Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender

Association of parity with the prevalence of hypertension in Japan: The Tohoku Medical Megabank Community-based cohort study

This study investigated the association of parity with hypertension prevalence in Japanese women while considering a clinical history of hypertensive disorders of pregnancy (HDP) and menopausal status. This cross-sectional study included 30,530 Japanese women (6700 premenopausal; 23 830 postmenopausal). The association between parity and the prevalence of hypertension was evaluated using a multiple logistic regression model with possible confounders. In premenopausal women, no statistically significant association between parity and hypertension prevalence was found. When not adjusted for current body mass index (BMI), a linear graded association was observed between parity and the prevalence of hypertension in postmenopausal women. However, the association between parity and hypertension prevalence in postmenopausal women was attenuated after adjustment for current BMI. Both current BMI and a clinical history of HDP were significantly associated with a high risk of hypertension in both premenopausal and postmenopausal women. Our results also suggest that continuous surveillance and preventive measures for hypertension should be provided for women with HDP and high parity.

Combined exposure to multiple dioxins and dioxin-like polychlorinated biphenyls on hypertension among US adults in NHANES: a cross-sectional study under three statistical models

Dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) are mainly released as by-products of human activities, often in the form of mixtures, and the potential harm on human health deserves attention. Therefore, our study aimed to analyze the combined effect of dioxins and DL-PCB exposures on hypertension (HTN) among US adults. Data of eligible participants were acquired from the National Health and Nutrition Examination Survey (NHANES). Multiple logistic regression models with adjustment for covariates were applied to explore the associations between 13 persistent organic pollutants (POPs) and HTN. Stratified analyses and interaction analyses were then conducted by age and gender. Finally, the combined effects of dioxins and DL-PCBs on HTN were assessed by the weighted quantile sum (WQS) model and the Bayesian kernel machine regression (BKMR) model. A total of 976 adults were included in our study, of whom 397 had HTN. Spearman correlations indicated positive correlations among 13 POPs. And most of them (except PCB28, PCB66, and 1,2,3,4,7,8,9-hpcdf) had significant effects on HTN. The result of WQS revealed that mixed exposure to dioxins and DL-PCBs was significantly associated with increased risk of HTN (OR: 2.205; 95% CIs: 1.555, 3.127). The BKMR model also presented a positive trend of HTN risk with exposure to multiple dioxins and DL-PCBs. And 1,2,3,4,6,7,8,9-ocdd may be the main factor for this positive association. Considering the limitations of our cross-sectional study with the small sample, further prospective studies are necessary to validate our findings.

Genome-wide association study identifies genetic risk loci for adiposity in a Taiwanese population

Overweight and obese are risk factors for various diseases. In Taiwan, the combined prevalence of overweight and obesity has increased dramatically. Here, we conducted a genome-wide association study (GWAS) on four adiposity traits, including body-mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-hip ratio (WHR), using the data for more than 21,000 subjects in Taiwan Biobank. Associations were evaluated between 6,546,460 single-nucleotide polymorphisms (SNPs) and adiposity traits, yielding 13 genome-wide significant (GWS) adiposity-associated trait-loci pairs. A known gene, FTO, as well as two BF%-associated loci (GNPDA2-GABRG1 [4p12] and RNU6-2-PIAS1 [15q23]) were identified as pleiotropic effects. Moreover, RALGAPA1 was found as a specific genetic predisposing factor to high BMI in a Taiwanese population. Compared to other populations, a slightly lower heritability of the four adiposity traits was found in our cohort. Surprisingly, we uncovered the importance of neural pathways that might influence BF%, WC and WHR in the Taiwanese (East Asian) population. Additionally, a moderate genetic correlation between the WHR and BMI (γg = 0.52; p = 2.37×10−9) was detected, suggesting different genetic determinants exist for abdominal adiposity and overall adiposity. In conclusion, the obesity-related genetic loci identified here provide new insights into the genetic underpinnings of adiposity in the Taiwanese population.

Association between hypertension, obesity and dietary intake in post-menopausal women from rural Zambian communities

BACKGROUND

Amongst the cardiovascular risk (CVR) factors, hypertension (HT) and obesity appear to be prominent in post-menopausal women. The underlying mechanisms of HT development in menopause are not fully understood.

AIM

To determine the association between HT, obesity and dietary intakes in post-menopausal women from rural Zambia.

SETTING

This study was conducted in Twatasha Compound of Kitwe and Ndeke Community of Ndola.

METHODS

Blood pressure (BP), weight, height and dietary intakes (24-h recall) were measured in 153 women (> 50 years) from households. The South African Hypertension Society (SAHS), the World Health Organization (WHO) and estimated average requirements (EARs) guidelines were followed for HT, obesity and dietary intake definitions, respectively. Statistical Package for the Social Sciences (SPSS) version 26 was used for descriptive and inferential statistical analyses.

RESULTS

Prevalence of HT was 70%, whilst 37.25% and 28.10% of the participants were overweight and obese, respectively. The median interquartile range (IQR) dietary intakes showed inadequate intakes for most nutrients, except for carbohydrates (170 g [133; 225]). The total fat intake represented 14% of total energy intake. All median fatty acid intakes and sodium intakes (409 mg [169; 662]) were below the recommended levels. Only body mass index (BMI) correlated with HT (r = 0.268; p = 0.001).

CONCLUSIONS

Despite low dietary intakes, an alarming prevalence of HT and obesity was found in our population. Hormonal changes, a high energy-dense diet and poor treatment adherence, may be possible underlying factors. We recommend measures to better manage HT as a CVR factor.

CONTRIBUTION

This article supplements evidence on the prevalence of obesity-related hypertension in post-menopausal women and the link to dietary intake.

Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

OBJECTIVES

This study is designed to identify different body mass index (BMI) trajectories of individuals aged 40-70 years and test the effect of distinct BMI trajectories on incident hypertension.

DESIGN

The accelerated longitudinal design was used for this study.

METHODS

The study drew data from the third to ninth China Health and Nutrition Surveys (CHNS), and 4697 participants were included between 1991 and 2015. As analysed, three distinct individual BMI trajectories were identified by the latent class growth mixed model (LCGMM). Then, BMI values and BMI slopes were worked out through calculation with LCGMM trajectory parameters and their primary derivatives, respectively. Later, Cox proportional hazard models were applied to examine BMI values and slopes, and find out the relationship between the said predicted data and incident hypertension for different classes.

RESULTS

Three different trajectory classes were identified, that is, low-stable class (n=3711), sharp-increasing class (n=282) and high-stable class (n=704). Compared with the low-stable class, the adjusted HRs (95% CI) were 1.321 (1.119 to 1.559) and 1.504 (1.322 to 1.711) for the sharp-increasing class and the high-stable class, respectively. The HR (95% CI) for BMI values rose from 1.081 (1.030 to 1.135) to 1.221 (1.171 to 1.273) while the HR (95% CI) for BMI slopes dropped from 1.154 (1.100 to 1.211) to 0.983 (0.943 to 1.025). That is, the HR for BMI slopes were higher than that for BMI values for the class aged 40-47 years.

CONCLUSION

These findings suggest that the calibrated BMI trajectories for the period from mid-life to elderly adulthood have a significant effect on the risk of incident hypertension. The period from age 40 to 47 years is critical and has positive implications for the early prevention of hypertension.

Compared to What? Is BMI Associated with Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens?

BACKGROUND

Obesity is a risk for many different cancers. Laparoscopic sleeve gastrectomy (LSG) is common, and benign or pre-malignant histopathology types are reported in the removed gastric specimens. We assessed whether higher BMI was associated with certain benign or pre-malignant histopathological changes.

METHOD

Retrospective chart review of all primary LSG patients (N = 1555). Demographic, clinical, and LSG histopathology data were retrieved. BMI of patients with specific benign or pre-malignant conditions in their gastric specimens was compared with the BMI of the rest of the patients with abnormal histopathology specimens and also compared with the BMI of patients with normal control specimens.

RESULTS

Females comprised 70% of the patients. Mean BMI were 46.3 (females) and 48 (males). Normal LSG specimens comprised 52%. Most common abnormal histopathologies were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), lymphoid aggregates (2.2%), intestinal metaplasia (1.4%) and GIST (0.7%). After controlling for confounders (age, gender, H. pylori, diabetes mellitus type 2, hypertension), no significant association was observed between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies.

CONCLUSION

When confounders were taken into account, there appeared no significant associations between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies of their gastric specimens. There was a very weak correlation between BMI and other covariates.

Obesity-related hypertension: Findings from The Korea National Health and Nutrition Examination Survey 2008-2010

We aimed to investigate the association of various obesity parameters and phenotypes with hypertension in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2008-2010, a total of 16,363 subjects (8,184 men and 8,179 women) were analyzed. Hypertension was defined as blood pressure of 140/90 mm Hg or higher or taking antihypertensive medication. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Higher obesity parameters [body mass index (BMI) representing general obesity, waist circumference (WC) representing central obesity, and percentage body fat (PBF) representing elevated body fat] were consistently associated with increased odds of prevalent hypertension (OR, 7.54; 95% CI, 5.89-9.65 for BMI ≥30 vs. 18.5-23; OR, 3.97; 95% CI, 3.41-4.63 for WC ≥95 cm in males and ≥90 cm in females vs. <85 cm in males and <80 cm in females; OR, 3.56; 95% CI, 3.05-4.15 for PBF, highest vs. lowest quartile; all p trends<0.0001). These associations were stronger in the younger age group (<40 years), and were observed in both sexes. Furthermore, even in individuals with normal BMI (18.5-23), the odds of prevalent hypertension were consistently increased in those with central obesity (WC≥90 cm in males, WC≥80 cm in females; normal weight central obesity phenotype) (OR, 1.89; 95% CI, 1.63-2.19) and those with high PBF (highest quartile of PBF; normal weight obesity phenotype) (OR, 1.49; 95% CI, 1.25-1.77). These associations were consistent with updated hypertension guidelines in 2017. Obesity may be positively associated with hypertension, regardless of obesity parameters. Even within normal BMI range, high WC and high PBF may be associated with hypertension.

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

Background

Although combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece.

Settings

Cross-sectional comparison of PLHIV (Athens-Multicenter-AIDS-Cohort-Study; AMACS) versus general population controls (National health examination survey; EMENO).

Methods

All HIV-infected adults with ≥1 measurement of interest (blood pressure, lipids, glucose, weight, height) between 2012–2014 and all EMENO participants (2014–2016) were included. Ten-year total CVD risk was estimated using the Framingham (FRS) or the Systematic Coronary Risk Evaluation (SCORE) equations.

Results

5839 PLHIV (median age:41.6 years, 85.4% males) and 4820 controls (median age:48 years, 48.4% males) were included. Adjusting for age, sex and origin, PLHIV were more likely to be current smokers (adjusted OR:1.53 [95% CI:1.35–1.74]) and dyslipidemic (aOR:1.18; [1.04–1.34]), less likely to be obese (aOR:0.44 [0.38–0.52], with no differences in hypertension, diabetes or high (≥20%) FRS but with greater odds of high (≥5%) SCORE (aOR:1.55 [1.05–2.30]). Further adjustment for educational level, anti-HCV positivity and BMI showed higher prevalence of hypertension in PLHIV.

Conclusions

Despite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population. Regular screening and early management of CVD risk factors in PLHIV should be of high priority for CVD prevention.

Body fat change and 8-year incidence of hypertension: Korean Genome and Epidemiology Study

Hypertension is strongly correlated with an increased risk of cardiovascular events. Recent studies have demonstrated that body fat percentage (BF%) is associated with cardiometabolic risk factors. The aim of this study was to investigate the association between a change in BF% and body mass index (BMI) and the incidence of new-onset hypertension in a normotensive Korean cohort. At baseline (2001-2002), 8848 participants aged 40-70 years were recruited for the study; follow-up surveys were completed in the year 2012. A total of 3902 adults (1866 men and 2036 women) were included in the final analysis. These subjects were divided into quartile groups according to changes in BF% and were followed for 8.4 years to monitor for the development of hypertension. A Poisson regression model was used to evaluate the relative risk (RR) for hypertension according to BF% change quartile. Additionally, we also stratified participants into four groups according to BMI change levels and body fat change levels. Finally, we compared two factors, BF% change, and BMI change, to determine which is more predictive of incident hypertension. In an adjusted model, compared with the lowest BF% quartile group, the risk of new-onset hypertension significantly increased with BF% change: Changes in risk were 0%-2.0% for quartile 3 subjects (RR: 1.32 [1.06-1.63]) and 2.0%-8.9% for quartile 4 participants (RR: 1.78 [1.43-2.19]). We also revealed that the RR for new-onset hypertension was 1.81 (95% CI: 1.47-2.21) for quartile 4 group subjects, compared with subjects in quartile 1 (change in BMI -6.80 to -0.86% [kg/m2 ]). Body fat gain and BMI increase were predictors of hypertension in this community-based Korean cohort.

Central obesity and hypertension among rural adults of Paschim Medinipur, West Bengal, India

Obesity is generally classified into generalized obesity (BMI ≥30 kg/m2) and abdominal or central obesity (WC ≥90 cm for men and WC ≥80 cm for women) based on World Health Organization recommendation for Asians. Hypertension is one of the most common obesity-related complications, and about 30% of hypertensive individuals can be classified as being obese. The present study aimed to investigate the effect of different age groups (years) on the anthropometric and derived variables. It determined the correlation between anthropometric and derived variables and also estimated the frequency of central obesity and hypertension. Finally, it investigated the relationship between central obesity and blood pressure among rural Bengalee adults of Dirghagram village of Ghatal Block, Paschim Medinipur, West Bengal, India. The present cross-sectional study was undertaken among 310 rural adults (154 males; 156 females) aged over 18 years. Our study was carried out during March, 2017. Height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and blood pressure (systolic and diastolic) were measured using standard procedures. One way ANOVA analysis on most of the anthropometric and derived variables showed a statistically significant increase from younger to older age group in both sexes (p<0.001;p<0.01; p<0.05). In addition to that, more females had central obesity using waist circumference (55.8% vs. 19.5%), waist hip ratio (87.2% vs. 35.7%), waist height ratio (73.7% vs. 44.2%), and conicity index (87.2% vs. 57.8%) criteria, and hypertension (52.5% vs. 27.3%). The prevalence of central obesity was much higher in case of hypertensive individuals. Therefore, the present study showed a high prevalence of central obesity among the rural adults of Dirghagram village. Furthermore, central obesity contributed in increasing hypertension among the villagers.

Excess weight loss is a vital strategy for controlling hypertension among multi-ethnic population in northwest China: A cross-sectional analysis

Hypertension is a common global health problem including China. This study aimed to assess the prevalence and awareness of hypertension, and evaluate risk factors associated with hypertension among multi-ethnic population in northwest China using a random sampling cross-sectional data.A cross-sectional survey was conducted between 2014 and 2015 as part of a nationwide survey using stratified four-stage random sampling in Xinjiang. Hypertension was defined as mean systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥140/90 mm Hg and/or taking anti-hypertensive medication. In addition, the prevalence of hypertension (SBP ≥ 130 or DBP ≥ 80 mm Hg) was also estimated according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline. Awareness of hypertension was based on self-report. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on hypertension.Totally 6722 subjects aged ≥18 years were enrolled and prevalence of hypertension was 24.3%, while the prevalence of hypertension based on the 2017 ACC/AHA guideline was approximately twice as high as that based on 2010 Chinese guideline (37.6%). Among individuals with hypertension, 55.5% were aware of their condition. Six potential factors were estimated to be associated with increased risk of hypertension including age, ethnicity, marital status, body mass index (BMI), waistline circumference, and comorbidity. In the analyses of calculated risk score, BMI ≥ 28.0 corresponded to the highest risk score of 23 points. The area under the receiver operation curve for the multivariable prediction model was 0.803 (95%CI: 0.789-0.813).There is a considerable prevalence of hypertension among Xinjiang adults, northwest China; awareness of hypertension is low. Excess weight loss may be a vital strategy for controlling hypertension, particularly if accompanied with other preventive measures in this region.

A cross-sectional study of risk factors and hypertension among adolescent Senior High School students

INTRODUCTION

Hypertension is among the first five causes of mortality, globally contributing more than 40% to cardiac related deaths worldwide, with almost 70% cardiovascular deaths in the low- and middle-income countries. Its burden is projected to be 150 million by 2025 based on epidemiological data within the Sub-Saharan Africa regions, with Ghana experiencing 505,180 increases in 2007. It is currently among the leading cause of death in the country, with prevalence ranging from 19% to 48%. There is limited data concerning hypertension on Ghanaian youth. Particularly, on those at the Senior High School (SHS) level that represents the immediate workforce of the country on the depth of prevalence, knowledge as well as the risk factors that may predispose them into having prehypertension and hypertension for proper records and interventional measures and that is what this study pursues to do.

MATERIALS AND METHODS

A cross-sectional study was employed in five different SHSs in the Ashanti region of Ghana from December 2018 to February 2019 with structured questionnaires and physical screening of participants. Logistic regression analysis was performed to test for relation knowledge and riskfactors on HTN.

RESULTS

The overall prevalence of pre-HTN within the group was 33.8%, with stages 1 and 2 HTN prevalence of 5.4%. Sixty-three percent do not have an idea of what HTN is, and positive associations were found between no physical exercises, no addition of extra salt, type of food often eaten and family history.

CONCLUSION

This study establishes prevalence in pre-HTN within students at the SHS level with low knowledge and high risk factors on the disease. This indication is beneficial to target the interventional programs on this population at this early stage by inculcating education on HTN prevalence and its risks in the educational curricular by the government.

Association of Social and Behavioral Risk Factors With Earlier Onset of Adult Hypertension and Diabetes

IMPORTANCE

The National Academy of Medicine has recommended incorporating information on social and behavioral factors associated with health, such as educational level and exercise, into electronic health records, but questions remain about the clinical value of doing so.

OBJECTIVE

To examine whether National Academy of Medicine-recommended social and behavioral risk factor domains are associated with earlier onset of hypertension and/or diabetes in a clinical population.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study used data collected from April 1, 2005, to December 31, 2016, from a population-based sample of 41 745 patients from 4 cycles of Kaiser Permanente Northern California's Adult Member Health Survey, administered to members at 19 Kaiser Permanente Northern California medical center service populations. The study used Kaplan-Meier survival tables and Cox proportional hazards regression analysis to estimate the onset of hypertension and diabetes among patients with no indication of disease at baseline. Data analysis was performed from June 2, 2017, to March 26, 2019.

EXPOSURES

Race/ethnicity, educational level, financial worry, partnership status, stress, intimate partner violence, concentrated neighborhood poverty, depressive symptoms, infrequent exercise, smoking, heavy alcohol consumption, and cumulative social and behavioral risk.

MAIN OUTCOMES AND MEASURES

Onset of hypertension and diabetes during the 3.5 years after survey administration.

RESULTS

The study included 18 133 people without baseline hypertension (mean [SD] age, 48.1 [15.3] years; 10 997 [60.7%] female; and 11 503 [63.4%] white) and 35 788 people without baseline diabetes (mean [SD] age, 56.2 [16.9] years; 20 191 [56.4%] female; and 24 351 [68.0%] white). There was a dose-response association between the number of social and behavioral risk factors and likelihood of onset of each condition. Controlling for age, sex, race/ethnicity, body mass index, and survey year, hazard ratios (HRs) comparing those with 3 or more risk factors with those with 0 risk factor were 1.41 (95% CI, 1.17-1.71) for developing hypertension and 1.53 (95% CI, 1.29-1.82) for developing diabetes. When the same covariates were adjusted for, having less than a high school educational level (hazard ratio [HR], 1.84; 95% CI, 1.40-2.43), being widowed (HR, 1.38; 95% CI, 1.11-1.71), concentrated neighborhood poverty (HR, 1.26; 95% CI, 1.00-1.59), infrequent exercise (HR, 1.22; 95% CI, 1.08-1.38), and smoking (HR, 1.35; 95% CI, 1.10-1.67) were significantly associated with hypertension onset. Having less than a high school educational level (HR, 1.58; 95% CI, 1.26-1.97), financial worry (HR, 1.29; 95% CI, 1.13-1.46), being single or separated (HR, 1.24; 95% CI, 1.08-1.42), high stress (HR, 1.28; 95% CI, 1.09-1.51), intimate partner violence (HR, 1.68; 95% CI, 1.14-2.48), concentrated neighborhood poverty (HR, 1.31; 95% CI, 1.07-1.60), depressive symptoms (HR, 1.28; 95% CI, 1.10-1.50), and smoking (HR, 1.53; 95% CI, 1.27-1.86) were significantly associated with diabetes onset, although heavy alcohol consumption was associated with protection (HR, 0.75; 95% CI, 0.66-0.85) rather than risk.

CONCLUSIONS AND RELEVANCE

Independent of traditional risk factors, individual and cumulative social and behavioral risk factor exposures were associated with onset of hypertension and diabetes within 3.5 years in a clinical setting. The findings support the value of assessing social and behavioral risk factors to help identify high-risk patients and of providing targets for intervention.

Impact of Successful Weight Loss Maintenance on Serum Lipids and Glucose Concentrations of Previous Participants of a Weight Loss Programme in Accra, Ghana

BACKGROUND AND AIM

There is a need to investigate the long-term impact of successful weight loss maintenance on blood lipids and glucose concentrations in populations within Africa, where obesity and cardiovascular disease (CVD) rates are increasingly becoming a public health threat. The aim of this study was to compare the serum lipid and glucose concentrations of successful and unsuccessful weight loss maintainers who previously participated in the Nutriline Weight Loss Programme (NWLP) in Accra, Ghana.

METHODS

112 participants were randomly selected to participate in this cross-sectional study. Baseline and end of weight loss programme anthropometric and programmatic data were accessed via the NWLP archival database. On follow-up, anthropometric data, physical activity, dietary behaviour, serum lipid, and glucose indices were taken. Successful weight loss maintainers (SWLM) were defined as those achieving at least 5% weight loss below the baseline weight at follow-up, otherwise unsuccessful (UWLM).

RESULTS

The adjusted serum total cholesterol (TC) concentration was significantly lower for SWLM (5.17 ± 0.99 mmol/L) compared to UWLM (5.59 ± 1.06 mmol/L). Serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood glucose (FBG), and glycosylated haemoglobin (HbA1c) concentrations for SWLM versus UWLM did not differ significantly and were as follows: 3.58 ± 0.92 mmol/L versus 3.87 ± 0.99 mmol/L, 1.22 ± 0.38 mmol/L versus 1.17 ± 0.32 mmol/L, 4.48 ± 0.72 mmol/L versus 4.73 ± 1.00 mmol/L, and 5.52 ± 0.39% versus 5.59 ± 0.59%, respectively. Triglyceride (TG) concentration was significantly (P < 0.001) lower for SWLM (0.79 ± 0.28 mmol/L) compared to UWLM (1.17 ± 0.51 mmol/L). After adjusting for covariates, it was no longer significant. Additionally, there was no significant association between weight loss maintenance success and having a normal status for selected lipids and glucose parameters.

CONCLUSION

SWLM had a significantly lower serum TC compared to UWLM. In addition, a greater proportion of SWLM had normal values for TC, TG, HbA1c, and LDL out of the six parameters measured although not statistically significant.

The importance of waist circumference and body mass index in cross-sectional relationships with risk of cardiovascular disease in Vietnam

BACKGROUND

Waist circumference (WC) is an indicator of intra-abdominal adipose tissue, high levels of which confer an increased risk of cardiometabolic disease. Population data on WC should be more informative than data on body mass index (BMI), which is a general indicator of body size. This study aimed to evaluate the importance of WC relative to BMI in cross-sectional relationships with blood pressure (BP), glucose, and total cholesterol (TC) in the adult population of Vietnam.

METHODS

The data were collected in a population-based survey conducted during 2009-10 using the "WHO STEPwise approach to surveillance of risk factors for non-communicable disease" (STEPS) methodology. The survey participants (n = 14 706 aged 25 to 64 years) were selected by multi-stage stratified cluster sampling from eight provinces representative of the eight geographical regions of Vietnam. All measurements were performed in accordance with the STEPS protocols. All analyses were performed using complex survey methods.

RESULTS

The measurements of WC and BMI were highly correlated (men r = 0.80, women r = 0.77). For men, the strongest and predominant associations with BP, glucose, and TC were for WC or an index based on WC. For women, this was true for glucose but BMI was more important for BP and TC. WC or an index based on WC provided better discrimination than BMI of hypertension and elevated glucose, and of raised TC for men. Information on four new anthropometric indices did not improve model fit or subject discrimination.

CONCLUSION

For BP/hypertension, glucose/elevated glucose, and TC/raised TC, WC was more informative than BMI for Vietnamese men, but both WC and BMI were important for Vietnamese women. Both WC and BMI need to be assessed for estimation of CVD risk in Vietnam.

Hypertension and Pharmacological Therapy in Women

Cardiovascular (CV) disease is the leading cause of morbidity and mortality for women all over the world. The role and weight of risk factors in relation to gender are not completely clarified as well as their treatment. Pathophysiology of hypertension in woman presents different aspects in relation to phase of life, with an impact on treatment. The only certainties that we have nowadays regarding hypertension therapy in women are really few and may be summarized in: how to treat or, better, what not to use in hypertension in pregnancy and how to treat acute severe hypertension in pregnancy. We have some certainties also on treatment of hypertension associated to some women's comorbidities. Considering guidelines and analyzing what happens in the real world, we report in this review that women have similar major CV risk factors of men, although a minor CV global risk. However, there are some data that suggest that hypertension and diabetes are more important risk factors in women than in men. Blood pressure reduction and benefit by treatment appear similar in women and men, suggesting that we should aim for similar target of blood pressure, although the lower global risk profile should imply different target. Theoretically, recommended drugs are similar in women and men, but in women we must take in account CV risk profile, comorbidity, side effects, and reproductive health. Finally, registries and observational studies show that fewer women reach the target values of blood pressure and that women receive more frequently prescription of "other" classes of drugs than those recommended by guidelines, even after normalization by age and comorbidities.

Association between CD4 Cell Count and Blood Pressure and Its Variation with Body Mass Index Categories in HIV-Infected Patients

The aim of this study was to establish whether an independent relationship exists between CD4 count and hypertension and if this relationship is modified or confounded by the body mass index (BMI). Methods. A secondary data analysis of a cross-sectional study on 200 HIV/AIDS patients at a referral hospital in Cameroon was conducted. Linear and logistic regression models were used as appropriate to explore the association between the variables of interest. Results. There was no linear association between log CD4 count and both systolic (p = 0.200; r = 0.12) and diastolic blood pressures (p = 0.123; r = 0.14), respectively. After adjusting for BMI, patients with CD4 count ≥ 350 cells/μl were more likely to have hypertension than those with CD4 count < 350 cells/μl (AOR: 2.50, 95% CI: 1.05–5.93, and p = 0.032). There was no effect modification from BMI (test of homogeneity, p = 0.721). There was no independent relationship between CD4 count and hypertension after controlling for age, sex, family history of hypertension, BMI-defined overweight, HAART use, and duration of HIV infection (AOR: 1.66, 95% CI: 0.48–5.71, and p = 0.419). Conclusion. This study did not identify any independent relationship between CD4 count and hypertension. Large prospective studies are recommended to better explore this relationship between hypertension and CD4 count.

Comparing measures of general and abdominal adiposity as predictors of blood pressure in college students

OBJECTIVE

To compare anthropometric measures of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and sagittal abdominal diameter (SAD) as predictors of blood pressure in college students.

PARTICIPANTS

Students (N = 116) were recruited from November 2012 to May 2014 at an urban university and rural community colleges.

METHODS

Students underwent a brief physical examination during which anthropometric measures were obtained and blood pressure was measured. Covariates were measured using self-reported questionnaires. Hierarchical multiple linear regressions were used for the data analysis.

RESULTS

All anthropometric measures were predictive of systolic (SBP) and diastolic blood pressure (DBP). WC was the strongest predictor of SBP (β = .582, p < .01) explaining an additional 3-4% of the variance than BMI, WHtR, or SAD. The measures were similar in predicting DBP. WC predicted SBP independent of BMI.

CONCLUSIONS

Clinicians should consider using WC to assess the risk for hypertension in college students.

Epidemiology of hypertension in Fulani indigenous populations-age, gender and drivers

BACKGROUND

Hypertension is a public health problem and the main contributor to cardiovascular mortality and morbidity. Little is known about hypertension among the minority, diverse and socially disadvantaged 23-24 million Fulani/Peul populations dispersed in West, Central and East Africa, undergoing a transition from traditional to transitional and modern lifestyle. This study describes age and gender variations in blood pressure and drivers of hypertension among rural Fulani population of Cameroon.

METHODS

We analysed population-based cross-sectional data collected in 2013 by standard methods from 1337 Fulani/Peul aged ≥ 20 years. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or current use of anti-hypertensive medication. We elucidated the occurrence and drivers of hypertension by chi-square test, Student's t test and univariate and multivariable logistic regression models.

RESULTS

The prevalence of hypertension was 31.1% (men 36.5% and women 28.7%). Systolic and diastolic blood pressure increased with age. Older women suffered more from grades 1, 2 and 3 hypertension than older men. Old age, divorced/separated, never attended school, current/former smoker, family history (FH) of hypertension, diabetic, underweight and substantially increased risk from waist circumference were independently associated with hypertension. Insomnia and had 8-12 children were the only drivers of hypertension among men.

CONCLUSION

Prevalence of hypertension was high. Awareness and control were low. Hypertension prevalence increased with age and was more prevalent among men than women. Older women experienced severe hypertension more than older men. Culturally embedded interventions are warranted to curb the high burden of hypertension among the Fulani.

Prehypertension and its optimal indicator among adults in Hubei Province, Central China, 2013-2015

BACKGROUND

Hypertension accounts for 7% of the annual global disease burden, despite great efforts to counter this trend. Thus, interventions targeted at prehypertension might lead to a breakthrough for hypertension prevention. This study focused on the prevalence of prehypertension among adults in Central China and the best indicator of prehypertension, which would provide the basis for future interventions.

METHODS

This cross-sectional study was conducted using multistage stratified random sampling in seven counties in Hubei Province. Data from 30,634 survey respondents were analyzed using logistic regression and receiver operating characteristic (ROC) curve statistical tests, for the prevalence of prehypertension and the predictive ability of body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) for prehypertension.

RESULTS

The prevalence of prehypertension in adults was 42.2%. The following factors contributed to the risk of prehypertension: male sex, elder age, divorce/separation, drinking, heavy labor intensity, and high BMI (p < 0.05). Being a farmer and exercise exhibited positive associations with prehypertension (p < 0.05). Compared with BMI and WHtR, WC had a higher predictive value for prehypertension (area under ROC curve, AUC = 0.630, 95% confidence interval: 0.623-0.637, p < 0.0001), especially for men. The optimal cutoffs of WC for prehypertension were 79.95 cm in men and 76.85 cm in women.

CONCLUSIONS

The prehypertension rate in adults was high in Central China. Significant factors related to hypertension were identified. More interventions targeting individuals with WC above the cutoff level are needed for timely awareness of prehypertension and early prevention of hypertension.

Associations Between Obesity Indicators and Blood Pressure in Chinese Adult Twins

Obesity is associated with blood pressure (BP), but the associations between different obesity indicators and BP have not reached agreement. Besides, both obesity and BP are influenced by genetic and environmental factors. Whether they share the same genetic or environmental etiology has not been fully understood. We therefore analyzed the relationship between different obesity indicators and BP components as well as the genetic and environmental contributions to these relationships in a Chinese adult twin sample. Twins aged 18–79 years (n = 941) were included in this study. Body mass index (BMI) was used as the index of general obesity, whereas waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) were used as the indicators of central obesity. BP components included systolic blood pressure (SBP) and diastolic blood pressure (DBP). Linear regression models and bivariate structural equation models were used to examine the relation of various obesity indicators with BP components, and genetic or environmental influences on these associations, respectively. A strong association of BP components with BMI—and a somewhat weaker association with WC, WHtR, and WHR—was found in both sexes, independent of familial factors. Of these phenotypic correlations between obesity indicators and BP components, 60–76% were attributed to genetic factors, whereas 24–40% were attributed to unique environmental factors. General obesity was most strongly associated with high BP in Chinese adult twins. There were common genetic backgrounds for obesity and BP, and unique environmental factors also played a role.

Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: a cross sectional population study

BACKGROUND

Limited information is available about the prevalence, ethnic disparities, and risk factors of hypertension within developing countries. We used data from a nationwide study on non-communicable disease (NCD) risk factors to estimate, explore, and compare the prevalence of hypertension overall and in subgroups of risk factors among different ethnic groups in Suriname.

METHOD

The Suriname Health Study used the World Health Organization Steps design to select respondents with a stratified multistage cluster sample of households. The overall and ethnic specific prevalences of hypertension were calculated in general and in subgroups of sex, age, marital status, educational level, income status, employment, smoking status, residence, physical activity, body mass index (BMI), and waist circumference (WC). Differences in the prevalence between ethnic subgroups were assessed using the Chi-square test. We used several adjustment models to explore whether the observed ethnic differences were explained by biological, demographic, lifestyle, or anthropometric risk factors.

RESULTS

The prevalence of hypertension was 26.2 % (95 % confidence interval 25.1 %-27.4 %). Men had higher mean values for systolic and diastolic blood pressure compared to women. Blood pressure increased with age. The prevalence was highest for Creole, Hindustani, and Javanese and lowest for Amerindians, Mixed, and Maroons. Differences between ethnic groups were measured in the prevalence of hypertension in subcategories of sex, marital status, education, income, smoking, physical activity, and BMI. The major difference in association of ethnic groups with hypertension was between Hindustani and Amerindians.

CONCLUSION

The prevalence of hypertension in Suriname was in the range of developing countries. The highest prevalence was found in Creoles, Hindustani, and Javanese. Differences in the prevalence of hypertension were observed between ethnic subgroups with biological, demographic, lifestyle, and anthropometric risk factors. These findings emphasize the need for ethnic-specific research and prevention and intervention programs.