Prehypertension, racial prevalence and its association with risk factors: Analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Blood Pressure, HIV, and Cocaine Use Among Ethnically and Racially Diverse Individuals

OBJECTIVES

Racial minorities are at greater risk of cardiovascular disease (CVD), and CVD is the primary cause of mortality among human immunodeficiency virus (HIV)-infected individuals. Cocaine use also has been associated with hypertension. This study examined the contribution of lifestyle factors to systolic, diastolic, and mean arterial pressure (MAP) among people living with HIV and cocaine users from racially and ethnically diverse backgrounds.

METHODS

Participants (N = 401: 213 men, 188 women) aged 18 to 50 years with no history of CVD were recruited from South Florida. A total of 200 participants were HIV-cocaine-infected, 100 were HIV-infected individuals with no history of cocaine use, and 101 were HIV-uninfected individuals with cocaine abuse or dependence. Carotid intima-media thickness and plaque, blood pressure (BP), and lifestyle risk were assessed.

RESULTS

Mean age was 36 years (standard deviation 9.33); the majority (62%) were African American. Carotid plaques were identified in 23% of participants; 42% were obese, 68% engaged in ≥150 minutes of weekly exercise, and 68% were smokers. Sex, body mass index (BMI), and diet were associated with systolic BP. Age, BMI, cannabis use, and diet were associated with diastolic BP and MAP.

CONCLUSIONS

Age, BMI, cannabis use, and diet were associated with increased diastolic BP and MAP. Cocaine did not emerge as a significant predictor of CVD after controlling for cannabis dependence. Cocaine and HIV lacked significant association with CVD, possibly because the majority of the sample was younger than age 40. Lifestyle modifications and substance abuse counseling may be important in preventing CVD among those without a history of CVD.

An Investigation of Selection Bias in Estimating Racial Disparity in Stroke Risk Factors

Selection due to survival or attrition might bias estimates of racial disparities in health, but few studies quantify the likely magnitude of such bias. In a large national cohort with moderate loss to follow-up, we contrasted racial differences in 2 stroke risk factors, incident hypertension and incident left ventricular hypertrophy, estimated by complete-case analyses, inverse probability of attrition weighting, and the survivor average causal effect. We used data on 12,497 black and 17,660 white participants enrolled in the United States (2003-2007) and collected incident risk factor data approximately 10 years after baseline. At follow-up, 21.0% of white participants and 23.0% of black participants had died; additionally 22.0% of white participants and 28.4% of black participants had withdrawn. Individual probabilities of completing the follow-up visit were estimated using baseline demographic and health characteristics. Adjusted risk ratio estimates of racial disparities from complete-case analyses in both incident hypertension (1.11, 95% confidence interval: 1.02, 1.21) and incident left ventricular hypertrophy (1.02, 95% confidence interval: 0.84, 1.24) were virtually identical to estimates from inverse probability of attrition weighting and survivor average causal effect. Despite racial differences in mortality and attrition, we found little evidence of selection bias in the estimation of racial differences for these incident risk factors.

Risk factors for prehypertension and their interactive effect: a cross- sectional survey in China

BACKGROUND

Individuals with prehypertension are at higher risk of developing hypertension and cardiovascular diseases, while the interaction between factors may aggravate prehypertension risk. Therefore, this study aimed to evaluate the risk factors for prehypertension in Chinese middle-aged and elderly adults, and explore the potentially interactive effect of evaluated factors.

METHODS

All the participants that came from a community based cross-sectional survey were investigated in Bengbu, China, by being interviewed with a questionnaire. Body mass index (BMI), Waist circumference (WC) and lipid accumulation product (LAP) that reflect participants' obesity were also calculated. In addition, logistic regression model was applied to explore the risk factors of prehypertension, followed by the assessment of the interactive effects between risk factors on prehypertension by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).

RESULTS

A total of 1777 participants were enrolled in this study, among which the prevalence of normtension, prehypertension and hypertension were 41.70%, 33.93% and 24.37% respectively. According to the multivariate logistic regression analysis, age (OR: 1.01, 95%CI: 1.00-1.02), smoking (OR: 1.67, 95%CI: 1.22-2.29), family history of cardiovascular diseases (OR: 1.52, 95%CI: 1.14-2.02), general obesity (OR: 1.51, 95%CI: 1.15-1.97) and LAP (OR: 2.58, 95%CI: 1.76-3.80) were all defined as the major factors that significantly related with the risk of prehypertension. When identifying prehypertension risk, the receiver-operating characteristics (ROC) curves (AUC) analysis indicated that LAP performed better than BMI in males (Z = 2.05, P = 0.03) and females (Z = 2.12, P = 0.03), but was superior to WC only in females (Z = 2.43, P = 0.01). What is more, there were significant interactive effects of LAP with family history of cardiovascular diseases (RERI: 1.88, 95%CI: 0.25-3.51; AP: 0.44, 95%CI: 0.20-0.69; SI: 2.37, 95%CI: 1.22-4.60) and smoking (RERI: 1.99, 95%CI: 0.04-3.93; AP: 0.42, 95%CI: 0.17-0.67; SI: 2.16, 95%CI: 1.68-4.00) on prehypertension risk. The value of AP (0.40, 95%CI: 0.03-0.77) also indicated a significant interaction between family history of cardiovascular diseases and smoking on prehypertension.

CONCLUSION

Prehypertension is currently prevalent in Chinese adults. This study indicated that age, family history of cardiovascular diseases, smoking, general obesity and LAP were significantly related with prehypertension risk. Furthermore, interactive effects on risk of prehypertension had been demonstrated in this study as well, which would help researchers to build strategy against prehypertension more comprehensively and scientifically.

Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women

BACKGROUND

Internet and mobile devices are widely used and provide alternative approaches for promoting healthy lifestyles, yet less information is available describing outcomes of these approaches when used with young African American (AA) women at risk for developing hypertension.

OBJECTIVE

In this study, we evaluated a Web-based, culturally relevant lifestyle change intervention targeting AA women (referred to as the eHealth study).

METHODS

African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week study that incorporated social cognitive theory strategies. Participants were randomized to (1) lifestyle physical activity (PA) or (2) Dietary Approaches to Stop Hypertension (DASH) online education modules.

RESULTS

The 14 DASH and 12 PA participant attributes were similar at baseline. The DASH participants had a significant change in total DASH score (P = .001) and large effect sizes for DASH components (vegetables, 0.84; nonfat dairy, 0.71; fruit, 0.62). The PA participants had a favorable change (+39%) in pedometer steps (P = .055). With respect to weight change, a large effect size was observed for PA (0.84) and smaller for DASH participants (0.18). Seventy-one percent of DASH and 48% of PA participants completed program activities, corresponding to a moderate difference in program engagement between groups (d = 0.58).

CONCLUSION

Our eHealth platform provides an alternative approach for reaching young AA women and was successful with respect to improving PA and dietary behaviors. Furthermore, the eHealth approach has the potential as a powerful program for changing health behaviors for other at-risk populations.

Survival-related Selection Bias in Studies of Racial Health Disparities: The Importance of the Target Population and Study Design

The impact of survival-related selection bias has not always been discussed in relevant studies of racial health disparities. Moreover, the analytic approaches most frequently employed in the epidemiologic literature to minimize selection bias are difficult to implement appropriately in racial disparities research. This difficulty stems from the fact that frequently employed analytic techniques require that common causes of survival and the outcome are accurately measured. Unfortunately, such common causes are often unmeasured or poorly measured in racial health disparities studies. In the absence of accurate measures of the aforementioned common causes, redefining the target population or changing the study design represents a useful approach for reducing the extent of survival-related selection bias. To help researchers recognize and minimize survival-related selection bias in racial health disparities studies, we illustrate the aforementioned selection bias and how redefining the target population or changing the study design can be useful.

Apelin/APJ expression in the heart and kidneys of hypertensive rats

Hypertension is an important health problem that is manifested by systemic arterial blood pressure being permanently elevated and leading to serious complications. Hypertension is the basis for coronary heart diseases, heart failure, kidney damage, cerebrovascular diseases. Due to ethical concerns, there is no detailed study of the mechanism, side effects and treatment of hypertension in humans. For this reason, specific studies related to the organ of hypertension are performed in experimental animals. The heart and kidney tissue, which are the most important organs that hypertension has damaged, have formed specific organs of our work. In our experimental study, a total of 35 (hypertensive group: 20, control group: 15) Rattus Norvegicus Wistar albino rats were used. In order to obtain our hypertension model, our experimental animals were given L-NAME together with drinking water for six weeks. After six weeks, the experimental procedures were terminated. Heart and kidney tissues of the hypertensive and control group were obtained. Expression of apelin and apelin receptor (APJ) was demonstrated by immunohistochemical and Western Blot protocols. Hypertrophic cardiac atrium of the hearts of the large cavities, interventricular septum and myocardium to the disintegration, as well as an increase in the diameter of the coronary artery has been observed. In general, kidney tissues of the hypertensive group showed narrowing in cortical renal structures and enlargement in structures in the renal medulla. As a result, in hypertensive cases, there was an increase in expression of Apelin and APJ receptor in heart tissue, and a decrease in expression of Apelin and APJ receptor in kidney tissue. We think that our findings may contribute to experimental or clinical studies related to hypertension and apelin.

Stroke Risk Factors, Genetics, and Prevention

Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.

Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

The association of atrial fibrillation (AF) with the severity and control of hypertension (HTN) remains unclear. We analyzed data from the national biracial cohort of REasons for Geographic And Racial Differences in Stroke study. The AF prevalence ratios were estimated and full multivariable adjustment included demographics, risk factors, medication adherence, HTN duration, and antihypertensive medication classes. Of the 30,018 study participants (8.6% with AF), 4386 had normotension (4.3% with AF), 5916 had prehypertension (4.3 with AF%), 12,294 had controlled HTN (11.2% with AF), 5587 had uncontrolled HTN (8.1% with AF), 547 had controlled apparent treatment-resistant hypertension (aTRH) (19.2% with AF), and 1288 had uncontrolled aTRH (15.5% with AF). Compared with normotension, the AF prevalence ratios for prehypertension, controlled HTN, uncontrolled HTN, controlled aTRH, and uncontrolled aTRH groups in fully adjusted model were 1.01 (95% confidence interval: 0.84, 1.21), 1.42 (1.18, 1.71), 1.37 (1.14, 1.65), 1.17 (0.86, 1.58), and 1.42 (1.10, 1.84), respectively (P < .001). The prevalence of AF was similar among persons with HTN regardless of blood pressure level and antihypertensive treatment resistance.

Prehypertension is Associated With Abnormalities of Cardiac Structure and Function in the Atherosclerosis Risk in Communities Study

BACKGROUND

Prehypertension (blood pressure (BP) of 120-139 mm Hg systolic and/or 80-89 mm Hg diastolic) is highly prevalent and is associated with increased cardiovascular risk. Our goal was to investigate the extent to which prehypertension is associated with end-organ alterations in cardiac structure and function in a large biracial cohort of older men and women.

METHODS

We studied 4,871 participants of the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 (2011-2013) and underwent two-dimensional echocardiography while free of prevalent coronary heart disease or heart failure. We categorized participants into 3 groups: optimal BP (BP <120 mm Hg and <80 mm Hg) (n = 402), prehypertension (n = 537), and hypertension (n = 3,932).

RESULTS

Individuals with prehypertension (75±5 years) had higher left ventricular (LV) mass index and wall thickness, and higher prevalence of abnormal LV geometry than those with optimal BP (74±5 years), but lower than those with frank hypertension (76±5 years). In addition, participants with prehypertension had impairment of diastolic parameters (E/A, E' and E/E'), and had higher prevalence of mild and moderate-severe diastolic dysfunction compared to those with optimal BP, but no differences in systolic parameters. These differences in cardiac structure and function remained significant after adjusting for important clinical covariates.

CONCLUSION

In the ARIC cohort at visit 5, prehypertension was associated with increased LV remodeling and impaired diastolic function, but not systolic function, suggesting that even mildly elevated BP within the normal range is associated with cardiac end-organ damage.

The prevalence and heterogeneity of prehypertension: a meta-analysis and meta-regression of published literature worldwide

Objective

Prehypertension appears to be a precursor of hypertension and has been recognised as a major risk factor for cardiovascular disease (CVD). Recognition of prehypertension provides important opportunities for preventing hypertension and CVD. We aimed to investigate the world-wide prevalence and heterogeneity of prehypertension.

Methods

We performed a meta-analysis of cross-sectional studies worldwide that reported the prevalence of prehypertension. We searched for publications between January 1966 and November 2010, using PubMed, Ovid and the Cochrane Library, with the keyword ‘prehypertension’, supplemented by a manual search of references from recent reviews and relevant published original studies. Pooled prevalence of prehypertension was calculated using random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression. Twenty-two articles met our inclusion criteria, with a total sample of 242 322 individuals.

Results

The overall pooled prevalence of prehypertension was 38%. Significant heterogeneity across estimates of prevalence was observed (p = 0.000, I² = 99.9%). The prevalence rose as the sample size increased, and was higher among men than women (41 vs 34%). The non-Asian population was more likely to be prehypertensive than Asian individuals (42 vs 36%). A high prevalence of 47% was observed among the black African population in the non-Asian subgroup. The inception year of the surveys was the only source of heterogeneity we found by meta-regressional analysis (p = 0.06).

Conclusion

These results indicate that the prevalence of prehypertension was relatively high, particularly among males. Although more attention has been paid to this segment of the population since 2003, additional practical and reasonable steps should be taken to prevent and treat prehypertension.

Informing Policy for Reducing Stroke Health Disparities from the Experience of African-American Male Stroke Survivors

BACKGROUND

The burden of stroke is severe among African-Americans. Despite overall declines in the rate of stroke since 2000, outcomes are largely unimproved or have worsened for African-American men. Adverse psychosocial challenges may hinder adherence to a regimen of risk factor reduction.

METHODS AND RESULTS

Focus group analysis was combined with a review of current published guidelines and epidemiologic evidence on risk factors to better understand stroke health disparities and potential policy solutions. Transcripts from three focus groups with ten African-American male stroke survivors under age 65 and their care partners (N = 7) were analyzed and compared with existing published data on (a) the burden of stroke (b) trends in clinical risk factors, and (c) trends in behavioral risk factors. Participants described myriad psychosocial barriers that impede reduction of risk indicators, including low trust in providers, poor social support, access difficulties, depression, and distress.

CONCLUSIONS

In order to be effective, policies and programs must target mechanisms consistent with the challenges faced by African-American men. Infrastructure is needed to better identify and share practices effective for improving cardiovascular outcomes within specific racial and ethnic groups.

Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.

Prehypertension--prevalence, health risks, and management strategies

Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) prehypertension; only stage 2 prehypertension increases cardiovascular mortality. Among individuals with prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of prehypertension. Data on primary prevention of CVD with pharmacotherapy in prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.

Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Human aldosterone synthase gene polymorphism promotes miRNA binding and regulates gene expression

Hypertension is a serious risk factor for myocardial infarction, heart failure, vascular disease, stroke, and renal failure. Like other complex diseases, hypertension is caused by a combination of genetic and environmental factors. The renin-angiotensin-aldosterone system plays an important role in the regulation of blood pressure. The octapeptide angiotensin II (ANG II) is one of the most active vasopressor agents and is obtained from the precursor molecule, angiotensinogen, by the combined proteolytic action of renin and angiotensin-converting enzyme. ANG II increases the expression of aldosterone synthase (coded by Cyp11B2 gene), which is the rate-limiting enzyme in the biosynthesis of aldosterone. Previous studies have shown that increased expression of aldosterone synthase increases blood pressure and cardiac hypertrophy in transgenic mice. Human Cyp11B2 gene has a T/C polymorphism at -344 positions in its 5'-untranslated region (UTR), and the -344T allele is associated with hypertension. Human Cyp11B2 gene also has an A/G polymorphism at 735 position in its 3'-UTR (rs28491316) that is in linkage disequilibrium with single nucleotide polymorphism at -344. We show here that 1) microRNA (miR)-766 binds to the 735G-allele and not the 735A-allele of the hCyp11B2 gene and 2) transfection of miR-766 reduces the human aldosterone synthase mRNA and protein level in human adrenocortical cells H295R. These studies suggest that miR-766 may downregulate the expression of human aldosterone synthase gene and reduce blood pressure in human subjects containing -344T allele.

Prehypertension: Underlying pathology and therapeutic options

Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.

Effect of apelin on the cardiac hemodynamics in hypertensive rats with heart failure

It is known that apelin has definite protective effects on various cardiovascular diseases; however, the mechanism through which hypertension with heart failure (H-HF) is affected by pyroglutamylated apelin-13 (Pyr-AP13) remain unclear. Thus, in the present study, we investigated the effects of apelin on the cardiac hemodynamics in rats with hypertension and heart failure. In our study, cardiac function, dimensions and histological determination of the fibrosis of rats with two-kidney, one-clip induced hypertension and sham-operated rats were assessed using an echocardiography system and Masson’s trichrome. The infusion of either 5% glucose injection (GS) alone or 5% GS containing Pyr-AP13 as a dose, time-matched design on the cardiac hemodynamics in H-HF rats and sham-operated rats was recorded. For the determination of the effects of potential related proteins on cardiac hemodynamics in the H-HF rats, the animals were divided into 5 groups: i) the sham-operated group (n=8); ii) H-HF (n=8); iii) H-HF with infusion of 0.1 μg dose of Pyr-AP13 (n=8) or 5% glucose (GS) (n=8); iv) H-HF with infusion of 1 μg dose of Pyr-AP13 (n=8) or 5% GS (n=8); and v) H-HF with infusion of 10 μg dose of Pyr-AP13 (n=8) or 5% GS (n=8). The concentration of cyclic adenosine 3′,5′-monophosphate (cAMP) was determined by ELISA. The expression of membrane and cytosolic proteins was evaluated by western blot analysis. Significant cardiac and perivascular fibrosis was observed in the H-HF rats. Following the infusion of Pyr-AP13, the systolic and diastolic function was significantly improved in the cardiac hemodynamic parameters in the H-HF rats treated with Pyr-AP13. The apelin receptor (APJ), which was activated by the exogenous infusion of Pyr-AP13, was partially recycled from the cytoplasm back to the plasma membrane; however, membrane APJ was eventually downregulated in the H-HF rats treated with Pyr-AP13 compared with the sham-operated group rats. Our findings suggested that a complex was formed after Pyr-AP13 combined with cellular membrane APJ receptor. However, the endogenous downregulation of the APJ receptor results in benefits from the exogenous administration of apelin.

Vascular risk factors, depression, and cognitive change among African American older adults

OBJECTIVE

Vascular burden has been linked to future depression and cognitive change in predominately European American samples. This study investigated these relationships in older African Americans.

METHODS

To examine the connection between vascular risk factors, depression, and cognitive change, this study utilized data from 435 older African Americans. Specifically, the study examined the link between vascular risk at baseline with depression and cognitive functioning at a 2.5-year follow-up visit.

RESULTS

High baseline vascular risk was associated with increased odds of future depression while controlling for age and current depression. A series of path analyses demonstrated links between baseline vascular risk, increases in depression, and decreases in processing speed.

CONCLUSIONS

These findings suggest that African Americans with greater vascular burden are at greater risk for depression and cognitive change.

Prehypertension and incident acute coronary heart disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study

BACKGROUND

The independent prognostic value of prehypertension for incident coronary heart disease (CHD) remains unsettled. We examined associations between prehypertension (systolic blood pressure of 130-139.9 and/or diastolic blood pressure of 80-89mm Hg) and incident acute CHD and cardiovascular disease (CVD) death.

METHODS

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study includes 30,239 black and white community-dwelling adults aged ≥45 years recruited from 2003 to 2007. Endpoints were centrally adjudicated by experts and included incident nonfatal myocardial infarction (MI), acute CHD (nonfatal and fatal MI), and a composite of nonfatal MI or CVD death. Cox proportional hazards models estimated the hazard ratios (HRs) for these endpoints by blood pressure (BP) categories adjusting for sociodemographics and CHD risk factors.

RESULTS

The 24,388 participants free of CHD at baseline (mean age = 64.1±9.3 years; 58% women; 42% blacks) were followed for a mean of 4.2±1.5 years. The unadjusted HR for incident acute CHD was 1.23 (95% confidence interval (CI) = 0.93-1.64) for prehypertension and 2.28 (95% CI = 1.71-3.04) for hypertension. With full adjustment, the HR for prehypertension remained nonsignificant. The HR for nonfatal MI and for acute CHD death was also nonsignificant. For the combined endpoint (incident fatal and nonfatal MI or CVD death), the unadjusted HR was 1.29 (95% CI = 1.02-1.64) but the adjusted HR was 1.15 (95% CI = 0.91-1.47). Finally, after adjustment for other CHD risk factors, there was no significant interaction of BP with race.

CONCLUSIONS

In this sample, prehypertension was not associated with incident acute CHD.

A Question of Color

This study describes the relative influence of facial skin color, lifetime exposure to racial discrimination, chronic stress, and traditional prehypertension risk factors (family history of hypertension and age) on resting blood pressure and body mass index (BMI) among 196 southern African American (AA) female undergraduate students. Stepwise regression analyses indicated that skin color was the strongest predictor of systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. Skin color, chronic stress, and family history of hypertension predicted 53% of the SBP variance. Skin color, chronic stress, and family history of hypertension predicted 30.2% of the DBP variance. Racism and age were not significant predictors of SBP or DBP. Of the variance in BMI, 33% was predicted by skin color, chronic stress, and racism. Age and family history of hypertension were not predictors of BMI. The current study provides evidence of the relationship of skin color and chronic stress to blood pressure among young southern AA women. The study identifies an important relationship between increased racial stress exposure and heavier BMIs, a predictor of prehypertensive risk.

Hypertension in black patients: an update

Black individuals are at high risk for hypertension and increased morbidity from cardiovascular and renal disease, in particular. Increased understanding of racial disparities in hypertension, in terms of risk factors, patient/physician behaviors, and treatment outcomes, is key to improving racially oriented care in black patients. Recent data suggest that black patients progress more rapidly from prehypertension to hypertension, highlighting the need for early and prompt intervention. Unfortunately, adherence to and persistence with antihypertensive therapy are generally poor in black patients and are compounded by the increased need for multidrug therapy in this patient population. Treatment strategies currently under investigation are focusing on methods to improve self-care behaviors and medication adherence. Because this is a constantly and rapidly evolving field of study, this article provides an update of recent findings that should be of relevance and interest to practicing clinicians.

Human angiotensinogen +11525 C/A polymorphism modulates its gene expression through microRNA binding

Hypertension is a serious risk factor for cardiovascular disease. Like other complex disease, hypertension is caused by a combination of genetic and environmental factors. The renin-angiotensin system plays an important role in the regulation of blood pressure. Angiotensinogen (AGT) gene is associated with essential hypertension in Caucasians, Japanese, and Asian-Indian subjects. AGT gene may also be associated with cardiac hypertrophy, coronary atherosclerosis, and microangiopathy related cerebral damage. Human AGT gene has a C/A polymorphism at nucleoside 11525 (rs7079) that is located in the 3'-untranslated region (3'-UTR) and is modestly associated with increased blood pressure. We show here that miR-31 and miR-584 bind strongly to the hAGT 3'-UTR containing 11525C allele compared with 11525A allele. We also show that transfection of miR-31 and miR-584 downregulates the hAGT mRNA and protein levels in human liver cells. These studies may provide new therapeutic approach to reduce hypertension.

Linking sleep to hypertension: greater risk for blacks

Background. Evidence suggests that insufficient sleep duration is associated with an increased likelihood for hypertension. Both short (<6 hours) and long (>8 hour) sleep durations as well as hypertension are more prevalent among blacks than among whites. This study examined associations between sleep duration and hypertension, considering differential effects of race and ethnicity among black and white Americans. Methods. Data came from a cross-sectional household interview with 25,352 Americans (age range: 18-85 years). Results. Both white and black short sleepers had a greater likelihood of reporting hypertension than those who reported sleeping 6 to 8 hours. Unadjusted logistic regression analysis exploring the race/ethnicity interactions between insufficient sleep and hypertension indicated that black short (<6 hours) and long (>8 hours) sleepers were more likely to report hypertension than their white counterparts (OR = 1.34 and 1.37, resp.; P < 0.01). Significant interactions of insufficient sleep with race/ethnicity were observed even after adjusting to effects of age, sex, income, education, body mass index, alcohol use, smoking, emotional distress, diabetes, coronary heart disease, and stroke. Conclusion. Results suggest that the race/ethnicity interaction is a significant mediator in the relationship between insufficient sleep and likelihood of having a diagnosis of hypertension.

Association of plasma B-type natriuretic peptide concentrations with longitudinal blood pressure tracking in African Americans: findings from the Jackson Heart Study

Water and sodium retention precedes the development of high blood pressure (BP) and explains a compensatory rise in B-type natriuretic peptide (BNP) concentrations. It is unclear whether BNP concentrations antedate the BP progression. We hypothesized that higher BNP concentrations in our African American cohort will be associated with longitudinal increases in BP, progression of BP stage, and incident hypertension. Our study sample consisted of 888 normotensive (based on BP at examination 1 [2000-2004]) participants of the Jackson Heart Study (mean age, 47±12 years; 61% women). We examined the relation of BNP concentrations at the baseline examination to change in systolic and diastolic BPs, BP progression (an increase by 1 BP stage as defined by THE sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) and incident hypertension by examination 2 (2005-2008) adjusting for baseline BP stages, systolic and diastolic BPS, traditional risk factors, and echocardiographic left ventricular mass. Over a median follow-up period of 5.0±0.8 years, 36.9% progressed to a higher BP stage and 19.3% developed hypertension. In multivariable regression models, higher log-BNP concentrations at examination 1 were significantly and positively associated with changes in systolic and diastolic BPs (P<0.05 for both). Baseline log-BNP was significantly associated with BP progression (P=0.046). Every SD increase in baseline log BNP was associated with a 12% increased risk of BP progression. Log-BNP was not significantly associated with incident hypertension (P=0.12). In our community-based sample of African Americans, higher BNP concentrations predicted a longitudinal increase in systolic and diastolic BPs and progression of BP stage.

Treatment of prehypertension: lifestyle and/or medication

Prehypertension is a warning to individuals with resting blood pressures between 120/80 mmHg and 139/89 mmHg of an insidious progression of blood pressure towards hypertensive levels (≥ 140/90 mmHg). Prehypertension is associated with increased cardiovascular risk and end organ damage compared with individuals who are normotensive. This review primarily focuses on internal and external factors associated with the prevalence of prehypertension. Elucidating all of the factors associated with a rise in resting blood pressure and comparing the effects of medication versus lifestyle changes may aid the clinician in developing a preventive and/or treatment strategy for each individual.

High prevalence of prehypertension and hypertension in a working population in Hungary

BACKGROUND

Hungary has one of the highest mortality rates due to strokes among the European Union countries. As elevated blood pressure (BP) is the principal risk factor for strokes, we assessed BP levels, as well as awareness and treatment status of hypertension and prehypertension in a working population sample in Hungary.

METHODS

Worksite employees in Budapest and Szeged were screened for their BP using an automated BP measuring instrument (BpTRU). BpTRU readings of heart rate (HR) were also recorded. Respondents were classified as normotensives (NT), prehypertensives (PHTN) and hypertensives (HTN) according to their BP levels, as defined by the JNC 7 guidelines. Body height and body weight were measured and body mass index (BMI) was calculated. Self-reported information regarding smoking was collected.

RESULTS

In total, 2,012 respondents were recruited (1,000 white collar; 1,012 blue-collar workers), with a mean (±s.d.) age of 34.8 (±9.9) years. Of all respondents, 22.6% were identified as HTN and 39.8% as PHTN. Among HTN, 40% were unaware of their condition and only 18.5% were adequately treated. PHTN were similar in age as NT, but showed significantly higher HR.

CONCLUSIONS

A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

Alcohol intake and atherosclerotic risk factors in normotensive and prehypertensive men

BACKGROUND

The purpose of this study was to determine whether relationships between alcohol intake and atherosclerotic risk factors were different in normotensive and prehypertensive persons.

METHODS

Japanese men aged 35-60 years who showed normal blood pressure (n = 4,778) or prehypertension (n = 9,728) without any drug therapy for hypertension were divided into non, light (<22 g ethanol/day), heavy (≥ 22 and < 44 g ethanol/day) and very heavy (≥ 44 g ethanol/day) drinkers.

RESULTS

In subjects with prehypertension, body mass index (BMI) and waist circumference were significantly lower and smaller, respectively, in light, heavy and very heavy drinkers than in nondrinkers. In subjects with normal blood pressure, BMI was significantly lower in light and heavy drinkers but not in very heavy drinkers than in nondrinkers, and waist circumference was not significantly different in non, light and heavy drinkers and was significantly larger in very heavy drinkers than in nondrinkers. Both in the prehypertensive and normotensive groups, compared with nondrinkers, hemoglobin A(1C) and low-density lipoprotein (LDL) cholesterol were significantly lower and high-density lipoprotein (HDL) cholesterol was significantly higher in light, heavy and very heavy drinkers, and log-converted triglycerides was significantly higher in very heavy drinkers.

CONCLUSIONS

The association of alcohol intake with a lower occurrence of obesity is stronger in prehypertensives than in normotensives, while the associations of alcohol intake with lower occurrences of hyperglycemia and abnormal cholesterol profile, such as lowered HDL cholesterol and elevated LDL cholesterol, and a higher occurrence of elevated triglycerides are similar in normotensive and prehypertensive persons.