents aged 16-19 years were followed over a period of 24 years.

MAIN OUTCOME MEASURES

Baseline examinations included knee extension, handgrip, and elbow flexion strength tests, as well as measures of diastolic and systolic blood pressure and body mass index. Cox regression was used to estimate hazard ratios for mortality according to muscular strength categories (tenths).

RESULTS

During a median follow-up period of 24 years, 26,145 participants died. Suicide was a more frequent cause of death in young adulthood (22.3%) than was cardiovascular diseases (7.8%) or cancer (14.9%). High muscular strength in adolescence, as assessed by knee extension and handgrip tests, was associated with a 20-35% lower risk of premature mortality due to any cause or cardiovascular disease, independently of body mass index or blood pressure; no association was observed with mortality due to cancer. Stronger adolescents had a 20-30% lower risk of death from suicide and were 15-65% less likely to have any psychiatric diagnosis (such as schizophrenia and mood disorders). Adolescents in the lowest tenth of muscular strength showed by far the highest risk of mortality for different causes. All cause mortality rates (per 100,000 person years) ranged between 122.3 and 86.9 for the weakest and strongest adolescents; corresponding figures were 9.5 and 5.6 for mortality due to cardiovascular diseases and 24.6 and 16.9 for mortality due to suicide.

CONCLUSIONS

Low muscular strength in adolescents is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases. The effect size observed for all cause mortality was equivalent to that for well established risk factors such as elevated body mass index or blood pressure.

Sodium intake and blood pressure among US children and adolescents

OBJECTIVE

To assess the association between usual dietary sodium intake and blood pressure among US children and adolescents, overall and by weight status.

METHODS

Children and adolescents aged 8 to 18 years (n = 6235) who participated in NHANES 2003-2008 comprised the sample. Subjects' usual sodium intake was estimated by using multiple 24-hour dietary recalls. Linear or logistic regression was used to examine association between sodium intake and blood pressure or risk for pre-high blood pressure and high blood pressure (pre-HBP/HPB).

RESULTS

Study subjects consumed an average of 3387 mg/day of sodium, and 37% were overweight/obese. Each 1000 mg per day sodium intake was associated with an increased SD score of 0.097 (95% confidence interval [CI] 0.006-0.188, ∼1.0 mm Hg) in systolic blood pressure (SBP) among all subjects and 0.141 (95% CI: -0.010 to 0.298, ∼1.5 mm Hg) increase among overweight/obese subjects. Mean adjusted SBP increased progressively with sodium intake quartile, from 106.2 mm Hg (95% CI: 105.1-107.3) to 108.8 mm Hg (95% CI: 107.5-110.1) overall (P = .010) and from 109.0 mm Hg (95% CI: 107.2-110.8) to 112.8 mm Hg (95% CI: 110.7-114.9; P = .037) among those overweight/obese. Adjusted odds ratios comparing risk for pre-HBP/HPB among subjects in the highest versus lowest sodium intake quartile were 2.0 (95% CI: 0.95-4.1, P = .062) overall and 3.5 (95% CI: 1.3-9.2, P = .013) among those overweight/obese. Sodium intake and weight status appeared to have synergistic effects on risk for pre-HBP/HPB (relative excess risk for interaction = 0.29 (95% CI: 0.01-0.90, P < .05).

CONCLUSIONS

Sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese.

Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men

CONTEXT

Mental disorders have been associated with increased mortality, but the evidence is primarily based on hospital admissions for psychoses. The underlying mechanisms are unclear.

OBJECTIVES

To investigate whether the risks of death associated with mental disorders diagnosed in young men are similar to those associated with admission for these disorders and to examine the role of confounding or mediating factors.

DESIGN

Prospective cohort study in which mental disorders were assessed by psychiatric interview during a medical examination on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions and mortality during a mean 22.6 years of follow-up were obtained from national registers.

SETTING

Sweden.

PARTICIPANTS

A total of 1,095,338 men conscripted between 1969 and 1994.

MAIN OUTCOME MEASURE

All-cause mortality according to diagnoses of schizophrenia, other nonaffective psychoses, bipolar or depressive disorders, neurotic and adjustment disorders, personality disorders, and alcohol-related or other substance use disorders at conscription and on hospital admission.

RESULTS

Diagnosis of mental disorder at conscription or on hospital admission was associated with increased mortality. Age-adjusted hazard ratios according to diagnoses at conscription ranged from 1.81 (95% CI, 1.54-2.10) (depressive disorders) to 5.55 (95% CI, 1.79-17.2) (bipolar disorders). The equivalent figures according to hospital diagnoses ranged from 5.46 (95% CI, 5.06-5.89) (neurotic and adjustment disorders) to 11.2 (95% CI, 10.4-12.0) (other substance use disorders) in men born from 1951 to 1958 and increased in men born later. Adjustment for early-life socioeconomic status, body mass index, and blood pressure had little effect on these associations, but they were partially attenuated by adjustment for smoking, alcohol intake, intelligence, educational level, and late-life socioeconomic status. These associations were not primarily due to deaths from suicide.

CONCLUSION

The increased risk of premature death associated with mental disorder is not confined to those whose illness is severe enough for hospitalization or those with psychotic or substance use disorders.

The Norwegian Family Based Life Course (NFLC) study: data structure and potential for public health research

OBJECTIVES

To present details of the Norwegian Family Based Life Course Study.

METHODS

All Norwegians participating in censuses from 1960 to 2001 were included. In addition to the personal identity number, we used household and family information from the 1960 census to link family members together. The NFLC study is further linked to other health registers and surveys.

RESULTS

The proportion included and alive in 1960 increased from 67 % among those born in 1900 to more than 90 % for those born after 1940. In all, 5,266,270 were included. This combined family linkage approach gave 85 % parental linkage for those born in 1940 that dropped to 20 % of those born in 1930. The proportion with misclassified parents was less than 0.5 %. In all, 3,564,582 individuals were linked to their parents.

CONCLUSIONS

The NFLC is one of the largest follow-up of individuals over several decades in their life course. The comprehensive multigenerational, family linkage within the database contributes to large-scale use of various designs for investigating life course determinants.

The first Iranian recommendations on prevention, evaluation and management of high blood pressure

This paper presents the complete report of the first Iranian Recommendations on Prevention, Evaluation and Management of High Blood Pressure. The purpose is to provide an evidence-based approach to the prevention, management and control of hypertension (HTN) by adapting the most internationally known and used guidelines to the local health care status with consideration of the currently available data and based on the locally conducted researches on HTN as well as social and health care requirements. A working group of national and international experts participated in discussions and collaborated in decision-making, writing and reviewing the whole report. Multiple subcommittees worked together to review the recent national and international literature on HTN in different areas. We used the evaluation tool that is called "AGREE" and considered a score of > 60% as a high score. We adapted the Canadian Hypertension Education Program (CHEP), the United Kingdom's National Institute for Health and Clinical Excellence (NICE) and the US-based joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The key topics that are highlighted in this report include: The importance of ambulatory and self-measurement of blood pressure, evaluation of cardiovascular risk in HTN patients, the role of lifestyle modification in the prevention of HTN and its control with more emphasis on salt intake reduction and weight control, introducing pharmacotherapy suitable for uncomplicated HTN or specific situations and the available drugs in Iran, highlighting the importance of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and calcium channel blockers as the first line therapy in many situations, the non-use of beta blockers as the first time treatment except in specific conditions, treating HTN in women, children, obese and elderly patients, the patient compliance to improve HTN control, practical guidelines to improve the patient's information on knowing their risk and self-care as well as a quick reference guide that can serve as simplified guidelines for physicians. The working team decided to update these recommendations every two years.

Genetic variants and blood pressure in a population-based cohort: the Cardiovascular Risk in Young Finns study

Clinical relevance of a genetic predisposition to elevated blood pressure was quantified during the transition from childhood to adulthood in a population-based Finnish cohort (N=2357). Blood pressure was measured at baseline in 1980 (age 3-18 years) and in follow-ups in 1983, 1986, 2001, and 2007. Thirteen single nucleotide polymorphisms associated with blood pressure were genotyped, and 3 genetic risk scores associated with systolic and diastolic blood pressures and their combination were derived for all of the participants. Effects of the genetic risk score were 0.47 mm Hg for systolic and 0.53 mm Hg for diastolic blood pressures (both P<0.01). The combination genetic risk score was associated with diastolic blood pressure from age 9 years onward (β=0.68 mm Hg; P=0.015). Replications in 1194 participants of the Bogalusa Heart Study showed essentially similar results. The participants in the highest quintile of the combination genetic risk score had a 1.82-fold risk of hypertension in adulthood (P<0.0001) compared with the lowest quintile, independent of a family history of premature hypertension. These findings show that genetic variants are associated with preclinical blood pressure traits in childhood; individuals with several susceptibility alleles have, on average, a 0.5-mm Hg higher blood pressure, and this trajectory continues from childhood to adulthood.

Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts

BACKGROUND

Much of our understanding of the age-related progression of systolic blood pressure (SBP) comes from cross-sectional data, which do not directly capture within-individual change. We estimated life course trajectories of SBP using longitudinal data from seven population-based cohorts and one predominantly white collar occupational cohort, each from the United Kingdom and with data covering different but overlapping age periods.

METHODS AND FINDINGS

Data are from 30,372 individuals and comprise 102,583 SBP observations spanning from age 7 to 80+y. Multilevel models were fitted to each cohort. Four life course phases were evident in both sexes: a rapid increase in SBP coinciding with peak adolescent growth, a more gentle increase in early adulthood, a midlife acceleration beginning in the fourth decade, and a period of deceleration in late adulthood where increases in SBP slowed and SBP eventually declined. These phases were still present, although at lower levels, after adjusting for increases in body mass index though adulthood. The deceleration and decline in old age was less evident after excluding individuals who had taken antihypertensive medication. Compared to the population-based cohorts, the occupational cohort had a lower mean SBP, a shallower annual increase in midlife, and a later midlife acceleration. The maximum sex difference was found at age 26 (+8.2 mm Hg higher in men, 95% CI: 6.7, 9.8); women then experienced steeper rises and caught up by the seventh decade.

CONCLUSIONS

Our investigation shows a general pattern of SBP progression from childhood in the UK, and suggests possible differences in this pattern during adulthood between a general population and an occupational population. Please see later in the article for the Editors' Summary.