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Ngo Nkondjock VR, Cheteu Wabo TM, Kosgey JC, Zhang Y, Amporfro DA, Adnan H, Shah I, Li Y. Insulin Resistance, Serum Calcium and Hypertension: A Cross-Sectional Study of a Multiracial Population, and a Similarity Assessment of Results from a Single-Race Population's Study. Diabetes Metab Syndr Obes 2021; 14:3361-3373. [PMID: 34335037 PMCID: PMC8318711 DOI: 10.2147/dmso.s259409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent research suggests the need to assess more ethnic disparities in hypertension (HTN). On the other hand, studies reveal impressive mortality rates due to cardiovascular diseases for some race and ethnic groups compared to others. METHODS We referred to a recent study on serum calcium (SC) and insulin resistance associated with HTN incidence to compare different race groups in the latter found relationship. We compare the current study outcomes with those from the Wu et al study. RESULTS From 425 participants of the National Health and Nutrition Examination Survey (NHANES) data, we found a significant association between race and hypertension; Cramer's V (0.006) = 0.21 when adjusted with non-hypertensives and hypertensives. Mc Auley index (McA) was negatively related to hypertension, r (355) = -0.24, p < 0.0001. SC associated with HTN in all race groups significance persisted only in non-Hispanic Whites after multivariate adjustments R 2 of 74.1 (p = 0.03). McA was a mediator on SC-HTN in non-Hispanic Whites (NHW) (CoefIE = 13.25, [CI] = 1.42-32.13), and a moderator in other Hispanics interaction (0.04) = 0.27 and NHW interaction (0.001) = 0.028. CONCLUSION SC was associated with hypertension, similarly to the baseline study. SC and HTN association persisted in NHW compared to other race groups. Homeostasis model assessment (HOMA-IR) was not a mediator on SC-HTN, but with McA, this in NHW only. McA played a moderator role in OH and NHW. We suggest that race is a factor implicated in our findings, which may be investigated further in future research.
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Affiliation(s)
- Victorine Raïssa Ngo Nkondjock
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Thérèse Martin Cheteu Wabo
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | | | - Yunlong Zhang
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Daniel Adjei Amporfro
- Department of Social Medicine and Health Services Management, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Humara Adnan
- Department of Biostatistics and Epidemiology, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Imran Shah
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Ying Li
- Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
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McGowan CL, Proctor DN, Swaine I, Brook RD, Jackson EA, Levy PD. Isometric Handgrip as an Adjunct for Blood Pressure Control: a Primer for Clinicians. Curr Hypertens Rep 2017; 19:51. [PMID: 28528376 DOI: 10.1007/s11906-017-0748-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment. With larger reductions noted in HTN patients, IHG training may be especially beneficial for those who (a) have difficulties continuing or increasing drug-based treatment; (b) are unable to attain BP control despite optimal treatment; (c) have pre-HTN or low-risk stage I mild HTN; and (d) wish to avoid medications or have less pill burden. IHG training is not routinely prescribed in clinical practice. To shift this paradigm, we focus on (1) the challenges of current HTN management strategies; (2) the effect of IHG training; (3) IHG prescription; (4) characterizing the population for whom it works best; (5) clinical relevance; and (6) important next steps to foster broader implementation by clinical practitioners.
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Affiliation(s)
- Cheri L McGowan
- Department of Kinesiology, Faculty of Human Kinetics, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada. .,Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. .,School of Medicine, Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
| | - David N Proctor
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Ian Swaine
- Department of Life & Sport Sciences, University of Greenwich, Medway Campus, London, UK
| | - Robert D Brook
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth A Jackson
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Phillip D Levy
- School of Medicine, Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
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Propensity of people of African descent towards hypertension-associated cardiovascular pathologies. Hypertens Res 2016; 39:628-30. [PMID: 27307376 DOI: 10.1038/hr.2016.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vrijkotte TGM, van den Born BJH, Hoekstra CMCA, Gademan MGJ, van Eijsden M, de Rooij SR, Twickler MTB. Cardiac Autonomic Nervous System Activation and Metabolic Profile in Young Children: The ABCD Study. PLoS One 2015; 10:e0138302. [PMID: 26394362 PMCID: PMC4579089 DOI: 10.1371/journal.pone.0138302] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/28/2015] [Indexed: 12/25/2022] Open
Abstract
Background In adults, increased sympathetic and decreased parasympathetic nervous system activity are associated with a less favorable metabolic profile. Whether this is already determined at early age is unknown. Therefore, we aimed to assess the association between autonomic nervous system activation and metabolic profile and its components in children at age of 5–6 years. Methods Cross-sectional data from an apparently healthy population (within the ABCD study) were collected at age 5–6 years in 1540 children. Heart rate (HR), respiratory sinus arrhythmia (RSA; parasympathetic activity) and pre-ejection period (PEP; sympathetic activity) were assessed during rest. Metabolic components were waist-height ratio (WHtR), systolic blood pressure (SBP), fasting triglycerides, glucose and HDL-cholesterol. Individual components, as well as a cumulative metabolic score, were analyzed. Results In analysis adjusted for child’s physical activity, sleep, anxiety score and other potential confounders, increased HR and decreased RSA were associated with higher WHtR (P< 0.01), higher SBP (p<0.001) and a higher cumulative metabolic score (HR: p < 0.001; RSA: p < 0.01). Lower PEP was only associated with higher SBP (p <0.05). Of all children, 5.6% had 3 or more (out of 5) adverse metabolic components; only higher HR was associated with this risk (per 10 bpm increase: OR = 1.56; p < 0.001). Conclusions This study shows that decreased parasympathetic activity is associated with central adiposity and higher SBP, indicative of increased metabolic risk, already at age 5–6 years.
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Affiliation(s)
- Tanja G. M. Vrijkotte
- Department of Public Health, Academic Medical Center—University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Academic Medical Center—University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maaike G. J. Gademan
- Department of Public Health, Academic Medical Center—University of Amsterdam, Amsterdam, the Netherlands
| | - Manon van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands
| | - Susanne R. de Rooij
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands
| | - Marcel T. B. Twickler
- Department of Endocrinology, Diabetology and Metabolic Diseases, Antwerp University Hospital, Antwerp, Belgium
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Abstract
There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.
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Holmes L, Hossain J, Ward D, Opara F. Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/257842] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.
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Affiliation(s)
- L. Holmes
- American Health Research Institute, Houston, TX 77008, USA
- University of Delaware, Newark, DE, USA
- Nemours/A.I.duPont Hospital for Children, Office of Health Equity & Inclusion, Newark, DE 19716, USA
| | - J. Hossain
- University of Delaware, Newark, DE, USA
- Nemours Biomedical Research, Wilmington, DE 19803, USA
| | - D. Ward
- Christiana Care Health System, Newark, DE, USA
| | - F. Opara
- American Health Research Institute, Houston, TX 77008, USA
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Berendes A, Meyer T, Hulpke-Wette M, Herrmann-Lingen C. Association of elevated blood pressure with low distress and good quality of life: results from the nationwide representative German Health Interview and Examination Survey for Children and Adolescents. Psychosom Med 2013; 75:422-8. [PMID: 23645707 DOI: 10.1097/psy.0b013e31828ef0c2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Quality of life is often impaired in patients with known hypertension, but it is less or not at all reduced in people unaware of their elevated blood pressure. Some studies have even shown less self-rated distress in adults with elevated blood pressure. In this substudy of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KIGGS), we addressed the question whether, also in adolescents, hypertensive blood pressure is linked to levels of distress and quality of life. METHODS Study participants aged 11 to 17 years (N = 7688) received standardized measurements of blood pressure, quality of life (using the Children's Quality of Life Questionnaire), and distress (Strengths and Difficulties Questionnaire). RESULTS Elevated blood pressure was twice as frequent as expected, with 10.7% (n = 825) above published age-, sex- and height-adjusted 95th percentiles. Hypertensive participants were more likely to be obese and to report on adverse health behaviors, but they showed better academic success than did normotensive participants. Elevated blood pressure was significantly and positively associated with higher self- and parent-rated quality of life (for both, p ≤ .006), less hyperactivity (for both, p < .005), and lower parent-rated emotional (p < .001), conduct (p = .021), and overall problems (p = .001). Multiple regression analyses confirmed these findings. CONCLUSIONS Our observation linking elevated blood pressure to better well-being and low distress can partly be explained by the absence of confounding physical comorbidity and the unawareness of being hypertensive. It also corresponds to earlier research suggesting a bidirectional relationship with repressed emotions leading to elevated blood pressure and, furthermore, elevated blood pressure serving as a potential stress buffer.
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Affiliation(s)
- Angela Berendes
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany
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Okwuosa TEM, Williams KA. Cardiovascular Health in Africans Living in the United States. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0227-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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