Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study

Chinese visceral adiposity index and its relation to abnormal left ventricular remodeling assessed by relative wall thickness and left ventricular mass index

BACKGROUND AND AIMS

The Chinese visceral adipose index (CVAI) is more significantly associated with cardiometabolic risk factors than other obesity indices. This study investigated the relationship between CVAI and left ventricular (LV) remodeling.

METHODS AND RESULTS

This study included 75,132 Koreans who underwent echocardiography during a health checkup. They were grouped according to quartile levels of the CVAI, body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). LV remodeling was defined as the presence of abnormal relative wall thickness (ARWT) and left ventricular hypertrophy (LVH). Multivariate adjusted logistic regression analysis (adjusted OR [95% confidence interval]) was used to analyze the association between ARWT and LVH according to the quartile levels of each index. Receiver operating characteristic (ROC) graphs and areas under the curve (AUC) were calculated to identify the predictive ability of the indices for ARWT and LVH. ARWT was associated proportionally with CVAI quartiles in both men (second quartile: 1.42 [1.29-1.56], third quartile: 1.61 [1.46-1.77], fourth quartile: 2.01 [1.84-2.21]), and women (second quartile: 1.06 [0.78-1.45], third quartile: 1.15 [0.86-1.55], and fourth quartile: 2.09 [1.56-2.80]). LVH was significantly associated with third (1.74 [1.07-2.83]) and fourth quartile (1.94 [1.18-3.20]) groups of CVAI in women. ROC and AUC analyses indicated that CVAI was superior to other indices in predicting ARWT in men and LVH and ARWT in women.

CONCLUSION

The CVAI is an effective surrogate marker of LV remodeling, particularly in women.

Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

BACKGROUND

The age of onset of hypertension (HTN) is decreasing, and obesity is a significant risk factor. The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied. This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.

METHODS

Seven thousand, five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8-18 years from the 2013-2015 China Child and Adolescent Cardiovascular Health study and the 2011-2018 National Health and Nutrition Examination Surveys were analyzed. Blood pressure and body composition (fat and muscle) were measured by trained staff. The crude prevalence and age-standardized prevalence rate (ASPR) of primary HTN and its subtypes [isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH)] were calculated based on 2017 American Academy of Pediatrics guidelines. Multivariable-adjusted linear regression coefficients and odds ratios (ORs) were calculated to assess the associations of body composition indicators with HTN, ISH and IDH.

RESULTS

The ASPR of HTN was 18.5% in China (CN) and 4.6% in the United States (US), whereas the obesity prevalence was 7.4% and 18.6%, and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN. Increased fat mass, muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries. The percent of muscle body mass had a protective effect on HTN and ISH in both countries [HTN (CN: OR = 0.83, 95% CI = 0.78-0.88; US: OR = 0.72, 95% CI = 0.64-0.81); ISH (CN: OR = 0.87, 95% CI = 0.80-0.94; US: OR = 0.71, 95% CI = 0.62-0.81)], and the protective effect was more common among children and adolescents with high levels of physical activity.

CONCLUSIONS

The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US, and the contribution of obesity to HTN was higher in the US than in CN. Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations. Optimizing body composition positively influences blood pressure in children and adolescents, particularly those with high-level physical activity. Video abstract (MP4 149982 KB).

Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans

OBJECTIVES

The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.

METHODS

The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.

RESULTS

The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.

CONCLUSIONS

The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.

The Association between Mid-Upper Arm Circumference and Blood Pressure in an Italian Population of School-Aged Children and Adolescents with Lipid Disorders

Background: Many anthropometric measurements have been investigated concerning their association with blood pressure (BP) in paediatric age groups. This study aims to find a relationship between mid-upper arm circumference (MUAC) and BP in a population of children and adolescents aged 1-18 years. Methods: 5853 subjects (2977 females and 2876 males) were studied. MUAC, body mass index (BMI), and BP were measured. The individuals in the study were subdivided and grouped by gender and type of school attended in Italy: 1-5 years (pre-school), 6-10 years (primary school), 11-13 years (secondary school), 14-18 years (high school). Results: In the age range of 6-13 years, all the subjects with MUAC > 50th percentile had systolic and diastolic BP significantly higher than children with MUAC below 50th percentile (p < 0.0001). In the age range 14-18 years, the relationship persisted only in females (p < 0.001 and p < 0.05 for diastolic and systolic BP, respectively). A linear relationship was found between MUAC and BMI. Conclusions: In Italian children of both genders aged 6-13, arm distribution of body fat is strongly associated with increased systolic and diastolic BP. As such, a simple anthropometric measurement like MUAC might represent a tool to identify young subjects who are at risk for HTN.

Comparison of Several Adiposity Indexes in Predicting Hypertension among Chinese Adults: Data from China Nutrition and Health Surveillance (2015-2017)

The current study is to explore the association of the Chinese visceral adiposity index (CVAI) with hypertension, and to compare the predictive power of different adiposity indexes regarding hypertension among Chinese adults aged over 45 years. A total of 99,201 participants aged over 45 years from the China Nutrition and Health Surveillance 2015-2017 were included in this study. Multivariate adjusted logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of hypertension. Multivariate adjusted restricted cubic spline analyses were applied to explore the association of adiposity indexes with hypertension. Receiver operating characteristic (ROC) analyses were used to compare the predictive powers of different adiposity indexes of hypertension. All eight adiposity indexes included in this study were positively associated with hypertension. Compared with those in the lowest quartile of the CVAI, the participants in the highest quartile showed a significantly higher risk of hypertension (OR = 3.70, 95% CI = 3.54-3.86) after multiple adjustments. The ROC analyses suggested that the CVAI was the strongest predictor of hypertension compared to other adiposity indexes in both genders. The findings supported that the CVAI could serve as a reliable and cost-effective method for early identifying hypertension risk.

Obesity indicators as mediators of the association between age at menopause and blood pressure values

Having a later age at menopause is associated with having a higher blood pressure (BP) value, but the mediation pathways remain unclear. We quantitatively examined the mediation effects of various obesity indicators using baseline data from phase 4 of the Guangzhou Biobank Cohort Study. The product of coefficients approach and bootstrapping procedures were used to assess the mediation effects of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) on the association between age at menopause and BP values. Age, education, occupation, family income, smoking, drinking, diet, physical activity, age at menarche, number of births, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were adjusted as covariates. Of 5429 women with natural menopause, the mean age and menopausal age were 60.0 (standard deviation = 5.8) and 50.3 (3.1) years, respectively. The prevalence of hypertension was 29.6%. In women with a menopausal age of ≥50 years, BMI, WC, WHR and WHtR showed significant mediation effects on the positive association between menopausal age and BP. The adjusted proportion (95% confidence interval) of the mediation effects for those variables were 26.04% (10.40-116.82%), 25.92% (10.19-108.57%), 14.11% (3.59-62.78%), and 23.17% (8.70-95.81%), respectively, for systolic BP values and 22.59% (10.72-53.60%), 20.67% (9.83-49.31%), 9.21% (2.73-23.92%), and 17.19% (7.56-41.31%) for diastolic BP values. In women with a menopausal age of <50 years, no significant association between age at menopause and systolic/diastolic BP values was found. In conclusion, obesity indicators showed significant mediating effects on the association between having a later age at menopause and having a higher BP value. Further longitudinal studies with detailed and accurate measurements of metabolic changes after menopause and sufficient follow-up are warranted to confirm these results. We demonstrated obesity indicators showed significant mediating effects on the association between later age at menopause (≥50 years) and higher BP.

Chinese Visceral Adiposity Index Is More Closely Associated With Hypertension and Prehypertension Than Traditional Adiposity Indices in Chinese Population: Results From the REACTION Study

PURPOSE

The optimal adiposity index that is strongly associated with hypertension or prehypertension remains inconclusive in Chinese population. This study aimed to investigate the relationship between Chinese visceral adiposity index (CVAI) and hypertension and prehypertension, as well as to compare the discriminative power of CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), low-density lipoprotein cholesterol (LDL-C), and waist-to-hip ratio (WHR) with hypertension and prehypertension in Chinese general population.

PATIENTS AND METHODS

A total of 34732 participants from REACTION study were recruited. Multiple logistic regression analyses were performed to detect the association between adiposity indices (CVAI, VAI, BMI, WC, WHtR, WHR, LDL-C) and hypertension and prehypertension.

RESULTS

Multivariate logistic regression analysis showed that compared with other obesity indices, CVAI remained significantly associated with hypertension and prehypertension (Hypertension: odds ratio (OR) 3.475, 95% confidence interval (CI) 3.158-3.824, p<0.001 in total subjects; OR 2.762, 95% CI 2.369-3.221, p<0.001 in men; OR 3.935, 95% CI 3.465-4.469, p<0.001 in women, Prehypertension: OR 2.747, 95% CI 2.460-3.068, p<0.001 in total subjects; OR 2.605, 95% CI 2.176-3.119, p<0.001 in men; OR 2.854, 95% CI 2.465-3.304, p<0.001 in women).In a stratified analysis, CVAI was significantly associated with hypertension and prehypertension at any level of blood glucose, age or estimated glomerular filtration rate(eGFR).

CONCLUSION

CVAI is significantly associated with hypertension and prehypertension. CVAI shows the superior discriminative ability for hypertension and prehypertension compared with VAI, BMI, WC, WHtR, WHR and LDL-C in Chinese general population.

Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults

Background

Few studies have compared bioelectrical body and visceral fat indices with anthropometric measures, or evaluated their optimal cutoffs in relation to hypertension among Asians. We compared the efficiencies of bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for hypertension and re-evaluated the optimal cutoffs of each index by age and gender.

Methods

We conducted a cross-sectional survey among 8234 adults for health examination. PBF, VFA, BMI, WHR, and data on hypertension and behaviors were collected. Receiver operating characteristic (ROC) curve and areas under curves (AUCs) were used to analyze the efficiencies of the indices for hypertension, optimal cutoffs were estimated using the Youden index.

Results

A total of 8234 individuals aged 21–91 with median age 44 (interquartile range [IQR] 33–56) years were included and 40.56% were men. The overall prevalence of hypertension was 27.47%. The studied indices were all associated with hypertension in all age-specific groups both among men and women except for WHR in 21–29 years old men and PBF in in 21–29 years old women. Among males, there were no statistical differences in powers of four indices for hypertension in all age-specific groups, except for 40–49 years, in which WHR was better than VFA. Among females, no differences were found among the indices in 30–39 and 70–79 years groups, while WHR was the best in 21–29 years group, VFA was better than PBF in 30–39 and 50–59 years groups, BMI was better than PBF and WHR in 60–69 years group. The optimal cutoffs of PBF, VFA, BMI and WHR ranged from 23.9 to 28.7%, 86.4 to 106.9cm², 23.5 to 27.1 kg/m², 0.92 to 0.96 across the age categories in males, and 32.8 to 36.3%, 75.9 to 130.9cm², 21.9 to 26.4 kg/m², 0.84 to 0.95 across the age categories in females, respectively.

Conclusions

The obesity indices’ efficiencies for hypertension varied by age and gender, and their cutoff values varied across the age categories and gender. Specific indices and cutoffs based on person’s age and gender should be used to identify individuals with hypertension.

Association of adiposity indicators with hypertension among Chinese adults

BACKGROUND AND AIMS

Obesity has been linked to the development of hypertension, but the comparison of relationships between different obesity parameters with hypertension are scarcely studied with nationally representative Chinese adults samples. We sought to compare the predictive strengths of different obesity indicators to hypertension.

METHODS AND RESULTS

Data in this study were obtained from the Chinese National Stroke Prevention Project with a nationally representative sample of Chinese aged 40 years and older. A total of 162,880 individuals were included. Multi-level analyses and Receiver Operating Characteristic (ROC) curves were used to examine the risk of hypertension in relation to different obesity parameters, including body mass index (BMI), waist circumference (WC), lipid accumulation product index (LAP), visceral adiposity index (VAI), and body adiposity index (BAI). As results, the BMI, WC, LAP, VAI, and BAI were positively associated with the risk of hypertension (P < 0.001). In total, BMI had the strongest association with hypertension when compared with other obesity indicators, and one SD up of BMI would increase the risk of hypertension by 53.9% (95% CI: 1.514-1.566). For men, WC was most associated with hypertension, and one SD up of WC would increase the risk of hypertension by 73.3% (95% CI: 1.685-1.782). For women, BMI showed the strongest predictive power, one SD up of BMI would increase the risk of hypertension by 51.0% (95% CI: 1.479-1.543).

CONCLUSIONS

BMI, WC, LAP, VAI, and BAI are all positively corrected to hypertension, but gender disparities should be considered in predicting hypertension by obesity indicators.

Predictive capacity of obesity indices for high blood pressure among southern Ethiopian adult population: a WHO STEPS survey

BACKGROUND

World Health Organization (WHO) consultation experts recommend countries to have guidance to identify public health action points suitable for their country. The objective of the study was to evaluate different obesity indices to predict high blood pressure and its optimal cutoff values among the adult population.

METHOD

A total of 3368 individuals age from 25 to 64 years were included in this study. Data was collected based on the WHO Stepwise approach. Body mass index (BMI), waist circumference (WstC), waist to hip ratio (WHpR) and waist to height ratio (WHtR) were measured and calculated. High blood pressure was considered for those with systolic blood pressure above 135 mmHg, diastolic blood pressure above 85 mmHg or taking antihypertensive medications. To generate cutoff values, the receiver operator characteristic curve was generated with the maximum Youden index.

RESULT

Women had a significantly higher hip circumference (P = 0.003), BMI (P = 0.036) and WHtR (P < 0.001) than men. Men had significantly higher WHpR (P = 0.027) than women. There were significantly higher BMI, WstC, WHpR, and WHtR among those with high blood pressure. The cutoff values for BMI, WstC, WHpR and WHtR were 22.86 kg/m2, 84.05 cm, 0.91 and 0.50 for men and 24.02 kg/m2, 79.50 cm, 0.91 and 0.51 for women, respectively.

CONCLUSION

BMI, WstC, WHpR, and WHtR are a useful predictor of high blood pressure among adults' rural residents of southern Ethiopia. As the sensitivity for the cutoff values of most of indices were low, further surveys in different settings may need to be done before a conclusion can be drawn on whether or not to review the anthropometric cut offs for high blood pressure in Ethiopia.

Validity of anthropometric indices in predicting high blood pressure risk factors in Iranian children and adolescents: CASPIAN-V study

Anthropometric indices have been used as indicators for predicting hypertension (HTN) in children and adolescents but it is not clear which anthropometric measures are a better index for identifying elevated blood pressure (EBP) risk factors in pediatric population. Body mass index (BMI), waist circumference (WC), weight-height ratio (WHR), a body shape index (ABSI) and blood pressure were measured in 14 008 children and adolescents aged 7-18 years in a national school-aged survey CASPIN V. Hypertension (HTN) was defined according to the 2017 American Academy of Pediatrics guidelines, using the 95th percentile. The predictive power of anthropometric indices for HTN risk factors was examined using receiver operating characteristic (ROC) analyses. Multivariate logistic regression analysis was used to compare areas under ROC curves (AUCs) among the four anthropometric indices. BMI, WC, WHR, and ABSI were significantly higher in adolescents than in children. EBP was more prevalent in boys (7.2%) than girls (5.5%), whereas the prevalence of HTN was higher in girls (11.3%) than boys 10.4%. Prevalence odds ratio was around 2 for BMI, WC, and WHR with AUCs scores of nearly 0.6 to predict EBP in both children and adolescents of both sexes. Thus, the ability of BMI z-score, WC, WHR or ASBI to identify Iranian children and adolescents at higher risk of EBP was week. WC, WHR or ASBI in combination with BMI did not improve predictive power to identify subjects at higher risk of EBP.

The relationship between nocturnal blood pressure drop and body composition indices among hypertensive patients

Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6 ± 12.1 years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6 ± 12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6 ± 11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.

Association of 6-year waist-circumference change with progression from prehypertension to hypertension: the Rural Chinese Cohort Study

Whether dynamic change in waist circumference is associated with progression from prehypertension to hypertension is not well understood. We explored this issue. A total of 4221 prehypertensive adults ≥18 years were enrolled during 2007-2008 and followed up during 2013-2014. Participants were classified by percentage waist-circumference change at follow-up: ≤-2.5, -2.5 to ≤2.5, 2.5 to ≤5.0, and >5.0%. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression models, with stable waist-circumference change (-2.5 to 2.5%) as the reference. During the 6 years of follow-up, 1464 prehypertensive patients (851 women) showed progression to hypertension, with an incidence rate of 32.7% for men and 36.3% for women. As compared with stable waist circumference, a waist-circumference gain > 5.0% was associated with increased hypertension risk: adjusted ORs (95% CI) were 1.08 (1.01-1.14) for men and 1.09 (1.04-1.15) for women. The risk also decreased significantly for men with ≥2.5% waist-circumference loss (OR = 0.94, 95% CI 0.88-1.00). We found a linear association between percentage waist-circumference gain and risk of progression from prehypertension to hypertension for both sexes by restricted cubic splines (p_nonlinearity = 0.772 for men and 0.779 for women). For each 10% gain in waist circumference, the risk increased by 8% for men and 5% for women. The association remained significant for both sexes in a subgroup analysis by abdominal obesity at baseline. The long-term gain in waist circumference significantly increased the risk of progression from prehypertension to hypertension for both sexes in a rural Chinese population, regardless of abdominal obesity status at baseline.

Lowered obesity indicator cutoff points more effectively predict 5-year incidence of hypertension in premenopausal women

OBJECTIVE

To compare proposed new cutoff points for four obesity indicators-waist-to-height ratio (WHtR), waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI)-with their current cutoff points to determine which are better standards predicting 5-year incidence of hypertension (HT) and diabetes mellitus (DM) among premenopausal women.

DESIGN

Data were obtained from the 2002 and 2007 Survey on the Prevalence of HT, Hyperglycemia and Hyperlipidemia in Taiwan conducted by the Ministry of Health and Welfare, Taiwan. Premenopausal women were grouped based on the proposed cutoff points versus reference cutoff points for obesity indicators.

PARTICIPANT

A total of 1466 premenopausal women aged between 20 and 57 years old were recruited.

MAIN OUTCOME MEASURE

Five-year incidence of HT and DM.

RESULTS

Our new obesity indicator cutoff points-WHtR 0.49, WC 74.7 cm, WHR 0.79 and BMI 22.3 kg/m2-were better predictors for 5-year HT incidence in premenopausal women compared with those of current standards, but were not significantly different for DM. Among the four obesity indicators, WHtR and WC were optimal for their 5-year predictive ability for HT and DM in premenopausal women.

CONCLUSIONS

To avoid too many cutoff points for practitioners to adopt and memorize, the proposed new cutoff points were recommended preferentially to prevent the incidence of HT and DM in premenopausal women.

Hypertension is the underlying cause of death assessed at the autopsy of individuals

OBJECTIVE

To analyze hypertension and its relationship with the causes of death identified by the autopsy.

METHOD

Cross-sectional study analyzed 356 participants belonging to the Brazilian Aging Brain Study Group, over 50 years of age, autopsied at the Sao Paulo Autopsy Service between 2004 to 2014. A clinical interview was conducted with the informant of the deceased. Hypertension was defined by reporting the disease and/or use of antihypertensive medication, by the informant of the deceased. Descriptive analyzes and bivariate and multivariable associations were performed.

RESULTS

The prevalence of hypertension was 66.2% and it was the second leading cause of death (25.6%) identified by autopsy, preceded by atherosclerosis (37.8%). The variables associated with hypertension were: female gender (OR=2.30 (1.34-3.90)); living with partner [OR=0.55 (0.32-0.92)]; Body Mass Index [OR=1.14 (1.08-1.22)] and history of diabetes [OR=2.39 (1.34-4.27)].

CONCLUSION

The prevalence of hypertension was high, and it was the second most common underlying cause of death. The gold standard for the definition of cause of death, the autopsy, shows important results, which confirmed the relevance of hypertension as a public health problem.

The Association Between Six Surrogate Insulin Resistance Indexes and Hypertension: A Population-Based Study

Background: The relationship between insulin resistance and hypertension is well established, but the association of different surrogate insulin resistance indexes with the presence of hypertension is still under debate. The aim of this study was to compare the strength of the association between the presence of hypertension and six indexes: triglyceride/HDL cholesterol ratio (TG/HDL-C), Triglyceride Glucose (TyG) Index, Visceral adiposity index (VAI), Lipid accumulation product (LAP), TyG-Body mass index (TyG-BMI), and TyG-Waist circumference (TyG-WC). Methods: Data from a cross-sectional epidemiological study enrolling a sample representative for the Romanian population aged 18-80 years, excluding those with diabetes or requiring treatment for hypertriglyceridemia, were used to calculate the six indexes. The association with the presence of hypertension was examined with binomial and multinomial logistic regression. Results: In multinomial logistic models, which included age, gender, smoking, drinking, sedentary lifestyle, estimated glomerular filtration rate, urinary sodium, urinary albumin creatinine ratio, and use of medications known to influence insulin resistance as covariates, all individual components and surrogate insulin resistance indexes were independently associated with the presence of hypertension. Values of pseudo R square ranged from 0.342 for the multivariate model including TG/HDL-C to 0.357 for the model including TyG-WC, but with no clear superiority of any of the tested indexes over all others. Models including BMI and WC had a similar ability to predict the presence of hypertension as most of the surrogate indexes and they were slightly superior to TG/HDL-C and TyG. Conclusions: Although TG/HDL-C, VAI, LAP, TyG, TyG-BMI, and TyG-WC were independently associated with the presence of hypertension, no superiority could be demonstrated over the use of BMI and WC as predictors of hypertension in this cross-sectional study.

Association of Adiposity Indices with Hypertension in Middle-Aged and Elderly Thai Population: National Health Examination Survey 2009 (NHES-IV)

Obesity in terms of excess fat mass is associated with increased morbidity, disability and mortality due to obesity-related disorders, including hypertension. Many hypertensive individuals are overweight and often receive their advice to lose weight related to body-fat, in order to lower their blood pressure. However, it is still unclear whether there is a strong association of adipose tissue measured by adiposity indicators with hypertension in the Thai population. Various adiposity indices have been published to distinguish the distribution of body fat with disparate properties. This study examined nine adiposity markers and their association with hypertension in 15,842 Thai adults ≥35 years old. Data were obtained from the nationwide Thai National Health Examination Survey 2009. Accuracy performance and associations of indexes with hypertension were analyzed by Area Under Curve (AUC) and logistic regression analyses. Regardless of gender, the best methods to distinguish performance were waist-to-height ratio (WHtR) [AUC: 0.640 (0.631⁻0.649)], followed by lipid accumulation product (LAP) [AUC: 0.636 (0.627⁻0.645)], waist circumference (WC) [AUC: 0.633 (0.624⁻0.641)], and Conicity index (C-Index) [AUC: 0.630 (0.621⁻0.639)]. Linear regression analysis exhibited the independent association of the top four indices, WC, WHtR, C-Index, and LAP with higher systolic and diastolic blood pressure. Those indices' quartiles were graded in a dose-response manner which significantly increased at the higher quartiles. The indicator's cutoff point carried the odds ratio of presence hypertension in the range of 1.7 to 2.5 (p < 0.001). Among the nine obesity indices, WHtR (cutoff >0.52) in both genders was the simplest and most practical measurement for adiposity in association with hypertension in middle-aged and elderly Thais.

“A body shape index” and its association with arterial hypertension and diabetes mellitus among Brazilian older adults: National Health Survey (2013)

The aim was to evaluate the separate and joint association of abdominal adiposity indicators (a body shape index - ABSI, waist circumference - WC, waist-to-height ratio - WHtR) and body mass index (BMI) with arterial hypertension and diabetes mellitus, in Brazilian older adults. Data from the 2013 Brazilian National Health Survey (PNS 2013) were used for the population aged 60 years or older (10,537 older adults). Arterial hypertension and diabetes mellitus outcomes were self-reported and the following anthropometric indices were evaluated by direct measurement: a ABSI, BMI, WC and WHtR. Associations were assessed by logistic regression, with adjustments for confounding factors. The results of this study evidenced a higher strength of association between the report of arterial hypertension and diabetes mellitus with BMI, WC and WHtR in the Brazilian population of older adults in separate analyses, when compared to ABSI. When adjusted for BMI, ABSI showed a greater strength of association with the outcomes, but it was not superior to the performance of WC and WHtR. Considering the lower strength of association, in separate and joint analyses, between the new index (ABSI) and the chronic conditions assessed, BMI, WC and WHtR probably remain as useful indices in public health, at least in relation to arterial hypertension and diabetes mellitus in Brazilian older adults.

Comparison of adiposity indices in relation to prehypertension by age and gender: A community-based survey in Henan, China

BACKGROUND

To compare the efficiency of bioelectrical indices (visceral fat index [VFI], percentage body fat [PBF]) and anthropometric indices (body mass index, waist circumference, waist-to-height ratio, a body shape index ) in the relation to prehypertension (120-139/80-89 mm Hg) among the Chinese population.

METHODS

Using stratified multistage random sampling method, a general population-based sample of 11 175 adults in Henan province were selected from 2013 to 2015. The individuals were divided into three categories by blood pressure levels: normotension (<120 and 80 mm Hg), stage 1 prehypertension (120-129/80-84 mm Hg) and stage 2 prehypertension (130-139/85-89 mm Hg).

RESULTS

VFI and PBF tended to increase with age in men and women. However, for each age-specific group, men tended to have higher VFI than women (all P < 0.01) and women tended to have greater PBF (all P < 0.0001). The odds ratios (OR) and area under the receiver operating characteristic curves for prehypertension associated with adiposity indices declined with age. VFI and PBF showed higher standardized adjusted ORs for prehypertension in young (~40 years) men (VFI: 2.02-3.05; PBF: 1.82-2.80) and young women (VFI: 1.90-2.58; PBF:1.70-2.29). Moreover, based on Youden's index, VFI and PBF exhibited the superiority for identifying prehypertension in men (0.20-0.32) and women (0.31-0.39), respectively.

CONCLUSION

In summary, there was stronger association of VFI and PBF with prehypertension in men than in women, respectively, especially for young adults.

Associations of Body Composition with Blood Pressure and Hypertension

OBJECTIVE

The present study investigated the associations of body composition, including skeletal muscle and fat mass, with blood pressure (BP) and hypertension.

METHODS

Data from 3,130 participants aged 18 to 80 years were analyzed. Body composition and total skeletal muscle (TSM) were measured or calculated based on dual-energy x-ray absorptiometry. Multivariate linear and logistic regression models were used to analyze the associations of TSM, body fat percentage, android to gynoid fat ratio, and leg and arm lean body mass (LBM) with BP and hypertension. The Wald test was used to estimate the differences in the coefficients.

RESULTS

TSM indices, body fat percentage, and android to gynoid fat ratio were significantly associated with higher odds ratio for prehypertension and hypertension, except for TSM/weight, after controlling for potential confounders. The standardized beta coefficients of arm LBM indices for systolic and diastolic BP were higher than relevant indices of leg LBM.

CONCLUSIONS

Different indices of TSM, especially in arm LBM, were all positively associated with elevated BP, prehypertension, and hypertension in Chinese adults, after considering potential confounding factors, including body fat and fat distribution. Future longitudinal studies are warranted to confirm our findings.

The association between obesity indices and hypertension: Which index is the most notable indicator of hypertension in different age groups stratified by sex?

OBJECTIVE

This study aimed to investigate the most notable obesity index and its optimal cut-off point of hypertension in different age groups stratified by sexes among community residents in southern China.

METHODS

In this cross-sectional study, 620 men and 631 women aged 18-59 years were enrolled. The independent-samples t-test and chi-square test were conducted to analyze continuous and categorical variables, respectively. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis assessed the association between the obesity indices and hypertension risk.

RESULTS

Waist-stature ratio (WSR) and waist-hip ratio (WHR) were the most notable risk factors for hypertension in young men and women, respectively. The odds ratios (ORs) of hypertension risk increased with per standard deviation (SD) in WSR and WHR (WSR: OR = 2.877, 95% confidence interval [CI] = 1.602 to 5.167; WHR: OR = 10.683, 95%CI = 2.179 to 52.376). In the middle-aged group of both sexes, body mass index (BMI) was the most distinctive risk factor for hypertension, the ORs of hypertension risk increased with per SD in BMI (men: OR = 2.297, 95%CI = 1.683 to 3.136; women: OR = 1.810, 95%CI = 1.338 to 2.450). ROC curve analysis demonstrated WSR and PI were better indicators than other indices among young men, and WSR was the best marker among young women. However, BMI and WC were the most sensitive markers in middle-aged men and women, respectively.

CONCLUSIONS

In this Chinese population, the association of obesity indices and hypertension is inconsistent in different age groups and sexes. It is important to choose appropriate indicators for specific groups of people.

Prevalence of prehypertension and its associated factors among adults visiting outpatient clinic in Northeast Malaysia

Objectives

Prehypertension refers to a systolic blood pressure of 120–139 mmHg systolic or a diastolic blood pressure of 80–89 mmHg. Estimation of the prevalence of prehypertension in the population and identification of cardiovascular associated factors are important to reduce progression to hypertension. This study aimed to determine the prevalence of prehypertension and its associated factors among Malaysian adults.

Methods

In 2015, a cross-sectional study was conducted among adults visiting an outpatient clinic in Northeast Malaysia. Face-to-face interviews were conducted using Malay and English versions of the Malaysia Non-Communicable Disease surveillance questionnaire. This instrument captured information about sociodemographic, lifestyle status, and anthropometric data. Blood pressure was measured three times with a sphygmomanometer, the first measurement value was discarded, and an average of blood pressure from the second two readings was recorded for further data analysis. Logistic regression was performed to analyse factors associated with prehypertension.

Result

A total 151 adults participated in the study, and the prevalence of prehypertension was 37.1% (95% confidence interval [CI]: 29.29, 44.69). Factors associated with prehypertension in this study were age (adjusted odds ratio [aOR] = 1.06 95% CI: 1.02, 1.11; p = 0.007), male sex (aOR = 4.44 95% CI: 1.58, 12.44; p = 0.005), and abnormal waist circumference (aOR = 31.65 95% CI: 11.25, 89.02; p < 0.001) as determined by multiple logistic regression analysis.

Conclusion

In this study, the prevalence rate of prehypertension of 37.1% is higher than that of hypertension reported in the literature. Age, male sex, and abnormal waist circumference are significant associated factors that lead to prehypertension.

The importance of waist circumference and body mass index in cross-sectional relationships with risk of cardiovascular disease in Vietnam

BACKGROUND

Waist circumference (WC) is an indicator of intra-abdominal adipose tissue, high levels of which confer an increased risk of cardiometabolic disease. Population data on WC should be more informative than data on body mass index (BMI), which is a general indicator of body size. This study aimed to evaluate the importance of WC relative to BMI in cross-sectional relationships with blood pressure (BP), glucose, and total cholesterol (TC) in the adult population of Vietnam.

METHODS

The data were collected in a population-based survey conducted during 2009-10 using the "WHO STEPwise approach to surveillance of risk factors for non-communicable disease" (STEPS) methodology. The survey participants (n = 14 706 aged 25 to 64 years) were selected by multi-stage stratified cluster sampling from eight provinces representative of the eight geographical regions of Vietnam. All measurements were performed in accordance with the STEPS protocols. All analyses were performed using complex survey methods.

RESULTS

The measurements of WC and BMI were highly correlated (men r = 0.80, women r = 0.77). For men, the strongest and predominant associations with BP, glucose, and TC were for WC or an index based on WC. For women, this was true for glucose but BMI was more important for BP and TC. WC or an index based on WC provided better discrimination than BMI of hypertension and elevated glucose, and of raised TC for men. Information on four new anthropometric indices did not improve model fit or subject discrimination.

CONCLUSION

For BP/hypertension, glucose/elevated glucose, and TC/raised TC, WC was more informative than BMI for Vietnamese men, but both WC and BMI were important for Vietnamese women. Both WC and BMI need to be assessed for estimation of CVD risk in Vietnam.

Validity of cardiometabolic index, lipid accumulation product, and body adiposity index in predicting the risk of hypertension in Chinese population

OBJECTIVES

Adiposity, defined by higher cardiometabolic index (CMI), lipid accumulation product (LAP), and body adiposity index (BAI), has conferred increased metabolic risk. However, the incremental utility of CMI, LAP, and BAI in association with prevalent hypertension has not been well described in a population-based setting. We hypothesized that CMI, LAP, and BAI would provide important insight into hypertension risk.

METHODS

Blood pressure (BP), fasting lipid profiles, and anthropometric parameters were recorded in a cross-sectional study of 11,400 participants (mean age, 54 years; 53% women) from China. Logistic regression models were used to assess associations of CMI, LAP, and BAI with prevalent hypertension. BAI was evaluated according to hip (cm)/[height (m)^1.5]-18; LAP was calculated separately for men [(WC-65) × TG] and women [(WC-58) × TG]; and CMI was defined by TG/HDL-C × waist-to-height ratio.

RESULTS

CMI, LAP, and BAI were independently correlated with higher SBP and DBP, with nonstandardized (B) coefficients ranging from 1.827 to 4.590 mmHg and 1.475 to 2.210 mmHg (all P < 0.001). After adjustment for hypertension risk factors and potential confounders, CMI, LAP, and BAI, modeled as continuous measures, carried hypertension odds (95% CI) of 1.356 (1.259-1.459), 1.631 (1.501-1.771), and 1.555 (1.454-1.662) in women, respectively, per SD increment. In men, each SD increase in CMI, LAP, and BAI experienced a 31%, 65%, and 53% higher hypertension risk, respectively. Moreover, among women, the odds ratio (95% CI) for hypertension were 2.318 (1.956-2.745), 3.548 (2.985-4.217), and 3.004 (2.537-3.557) in the 4th quartile vs the first quartile of CMI, LAP, and BAI, respectively. For men, the corresponding figures were 2.200 (1.838-2.635), 3.892 (3.238-4.677), and 3.288 (2.754-3.927), respectively.

CONCLUSION

Measurements of CMI, LAP, and BAI provide a more complete understanding of hypertension risk related to variation in body fat distribution and pinpoint hypertensive participants in great risk of cardiovascular disease in the future.

Prevalence and Gender-Specific Influencing Factors of Hypertension among Chinese Adults: A Cross-Sectional Survey Study in Nanchang, China

Hypertension has become the leading cause of death worldwide; data on hypertension among Nanchang adults are sparse. The aim of this study was to investigate the prevalence and gender-specific influencing factors of hypertension in adults in Nanchang, China. A cross-sectional survey was conducted with a representative sample of 2722 Chinese residents aged 18 years and above between May and September 2016, with a response rate of 92.4% (2516/2722). A stratified cluster sampling method was adopted in this study. Data on prevalence and influencing factors were obtained from a standard questionnaire and physical measurements. Univariate and multivariate logistic regressions were performed to analyze the influencing factors. The age-standardized prevalence was 19.8% (18.2-21.3) (male: 19.5% (18.0-21.1); female, 20.01% (18.5-21.6)). Factors positively associated with hypertension prevalence were past smoking, diabetes mellitus (DM), and overweight and obesity in both genders. Abdominal obesity and family history of cardiovascular diseases (CVD) were risk factors only in males; sleeping time and consumption of fresh vegetables and fruits were related to the prevalence of hypertension only in females. These findings will form the baseline information for the development of more effective approaches to enhance current prevention and control management of hypertension.

The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study

PURPOSE

To examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups.

METHODS

Data of 21,030 persons (18-70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m²) and waist circumference (cm)] and depressed mood (PHQ-9 score ≥ 10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models.

RESULTS

Obesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI ≥ 30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR) = 1.72; 95% Confidence intervals (CI) 1.24-2.40, and OR = 1.86; 95% CI 1.38-2.50], respectively, and African Surinamese (OR = 1.60; 95% CI 1.29-1.98 and OR = 1.59; 95% CI 1.27-2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern.

CONCLUSION

Obesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.

The feasibility of two new anthropometric indices to identify hypertension in rural China: A cross-sectional study

Recently, 2 new anthropometric indices, the A Body Shape Index (ABSI) and Body Roundness Index (BRI), have been developed. Our study was to compare the associations between different anthropometric indices, including ABSI, BRI, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR), and hypertension in a rural population of northeast China.This cross-sectional study was conducted in the rural areas of northeast China from January 2012 to August 2013 using a multistage, stratified random cluster-sampling scheme. All eligible permanent residents aged ≥35 years (a total of 14,016 individuals) in each village were invited to participate in the study. A final sample size of 11,345 (5253 males and 6092 females) were included in this study.All the 5 anthropometric measures were positively correlated with hypertension. The prevalence of hypertension increased across quartiles for ABSI, BMI, BRI, WC, and WHR. Multivariable logistic regression analysis of the presence of hypertension for the highest quartile versus the lowest quartile of each anthropometric measure, showed that BRI had the largest values of ORs (OR: 3.49, 95% CI: 2.86-4.21 in men; OR: 3.06, 95% CI: 2.56-3.67 in women) and ABSI had the smallest ORs (OR: 1.30, 95% CI: 1.06-1.58 in men; OR: 1.19, 95% CI: 1.04-1.34 in women). BRI had the highest AROCs for hypertension (AROC: 0.65, 95% CI: 0.64-0.67 for men and AROC: 0.68, 95% CI: 0.67-0.70 for women), while ABSI had the lowest AROCs for hypertension (AROC: 0.60, 95% CI: 0.58-0.61 for men and AROC: 0.59, 95% CI: 0.58-0.61 for women).Our results showed that ABSI, BMI, BRI, WC, and WHR were all associated with hypertension. ABSI showed the weakest association with hypertension, while BRI showed potential for use as an alternative obesity measure in assessment of hypertension.

Prevalence of prehypertension and associated risk factors among Chinese adults from a large-scale multi-ethnic population survey

Background

Up to date, most of previous studies about Chinese prehypertension were conducted based on a small sample or in only one province, which could not represent the general population in China. Furthermore, no information on the ethnic difference in prevalence of prehypertension has been reported in China. The aim of this study is to examine the sex-specific, age-specific and ethnic-specific prevalence of prehypertension and associated risk factors in a large-scale multi-ethnic Chinese adult population.

Methods

The subjects came from a large-scale population survey about Chinese physiological constants and health conditions conducted in six provinces. 47, 495 adults completed blood pressure measurement. Prehypertension was defined as not being on antihypertensive medications and having SBP of 120–139 mmHg and/or DBP of 80–89 mmHg. Odds ratio (OR) and its 95 % confidence interval (CI) from logistic models were used to reflect the prevalence of prehypertension.

Results

The mean age of all subjects was 43.9 ± 16.8 years. The prevalence of hypertension and prehypertension for all them was 29.5 and 36.4 %, respectively. The prevalence of hypertension and prehypertension for males (33.2 and 41.1 %, respectively) was higher than that for females (27.0 and 33.2 %, respectively), and P < 0.001. The mean age of the subjects was 54.8 ± 14.0 years for hypertensive, 44.0 ± 16.0 years for prehypertensive and 35.3 ± 14.5 years for normotensive. With aging, subjects had more odds of getting prehypertension. Multivariate logistic model indicated that males (OR = 2.076, 95 % CI: 1.952–2.208), laborers with mental work (OR = 1.084, 95 % CI: 1.020–1.152), Yi (OR = 1.347, 95 %CI: 1.210–1.500) and Hui subjects (OR = 1.133, 95 % CI: 1.024–1.253), alcohol drinkers (OR = 1.147, 95 % CI: 1.072–1.228), the generally obese (OR = 2.460, 95 % CI: 2.190–2.763), the overweight (OR = 1.667, 95 % CI: 1.563–1.788), the abdominally obese (OR = 1.371, 95 % CI: 1.280–1.467) and subjects with family history of cardiovascular diseases (OR = 1.132, 95 % CI: 1.045–1.226) had higher prevalence of prehypertension. Subjects with higher educational level (OR = 0.687, 95 % CI: 0.627–0.752 for university) and Miao (OR = 0.753, 95 % CI: 0.623–0.910), Tibetan (OR = 0.521, 95 % CI: 0.442–0.613), Tujia (OR = 0.779, 95 % CI: 0.677–0.898) subjects had lower prevalence.

Conclusion

High prevalence rate of prehypertension was general in Chinese adults. Many sociodemographic characteristics were significantly associated with prehypertension. There were important clinical significance and public health significance about age-specific, gender-specific and ethnic-specific Chinese prehypertension conditions studies.

Evaluation of a community-based behavioral weight loss program in Chinese adults: A randomized controlled trial

OBJECTIVE

Weight losses between a group of participants assigned to a weight loss program based in the community [i.e., specifically the methodology used by Weight Watchers (WW)] and a Nutrition Education (NE) control group were compared in this study.

METHODS

In this 6-month trial, 300 participants with overweight or obesity were recruited from Beijing city, China, and randomly assigned to the WW or NE group. Weight, waist circumference, and biochemical parameters were assessed at baseline and 6 months.

RESULTS

At 6 months, the majority of participants (79% for WW; 89% for NE) completed the study. WW participants lost significantly more weight than the NE group (-4.2 ± 5.6 kg vs. -0.6 ± 3.6 kg). More WW participants lost 5% or 10% of their starting weight [≥5%: 52.0% of WW participants vs. 11.3% of NE participants (odds ratio 8.15, 95% CI: 4.43-14.97)]; [≥10%: 26.0% of WW vs. 3.3% of NE participants (odds ratio 9.39, 95% CI: 3.55-24.83)]. In addition, WW participants reduced waist circumference by 3.9 ± 6.3 cm, while the NE group increased waist circumference by 0.6 ± 5.5 cm.

CONCLUSIONS

The WW program was associated with clinically significant weight loss, demonstrating its potential value as an intervention strategy, based in the community, for the treatment of obesity in China.

Relationship Between Prehypertension/Hypertension and Periodontal Disease: A Prospective Cohort Study

BACKGROUND

Most cross-sectional studies have found a significant positive relationship between periodontal disease and prehypertension/hypertension. However, these studies had limitations and there are few prospective cohort studies in young adults. The purpose of this prospective cohort study was to investigate whether periodontal disease was related to prehypertension/hypertension in Japanese university students.

METHODS

Students (n = 2,588), who underwent health examinations before entering university and before graduation, were included in the analysis. The association between periodontal disease such as the percentage of bleeding on probing (BOP) and community periodontal index (CPI) scores, and change in blood pressure status was determined.

RESULTS

At the reexamination, the numbers of participants with prehypertension (systolic blood pressure 120-139mm Hg or diastolic blood pressure 80-89mm Hg) and hypertension (≥140/90mm Hg) were 882 (34.1%) and 109 (4.2%), respectively. In a logistic regression model, the risk of hypertension was significantly associated with male (odds ratio (OR): 6.31; 95% confidence interval (CI): 2.63-15.13; P < 0.001), no habitual physical activity at baseline (OR: 2.90; 95% CI: 1.56-5.38; P < 0.01) and periodontal disease defined as the presence of both probing pocket depth (PPD) ≥ 4mm and BOP ≥ 30% at baseline (OR: 2.74; 95% CI: 1.19-6.29; P = 0.02) in participants with prehypertension at baseline. On the other hand, the risk of prehypertension was not associated with presence of periodontal disease (OR: 0.93; 95% CI: 0.51-1.70; P = 0.82).

CONCLUSION

In the short-term prospective cohort study, a significant association between presence of periodontal disease and hypertension was observed in Japanese university students.

Long term trends in control of hypertension in the Northern Sweden MONICA study 1986-2009

Background

A large proportion of treated hypertensive subjects do not achieve target blood pressure (BP) levels. We investigated trends in treatment and BP levels in the population, and among treated hypertensive subjects in northern Sweden.

Methods

The six Northern Sweden MONICA population surveys 1986 to 2009, included 6342 subjects aged 45 to 74 years of age, participation rate 79.3 %. Factors associated with lack of BP control are presented for 1106 participants in 2009. BP control was defined as a systolic BP <140 and a diastolic BP <90 mm Hg among treated hypertensive patients.

Results

Between 1986 and 2009, the proportion of the population that received antihypertensive treatment increased. The proportion of the whole population having BP <140/90 mm Hg increased for all (p < 0.001 for each subgroup), except for men 45–55 years old. In 2009, 62.4 % of the population had BP <140/90 mm Hg, 67.2 % in women and 58.1 % in men (p = 0.002). In the group of treated hypertensive patients, the proportion having BP control increased (p < 0.001) with no difference between sex or age groups. In 2009 52.1 % of treated hypertensives had BP control.

In 2009, adequate BP control among treated hypertensive patients was 63.9 % for those with BMI <25, but only 48.8 % for those with BMI > 25 (p = 0.015). Abdominal obesity was associated with less BP control (48.1 %) than without abdominal obesity (66.2 %, p = 0.007). Women who were physically inactive had better BP control than those who were active (p = 0.03). Men treated with two or more antihypertensive drugs were 50 % more likely to reach target BP than men with monotherapy (60.4 % vs. 40.0 %, p = 0.035). Rural or urban living, level of education, diabetes mellitus or having a high cardiovascular risk were not associated with better BP control.

Conclusion

Antihypertensive treatment and BP control have increased in northern Sweden since 1986, although in 2009 still barely half of the treated patients achieved adequate BP levels. Intensified treatment and weight reduction may help to further improve BP control.

Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender

INTRODUCTION

The body mass index (BMI) and waist circumference (WC) are a risk of hypertension, but their potentially multiplicative effect on hypertension is underexplored.

AIM

To examine modifying effects of BMI and WC on hypertension using a nationally representative U.S. adult sample stratified by gender.

METHODS

Data were derived from the 2009-2010 NHANES. Overweight and obesity were based on BMI of 25.0-29.9 and ≥30 kg/m(2), respectively. High-risk WC was based on ≥102.0 and ≥88.0 cm for males and females, respectively. Hypertension was determined by systolic/diastolic blood pressure of ≥140/≥90 mmHg, or taking prescribed medications. Logistic regression was used to examine the association between hypertension and BMI and WC by gender. Interaction terms were added to examine if BMI modified the effect of WC on hypertension.

RESULTS

Both BMI and WC were significant predictors of hypertension in overall population. Gender-specific models indicated that BMI played an important role in hypertension risk among males, but WC in females. The interaction effects were present among males implying that the association of WC with hypertension was stronger if subjects were overweight or obese. This effect, however, was not present in females.

CONCLUSION

BMI and WC may influence hypertension differently among males and females.

The management of pre-hypertension in primary care: Is it adequate?

BACKGROUND

Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized.

METHODS

All individuals aged 30-45 years who were insured by Clalit Health services in the Tel Aviv district and had their blood pressure (BP) measured from January 2006 to December 2010 were evaluated. Individuals were divided into three groups based on their initial BP value: optimal (< 120/80 mmHg), normal (systolic BP 120-129 or diastolic 80-84 mmHg) and borderline (130-139/85-89 mmHg). Groups were compared regarding clinical and laboratory follow-up performed by their PCP.

RESULTS

Of the 20,214 individuals included in the study, 6576 (32.5%) had values in the pHT range. Of these, 2126 (32.3% of those with pHT) had BP values defined as "borderline" and 4450 (67.6% of those with pHT) had BP values defined as "normal". The number of follow-up visits by the PCP and repeat BP measurement were similar in those with "optimal" BP and pHT. A third and fourth BP measurement were recorded more frequently in those with pHT. In those with pHT, there were more recorded BP measurements than in those with borderline BP (3.35 ± 3 vs. 3.23 ± 2.6), but the time from the initial to the second measurement and a record of a third and fourth measurement were the same in the two groups.

CONCLUSION

Identification of pHT does not lead to a significant change in follow-up by PCPs, irrespective of BP values in the pHT range.

Lowered cutoff points of obesity indicators are better predictors of hypertension and diabetes mellitus in premenopausal Taiwanese women

INTRODUCTION

In previous study, we found that in order to prevent MS in women aged <65 years, the cutoff points of obesity indicators should be lowered.

OBJECTIVE

To investigate whether our proposed cutoff points of obesity indicators predict the occurrence of hypertension (HT), diabetes mellitus (DM), and hyperlipidemia in premenopausal women with greater sensitivity and specificity compared to reference cutoff points of obesity that are currently being used.

METHODS

Using the database of the "2002 Survey on the Prevalence of Hypertension, Hyperglycemia and Hyperlipidemia in Taiwan" provided by the Bureau of Health Promotion, Taiwan as research material, data from 2270 premenopausal women aged 20-65 years were used for the analyses. The receiver-operating characteristic curves (ROC) of the body-mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were used to predict HT, DM, and hyperlipidemia.

RESULTS

Obesity is not a good predictor of the occurrence of hyperlipidemia in premenopausal women aged <65 years. However, our proposed cutoff points had greater sensitivity and specificity than did the reference cutoff points. To prevent the risk of HT and DM in premenopausal women, the cutoff points of obesity indicators should be reduced. The proposed values are as follows: a WHR of 0.79; a WC of 74.7 cm; a WHtR of 0.49; and a BMI of 22.3 kg/m(2).

Viola mandshurica ethanolic extract prevents high-fat-diet-induced obesity in mice by activating AMP-activated protein kinase

Viola mandshurica W. Becker has been used as an expectorant, diuretic, and anti-inflammatory agent. We evaluated the effects of V. mandshurica ethanol extract (VME) on high-fat-diet (HFD)-induced obesity in mice. HPLC analysis showed that the VME contained 11.95 ± 0.37 mg/g esculetin and 0.13 ± 0.01 mg/g scopoletin. Orally administered VME decreased the body weight, adipose tissue mass, adipocyte size, and triglyceride and leptin serum concentrations. In contrast, VME increased serum adiponectin concentrations and adiponectin expression levels in epididymal adipose tissues. VME also significantly reversed the HFD-induced elevation of the mRNA and protein levels of lipogenic genes such as peroxisome proliferator-activated receptor γ, sterol regulatory element-binding protein-1c, fatty-acid synthase, and adipocyte protein 2. Moreover, VME reversed the HFD-induced inhibition of AMP-activated protein kinase (AMPK) and acetyl-coA carboxylase phosphorylation in epididymal adipose tissues. Furthermore, treatment of VME and esculetin in 3T3-L1 cells inhibited adipocyte differentiation and fat accumulation. These results suggest that VME exerts anti-obesity effects in HFD-induced obese mice by activating AMPK and suppressing PPARγ expression in adipose tissues.

Trends in incidence of hypertension in Chinese adults, 1991-2009: the China Health and Nutrition Survey

BACKGROUND/OBJECTIVES

Previous studies have shown an upward trend in the prevalence of hypertension, but data on trend of incidence of hypertension are lacking. We seek to investigate the trends in incidence of hypertension and control of incident hypertension among Chinese adults during 1991-1997 and 2004-2009.

METHODS

Within the China Health and Nutrition Survey (1991-2009), we identified five cohorts of adults (age ≥ 18 years) who were free of hypertension at baseline of each cohort: cohorts 1991-1997 (n=4107), 1993-2000 (n=4068), 1997-2004 (n=4141), 2000-2006 (n=4695), and 2004-2009 (n=4523). Data on demographics, smoking, alcohol intake, physical activity, body mass index (BMI), and blood pressure were collected through interviews and clinical examination. Hypertension was defined as blood pressure ≥ 140/90 mmHg or currently using antihypertensive drugs. Multiple generalized estimation equations and Coxregression models were used to test the trends in blood pressure, incidence of hypertension, use of antihypertensive drugs, and control status of incident hypertension.

RESULTS

After controlling for potential confounders, incidence of hypertension (per 100 person-years) significantly increased from 2.9 in 1991-1997 to 5.3 in 2004-2009 (ptrend=0.024); the linear trend was statistically or marginally significant in the age group of 18-39 years, in women, in rural residents, and in adults with normal BMI. The overall rates of antihypertensive treatment and control of incident hypertension increased significantly from 5.7% and 1.7% in 1991-1997 to 19.9% and 7.6% in 2004-2009, respectively (ptrend<0.001).

CONCLUSIONS

The incidence of hypertension has increased in Chinese adults since early 1990s. The treatment and control status of incident hypertension, while improved, remain very poor.

Gender differences in hypertension: myths and reality

Life expectancy is longer in women compared to men, and cardiovascular events occur at a lower rate and at a later age in females than males. The impact of gender on the prevalence, the presentation, and the long-term outcome of cardiovascular disease has long been a topic of active research. Gender differences have been found in several studies but opposite findings also exist. The impact of gender in hypertension and antihypertensive therapy remains poorly clarified. The prevalence, awareness, treatment, and control rates of hypertension exhibit some differences between the two sexes, which are age-dependent. The female advantage in the cardiovascular risk of hypertensive patients might be attenuated by comorbidities and target organ damage. Another aspect of major clinical importance is whether gender differences exist on the effects of antihypertensive agents in blood pressure reduction and cardiovascular morbidity and mortality. The aim of this review is to critically evaluate recent data regarding gender differences in hypertension and incorporate new data into the body of existing knowledge.

"A Body Shape Index" in middle-age and older Indonesian population: scaling exponents and association with incident hypertension

Background

“A Body Shape Index” (ABSI) is a recently proposed index that standardizes waist circumference for body mass index (BMI) and height. This study aims to: (a) examine if the ABSI scaling exponents for standardizing waist circumference for BMI and height are valid in middle-aged and older Indonesian population, and (b) compare the association between incident hypertension and ABSI and other anthropometric measures.

Methods and Findings

The Indonesian Family Life Survey Wave 3 measured anthropometric variables and blood pressure of 8255 adults aged between 40 to 85 years in 2000. The relationship between two anthropometric quantities, e.g. weight (w) and height (h), can be expressed as the power law-equivalent , where p = 2 is the scaling exponent in the derivation of the BMI and can be estimated by linear regression analysis. This was extended to the regression analysis of the log-transformed waist circumference, weight and height to establish the scaling exponents in the ABSI. The values for men were similar to those developed by the previous American study, which were 2/3 (BMI) and 1/2 (height). Those for women were somewhat smaller, at 3/5 (BMI) and 1/5 (height). The original (American) ABSI leads to mild negative correlation with BMI (−0.14) and height (−0.12) in the female population. Analysis of the development of hypertension between Waves 3 and 4 (average interval 7.5 years) in relation to ABSI measured at Wave 3 showed stronger association if the locally derived (Indonesian) scaling exponents were used. However, both versions of the ABSI were less associated with incident hypertension than waist circumference and BMI.

Conclusions

The values for the scaling exponents for ABSI are roughly similar between the American population and the middle-aged and older Indonesian population, although larger discrepancy was found in women. The ABSI is less associated with incident hypertension than waist circumference and BMI.

Sex and age differences in the effect of obesity on incidence of hypertension in the Japanese population: A large historical cohort study

Elevated risk of death from any cause and stroke associated with high body mass index (BMI) values decline with aging. However, it is not clear whether the effect of obesity on the incidence of hypertension varies by sex or age. Cox regression analyses were performed using a large historical cohort composed of 6803 men and 22,800 women. In the final model, which included the main effect (sex, age, and BMI), all two-way interactions (sex*age, sex*BMI, and age*BMI), a three-way interaction (sex*age*BMI), and adjusted variables determined by backward elimination, the three-way interaction and two of the two-way interactions (age*sex and age*BMI) were not significant; the remaining two-way interaction between sex and BMI was significant (P = .016). In the next step, the effect of BMI on the incidence of hypertension stratified by sex was evaluated. Hazard ratios (HRs) were significantly higher for BMI 27.0 to <29.0 and ≥29.0 kg/m(2) than for the HR for BMI 21.0 to <23.0 kg/m(2) in women (HR, 1.45; 95% confidence interval [CI], 1.32-1.59 and HR, 1.46; 95% CI, 1.29-1.65, respectively), but not in men (HR, 1.14; 95% CI, 0.98-1.33 and HR, 1.01; 95% CI, 0.77-1.32, respectively). The effect of obesity on the incidence of hypertension is stronger in women than in men.

New Obesity Indices and Adipokines in Normotensive Patients and Patients With Hypertension

We compared the obesity parameters and selected adipokines—leptin, adiponectin, and resistin—in obese patients with hypertension and normotensive patients. A total of 67 nondiabetic obese outpatients were divided into 2 groups: A–hypertensive and B–normotensive. Serum levels of leptin, adiponectin, resistin, and insulin were measured. Weight, height, waist circumference, and hip circumference were measured to calculate waist-to-hip ratio (WHR), weight-to-height ratio, visceral adiposity index, and body adiposity index (BAI). Among patients with hypertension, significant positive correlations were observed between leptin and body mass index and BAI ( r = .31 and r = .63, respectively). In normotensive patients, leptin positively correlated with BAI ( r = .73, P < .01) and negatively with WHR ( r = −.55, P < .0001); adiponectin negatively correlated with WHR ( r = .38, P < .01) and BAI ( r = .52; P < .0001), and resistin negatively correlated with WHR ( r = −.36, P < .05). In conclusion, visceral obesity and leptin are associated with hypertension in obese patients.