1
|
Vriend EM, Bouwmeester TA, Franco OH, Galenkamp H, Zwinderman AH, van den Born BJH, Collard D. Sex differences in blood pressure phenotypes over time - the HELIUS study. J Hypertens 2024; 42:977-983. [PMID: 38372386 PMCID: PMC11064915 DOI: 10.1097/hjh.0000000000003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Hypertension can be classified into different phenotypes according to systolic and diastolic blood pressure (BP). In younger adults, these phenotypical differences have different prognostic value for men and women. However, little is known about sex differences in the natural course of different BP phenotypes over time. METHODS We used baseline and follow-up data from the multiethnic, population-based HELIUS study to assess differences in BP phenotypes over time in men and women aged < 45 years stratified according to baseline office BP into normotension (<140/<90 mmHg), isolated systolic hypertension (ISH, ≥140/<90 mmHg), isolated diastolic hypertension (IDH, <140/≥90 mmHg) or systolic diastolic hypertension (SDH, ≥140/≥90 mmHg). Logistic regression adjusted for age, ethnicity, and follow-up time was used to assess the risk of hypertension at follow-up (BP ≥140/90 mmHg or use of antihypertensive medication), stratified by sex. RESULTS We included 4103 participants [mean age 33.5 years (SD 7.4), 43.4% men] with a median follow-up time of 6.2 years. Compared to normotensive individuals, the age-adjusted odds ratios (OR) for having hypertension at follow-up were 4.78 (95% CI 2.90; 7.76) for ISH, 6.02 (95% CI 3.70; 9.74) for IDH and 33.73 (95% CI 20.35; 58.38) for SDH in men, while in women, OR were 10.08 (95% CI 4.09; 25.56) for ISH, 27.59 (95% CI 14.68; 53.82) for IDH and 50.58 (95% CI 24.78; 114.84) for SDH. CONCLUSIONS The risk of hypertension at follow-up was higher among women for all phenotypes compared to men, particularly in those with IDH. Findings of this study emphasize the importance of close BP monitoring in the young, especially in women.
Collapse
Affiliation(s)
- Esther M.C. Vriend
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Thomas A. Bouwmeester
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
| | - Oscar H. Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Henrike Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Aeilko H. Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology, Biostatistics & Bioinformatics, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Didier Collard
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
| |
Collapse
|
2
|
Chen L, Xie W, Hong X, Hong H. Association of pulse pressure and aortic root diameter in elderly Chinese patients with chronic heart failure. Front Cardiovasc Med 2024; 11:1366282. [PMID: 38495938 PMCID: PMC10940542 DOI: 10.3389/fcvm.2024.1366282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background High pulse pressure (PP) and aortic root diameter (AoD) are hallmarks of arterial stiffness or vascular aging and they are considered as risk factors for age-related cardiovascular disease, including heart failure (HF). However, the relationship between PP and AoD in patients with heart failure (HF) is uncertain. This study aimed to evaluate the relationship between PP and AoD in the middle-aged and the elderly with HF. Methods A total of 1,027 Chinese middle-aged and elderly patients with HF, including HF with reduced ejection fraction (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF) were included in this study. Pearson correlation analysis was used to evaluate the relationship between PP and AoD in the three types of HF. Multiple linear regression analysis was performed to assess the factors that affected AoD. Multivariate logistic regression was performed to determine the association between the PP level quartiles and AoD. The results were validated in an independent dataset included a total of 378 consecutive patients with HFrEF hospitalized at the Pingtan Branch of Fujian Medical University Union Hospital (Fujian, China). Results There was a positive correlation between PP and AoD in the middle-aged and the elderly with HFrEF. Multiple linear regression analysis revealed that PP, age, and body mass index (BMI) were independently correlated with AoD in HFrEF patients. In multivariate logistic regression analysis, an increased risk of aortic root dilation was observed in the highest quartile of the PP level compared with the lowest quartile. Age significantly interacted with PP (p = 0.047). A significant association between PP levels and AoD was only observed in patients ≥ 65 years old, but not in patients < 65 years old. In the validation dataset, PP was independently related to AoD in patients with HFrEF (β = 0.205, p = 0.001). Conclusions PP level was independently and positively associated with AoD, especially in the elderly with HFrEF, but not in patients with HFmrEF and HFpEF. Arterial stiffening or vascular aging may play a certain role in the elderly HFrEF patients.
Collapse
|
3
|
Divison-Garrote JA, Carbayo-Herencia JA, Simarro-Rueda M, Molina-Escribano F, Escobar-Cervantes C, Artigao-Rodenas LM, Gil-Guillén V, Banegas JR. Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019. Hypertension 2023; 80:2485-2493. [PMID: 37694400 DOI: 10.1161/hypertensionaha.123.21732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Guidelines recommend pharmacological treatment for systolic blood pressure (SBP) of 130 to 139 mm Hg in secondary prevention. However, uncertainty persists in primary prevention in low cardiovascular risk patients (CVR). METHODS Cohort study representative of the general population of Albacete/Southeast Spain. We examined 1029 participants with untreated blood pressure and free of cardiovascular disease, followed-up during 1992 to 2019. Cox regression modeled the association of SBP with cardiovascular morbidity and mortality (outcome-1) and cardiovascular morbidity and all-cause mortality (outcome-2). RESULTS Participants' mean age was 44.8 years (53.8%, women; 77.1% at low-CVR); 20.3% had SBP 120 to 129; 13.0% 130 to 139 at low-CVR and 3.4% at high-CVR; and 27.4% ≥140 mm Hg. After a 25.7-year median follow-up, 218 outcome-1 and 302 outcome-2 cases occurred. Unadjusted hazard ratios of outcome-1 for these increasing SBP categories (versus <120) were 2.72, 2.27, 11.54, and 7.52, respectively; and 2.69, 2.32, 10.55, and 7.34 for outcome-2 (all P<0.01). After adjustment for other risk factors, hazard ratio (95% CI) of outcome-1 were 1.49 (0.91-2.44), 1.65 (0.94-2.91, P=0.08), 1.36 (0.72-2.57), and 1.82 (1.15-2.88), respectively, and 1.39 (0.91-2.11), 1.69 (1.05-2.73), 1.09 (0.63-1.88), and 1.64 (1.11-2.41) for outcome-2. Compared with 130 to 139 at low-CVR, hazard ratio for 130 to 139 at high-CVR was 4.85 for outcome-1 (P<0.001) and 4.43 for outcome-2 (P<0.001). CONCLUSIONS In this primary prevention population of relatively young average age, untreated SBP of 130 to 139 mm Hg at low-CVR had long-term prognostic value and might benefit from stricter SBP targets. High-CVR patients had nonsignificant higher risk (limited sample size) but 4-fold greater risk when compared with low-CVR. Overall, results indicate the importance of risk stratification, supporting risk-based decision-making.
Collapse
Affiliation(s)
- Juan A Divison-Garrote
- Casas Ibáñez Primary Care Center (J.A.D.-G., F.M.-E.), Atención Primaria Albacete, Spain
- Department of Medicine, Universidad Católica de Murcia (UCAM), Spain (J.A.D.-G.)
- GEVA (Grupo Enfermedades Vasculares Albacete), Spain (J.A.D.-G., J.A.C.-H., M.S.-R., F.M.-E., L.M.A.-R., V.G.-G., J.R.B.)
| | - Julio A Carbayo-Herencia
- GEVA (Grupo Enfermedades Vasculares Albacete), Spain (J.A.D.-G., J.A.C.-H., M.S.-R., F.M.-E., L.M.A.-R., V.G.-G., J.R.B.)
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain (J.A.C.-H., V.G.-G.)
| | - Marta Simarro-Rueda
- Villamalea Primary Care Center (M.S.-R.), Atención Primaria Albacete, Spain
- GEVA (Grupo Enfermedades Vasculares Albacete), Spain (J.A.D.-G., J.A.C.-H., M.S.-R., F.M.-E., L.M.A.-R., V.G.-G., J.R.B.)
| | - Francisca Molina-Escribano
- Casas Ibáñez Primary Care Center (J.A.D.-G., F.M.-E.), Atención Primaria Albacete, Spain
- GEVA (Grupo Enfermedades Vasculares Albacete), Spain (J.A.D.-G., J.A.C.-H., M.S.-R., F.M.-E., L.M.A.-R., V.G.-G., J.R.B.)
| | | | - Luis M Artigao-Rodenas
- GEVA (Grupo Enfermedades Vasculares Albacete), Spain (J.A.D.-G., J.A.C.-H., M.S.-R., F.M.-E., L.M.A.-R., V.G.-G., J.R.B.)
| | - Vicente Gil-Guillén
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain (J.A.C.-H., V.G.-G.)
- Institute of Health and Biomedical Research of Alicante, Hospital General Universitario de Alicante, Spain (V.G.-G.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain (V.G.-G.)
| | - José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain (J.R.B.)
| |
Collapse
|
4
|
Pallarés-Carratalá V, Ruiz-García A, Serrano-Cumplido A, Arranz-Martínez E, Divisón-Garrote JA, Moyá-Amengual A, Escobar-Cervantes C, Barrios V. Prevalence Rates of Arterial Hypertension According to the Threshold Criteria of 140/90 or 130/80 mmHg and Associated Cardiometabolic and Renal Factors: SIMETAP-HTN Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1846. [PMID: 37893564 PMCID: PMC10608132 DOI: 10.3390/medicina59101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and objectives: Arterial hypertension (HTN) is the leading preventable cause of atherosclerotic cardiovascular diseases (ASCVD) and death from all causes. This study aimed to determine the prevalence rates of HTN diagnosed according to the threshold diagnostic criteria 130/80 mmHg and 140/90 mmHg, to compare blood pressure (BP) control, and to evaluate their associations with cardiovascular diseases and cardiometabolic and renal risk factors. Materials and Methods: This was a cross-sectional observational study conducted in primary care with a population-based random sample: 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HTN were calculated. BP control was compared in HTN patients with and without ASCVD or chronic kidney disease (CKD). Their associations with cardiovascular diseases and cardiometabolic and renal factors were assessed using bivariate and multivariate analysis. Results: Adjusted prevalence rates of HTN diagnosed according to 140/90 and 130/90 criteria were 30.9% (32.9% male; 29.7% female) and 54.9% (63.2% male; 49.3% female), respectively. BP < 130/80 mmHg was achieved in 60.5% of HTN patients without ASCVD or CKD according to 140/90 criterion, and 65.5% according to 130/80 criterion. This BP-control was achieved in 70% of HTN patients with ASCVD and 71% with CKD, according to both criteria. Coronary heart disease (CHD), heart failure, atrial fibrillation, stroke, diabetes, prediabetes, low glomerular filtration rate (eGFR), hyperuricemia, hypercholesterolemia, obesity, overweight, and increased waist-to-height ratio were independently associated with HTN according to both criteria. Conclusions: Almost a third of the adult population has HTN according to the 140/90 criterion, and more than half according to the 130/90 criterion, with a higher prevalence in men. The main clinical conditions associated with HTN were heart failure, diabetes, CHD, low eGFR, and obesity.
Collapse
Affiliation(s)
- Vicente Pallarés-Carratalá
- Health Surveillance Unit, Mutual Insurance Union, 12004 Castellon, Spain
- Department of Medicine, Jaume I University, 12006 Castellon, Spain
| | - Antonio Ruiz-García
- Lipids and Cardiovascular Prevention Unit, Pinto University Health Centre, Pinto, 28320 Madrid, Spain
- Department of Medicine, European University of Madrid, Villaviciosa de Odon, 28670 Madrid, Spain
| | | | | | | | | | | | - Vivencio Barrios
- Ramon y Cajal University Hospital, 28034 Madrid, Spain;
- Department of Medicine, Alcala University, 28801 Madrid, Spain
| |
Collapse
|
5
|
Middeke M. [High blood pressure in women - gender-specific features]. Dtsch Med Wochenschr 2023; 148:547-554. [PMID: 37094590 DOI: 10.1055/a-1892-4800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Arterial hypertension, particularly elevated systolic blood pressure, is the most common risk factor for cardio- and cerebrovascular morbidity and mortality in women as it is in men. Blood pressure regulation and the development of sustained hypertension differ by sex. There are still few data on the question of whether the current normal values can apply equally to men and women and on the question of a different effect and dosage of antihypertensive drugs in women.
Collapse
|
6
|
Floege J. Central blood pressure: nice to know but not yet ready for routine practice. Kidney Int 2023; 103:40-41. [PMID: 36603984 DOI: 10.1016/j.kint.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Jürgen Floege
- Division of Nephrology and Rheumatology, Rheinisch Westfälische Technische Hochschule University Hospital, Aachen, Germany.
| |
Collapse
|
7
|
Pucci G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Chiatti L, Arrivi A, Bisogni V, Veca V, Vaudo G. Importance of central BP assessment in ISH of the young. Which devices are best suited for practical use? Minerva Med 2022; 113:779-787. [PMID: 35266660 DOI: 10.23736/s0026-4806.22.07940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Isolated systolic hypertension (ISH), defined as brachial systolic blood pressure (bSBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg, is highly prevalent among young subjects and in the elderly. The prognostic significance of ISH in young individuals remains the object of large debate which might be solved, at least in part, if considering the prognostic role of central BP. For any given value of pBP, the cardiovascular (CV) risk is better defined by central BP (cBP). Young individuals with ISH have long been considered at low CV risk, given the assumption that a "spurious hypertension" phenotype characterized by elevated peripheral (brachial) BP (pBP), normal cBP, and elevated BP amplification was often found in this population. However, this remains to be proven, because many other studies found no differences in BP amplification between ISH and sisto-diastolic hypertension. Despite numerous attempts, methodologies for cBP assessment by non-invasive devices are currently not standardized. As a result, different devices could provide different cBP values despite using the same biological signals. Devices providing accurate estimates of BP amplification as a dimensionless ratio between amplitudes of central and peripheral arterial waveforms might be well suited for clinical purposes in young individuals with ISH. There is urgent need of well-designed prospective studies aiming at longitudinally evaluating the amount of CV risk associated with elevated cBP in young subjects with ISH and their related incremental prognostic value.
Collapse
Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy - .,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy -
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Alessio Arrivi
- Unit of Cardiology, S. Maria University Hospital, Terni, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Vito Veca
- Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.,Unit of Internal Medicine, S. Maria University Hospital, Terni, Italy
| |
Collapse
|
8
|
Association between isolated systolic hypertension in young adults and future cardiovascular mortality: three clues prove it. J Hum Hypertens 2022; 36:341-343. [DOI: 10.1038/s41371-022-00674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 11/09/2022]
|
9
|
Middeke M. [The taller the longer? - Body height and life expectancy]. Dtsch Med Wochenschr 2021; 146:1619-1623. [PMID: 34879412 DOI: 10.1055/a-1220-8297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The importance of height for mortality and life expectancy is a matter of controversy. The data on this in different countries vary depending on ethnicity, socio-economic and other factors such as age at the time of the study. Current German data show a positive correlation in younger cohorts in men with hypertension. Vascular factors such as the length of the aorta and its elasticity or stiffness seem to play an important role. A recent Dutch study shows a negative correlation between height and life expectancy in older women. Gender-specific differences in hemodynamics depending on body size or aortic length play a decisive role alongside age at the time of the examination.
Collapse
|