Association between lifestyle risk factors and incident hypertension among middle-aged and older Australians

Transition to healthier lifestyle associated with reduced risk of incident dementia and decreased hippocampal atrophy

BACKGROUND

Research has estimated the associations of lifestyle at one-time point with the risk of dementia and hippocampal volume, but the impact of lifestyle transition on dementia and hippocampal volume remains unclear. This study aims to examine the associations of lifestyle transition with the risk of dementia and hippocampal volume.

METHODS

Based on data from the UK Biobank, a weighted lifestyle score was constructed by incorporating six lifestyle factors. Within each baseline lifestyle group (i.e., healthy, intermediate, and unhealthy), lifestyle transition was classified into decline, maintenance, and improvement. Cox proportional hazard regression was used to estimate the association of lifestyle transition and incident dementia (N = 16,305). A multiple linear regression model was used to estimate the association between lifestyle transition and hippocampal volume (N = 5849).

RESULTS

During a median follow-up period of 8.6 years, 120 (0.7 %) dementia events were documented. Among participants with healthy baseline lifestyles, the improvement group had a lower risk of incident dementia (HR: 0.18, 95 % CI: 0.04-0.81) and a larger hippocampal volume (β = 111.69, P = 0.026) than the decline group. Similar results were observed among participants with intermediate baseline lifestyles regarding dementia risk but not hippocampal volume. No benefits were observed in the improvement group among those with unhealthy baseline lifestyles.

LIMITATIONS

A lower incidence of dementia than other cohort study and this may have resulted in an underestimation of the risk of dementia.

CONCLUSIONS

Earlier transitions to healthier lifestyle were associated with reduced risk of incident dementia and decreased hippocampal atrophy.

A longitudinal study of incident hypertension and its determinants in Indian adults aged 45 years and older: evidence from nationally representative WHO-SAGE study (2007-2015)

Objectives

Hypertension (HT) is a leading cause of mortality and morbidity in developing countries. This study aimed to estimate the incidence of HT among adults aged 45 years and older in India and its associated risk factors.

Methods

This study used longitudinal data from the Indian sample of the first and second waves of the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE). A bivariate analysis using Pearson's chi-square test was done to examine the associations of individual, lifestyle, and household characteristics with HT status reported in Wave 2. Incident HT changes were analyzed by adjusting for various covariates in the generalized estimating equation (logit link function) with an exchangeable correlation matrix and robust standard errors.

Results

The study found that during the 8-year period from 2007 to 2015, the incidence of HT in individuals aged 45 years and over was 20.8%. Pre-hypertensive individuals had an overall incidence rate of 31.1 per 1,000 [95% confidence interval (CI): 26.20-35.9] and a 2.24 times higher odds ratio: 2.24 (95% CI: 1.65-3.03) of developing incident HT compared to those who were normotensive. Adults aged 45 years and older, overweight/obese individuals, and women were more at risk of incident HT.

Conclusion

One in five individuals had developed HT over 8 years, with a greater risk of incident HT among women than men. Pre-hypertensive individuals were at a greater risk of developing incident HT compared to normotensive individuals. The study recommends comprehensive and effective management of pre-HT to tackle the burden of HT.

Lifestyle-related risk factors and their cumulative associations with hippocampal and total grey matter volume across the adult lifespan: A pooled analysis in the European Lifebrain consortium

BACKGROUND

Lifestyle-related risk factors, such as obesity, physical inactivity, short sleep, smoking and alcohol use, have been associated with low hippocampal and total grey matter volumes (GMV). However, these risk factors have mostly been assessed as separate factors, leaving it unknown if variance explained by these factors is overlapping or additive. We investigated associations of five lifestyle-related factors separately and cumulatively with hippocampal and total GMV, pooled across eight European cohorts.

METHODS

We included 3838 participants aged 18-90 years from eight cohorts of the European Lifebrain consortium. Using individual person data, we performed cross-sectional meta-analyses on associations of presence of lifestyle-related risk factors separately (overweight/obesity, physical inactivity, short sleep, smoking, high alcohol use) as well as a cumulative unhealthy lifestyle score (counting the number of present lifestyle-related risk factors) with FreeSurfer-derived hippocampal volume and total GMV. Lifestyle-related risk factors were defined according to public health guidelines.

RESULTS

High alcohol use was associated with lower hippocampal volume (r = -0.10, p = 0.021), and overweight/obesity with lower total GMV (r = -0.09, p = 0.001). Other lifestyle-related risk factors were not significantly associated with hippocampal volume or GMV. The cumulative unhealthy lifestyle score was negatively associated with total GMV (r = -0.08, p = 0.001), but not hippocampal volume (r = -0.01, p = 0.625).

CONCLUSIONS

This large pooled study confirmed the negative association of some lifestyle-related risk factors with hippocampal volume and GMV, although with small effect sizes. Lifestyle factors should not be seen in isolation as there is evidence that having multiple unhealthy lifestyle factors is associated with a linear reduction in overall brain volume.

Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies

PURPOSE

A high fruit and vegetable intake has been associated with reduced risk of hypertension; however, results have been inconsistent and it is unclear whether specific types of fruits and vegetables are particularly beneficial. This systematic review and meta-analysis aimed to summarize the published prospective studies on fruit and vegetable consumption and risk of hypertension.

METHODS

Embase and PubMed databases were searched for relevant prospective studies up to 15th May 2022. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between fruit and vegetable intake and risk of hypertension. Strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria.

RESULTS

Eighteen prospective studies (451 291 participants, 145 492 cases) were included. The summary RR (95% CI) of hypertension per 200 g/day was 0.97 (0.95-0.99, I² = 68%, n = 8) for fruits and vegetables, 0.93 (0.89-0.98, I² = 77%, n = 10) for fruits, and 1.00 (0.98-1.02, I² = 38%, n = 10) for vegetables. Reductions in risk were observed up to 800 g/day for fruits and vegetables, and 550 g/day for fruits, and these two associations were considered probably causal using WCRF criteria. Inverse associations were observed for apples or pears, blueberries, raisins or grapes, avocado, broccoli, carrots and lettuce, while positive associations were observed for cantaloupe, Brussels sprouts, cruciferous vegetables, and total and fried potatoes (n = 2-5).

CONCLUSION

A high intake of fruit and vegetables combined, and total fruit was associated with reduced risk of hypertension, while results for fruit and vegetable subtypes were mixed and need further study.

Association of healthy lifestyles on the risk of hypertension, type 2 diabetes mellitus, and their comorbidity among subjects with dyslipidemia

Background

Adherence to a healthy lifestyle could reduce the risk of hypertension and diabetes in general populations; however, whether the associations exist in subjects with dyslipidemia remains unclear. This study aimed to investigate the integrated effect of lifestyle factors on the risk of hypertension, type 2 diabetes mellitus (T2DM), and their comorbidity among subjects with dyslipidemia.

Methods

In total of 9,339 subjects with dyslipidemia were recruited from the baseline survey of the Guangzhou Heart Study. A questionnaire survey and medical examination were performed. The healthy lifestyle score (HLS) was derived from five factors: smoking, alcohol drinking, diet, body mass index, and leisure-time physical activity. Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated by using the logistic regression model and the multinomial logistic regression after adjusting for confounders.

Results

The prevalence of hypertension, T2DM, and their comorbidity was 47.65, 16.02, and 10.10%, respectively. Subjects with a higher HLS were associated with a lower risk of hypertension, T2DM, and their comorbidity. In comparison to the subjects with 0–2 HLS, the adjusted ORs for subjects with five HLS was 0.48 (95% CI: 0.40–0.57) and 0.67 (95% CI: 0.54–0.84) for hypertension and T2DM. Compared with subjects with 0-2 HLS and neither hypertension nor T2DM, those with five HLS had a lower risk of suffering from only one disease (OR: 0.48, 95% CI: 0.40–0.57) and their comorbidity (OR: 0.35, 95% CI: 0.26–0.47).

Conclusions

The results suggest that the more kinds of healthy lifestyle, the lower the risk of hypertension, T2DM, and their comorbidity among subjects with dyslipidemia. Preventive strategies incorporating lifestyle factors may provide a more feasible approach for the prevention of main chronic diseases.

The association between a combination of healthy lifestyles and the risks of hypertension and dyslipidemia among adults-evidence from the northeast of China

BACKGROUND AND AIMS

There is increasing evidence that lifestyle factors play an important role in the development of hypertension and dyslipidemia. However, existing research usually evaluated these risk factors individually (such as physical activity, smoking, drinking, obesity and so on), rather than joint evaluation. The aim of this study was to quantify the association between a combination of a healthy lifestyle and the risk of hypertension and dyslipidemia.

METHODS AND RESULT

A healthy lifestyle score was created based on 4 factors: never smoking, moderate to high-intensive physical activity, no alcohol drinking, and normal body mass index. We calculated the healthy lifestyle score using the cumulative number of health factors for each individual. Also, a multivariate analysis was used to assess the relationship between healthy lifestyle and hypertension and dyslipidemia. Among 6446 participants, 650 (10.08%) had lowest healthy lifestyle score (0) and 627 (9.72%) had highest healthy lifestyle score (4), respectively. The adjustment model indicated that participants with the highest score (score: 4), which integrated the four lifestyles, had significantly lower ORs for hypertension compared with the lowest score (score: 0) (0.21; (95%CI: 0.10, 0.43 P-trend< 0.001)). In the adjustment models, compared with lowest healthy lifestyle score, the ORs of highest healthy lifestyle score was: 0.17; (95%CI: 0.07, 0.42 P-trend<0.001) for dyslipidemia.

CONCLUSION

Hypertension and dyslipidemia were negatively correlated with healthy lifestyle score. Interventions with healthy lifestyle to reduce hypertension, dyslipidemia and promote population health are warranted.

The Roles of Platelet-Activating Factor and Magnesium in Pathophysiology of Hypertension, Atherogenesis, Cardiovascular Disease, Stroke and Aging

Hypertension and atherosclerosis are debilitating diseases that affect millions each year. Long-term consequences include but are not limited to stroke, myocardial infarction, and kidney failure. Platelet-activating factor (PAF) is a proinflammatory mediator synthesized from a subclass of phosphatidylcholines that increases platelet activation, leukocyte adhesion, infiltration of macrophages, and intracellular lipid accumulation, thereby contributing to atherosclerosis. Magnesium, a key micronutrient and free radical scavenger, is a water-soluble mineral that regulates peripheral vasodilation and calcium, phosphate, and hydroxyapatite homeostasis. Magnesium’s antihypertensive ability stems from its role as a natural calcium antagonist and promoter of vasodilatory mediators, such as nitric oxide. Platelet-activating factor and magnesium share an inverse relationship, and elevated magnesium levels have been shown to have protective effects against plaque formation as well as antihypertensive and antiarrhythmic effects, all of which allow for healthier aging. The purpose of this literature review is to investigate the role of platelet-activating factor and magnesium in the pathophysiology of hypertension, atherosclerosis, cardiovascular disease, stroke, and aging. Since the pathophysiology of the platelet-activating factor biomolecule is underexplored, further research studies are warranted in order to navigate the putative signaling pathways involved in the cardioprotective effects of dietary magnesium as a natural anti-PAF agent.

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.

Predicting the Risk of Hypertension Based on Several Easy-to-Collect Risk Factors: A Machine Learning Method

Hypertension is a widespread chronic disease. Risk prediction of hypertension is an intervention that contributes to the early prevention and management of hypertension. The implementation of such intervention requires an effective and easy-to-implement hypertension risk prediction model. This study evaluated and compared the performance of four machine learning algorithms on predicting the risk of hypertension based on easy-to-collect risk factors. A dataset of 29,700 samples collected through a physical examination was used for model training and testing. Firstly, we identified easy-to-collect risk factors of hypertension, through univariate logistic regression analysis. Then, based on the selected features, 10-fold cross-validation was utilized to optimize four models, random forest (RF), CatBoost, MLP neural network and logistic regression (LR), to find the best hyper-parameters on the training set. Finally, the performance of models was evaluated by AUC, accuracy, sensitivity and specificity on the test set. The experimental results showed that the RF model outperformed the other three models, and achieved an AUC of 0.92, an accuracy of 0.82, a sensitivity of 0.83 and a specificity of 0.81. In addition, Body Mass Index (BMI), age, family history and waist circumference (WC) are the four primary risk factors of hypertension. These findings reveal that it is feasible to use machine learning algorithms, especially RF, to predict hypertension risk without clinical or genetic data. The technique can provide a non-invasive and economical way for the prevention and management of hypertension in a large population.

Lifestyle Score and Genetic Factors With Hypertension and Blood Pressure Among Adults in Rural China

Background: Although high genetic risk and unhealthful lifestyles are associated with a high risk of hypertension, but the combined relationship between lifestyle score and genetic factors on blood pressure remains limited, especially in resource-constrained areas. Aim: To explore the separate and joint effects between genetic and lifestyle factors on blood pressure and hypertension in rural areas. Methods: In 4,592 adults from rural China with a 3-year of follow-up, a genetic risk score (GRS) was established using 13 single nucleotide polymorphisms (SNPs) and the lifestyle score was calculated including factors diet, body mass index (BMI), smoking status, drinking status, and physical activity. The associations of genetic and lifestyle factors with blood pressure and hypertension were determined with generalized linear and logistic regression models, respectively. Results: The high-risk GRS was found to be associated with evaluated blood pressure and hypertension and the healthful lifestyle with diastolic blood pressure (DBP) level. Individuals with unhealthful lifestyles in the high GRS risk group had an odds ratio (OR) (95% CI) of 1.904 (1.006, 3.603) for hypertension than those with a healthful lifestyle in the low GRS risk group. Besides, the relative risk (RR), attributable risk (AR), and population attributable risk (PAR) for unhealthful lifestyle are 1.39, 5.87, 0.04%, respectively, and the prevented fraction for the population (PFP) for healthful lifestyle is 9.47%. Conclusion: These results propose a joint effect between genetic and lifestyle factors on blood pressure and hypertension. The findings provide support for adherence to a healthful lifestyle in hypertension precision prevention. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375.

Factors Related to Blood Pressure Response after Community-Based Exercise Program in the Elderly Population

Exercise has been recommended for blood pressure (BP) control, but not every individual can improve BP and reduce the risk of cardiovascular disease effectively by exercise. This study aimed to evaluate the BP response after 12-week exercise intervention and then identify the potential factors of responders on BP (R-BP) control. This was a retrospective cohort study from a project of Taipei City Government. Subjects completed the original program were included for further analysis. Sociodemographic factors, health-related behaviors, and cardiovascular risks were extracted as potential factors. The results were categorized into R-BP control, i.e., BP under optimal level (systolic BP (SBP) < 140 mmHg; and diastolic BP (DBP) < 90 mmHg) or a significant BP reduction (SBP ↓10 mmHg or DBP ↓5 mmHg) after intervention, or non-responder on BP control, i.e., subjects who failed to achieve the targets. There were 81.62% R-BP subjects. R-BP showed lower SBP and lower risk of hypertension at baseline. Active lifestyle could quadruple the number of R-BP. Higher educational level or more prescription medications were likely to be R-BP in subjects with diagnosed hypertension. Active lifestyle combined with exercise could benefit R-BP in the elderly population. Health-related factors also need to be considered for BP control.

The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis

BACKGROUND

Previous work has evaluated the effect of remote ischaemic conditioning (RIC) in a number of clinical conditions (e.g. cardiac surgery and acute kidney injury), but only one analysis has examined blood pressure (BP) changes. While individual studies have reported the effects of acute bouts and repeated RIC exposure on resting BP, efficacy is equivocal. We conducted a systematic review and meta-analysis to evaluate the effects of acute and repeat RIC on BP.

METHODS

A systematic search was performed using PubMed, Web of Science, EMBASE, and Cochrane Library of Controlled Trials up until October 31, 2020. Additionally, manual searches of reference lists were performed. Studies that compared BP responses after exposing participants to either an acute bout or repeated cycles of RIC with a minimum one-week intervention period were considered.

RESULTS

Eighteen studies were included in this systematic review, ten examined acute effects while eight investigated repeat effects of RIC. Mean differences (MD) for outcome measures from acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p = 0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73 mmHg (95%CI -3.11, -0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p = 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p = 0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP -2.94 mmHg (95%CI -4.08, -1.79; p < 0.00001) and MAP -3.21 mmHg (95%CI -4.82, -1.61; p < 0.0001) were significantly reduced.

CONCLUSIONS

Our data suggests repeated, but not acute, RIC produced clinically meaningful reductions in diastolic BP and MAP.

Long-term effects of weight-reducing diets in people with hypertension

BACKGROUND

All major guidelines for antihypertensive therapy recommend weight loss. Dietary interventions that aim to reduce body weight might therefore be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension.

OBJECTIVES

Primary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events). Secondary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction.

SEARCH METHODS

For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 3), Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. We also contacted authors of relevant papers about further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared weight-reducing dietary interventions to no dietary intervention in adults with primary hypertension.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risks of bias and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. In case of moderate or larger heterogeneity as measured by Higgins I2, we used a random-effects model.

MAIN RESULTS

This second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. We judged the risks of bias as unclear or high for all but two trials. No study included mortality as a predefined outcome. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight-reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). None of the trials evaluated adverse events as designated in our protocol. The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight-loss diets as compared to controls: systolic blood pressure: mean difference (MD) -4.5 mm Hg (95% CI -7.2 to -1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD -3.2 mm Hg (95% CI -4.8 to -1.5 mm Hg) (3 studies, 731 participants). We judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD -4.0 kg (95% CI -4.8 to -3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though we did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight-loss interventions.

AUTHORS' CONCLUSIONS

In this second update, the conclusions remain unchanged, as we found no new trials. In people with primary hypertension, weight-loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials.

Association of Cardiovascular Risk Factors and Lifestyle Behaviors With Hypertension

Hypertension is a major risk factor for cardiovascular disease and mortality. To identify targets for the prevention of hypertension and its associated disease burden, we used the 2-sample Mendelian randomization method to investigate the causal associations of 18 cardiovascular risk factors and lifestyle behaviors with hypertension. From European-descent genome-wide association studies, we selected genetic variants (P<5×10−8) for type 2 diabetes, fasting glucose, lipids, body mass index, smoking, alcohol and coffee consumption, physical activity, sleep duration, insomnia, and educational level. We extracted the genetic associations with hypertension from 2 European cohorts: the FinnGen Study (15 870 cases and 74 345 controls) and UK Biobank (54 358 cases and 408 652 controls). The inverse-variance weighted method was used as main analysis method. Genetically predicted triglycerides (pooled odds ratio [OR] per 1 SD, 1.17 [1.10–1.25]), body mass index (OR per 1 SD, 1.42 [1.37–1.48]), alcohol dependence (OR, 1.10 [1.06–1.13]), and insomnia (OR, 1.17 [1.13–1.20]) were associated with a higher odds of hypertension. Higher genetically predicted high-density lipoprotein cholesterol (OR per 1 SD, 0.88 [0.83–0.94]) and educational level (OR per 1 SD, 0.56 [0.54–0.59]) were associated with a lower odds of hypertension. Suggestive evidence was obtained for type 2 diabetes, smoking initiation and alcohol consumption with a higher hypertension odds, and longer sleep duration with a lower hypertension odds. This Mendelian randomization study identified high-density lipoprotein cholesterol, triglycerides, body mass index, alcohol dependence, insomnia, and educational level as causal risk factors for hypertension. This implicates that these modifiable risk factors are important targets in the prevention of hypertension.

The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis

OBJECTIVES

This study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.

METHODS

This cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.

RESULTS

A four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.

CONCLUSIONS

Metabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression

Background

Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.

Objectives

This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.

Methods

We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality.

Results

We included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64–0.86, p = 0.000; I² = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76–1.00, p = 0.052; I² = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64–0.82, p = 0.000; I² = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43–0.66, p = 0.000; I² = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66–0.89, p = 0.000; I² = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73–0.93, p = 0.001; I² = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated.

Conclusions

Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.

•

Question: What is the optimal blood pressure target in older adults with hypertension?

•

Findings: Intensive blood pressure treatment reduces RR of MCEs and all-cause mortality; it is well tolerated and safe.

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Meaning: Systolic BP targets of <130 mmHg are optimal for cardiovascular protection & support the ACC/AHA hypertension guidelines.

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms

INTRODUCTION AND AIMS

Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers.

DESIGN AND METHODS

Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking.

RESULTS

Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use.

DISCUSSION AND CONCLUSIONS

These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace.

Healthy lifestyle index and its association with hypertension among community adults in Sri Lanka: A cross-sectional study

Objectives

To investigate the association between a healthy lifestyle index (HLI) (i.e., a composite score comprising multiple lifestyle factors) and hypertension among community adults living in Sri Lanka.

Methods

The present study used baseline information of a cluster randomized controlled trial among 456 adults aged 27–65 years in a semi-urban community in Colombo, Sri Lanka. The HLI was constructed by summing a number of low-risk lifestyle factors: low body mass index, sufficient physical activity, non-smoking, low alcohol consumption, and sufficient fruit and vegetable consumption. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of antihypertensive medication. A logistic regression model was used to investigate the association between the HLI (low: 0–2; middle: 3; high: 4–5) and hypertension.

Results

A total of 178 (39%) participants were hypertensive. Compared with the low HLI group, multivariate-adjusted odds ratios (95% confidence intervals) of hypertension were 0.72 (0.44–1.19) and 0.28 (0.15–0.54) for the middle and high HLI groups, respectively (p-trend <0.001).

Conclusions

The present study provides essential evidence on an inverse association between adherence to healthy lifestyles and hypertension.

Consumption of Moringa oleifera Lam Leaves Lowers Postprandial Blood Pressure

Objective: This clinical study monitored the effect of eating cooked Moringa oleifera leaves on the blood pressure (BP) of healthy participants in view of the perception that consumption of Moringa is associated with an increase in blood pressure, which is contradictory to the findings from the literature.Methods: A random sample of 41 healthy participants were enrolled in this prospective, placebo-controlled clinical study. Participants in the case study consumed 120 g of cooked M. oleifera leaves while the control group did not eat Moringa leaves. BP was measured at baseline before the meal and followed up at regular intervals over 24 hours for both groups. Baseline (T0) mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and postprandial follow-up (T2-T24) were measured for both groups. Participants recorded their diet for a week and this led to an estimation of the total salt consumption per day.Results: A significant difference was observed between DBP at baseline and two hours postprandial (T2) for the case group (p = 0.013). Moreover, in the case group, despite high consumption of salt (7 g/d) during the week preceding the clinical study, there was a significant decrease in both the SBP and DBP. In the control group, participants with prior high consumption of salt (7 g/d) during the week had elevated SBP and DBP.Conclusions: These findings in human subjects indicated the lowering effect of Moringa oleifera leaves consumption on the 2 hours postprandial BP and showed a potential lowering effect on both SBP and DBP despite prior high consumption of salt (7 g/d).