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Zhou TL, Schütten MTJ, Kroon AA, Henry RMA, Houben AJHM, van der Kallen CJH, van Greevenbroek MMJ, de Leeuw PW, Stehouwer CDA. Urinary Sodium Excretion and Salt Intake Are Not Associated With Blood Pressure Variability in a White General Population. J Am Heart Assoc 2022; 12:e026578. [PMID: 36565181 PMCID: PMC9973596 DOI: 10.1161/jaha.122.026578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Salt restriction may lower blood pressure variability (BPV), but previous studies have shown inconsistent results. Therefore, we investigated in an observational study and intervention trial whether urinary sodium excretion and salt intake are associated with 24-hour BPV. Methods and Results We used data from the cross-sectional population-based Maastricht Study (n=2652; 60±8 years; 52% men) and from a randomized crossover trial (n=40; 49±11 years; 33% men). In the observational study, we measured 24-hour urinary sodium excretion and 24-hour BPV and performed linear regression adjusted for age, sex, mean blood pressure, lifestyle, and cardiovascular risk factors. In the intervention study, participants adhered to a 7-day low- and high-salt diet (50 and 250 mmol NaCl/24 h) with a washout period of 14 days, 24-hour BPV was measured during each diet. We used linear mixed models adjusted for order of diet, mean blood pressure, and body mass index. In the observational study, 24-hour urinary sodium excretion was not associated with 24-hour systolic or diastolic BPV (β, per 1 g/24 h urinary sodium excretion: 0.05 mm Hg [95% CI, -0.02 to 0.11] and 0.04 mm Hg [95% CI, -0.01 to 0.09], respectively). In the intervention trial, mean difference in 24-hour systolic and diastolic BPV between the low- and high-salt diet was not statistically significantly different (0.62 mm Hg [95% CI, -0.10 to 1.35] and 0.04 mm Hg [95% CI, -0.54 to 0.63], respectively). Conclusions Urinary sodium excretion and salt intake are not independently associated with 24-hour BPV. These findings suggest that salt restriction is not an effective strategy to lower BPV in the White general population. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02068781.
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Affiliation(s)
- Tan Lai Zhou
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Monica T. J. Schütten
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Abraham A. Kroon
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Ronald M. A. Henry
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands,Heart and Vascular Center Maastricht University Medical Center+MaastrichtThe Netherlands
| | - Alfonsius J. H. M. Houben
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. J. van Greevenbroek
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Peter W. de Leeuw
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
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Lopes JAS, Giatti L, Griep RH, Lopes AADS, Matos SMA, Chor D, Fonseca MDJM, Barreto SM. Life Course Socioeconomic Position, Intergenerational Social Mobility, and Hypertension Incidence in ELSA-Brasil. Am J Hypertens 2021; 34:801-809. [PMID: 33544821 DOI: 10.1093/ajh/hpab029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Life course epidemiology is a powerful framework to unravel the role of socioeconomic position (SEP) disparities in hypertension (HTN). This study investigated whether life course SEP is associated with HTN incidence. Specifically, to test whether cumulative low SEP throughout life and unfavorable intergenerational social mobility increased HTN incidence. METHODS Longitudinal analysis of 8,754 ELSA-Brasil participants without HTN or cardiovascular in visit 1 (2008-2010). The response variable was the incidence of HTN between visits 1 and 2 (2012-2014). The explanatory variables were childhood, youth, and adulthood SEP, cumulative low SEP, and intergenerational social mobility. Associations were estimated by incidence rate ratios (IRRs) obtained by generalized linear models, with Poisson distribution and logarithmic link function, after adjustment for sociodemographic, behavioral, and health factors. RESULTS The incidence of HTN was 43.2/1,000 person-years, being higher in males, elderly (70-74 years), self-declared black, and low SEP individuals. After considering sociodemographic factors, low SEP in childhood, youth, and adulthood remained statistically associated with increased HTN incidence. Individuals in the third (IRR: 1.26; 95% confidence interval (CI): 1.11-1.44) and fourth top quartiles (IRR: 1.29; 95% CI: 1.11-1.49) of cumulative low SEP, vs. first, as well as those with low stable intergenerational trajectory (IRR: 1.29; 95% CI: 1.16-1.43), vs. high stable, also had increased HTN incidence rates. CONCLUSIONS Socioeconomic disparities at all phases of the life cycle appear to raise HTN incidence rates, being the individuals with greater accumulation of exposure to low SEP and with more unfavorable intergenerational mobility at greatest risk, even in a short follow-up time.
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Affiliation(s)
- José Aparecido Soares Lopes
- Department of Student and Community Affairs, Instituto Federal do Norte de Minas Gerais, Januária, Brazil
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luana Giatti
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Sheila Maria Alvim Matos
- Department of Collective Health, Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Jesus M Fonseca
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandhi Maria Barreto
- Social and Preventive Department, Faculty of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Abstract
BACKGROUND Microvascular dysfunction (MVD) contributes to stroke, dementia, depression, retinopathy and chronic kidney disease. However, the determinants of MVD are incompletely understood. Greater blood pressure variability (BPV) may be one such determinant. METHODS AND RESULTS We used cross-sectional data of The Maastricht Study (n = 2773, age 59.9 years; 51.9% men) to investigate whether greater very short- to mid-term BPV is associated with various MVD measures. We standardized and averaged within-visit, 24-h and 7-day BPV into a systolic and a diastolic BPV composite score. MVD measures included a composite score of MRI cerebral small vessel disease (CSVD) features (total brain parenchymal volume, white matter hyperintensity volume, lacunar infarcts and cerebral microbleeds), a composite score of flicker light-induced retinal arteriolar and venular dilation response, albuminuria, heat-induced skin hyperemia and a composite score of plasma biomarkers of MVD (sICAM-1, sVCAM-1, sE-selectin and von Willebrand Factor). We used linear regression adjusted for age, sex, glucose metabolism status, mean 24-h systolic or DBP, cardiovascular risk factors and antihypertensive medication. We found that higher systolic and diastolic BPV composite scores (per SD) were associated with higher albuminuria [higher ratio, 1.04 (95% CI 1.00-1.08) and 1.07 (1.03-1.11), respectively], but not with other measures of MVD tested. CONCLUSION Greater systolic and diastolic BPV was associated with higher albuminuria, but not with CSVD features, flicker light-induced retinal arteriolar and venular dilation response, heat-induced skin hyperemia and plasma biomarkers of MVD. This suggests that the microvasculature of the kidneys is most vulnerable to the detrimental effects of greater BPV.
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Casagrande M, Favieri F, Guarino A, Di Pace E, Langher V, Germanò G, Forte G. The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2705. [PMID: 32326399 PMCID: PMC7216280 DOI: 10.3390/ijerph17082705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. METHODS We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State-Trait Anger Expression Inventory was used to assess anger. RESULTS Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. CONCLUSIONS These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica–Università di Roma “Sapienza”, Via degli Apuli 1, 00185 Roma, Italy;
| | - Francesca Favieri
- Dipartimento di Psicologia—Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (F.F.); (A.G.); (E.D.P.)
| | - Angela Guarino
- Dipartimento di Psicologia—Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (F.F.); (A.G.); (E.D.P.)
| | - Enrico Di Pace
- Dipartimento di Psicologia—Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (F.F.); (A.G.); (E.D.P.)
| | - Viviana Langher
- Dipartimento di Psicologia Dinamica e Clinica–Università di Roma “Sapienza”, Via degli Apuli 1, 00185 Roma, Italy;
| | - Giuseppe Germanò
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche–Università di Roma “Sapienza”, Piazzale Aldo Moro, 00185 Roma, Italy;
| | - Giuseppe Forte
- Dipartimento di Psicologia—Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (F.F.); (A.G.); (E.D.P.)
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Abstract
PURPOSE OF REVIEW Present a conceptual model and review the recent literature on family dynamics, sleep, and hypertension. RECENT FINDINGS Family dynamics predict hypertension and hypertension risk, in part, due to shared health behaviors. Sleep health behaviors (sleep duration, quality, and efficiency) predict hypertension risk in children and youth and are emerging as a family-level health behavior. Importantly, both family dynamics and sleep are modifiable. Family members influence one another's sleep through their physical presence and through psychological and emotional mechanisms. Family members' sleep patterns may also be coregulated. Negative family dynamics are associated with poor sleep health and predict greater cardiovascular risk. Sleep health behaviors in the family context may also interact with family dynamics to dampen or exacerbate hypertension risk factors in children and youth. This review proposes that promoting sleep health in a family context could be one way to reduce long-term hypertension risk.
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Affiliation(s)
- Heather E Gunn
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA.
| | - Kenda R Eberhardt
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
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Ewald DR, Haldeman PhD LA. Risk Factors in Adolescent Hypertension. Glob Pediatr Health 2016; 3:2333794X15625159. [PMID: 27335997 PMCID: PMC4784559 DOI: 10.1177/2333794x15625159] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.
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Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
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