Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension

Genetics of Hypertension: From Monogenic Analysis to GETomics

Arterial hypertension is the most frequent cardiovascular risk factor all over the world, and it is one of the leading drivers of the risk of cardiovascular events and death. It is a complex trait influenced by heritable and environmental factors. To date, the World Health Organization estimates that 1.28 billion adults aged 30-79 years worldwide have arterial hypertension (defined by European guidelines as office systolic blood pressure ≥ 140 mmHg or office diastolic blood pressure ≥ 90 mmHg), and 7.1 million die from this disease. The molecular genetic basis of primary arterial hypertension is the subject of intense research and has recently yielded remarkable progress. In this review, we will discuss the genetics of arterial hypertension. Recent studies have identified over 900 independent loci associated with blood pressure regulation across the genome. Comprehending these mechanisms not only could shed light on the pathogenesis of the disease but also hold the potential for assessing the risk of developing arterial hypertension in the future. In addition, these findings may pave the way for novel drug development and personalized therapeutic strategies.

Mitochondrial tRNA Mutations Associated With Essential Hypertension: From Molecular Genetics to Function

Essential hypertension (EH) is one of the most common cardiovascular diseases worldwide, entailing a high level of morbidity. EH is a multifactorial disease influenced by both genetic and environmental factors, including mitochondrial DNA (mtDNA) genotype. Previous studies identified mtDNA mutations that are associated with maternally inherited hypertension, including tRNA^Ile m.4263A>G, m.4291T>C, m.4295A>G, tRNA^Met m.4435A>G, tRNA^Ala m.5655A>G, and tRNA^Met/tRNA^Gln m.4401A>G, et al. These mtDNA mutations alter tRNA structure, thereby leading to metabolic disorders. Metabolic defects associated with mitochondrial tRNAs affect protein synthesis, cause oxidative phosphorylation defects, reduced ATP synthesis, and increase production of reactive oxygen species. In this review we discuss known mutations of tRNA genes encoded by mtDNA and the potential mechanisms by which these mutations may contribute to hypertension.

Impact of an active lifestyle on heart rate variability and oxidative stress markers in offspring of hypertensives

Familial history of hypertension is associated with autonomic dysfunction and increase in blood pressure (BP). However, an active lifestyle has been found to improve a number of health outcomes and reduce all-cause mortality. The aim of the present study was to investigate the effects of an active lifestyle on hemodynamics, heart rate variability (HRV) and oxidative stress markers in offspring of hypertensive parents. One hundred twenty-seven subjects were assigned into four groups: sedentary offspring of normotensives (S-ON) or hypertensives (S-OH); and physically active offspring of normotensives (A-ON) or hypertensives (A-OH). Diastolic BP and heart rate were reduced in the physically active groups when compared to S-OH group. A-ON and A-OH groups presented increased values of RR total variance when compared to the sedentary ones (A-ON: 4,912 ± 538 vs. S-ON: 2,354 ± 159; A-OH: 3,112 ± 236 vs. S-OH: 2,232 ± 241 ms²). Cardiac sympato-vagal balance (LF/HF), systemic hydrogen peroxide and superoxide anion were markedly increased in S-OH group when compared to all other studied groups. Additionally, important correlations were observed between LF/HF with diastolic BP (r = 0.30) and hydrogen peroxide (r = 0.41). Thus, our findings seem to confirm an early autonomic dysfunction in offspring of hypertensive parents, which was associated with a systemic increase in reactive oxygen species and blood pressure. However, our most important finding lies in the attenuation of such disorders in offspring of physically active hypertensives, thus emphasizing the importance of a physically active lifestyle in the prevention of early disorders that may be associated with onset of hypertension.

Arterial hypertension in adults. Clinical guidelines 2020

Arterial hypertension in adults. Clinical guidelines 2020

Combined effect of weight gain within normal weight range and parental hypertension on the prevalence of hypertension; from the J-MICC Study

The aim of this study is to show the combined effect of weight gain within normal weight range in adulthood and parental HT on the prevalence of HT. The study subjects were 44,998 individuals (19,039 men and 25,959 women) with normal weight (body mass index [BMI] 18.5-24.9) aged 35-69 years who participated in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. They were categorized into six groups by weight gain from age 20 years (<10 kg, and ≥10 kg) and by the number of parents having HT (no parent, one parent, and both parents). Odds ratios for HT were estimated after adjustment for age, sex, current BMI, estimated daily sodium intake, and other confounding factors. The prevalence of HT (31.5% in total subjects) gradually increased with greater weight gain from age 20 years and with greater number of parents with HT. Subjects who gained weight ≥10 kg and having both parents with HT showed the highest risk of having HT compared with those who gained weight <10 kg without parental HT (59.8% vs. 24.9%, odds ratio 4.25, 95% CI 3.53-5.13 after adjustment). This association was similarly observed in any category of age, sex, and BMI. Subjects who gained weight within normal range of BMI and having one or both parent(s) with HT showed the higher risk of having HT independent of their attained BMI in their middle ages. Thus, subjects having parent(s) with HT should avoid gaining their weight during adulthood, even within normal range of BMI, to reduce the risk of having HT.

Association of binge drinking in adolescence and early adulthood with high blood pressure: findings from the National Longitudinal Study of Adolescent to Adult Health (1994–2008)

Background

An investigation of the risk of high blood pressure (HBP) associated with heavy alcohol consumption in adolescence and early adulthood is lacking. Therefore, we aimed to investigate the association between binge drinking from adolescence to early adulthood and the risk of HBP in early adulthood.

Methods

We applied logistic regression to publicly available, population-representative data from waves I (1994–1995; ages 12–18) and IV (2007–2008; ages 24–32) of the National Longitudinal Study of Adolescent to Adult Health (n=5114) to determine whether past 12-month binge drinking in adolescence (wave I) and early adulthood (wave IV) was associated with HBP in early adulthood after adjusting for covariates, including smoking and body mass index. HBP was defined according to both the former and new classifications.

Results

HBP was significantly, positively associated with infrequent binge drinking (less than once a week) in adolescence based on the new classification (overall: OR 1.23, 95% CI 1.02 to 1.49; male: OR 1.35, 95% CI 1.00 to 1.81) and frequent binge drinking (heavy consumption) in adolescence based on the former classification (overall: OR= 1.64, 95% CI 1.22 to 2.22; male: OR= 1.79, 95% CI 1.23 to 2.60). The risk of HBP was high when participants engaged in frequent binge drinking in both adolescence and early adulthood, especially based on the former classification (overall: OR 2.43, 95% CI 1.13 to 5.20; female: OR 5.81, 95% CI 2.26 to 14.93).

Conclusion

Binge drinking in adolescence may increase risk of HBP in early adulthood. This association is independent of other important risk factors for HPB, such as smoking and obesity.

Risk Factors for Ischemic Heart Disease

BACKGROUND

Several risk factors have been empirically linked to an increased risk of cardiovascular disease. Some of them are therapeutically amenable to modification; while others are not. Modifiable risk factors include physical inactivity, tobacco use, diet, "bad fats" in the blood, hypertension, and being overweight; while non-modifiable risk factors include the patient's family history, the presence versus absence of diabetes mellitus, and demographic characteristics like age, gender, ethnicity, and socio-economic status.

METHODS

In this article, we review those risk factors that are both clinically important and amenable to change.

CONCLUSION

To prevent cardiovascular disease, it is important to minimize modifiable risk factors, like LDL cholesterol.

C-reactive protein and incident hypertension in a worksite population of Japanese men

Inflammation plays a key role in the pathogenesis of cardiovascular diseases via the development of atherosclerosis. Here, we evaluated the impact of serum C-reactive protein (CRP) and the white blood cell (WBC) count on the risk of hypertension in middle-aged Japanese men at a work site. We evaluated a total of 2991 Japanese male workers without hypertension who ranged in age from 18 to 64 years (mean age 40.4 ± 0.2 years) at a worksite in 2010. The hazard ratio (HR) for incident hypertension was estimated according to quartile levels of serum high-sensitivity CRP (hs-CRP) or WBC count. These men were followed up for 5 years from 2010 to 2015. During the follow-up period, 579 (19.4%) subjects developed hypertension. In a multivariable analysis, the risk of incident hypertension was significantly increased with higher hs-CRP levels: HR 1.00 (reference) for the lowest quartile, 1.39 (1.04-1.85) for the 2nd quartile, 1.46 (1.08-1.98) for the 3rd quartile, and 1.57 (1.17-2.11) for the highest quartile. In contrast, the WBC count was not associated with a greater risk of incident hypertension after multivariable adjustment. These findings suggest that higher levels of serum hs-CRP, but not the WBC count, are associated with the future incidence of hypertension in middle-aged Japanese men.

Familial history of hypertension-induced impairment on heart rate variability was not observed in strength-trained subjects

Family history of hypertension is an important predictive factor for hypertension and is associated with hemodynamic and autonomic abnormalities. Previous studies reported that strength training might reduce arterial blood pressure (AP), as well as improve heart rate variability (HRV). However, the benefits of strength training in the offspring of hypertensive parents have not been fully evaluated. Here, we analyzed the impact of strength training on hemodynamics and autonomic parameters in offspring of hypertensive subjects. We performed a cross-sectional study with sedentary or physically active offspring of normotensives (S-ON and A-ON) or hypertensives (S-OH and A-OH). We recorded RR interval for analysis of HRV. AP was similar between groups. Sedentary offspring of hypertensives presented impairment of total variance of RR interval, as well as an increase in cardiac sympathovagal balance (S-OH: 4.2±0.7 vs S-ON: 2.8±0.4 and A-ON: 2.4±0.1). In contrast, the strength-trained group with a family history of hypertension did not show such dysfunctions. In conclusion, sedentary offspring of hypertensives, despite displaying no changes in AP, showed reduced HRV, reinforcing the hypothesis that autonomic dysfunctions have been associated with higher risk of hypertension onset. Our findings demonstrated that strength-trained offspring of hypertensives did not present impaired HRV, thus reinforcing the benefits of an active lifestyle in the prevention of early dysfunctions associated with the onset of hypertension in predisposed populations.

Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study

BACKGROUND

Blacks have higher blood pressure levels compared with whites beginning in childhood. Few data are available on racial differences in the incidence of hypertension from young adulthood through middle age.

METHODS AND RESULTS

We calculated the cumulative incidence of hypertension from age 18 to 55 years among participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study. Incident hypertension was defined by the first visit with mean systolic blood pressure ≥130 mm Hg, mean diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medication. Among 3890 participants without hypertension at baseline (aged 18-30 years), cumulative incidence of hypertension by age 55 years was 75.5%, 75.7%, 54.5%, and 40.0% in black men, black women, white men, and white women, respectively. Among participants with systolic blood pressure/diastolic blood pressure <110 and 70, 110 to 119/70 to 74, and 120 to 129/75 to 79 mm Hg at baseline, blacks were more likely than whites to develop hypertension: multivariable-adjusted hazard ratios 1.97 (95% confidence interval, 1.65, 2.35), 1.80 (95% confidence interval, 1.52, 2.14), and 1.59 (95% confidence interval, 1.31, 1.93), respectively. Parental history of hypertension and higher body mass index, serum uric acid, and systolic blood pressure/diastolic blood pressure categories were associated with a higher risk for hypertension among blacks and whites. A higher Dietary Approaches to Stop Hypertension diet adherence score was associated with a lower risk for hypertension in blacks and whites.

CONCLUSIONS

Regardless of blood pressure level in young adulthood, blacks have a substantially higher risk for hypertension compared with whites through 55 years of age.

Risk for hypertension crosses generations in the community: a multi-generational cohort study

Aims

Parental hypertension is known to predict high blood pressure (BP) in children. However, the extent to which risk for hypertension is conferred across multiple generations, notwithstanding the impact of environmental factors, is unclear. Our objective was therefore to evaluate the degree to which risk for hypertension extends across multiple generations of individuals in the community.

Methods and results

We studied three generations of Framingham Heart Study participants with standardized blood pressure measurements performed at serial examinations spanning 5 decades (1948 through 2005): First Generation (n = 1809), Second Generation (n = 2631), and Third Generation (n = 3608, mean age 39 years, 53% women). To capture a more precise estimate of conferrable risk, we defined early-onset hypertension (age <55 years) as the primary exposure. In multinomial logistic regression models adjusting for standard risk factors as well as physical activity and daily intake of dietary sodium, risk for hypertension in the Third Generation was conferred simultaneously by presence of early-onset hypertension in parents [OR 2.10 (95% CI, 1.66-2.67), P < 0.001] as well as in grandparents [OR 1.33 (95% CI, 1.12-1.58), P < 0.01].

Conclusion

Early-onset hypertension in grandparents raises the risk for hypertension in grandchildren, even after adjusting for early-onset hypertension in parents and lifestyle factors. These results suggest that a substantial familial predisposition for hypertension exists, and this predisposition is not identical when assessed from one generation to the next. Additional studies are needed to elucidate the mechanisms underlying transgenerational risk for hypertension and its clinical implications.

Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study

Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death.Design Multigenerational, prospective cohort study.Setting Framingham Heart Study.Participants Two generations of community dwelling participants with blood pressure measurements performed at serial examinations spanning six decades: 3614 first generation participants with mortality data and 1635 initially non-hypertensive second generation participants with data available on parental blood pressure.Main outcome measures The main outcome measures were relation of parental early onset hypertension (age <55 years) with incidence of hypertension in offspring, using regression analyses, and relation of age at hypertension onset with cause specific mortality using a case (cardiovascular death) versus control (non-cardiovascular death) design.Results In second generation participants, having one or both parents with late onset hypertension did not increase the risk of hypertension compared with having parents with no hypertension; by contrast, the hazard ratios of hypertension were 2.0 (95% confidence interval 1.2 to 3.5) and 3.5 (1.9 to 6.1) in participants with one and both parents with early onset hypertension, respectively. In first generation decedents, 1151 cardiovascular deaths occurred (including 630 coronary deaths). The odds of cardiovascular death increased linearly with decreasing age of hypertension onset (P<0.001 for trend). Compared with non-hypertensive participants, hypertension onset at age <45 years conferred an odds ratios of 2.2 (1.8 to 2.7) for cardiovascular death and 2.3 (1.8 to 2.9) for coronary death, whereas hypertension onset at age ≥65 years conferred a lower magnitude odds ratios of 1.5 (1.2 to 1.9) for cardiovascular death and 1.4 (0.98 to 1.9) for coronary death (P≤0.002 for differences in odds ratios between hypertension onset at age <45 and age ≥65).Conclusions Early onset and not late onset hypertension in parents was strongly associated with hypertension in offspring. In turn, early onset compared with late onset hypertension was associated with greater odds of cardiovascular, and particularly coronary, death. These findings suggest it may be important to distinguish between early onset and late onset hypertension as a familial trait when assessing an individual's risk for hypertension, and as a specific type of blood pressure trait when estimating risk for cardiovascular outcomes in adults with established hypertension.

Prevalence of hypertension in primary school-children in Port Harcourt, Nigeria

BACKGROUND

Hypertension is defined as average systolic and/or diastolic blood pressure (BP) ≥95th per centile for gender, age and height, and pre-hypertension as ≥90th and <95th per centile, measured on three occasions. Although the prevalence of hypertension during childhood is lower than that in adulthood, it is not rare in children.

AIMS AND OBJECTIVES

To evaluate the prevalence of hypertension and its severity in primary school-children in Port Harcourt.

METHODS

A stratified, multi-staged sampling technique was used to recruit pupils between 6 and 12 years of age in 13 primary schools. Data were collected using a pre-tested questionnaire completed by parents/guardians. The average of three blood pressure measurements was taken for each pupil using standardized techniques.

RESULTS

A total of 1302 pupils of whom 585 (44·9%) males and 717 (55·1%) females were studied, giving a male to female ratio of 1:1·2. The prevalence of hypertension was 61 (4·7%), 55 (4·2%) with stage 1 and six (0·5%) with stage 2 hypertension. Sixty (4·6%) of the pupils had pre-hypertension. Twenty-three (3·9%) of the 585 males and 38 (5·3%) of the 717 females were hypertensive (P = 0·25). The mean (SD) age of 8·83 (1·90) years for the normotensive children was higher than the mean (SD) age of 8·56 (2·05) years for the hypertensive children (P = 0·27). Of the study subjects, 152 (11·7%) were underweight, 998 (76·7%) were of normal weight, 75 (5·7%) were overweight and 77 (5·9%) were obese. The prevalence of hypertension among the different weight groups fell steadily from 13 (16·9%) in the obese children to 4 (5·3%) in the overweight children, to 43 (4·3%) in the normal weight children and one (0·7%) in the underweight children (P<0·001).

CONCLUSION

The prevalence of hypertension in school-children in Port Harcourt is 4·7% which is similar to that in other studies in Nigeria and elsewhere. A higher BMI was significantly associated with a higher prevalence of hypertension.

Maternal history of hypertension and blood pressure response to potassium intake: the GenSalt Study

The relation between parental history of hypertension and blood pressure response to potassium intake is unknown. A 7-day high-sodium followed by a 7-day high-sodium plus potassium dietary-feeding study was conducted from 2003 to 2005 among 1,871 Chinese participants. Those with a maternal history of hypertension had larger systolic blood pressure responses to potassium compared with those without: -4.31 (95% confidence interval (CI): -4.99, -3.62) mm Hg versus -3.35 (95% CI: -4.00, -2.70) mm Hg, respectively (P(difference) = 0.002). A consistent trend was observed for diastolic blood pressure responses: -1.80 (95% CI: -2.41, -1.20) mm Hg versus -1.35 (95% CI: -1.95, -0.74) mm Hg, respectively (P = 0.07). Stronger associations between early onset maternal hypertension and blood pressure responses were noted, with systolic blood pressure decreases of -4.80 (95% CI: -5.65, -3.95) mm Hg versus -3.55 (95% CI: -4.17, -2.93) mm Hg and diastolic blood pressure decreases of -2.25 (95% CI: -3.01, -1.50) mm Hg versus -1.42 (95% CI: -1.99, -0.85) mm Hg among those with early onset maternal hypertension versus those without, respectively (P = 0.001 and 0.009, respectively). Odds ratios for high potassium sensitivity were 1.36 (95% CI: 0.96, 1.92) and 1.60 (95% CI: 1.08, 2.36) for those with maternal hypertension and early onset maternal hypertension, respectively (P = 0.08 and 0.02, respectively). Potassium supplementation could help to reduce blood pressure among those with a maternal history of hypertension.

Parental history of hypertension is associated with narrower retinal arteriolar caliber in young girls

We aimed to assess the associations between parental history of hypertension and indicators of cardiovascular risk (retinal vessel diameter, presence of obesity, and elevated blood pressure) in prepubertal children. There were 1739 (77.7% of those eligible) 6-year-old students (863 girls and 876 boys) who were examined from a random cluster sample of 34 Sydney schools. Parents completed questionnaires about their medical conditions, including whether they have/had hypertension. Retinal images were taken with a digital fundus camera, and retinal vessel caliber was quantified using computer software. Anthropometric (height, weight, percentage of body fat, and body mass index) and blood pressure measures were collected. There were 160 children (9.2%) with a positive parental history of hypertension (either biological mother and/or father). Children with a positive versus negative parental history of hypertension had significantly higher body mass index (16.8 versus 16.5 kg/m(2); P=0.04) and systolic blood pressure (101.3 versus 99.8 mm Hg; P=0.01). Girls with positive versus negative parental history of hypertension had significantly higher diastolic blood pressure (≈3.1 mm Hg; P=0.01) and narrower retinal arteriolar caliber (≈4.3 μm; P=0.0004). Positive parental history of hypertension was not associated with mean retinal vascular caliber among boys. We show that a positive parental history of hypertension in healthy prepubertal girls, but not boys, is associated with narrower retinal arteriolar vessels, likely conveying a predisposition to develop hypertension later in life. These findings may indicate the need for cardiovascular disease prevention measures starting early in life among offspring of hypertensive parents.

Effects of current size, postnatal growth, and birth size on blood pressure in early childhood

OBJECTIVE

In a prospective study, we investigated the impact of early growth on blood pressure at 3 years of age.

METHODS

We measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) for 590 children 3 years of age and related measurements to current size and size at birth, 6 months, 1 year, and 2 years of age.

RESULTS

SBP was related positively to weight at 3 and 2 years and, after adjustment for current size, negatively to weight at birth and 6 months but not at 1 or 2 years. No effect was observed for DBP. A family history of hypertension was associated with higher maternal blood pressure, greater weight, and gestational hypertension (P = .05). Mothers with a history of gestational hypertension had higher SBP and DBP values (P < .001). In multivariate linear regression analyses, SBP was influenced positively by weight at 3 years and family history of hypertension and negatively by weight at 6 months. None of the factors was associated with DBP.

CONCLUSIONS

For 3-year-old children, current weight was a determinant of SBP and postnatal growth to 6 months of age was more predictive than birth weight. A family history of hypertension is important in determining maternal blood pressure. These observations suggest a window in which postnatal growth might be modified.

Ambulatory blood pressure monitoring in healthy children with parental hypertension

The aim of this study was to compare ambulatory blood pressure monitoring (ABPM) parameters in offspring with at least one hypertensive parent (HP) to offspring with normotensive parents (NP) and to determine whether gender of parent or child might influence the association between parental hypertension and blood pressure (BP). Eighty-nine healthy children (mean age 11.1 +/- 3.9 years) with HP and 90 controls (mean age 10.5 +/- 3.1 years) with NP were recruited. Age, gender, and height did not differ between the two groups, whereas children of HP had higher weight, body mass index (BMI), and waist circumference compared with healthy controls. No difference was found in casual BP between the two groups. In contrast, during ABPM daytime and nighttime mean systolic and diastolic BP and mean arterial pressure (MAP) standard deviation scores (SDS) were significantly elevated in children with HP. The mean percentage of nocturnal BP decline (dipping) was not significantly different between the two groups. Children with hypertensive mothers had higher daytime systolic and MAP SDS than controls; no such difference was detected for children with hypertensive fathers. Daytime systolic and MAP SDS were significantly elevated in boys with HP compared with boys with NP but failed to be significant in girls. Multiple linear regression analysis showed that parental history of hypertension (B = 0.29) and BMI (B = 0.03) were independently correlated with increase of daytime MAP SDS. Early changes in ambulatory BP parameters were present in healthy children of HP. BP in HP offspring was influenced by the gender of the affected parent and the offspring.

Maternal influence on blood pressure suggests involvement of mitochondrial DNA in the pathogenesis of hypertension: the Framingham Heart Study

OBJECTIVE

To investigate the contribution of the mitochondrial genome to hypertension and quantitative blood pressure (BP) phenotypes in the Framingham Heart Study cohort, a randomly ascertained, community-based sample.

METHODS

Longitudinal BP values of 6421 participants (mean age, 53 years; 46% men) from 1593 extended families were used for analyses. In analyses of BP as a continuous trait, a variance components model with a variance component for maternal effects was used to estimate the mitochondrial heritability of the long-term average BP adjusted for age, sex, body mass index, and hypertension treatment. For analyses of BP as a categorical trait, a nonparametric test sensitive to excessive maternal inheritance was used to test for mitochondrial effect on long-term hypertension, defined as systolic BP of at least 140 mmHg or diastolic BP of at least 90 mmHg or use of antihypertensive medication in one-half or more of qualifying examinations. This test was based on 353 pedigrees comprised of 403 individuals informative for mitochondrial DNA contribution.

RESULTS

The estimated fraction of hypertensive pedigrees potentially due to mitochondrial effects was 35.2% (95% confidence interval, 27-43%, P < 10). The mitochondrial heritabilities for multivariable-adjusted long-term average systolic BP and diastolic BP were, respectively, 5% (P < 0.02) and 4% (P = 0.11).

CONCLUSION

Our data provide support for a maternal effect on hypertension status and quantitative systolic BP, consistent with mitochondrial influence. Additional studies are warranted to identify mitochondrial DNA variant(s) affecting BP.

Impact of different levels of weight loss on blood pressure in overweight and obese women

This study sought to determine the impact of different levels of weight loss on blood pressure in overweight/obese women. One hundred fifty-nine overweight/obese women (age 48.7 +/- 9.7, weight 101.3 +/- 18.7 kg, BMI 37.3 +/- 6.6 kg/m(2)) completed a six-month clinical weight loss program that included weekly nutrition, behavior, and exercise instruction. Participants consumed a very-low-energy diet (VLED) for 12 weeks. VLED was followed by four weeks of gradual reintroduction to solid foods. At week 16, participants received a diet to maintain weight or slightly reduce weight (<0.5 lb/week) which they followed for the duration of the study. All lab and blood pressure assessments were performed at baseline and six months. Three groups were formed according to the proportion of weight loss after six months; Group 1 had < 10% (n = 19), Group 2 had 10%-20% (n = 64), and Group 3 had >20% (n = 76) weight loss. Differences in systolic blood pressure (mm Hg) were found in dose response fashion for weight loss at six months with 125 +/- 17 (<10%), 119 +/- 13 (10%-20%), and 117 +/- 15 (>20%; p = 0.005). Differences in diastolic blood pressure (mm Hg) were also found in dose response fashion with 81 +/- 9 (<10%), 77 +/- 9 (10%-20%), and 75 +/- 9 (20%; p = 0.003). These data indicate that increasing weight loss beyond 10% of initial body weight may provide added improvements in blood pressure compared to less than 10% weight loss in overweight or obese women.

Lifestyle, family history and progression of hypertension

BACKGROUND

Unhealthy lifestyle practices are risk factors for future hypertension.

OBJECTIVES

The aim of this study was to investigate the association between lifestyle changes over a 6-year period and the risk of developing sustained hypertension in a cohort of young hypertensive individuals, and to identify the predictors of lifestyle impairment over time.

METHODS

Seven-hundred and eighty never-treated hypertensive HARVEST participants, 18-45 years old, were studied.

RESULTS

Only modest mean behavioral changes were observed during follow-up. This, however, was the net result of many participants improving and others worsening their lifestyle. Participants with a family history of hypertension (FH+, n = 459) had more undesirable lifestyles (P = 0.004) and higher clinic and ambulatory blood pressures (P = 0.03) at baseline than participants without a family history of hypertension (FH-). During the 6-year follow-up, FH- individuals strikingly worsened their lifestyle while FH+ participants exhibited impressive improvements (P < 0.00001). Other predictors of lifestyle impairment were male gender (P = 0.003) and age (P = 0.02). Adoption of an unfavorable lifestyle was accompanied by an increased risk of developing sustained hypertension (P = 0.04). Initiation of drug therapy for hypertension was significantly higher among FH- than FH+ individuals (53 versus 45%, respectively; P = 0.045).

CONCLUSIONS

'Lower risk' FH- stage 1 hypertensive individuals may initially be at higher risk of developing more severe hypertension in comparison with their FH+ counterparts. This increased risk may be attributed to worsening of their lifestyle profiles over time. Healthy lifestyles should be emphasized to all hypertensive individuals including patients with favorable lifestyle profiles.

Alcohol consumption and blood pressure in the adult US population: assessment of gender-related effects

OBJECTIVE

Our objective was to assess the gender-related effects of alcohol consumption on blood pressure (BP) in a representative sample of the adult US population.

METHODS

We examined data from the National Health and Nutrition Examination Survey 1999-2000. The effects of various risk factors for hypertension on BP were examined with analysis of covariance statistics.

RESULTS

Of the 5448 adults over 20 years of age, 2650 (48.7%) reported the intake of one or more drinks per day over the past year. In this population, the mean +/- SEM age was 46.9 +/- 0.34 years, the body mass index was 24.8 kg/m, 1257 (47.4%) were women, systolic BP was 124.3 +/- 0.44 mmHg and diastolic BP was 72.7 +/- 0.27 mmHg. Hypertension was reported in 21.1%, diabetes in 5.1% and cigarette smoking in 39.7%. A significant effect on systolic BP was shown with age (P < 0.01), body mass index (P < 0.01), race (P = 0.01), gender (P < 0.01) and diabetes (P < 0.01). The interaction with gender and alcohol drinking level was significant (P = 0.02). Post-hoc analysis localized the source of this effect. There was a significant increase in systolic BP between one and three and between one and four, but not between one and two, drinks per day in men. This effect was not observed in women.

CONCLUSION

Consistent with previous reports, our study suggests that alcohol intake up to two drinks per day has no effect on BP. There was a gender-related effect of alcohol intake in excess of two drinks per day on BP, with increased BP observed only in men but not in women.

Hypothesis: Uric acid, nephron number, and the pathogenesis of essential hypertension

BACKGROUND

Essential hypertension affects more than 25% of the world's population. Genetic, physiologic, and epidemiologic studies provide clues to its origins, but a clear understanding has been elusive. Recent experimental and clinical studies have implicated uric acid in the onset of essential hypertension.

METHODS

In a retrospective chart review, we identified 95 children with confirmed, new onset hypertension, and evaluated the cause of hypertension and parental history of hypertension, birth weight, and serum uric acid. In an open-label, cross-over trial we treated 5 children with confirmed essential hypertension with allopurinol as single treatment agent, and screened for change in blood pressure by casual and ambulatory methods. In tissue culture experiments, we evaluated the effect of uric acid on glomerular endothelial cell function.

RESULTS

Elevation of serum uric acid is related to the onset of essential hypertension in children, reduced birth weight, and endothelial dysfunction. Normalization of uric acid appears to ameliorate new onset essential hypertension.

CONCLUSION

These findings, combined with animal model data, support the hypothesis that uric acid has a key role in the pathogenesis of early onset essential hypertension, and may unify some of the disparate theories of the origins of essential hypertension.

Clinical characteristics of young-onset hypertension-implications for different genders

BACKGROUND

Hypertension may develop early, before the age of 40 years, in both genders, so-called young-onset hypertension. The clinical characteristics of young-onset hypertension have not been well defined.

METHODS

The personal history and clinical characteristics were evaluated in a series of patients with young-onset hypertension. With the individual-matching, case-controlled design, patients were initially matched for age, gender and residence with the first control (C1) group in either 2:1 or 1:1 fashion. They were then additionally matched for body mass index (BMI) with the second control (C2) group in 1:1 fashion. To elucidate the possible difference between genders, all the comparisons were conducted in males and females separately.

RESULTS

A total of 82 consecutive patients, 56 males and 26 females, with young-onset hypertension were included. Compared with the 148 subjects in C1 group, hypertensive patients were relatively highly educated and had less alcohol drinking in either gender. BMI (25.10+/-0.49 vs. 22.34+/-0.31 kg/m(2), P<0.001) and serum triglyceride level (153.35+/-10.71 vs. 98.76+/-5.12 mg/dl, P<0.001) were significantly increased in male patients, while serum uric acid (5.74+/-0.34 vs. 4.78+/-0.17 mg/dl, P=0.006) and triglyceride level (121.39+/-12.71 vs. 76.58+/-4.88 mg/dl, P=0.002) were increased in female ones. Compared to that in C2 group, serum triglyceride level was still increased in patients of either gender. Interestingly, serum cholesterol level in female patients was lower than that in either C1 or C2 group. Further, serum triglyceride level was significantly correlated to BMI, serum cholesterol and glucose level in male patients but only to serum uric acid level in female ones.

CONCLUSIONS

Clinical characteristics of young-onset hypertension were unique and different by gender. Though consistently increased in patients of either gender, serum triglyceride level was correlated to BMI, serum cholesterol and glucose level only in males, suggesting the gender-specific presence of metabolic syndrome in young-onset hypertension.

One-year hypertension incidence and its predictors in a working population: the IHPAF study

THE AIMS OF OUR STUDY WERE

(i). to estimate the yearly incidence rates based on one vs two visits in a working population and (ii). to identify incident hypertension modifiable risk factors. A total of 21566 normotensive subjects were included in a 1-year cohort study. Blood pressure (BP) levels at inclusion and at the second year screening were measured on the basis of two visits, that is, if BP was over 140/90 mmHg in untreated subjects, they were invited to a control visit 1 month later. Height and weight were measured and behavioural risk factors were collected. Among the 17465 subjects who completed the entire protocol (9691 men and 7774 women), 17026 remained normotensive at a 1-year interval and 439 (325 men and 114 women) became hypertensive. Crude yearly incidence rates based on one visit were 6.21% in men and 3.06% in women, compared with 3.04% in men and 1.34% in women when incidence rates were based on two visits, a more than twofold difference. Age and body mass index at baseline were the two major independent determinants of incident hypertension in both genders. Smoking and alcohol consumption were significant risk factors in men but not in women, and a low educational level only in women. BP measurement on separate occasions is necessary to avoid overestimation of incidence. Weight in both genders and alcohol consumption in men were the main modifiable predictors of hypertension.

The role of parental hypertension in the frequency and age of diagnosis of hypertension in offspring with autosomal-dominant polycystic kidney disease

BACKGROUND

Hypertension in autosomal-dominant polycystic kidney disease (ADPKD) patients is associated with more rapid progression of renal disease and a high incidence of left ventricular hypertrophy (LVH). The present study was undertaken to examine the role of parental hypertension in the occurrence of hypertension in 475 ADPKD offspring.

METHODS

Adult subjects participating in an ongoing study of the natural history of ADPKD were included in the analysis if they were diagnosed with ADPKD, had a known affected parent, and knew the hypertensive status of both parents.

RESULTS

When the affected parent was hypertensive, the ADPKD male (82% versus 62%, P < 0.05) and female (61% versus 37%, P < 0.005) offspring had a significantly higher frequency of hypertension than when the ADPKD-affected parent was normotensive. The median age of diagnosis of hypertension was also significantly earlier in both male (33 years versus 40 years, P < 0.05) and female (38 years versus 50 years, P < 0.05) ADPKD patients when their affected parents were hypertensive as compared with normotensive. These effects of hypertension in the affected parent on hypertension in the ADPKD offspring were independent of age, renal volume, and renal function in the offspring. Hypertension in unaffected parents also increased the frequency of hypertension in the ADPKD female (69% versus 53%, P < 0.01), but not male (89% versus 77%, NS) subjects.

CONCLUSION

The results indicate that parental hypertension influences the frequency of hypertension in ADPKD patients.

Association of parental history of stroke with clinical parameters in patients with ischemic stroke or transient ischemic attack

BACKGROUND AND PURPOSE

Data regarding hereditary influences on stroke remain controversial. We investigated possible associations of a family history of stroke with clinical parameters in a large cohort of well-documented patients with ischemic cerebrovascular events, with special reference to sex-specific differences.

METHODS

We analyzed the association between a maternal and/or paternal history of stroke and clinical parameters in 1564 patients with known maternal and paternal history of stroke and suffering from ischemic stroke or transient ischemic attack within the Vienna Stroke Registry.

RESULTS

Patients with a maternal history of stroke were significantly more often female (54%) than those without (44%; P=0.003). Hypertension was more prevalent in female patients with than in those without a maternal history of stroke (87% versus 74%; P=0.001). These associations remained significant after multivariate adjustment (adjusted odds ratio, 1.9; 95% CI, 1.1 to 3.5; P=0.024). Of those female patients with an echocardiogram (n=225), those with a maternal history of stroke more often had left ventricular hypertrophy (48%) than those without (20%) (adjusted odds ratio, 3.6; 95% CI, 1.5 to 8.2; P=0.003). In contrast, hypertension was equally prevalent in male patients with or without a maternal history of stroke (75% versus 74%; P=0.754). We found no significant associations of clinical parameters with a paternal history of stroke.

CONCLUSIONS

Our results indicate a sex-specific relationship between a maternal history of stroke and the prevalence of hypertension and left ventricular hypertrophy in female patients with ischemic cerebrovascular events.

Pharmacological Studies of Alcohol Susceptibility and Brain Monoamine Function in Stroke-Prone Spontaneously Hypertensive Rats (SHRSP) and Stroke-Resistant Spontaneously Hypertensive Rats (SHRSR)

Differences of alcohol drinking behavior, brain dopamine (DA) and serotonin (5-HT) levels and releases in the striatum were investigated in stroke-prone spontaneously hypertensive rats (SHRSP) and age-matched stroke-resistant spontaneously hypertensive rats (SHRSR). Voluntary alcohol (EtOH) consumption in SHRSP rats increased at 1 and 2 hours in the 4 hour time access. In the DA level, SHRSP showed decreases in the caudate-putamen (C/P) and dorsal raphe nucleus (DRN) compared with in SHRSR. 5-HT levels in the C/P, ventral tegmental area-subtantia nigra (V/S) and DRN of the SHRSP were decreased compared with that in SHRSR. The basal extracellular levels of 5-HT release in the C/P were increased in SHRSP as compared with those in SHRSR. K(+)- or EtOH-induced DA and 5-HT releases in the C/P of the SHRSP were a lower magnitude than those in SHRSR. Increased basal extracellular 5-HT releases showing low levels of 5-HT in the C/P of SHRSP mean an abnormality of serotonergic neuronal functions in a normal physiological condition. Higher voluntary alcohol drinking behavior, so called lower susceptibility to EtOH, in the SHRSP may be associated with the degenerated rewarding system including the DRN. These results suggest that the hypertensive state causes the dysfunction in the striatum of the brain rewarding system and induces the risk for increasing alcohol consumption to compensate for the alteration of serotonergic neurons.

White blood cell count as a risk factor for hypertension; a study of Japanese male office workers

OBJECTIVE

To investigate the association of white blood cell (WBC) count with risk of hypertension.

DESIGN

Cross-sectional and longitudinal studies.

SETTING

A work site in Japan.

PARTICIPANTS

A total of 3776 Japanese male office workers aged 23-49 years were enrolled in this study; 2900 hypertension-free [systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, no medication for hypertension, and no past history of hypertension] men were followed up over a 4-year period.

MAIN OUTCOME MEASURES

Blood pressure levels and the incidence of hypertension (SBP > or = 140 mm Hg and/or DBP > or = 90 mm Hg or medication for hypertension) according to WBC count at study entry.

RESULTS

After controlling for potential predictors of hypertension, SBP and DBP levels increased in a dose-dependent manner among both never-smokers and ex-smokers as WBC count increased. Among current smokers, only SBP level increased progressively with WBC count level. The multivariate-adjusted relative risk for development of hypertension compared with the first WBC count quintile was 1.29, 1.21, 1.67, and 1.92 among never-smokers (P for trend = 0.002): and 1.34, 1.46, 1.84, and 1.97 among ex-smokers (P for trend = 0.030) with the second, third, fourth, and fifth quintiles, respectively. Among current smokers, the respective multivariate-adjusted relative risks for hypertension relative to the first WBC count quintile were 0.91, 0.97, 1.08, and 0.84 (P for trend = 0.999).

CONCLUSIONS

WBC count is an important risk factor for hypertension, and the increased risk for hypertension associated with WBC count is more pronounced in non-smokers.

Long working hours and risk for hypertension in Japanese male white collar workers

STUDY OBJECTIVE

To evaluate the association of long working hours with the risk for hypertension.

DESIGN

A five year prospective cohort study.

SETTING

Work site in Osaka, Japan.

PARTICIPANTS

941 hypertension free Japanese male white collar workers aged 35-54 years were prospectively examined by serial annual health examinations. Men in whom borderline hypertension and hypertension were found during repeated surveys were defined as incidental cases of borderline hypertension and hypertension.

MAIN RESULTS

336 and 88 men developed hypertension above the borderline level and definite hypertension during the 3940 and 4531 person years, respectively. After controlling for potential predictors of hypertension, the relative risk for hypertension above the borderline level, compared with those who worked < 8.0 hours per day, was 0.63 (95% confidence intervals (CI): 0.43, 0.91) for those who worked 10.0-10.9 hours per day and 0.48 (95% CI: 0.31, 0.74) for those who worked > or = 11.0 hours per day. The relative risk for definite hypertension, compared with those who worked < 8.0 hours per day, was 0.33 (95% CI: 0.11, 0.95) for those who worked > or = 11.0 hours per day. The multivariate adjusted slopes of diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) during five years of follow up decreased as working hours per day increased. From the multiple regression analyses, working hours per day remained as an independent negative factor for the slopes of systolic blood pressure, DBP, and MABP.

CONCLUSIONS

These results indicate that long working hours are negatively associated with the risk for hypertension in Japanese male white collar workers.

Alcohol consumption and risk for hypertension in middle-aged Japanese men

OBJECTIVE

To investigate the association of alcohol intake with development of hypertension.

DESIGN

Longitudinal study (followed from 1990 to 1999).

SETTING

Work site in Osaka, Japan.

PARTICIPANTS

Japanese male office workers (n = 1,310) hypertension-free, with systolic blood pressure (SBP) less than 140 mmHg, diastolic blood pressure (DBP) less than 90 mmHg, no medication for hypertension, and no past history of hypertension, 30 to 59 years of age at study entry.

MAIN OUTCOME MEASURE

Incidence of hypertension.

RESULTS

After controlling for potential predictors of hypertension, the relative risk for hypertension (SBP 140 mmHg or greater and/or DBP 90 mmHg or greater or receipt of antihypertensive medication) compared with non-drinkers was 1.52 [95% confidence interval (CI), 1.05 to 2.19] for persons who drank 0.1 to 22.9 g/day of ethanol, 1.81 (95% CI, 1.29 to 2.54) for those who drank 23.0 to 45.9 g/day of ethanol, 2.12 (95% CI, 1.53 to 2.94) for those who drank 46.0 to 68.9 g/day of ethanol, and 2.48 (95% CI, 1.75 to 3.52) for those who drank > or = 69.0 g/day of ethanol (for trend, P < 0.001). The relative risk for hypertension in current drinkers versus non-drinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 than among men with a BMI 24.2 kg/m2 or more, although the absolute risk was greater in more obese men.

CONCLUSIONS

The risk for hypertension increased in a dose-dependent manner as alcohol intake increased in middle-aged Japanese men. The increased relative risk for hypertension associated with alcohol was more pronounced in leaner men.

Overweight, obesity, and blood pressure: the effects of modest weight reduction

Several large epidemiological studies have shown an association between body mass index and blood pressure in normal weight and overweight patients. Weight gain in adult life especially seems to be an important risk factor for the development of hypertension. Weight loss has been recommended for the obese hypertensive patient and has been shown to be the most effective nonpharmacological treatment approach. However, long-term results of weight loss programs are disappointing with people often regaining most of the weight initially lost. In recent years, a modest weight loss, defined as a weight loss of 5% to 10% of baseline weight, has received increasing attention as a new treatment strategy for overweight and obese patients. A more gradual and moderate weight loss is more likely to be maintained over a longer period of time. Several studies have confirmed the blood pressure-lowering effect of a modest weight loss in both hypertensive and nonhypertensive patients. A modest weight loss can normalize blood pressure levels even without reaching ideal weight. In patients taking antihypertensive medication, a modest weight loss has been shown to lower or even discontinue the need for antihypertensive medication. In patients with high normal blood pressure, a modest weight loss can prevent the onset of frank hypertension. The blood pressure-lowering effect of weight loss is most likely a result of an improvement in insulin sensitivity and a decrease in sympathetic nervous system activity and occurs independent of salt restriction. In conclusion, a modest weight loss that can be maintained over a longer period of time is a valuable treatment goal in hypertensive patients.

Association between alcohol intake and development of hypertension in Japanese normotensive men: 12-year follow-up study

Although it has been suggested that alcohol intake is related to hypertension, few long-term prospective studies have investigated this relationship. We therefore conducted a prospective study in male residents of a farming community in Japan to determine whether heavy drinking would predispose to the development of hypertension. A total of 325 normotensive (< 140/90 mm Hg) men were enrolled in 1977. Twelve years later, 93 (28.6%) subjects became hypertensive (defined as blood pressure > or = 140/90 mm Hg or use of antihypertensive medication). The probability of the development of hypertension in heavy drinkers predicted from a logistic regression equation was 44.6% (relative risk: 2.05 versus nondrinkers) after adjusting for age and body mass index (BMI). It was 36.2% (relative risk: 1.86 versus nondrinkers) after a further adjustment for systolic blood pressure at baseline. A high odds ratio of 2.39 for the development of hypertension with alcohol intake of < 46 g/day versus > or = 46 g/day at baseline was obtained even after adjustments for age, BMI, and confounding factors. We conclude that habitual heavy drinking of alcohol is a risk factor for the development of hypertension. This is the first report demonstrating a significant relationship between habitual alcohol intake and the development of hypertension in a long-term prospective study in Japan.

Risk factors for the development of hypertension: a 6-year longitudinal study of middle-aged Japanese men

OBJECTIVE

To identify the factors related to the development of hypertension on the basis of annual health examinations at the workplace.

SETTING

A cohort of Japanese male office workers who were reexamined for six successive years after their initial examinations in 1990.

SUBJECTS

The study cohort comprised 1089 hypertension-free subjects aged 30-54 years. Six-year follow-ups were completed for 934 subjects (85.8%)

RESULTS

An analysis using the Kaplan-Meier method showed that the incidence of hypertension above the borderline level increased significantly with increasing age, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol level, uric acid level, total protein level, hematocrit level, and alcohol intake. This increase was significant for systolic blood pressure, diastolic blood pressure, and hematocrit level. The highest cumulative incidences both of hypertension above the borderline level and of definite hypertension were observed among those with 85-89 mmHg diastolic blood pressure, and the second highest among those with 130-139 mmHg systolic blood pressure. Multivariate analysis using the Cox proportional hazards model indicated that age, systolic blood pressure, diastolic blood pressure, and alcohol intake were independent factors associated with the incidence of hypertension above the borderline level. Systolic blood pressure, diastolic blood pressure, and hematocrit level proved to be independently predictive of hypertension, and alcohol intake was of borderline significance as a risk factor for hypertension.

CONCLUSION

High normal blood pressure is the strongest predictor for the development of hypertension among middle-aged Japanese men. In addition, high alcohol intake and high hematocrit level may be contributory factors.

Family history as a predictor of blood pressure in a longitudinal study of Australian children

BACKGROUND

Sex both of parent and of child might influence associations between parental hypertension and blood pressure in offspring.

OBJECTIVE

To examine these associations.

DESIGN

A cohort of Australians was surveyed 3-yearly from age 9 to 18 years.

SETTING

A community-based sample.

PARTICIPANTS

When they were aged 18 years, 630 of 1565 participants who had been selected randomly at the age of 9 years were re-surveyed.

MAIN OUTCOME MEASURES

Systolic and diastolic blood pressures.

RESULTS

Paternal hypertension was reported by 18% of men and 15% of women and maternal hypertension by 15% of men and 14% of women. By the time they were aged 9 years, systolic blood pressure was significantly higher in sons [117.8 mmHg, 95% confidence interval (CI) 116A-119.2 versus 114.7 mmHg, CI 113.4-116.0] and daughters (118.2 mmHg, CI 116.9-119.5 versus 114.9 mmHg, CI 112.8-117.0) of hypertensive fathers than it was in sons and daughters of normotensive fathers. When they were aged 18 years, paternal hypertension predicted blood pressures in men and women independently of their weight at birth, fitness, alcohol consumption and weight for height for age. Systolic blood pressures increased more rapidly (by 0.6 mmHg/year) in men with hypertensive fathers.

CONCLUSIONS

Systolic blood pressure in young adults differs in relation to parental hypertension according to the sex of the affected parent and the sex of the offspring. This could reflect unmeasured environmental variables or the action of sex-related genetic or intrauterine factors.

Cardiovascular risk factors and behavior lifestyles of young women: implications from findings of the Bogalusa Heart Study

The primary purposes of this article are to highlight important issues related to cardiovascular risk factors and behavior life-styles in young women and to examine racial (black-white) differences in risk factors that relate to cardiovascular disease. In childhood, some girls show cardiovascular risk factors of higher blood pressure levels, dyslipidemia, and obesity, all of which continue into young adulthood. Factors that contribute to abnormal risk factors are a high-saturated fat diet, excess energy intake related to inactivity, and cigarette smoking. Trends of obesity are documented; and young white girls are continuing to use tobacco, more so than boys and black girls. Although the onset of clinical cardiovascular disease is delayed in women, the stage is set in childhood for the development of early cardiovascular risk.

Probability of having hypertension: effects of sex, history of hypertension in parents, and other risk factors

The objective of the present study was to determine whether paternal and maternal history of hypertension contributes to the probability of an individual having hypertension before and after other measured traits, including sex, are considered. A cross-sectional sample of 217 men and 196 women was selected from the general Caucasion population of Rochester, Minnesota without respect to the hypertension status of subjects and their parents. Logistic regression analyses indicated that when no other information was considered, paternal history of hypertension contributed to the probability of having hypertension in men (chi 2 = 4.14, df = 1, p = 0.042) and in women (chi 2 = 4.12, df = 1, p = 0.042). The odds ratio associated with paternal history of hypertension was 2.80 in men (95% confidence interval [CI] = 1.0-8.0); the odds ratio was 4.11 in women (95% CI = 0.9-19.3). Maternal history of hypertension provided a marginally significant contribution to the prediction of probability of having hypertension in men (chi 2 = 3.86, df = 1, p = 0.049 in men), and less so in women (chi 2 = 3.31, df = 1, p = 0.068). The odds ratios associated with maternal history of hypertension were 2.85 in men (95% CI = 0.9-8.8) and 3.60 in women (95% CI = 0.8-16.9). A stepwise selection algorithm was used to select other predictors of hypertension in men and women. Other predictors of hypertension identified in men were age and sodium-lithium countertransport level. After these other predictors were considered, paternal but not maternal history of hypertension contributed to the probability of having hypertension in men. In a model that contained these other predictors, the partial odds ratio associated with paternal history of hypertension was 3.38 (95% CI = 1.1 = 10.1). Other predictors identified in women were age, apolipoprotein (apo) B, and apo B squared. After these other predictors were considered, neither paternal nor maternal history of hypertension made a statistically significant contribution to the probability of having hypertension in women. These results suggest that evaluation of the hypertension risk of an individual depends on the sex of the individual, the sexes of the individual's hypertensive parents, and the values of other measured risk factor traits.

Parental history of premature coronary heart disease: an independent risk factor of myocardial infarction

We assessed the role of parental history of premature coronary heart disease (CHD) in the risk of acute myocardial infarction (AMI) and the extent to which the risk associated with positive parental history was independent of other risk factors: smoking, high serum cholesterol, elevated blood pressure, diabetes and obesity, and of socioeconomic status. The study is a prospective 12-year follow-up of 15,620 men and women aged from 30 to 59 years in eastern Finland. Parental history of premature CHD was defined as either fatal or nonfatal myocardial infarction or angina pectoris before the age of 60 years. The end point of the follow-up was either nonfatal AMI or coronary death. The risk ratio (RR) of AMI associated with positive family history of either parent was 1.61 in men and 1.85 in women. The risk decreased only slightly when an adjustment was made for other risk factors, and did not change at all when an adjustment was made for the indicators of socioeconomic status. The risk was slightly higher for early AMI (< 55 years) compared with later AMI (> or = 55 years), RR 1.71 versus 1.50, among men and markedly higher, RR 2.87 versus 1.49, among women. These results from this population with an exceptionally high risk of CHD support the hypothesis that positive family history is an independent risk factor of AMI.

Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland

BACKGROUND

Body weight is closely related to several known cardiovascular risk factors, but it may also have an independent effect on the risk of coronary heart disease (CHD). In this study, we analyzed the association between body mass index (BMI) and smoking, serum cholesterol, and blood pressure at baseline, as well as how BMI and the other risk factors are related to CHD mortality.

METHODS AND RESULTS

A total of 16 113 men and women aged 30 to 59 years were examined in eastern Finland in either 1972 or 1977. Serum cholesterol and blood pressure had a positive association and smoking had a negative association with BMI. During the 15-year prospective follow-up, mortality from CHD was positively associated with BMI. The BMI-associated risk ratio of CHD mortality, adjusted for age and study year, estimated from the Cox proportional hazards model was 1.04 (per kg/m2) (P < .001) among men. Inclusion of smoking in the model increased the risk ratio for BMI, whereas inclusion of serum cholesterol and blood pressure decreased it. In the model that included age, study year, and all three major cardiovascular risk factors, the BMI-associated risk ratio was 1.03 (P = .027). Among women, the BMI-associated risk ratio of CHD mortality adjusted for age and study year was 1.05 (P = .023) and the multifactorial adjusted risk ratio was 1.03 (P = .151).

CONCLUSIONS

Obesity is an independent risk factor for CHD mortality among men and also contributes to the risk of CHD among women. Part of the BMI-associated risk of CHD mortality is mediated through other known cardiovascular risk factors. By preventing overweight, a substantial part of CHD mortality may be prevented.

Alcohol and hypertension

Epidemiologic studies in the past two decades have firmly established a relationship between regular, heavier alcohol consumption and hypertension. This association has been demonstrated in both cross-sectional and prospective studies. It is found in both sexes and several races and is independent of the type of alcoholic beverage, adiposity, education, smoking, salt intake, and several other traits. Clinical experiments show that blood pressure falls in days to weeks with abstinence from alcohol and that it rises again within days after resuming drinking. No mechanism has been demonstrated for this alcohol/blood pressure effect. Alcohol withdrawal symptoms have not been seen in the clinical experiments; thus, this is not likely to be the major explanation. Studies of the role of alcohol in hypertension sequelae, such as coronary heart disease and stroke, have been difficult because of the effects of alcohol, independent of blood pressure, in these conditions. Overall, it is likely that this alcohol-hypertension relation is causal. Restriction of intake by heavier drinkers lowers blood pressure in some, and heavy alcohol ingestion should always be considered by clinicians as a possible hypertension risk factor.