Alcohol intake and hypertension subtypes in Chinese men

Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data

OBJECTIVES

This study assessed the association between alcohol use patterns and the prevalence of hypertension.

STUDY DESIGN

Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study.

METHODS

The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05.

RESULTS

Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590).

CONCLUSION

Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States.

Effect of different alcohol consumption levels on the left atrial size: A cross-sectional study in rural China

OBJECTIVE

Previous studies have investigated the relationship between alcohol and ventricular structure; however, few studies have evaluated the relation between alcohol consumption and the atrium size. In this study, we aimed to test the association between alcohol consumption and left atrium (LA) size in the general population.

METHODS

A population-based sample of 10,211 subjects aged ≥35 years and free from hypertension at baseline were followed from January 2012 to August 2013. Left atrial enlargement (LAE) was defined as the ratio of LA diameter to body surface area exceeding 2.4 cm/m2 in both the sexes. Independent factors for LAE were estimated by multiple logistic regression analyses.

RESULTS

The study included 10,211 participants (4,751 men and 5,460 women). Left atrial diameter/body surface area (LAD/BSA) was higher in the moderate and heavy alcohol consumption groups than in the non-drinker group (non-drinker, 20.5±0.03 cm/m2; moderate, 20.8±0.09 cm/m2; and heavy, 20.6±0.06 cm/m2; p<0.001). Both the groups of moderate and heavy drinkers had a higher incidence of LAE than the non-drinker group (6.9% of non-drinkers, 9.9% of moderate drinkers, and 8.4% of heavy drinkers; p<0.001). After adjusting for related risk factors, multiple logistic regression analyses showed that moderate drinkers had an approximately 1.4-fold higher risk of LAE [odds ratio (OR): 1.387, 95% confidence interval (CI) 1.056-1.822, p=0.019] compared with the non-drinkers, and the heavy drinkers had an approximately 1.2-fold higher risk of LAE (OR: 1.229, 95% CI: 1.002-1.508, p=0.047) compared with that of the non-drinkers.

CONCLUSION

Both heavy and moderate drinkers had increased odds for LAE compared with participants with no alcohol consumption in the general population.

Household income and the risk of incident hypertension in employees at multiple workplaces in Japan: J-HOPE

This cohort study aimed to investigate the association between household income and incident hypertension in a Japanese employed population. During 2012, a total of 4314 normotensive daytime employees (3153 men and 1161 women) were included in this study. Participants had a wide range of occupations and were employed at one of 12 workplaces from various economic sectors in Japan. After a 2-year follow-up, incident hypertension was compared among groups according to household income: <5.0, 5.0-7.9, 8.0-9.9, and ≥10.0 million Japanese yen (¥)/year. A Cox proportional hazard model was used to calculate the hazard ratio for incident hypertension in each household income group, compared with the group earning <5.0 million ¥/year. The hazard ratios for men were 1.52 (95% confidence interval, 1.08-2.18) for 5.0-7.9 million ¥/year, 1.49 (0.98-2.27) for 8.0-9.9 million ¥/year, and 1.92 (1.23-3.01) for ≥10.0 million ¥/year after adjusting for age, baseline systolic blood pressure, worksite, type of occupation, number of family members, and smoking status. This positive relationship was attenuated but remained significant after further adjustment for alcohol consumption and body mass index, both of which were higher among men with higher household income. Conversely, there was no significant difference for women in the risk of incident hypertension among household income groups, although those with higher household income tended to have a lower risk of incident hypertension. Household income is positively associated with the onset of hypertension in Japanese employed men working daytime hours.

Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.

Prevalence, awareness, treatment, and control of hypertension among Chinese working population: results of a workplace-based study

We investigated the prevalence, awareness, treatment, and control of hypertension and the related risk factors among Chinese working population. From 2012 to 2013, a total of 37,856 employees aged 18-60 years from 61 workplaces were sampled. Standard questionnaire surveys and physical examinations were undertaken. Multilevel logistic regression models were performed to identify the risk factors. Overall, the age-standardized prevalence of hypertension was 23.3% (95% confidence interval [CI]: 22.9%-23.7%). Among the hypertensives, 47.8% (95% CI: 46.8%-48.8%) were aware of their condition, 20.6% (95% CI: 19.8%-21.4%) were in treatment, but only 8.5% (95% CI: 7.9%-9.1%) had controlled hypertension. White-collar employees had a lower odds of hypertension compared with the blue-collar (odds ratio: 0.77, 95% CI: 0.71-0.84), whereas the state-owned enterprise employees had a higher odds compared with their private enterprise counterparts (odds ratio: 1.69, 95% CI: 1.07-2.65). Lower awareness and treatment were associated with being younger, higher education, and those from workplace without affiliated hospital. Higher occupation status individuals were more likely to be treated but no sign of better control. There is substantial room for improvement in hypertension diagnosis and treatment among the employees. Effective intervention programs are urgently needed at the workplaces.

Hypertension in Chronic Kidney Disease

Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD. The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity. Standardized blood pressure (BP) measurement is essential in establishing the diagnosis and management of hypertension in CKD. Use of ambulatory blood pressure monitoring provides an additional assessment of diurnal variation in BP commonly seen in CKD patients. The optimal BP target in the treatment of hypertension in general and CKD population remains a matter of debate and controversial despite recent guidelines and clinical trial data. Medical therapy of patients with CKD associated hypertension can be difficult and challenging. Additional evaluation by a hypertension specialist may be required in the setting of treatment resistant hypertension by excluding pseudo-resistance and treatable secondary causes. Treatment with a combination of antihypertensive drugs, including appropriate diuretic choice, based on estimated glomerular filtration rate, is a key component of hypertension management in CKD patients. In addition to drug treatment non-pharmacological approaches including life style modification, most important of which is dietary salt restriction, should be included in the management of hypertension in CKD patients.

Sympathetic activation in resistant hypertension: theory and therapy

Resistant hypertension defined as requiring 3 or more complementary antihypertensive drugs at maximally tolerated doses accounts for approximately 3% to 4% of all cases of hypertension. Its increased incidence over the past decade is related to the increase in obesity in the Western world. There are a number of dietary factors that affect sympathetic tone including sodium intake apart from increased body mass. This article discusses the mechanisms of sympathetic stimulation and activation in the context of animal models and human studies. In addition, there is a review of clinical trials with and without device therapy that summarizes the clinical findings. Effective management should be based on pathophysiologic principles and a focus on blood pressure reduction to levels well below 150/90 mm Hg because outcome trial evidence and Food and Drug Administration guidance supports this construct. The key to success of device-based therapy depends on identifying the cohort with true resistant hypertension that can benefit from therapies that are adjuncts to pharmacotherapy. Physicians need to concentrate on educating the patient on lifestyle modifications and themselves on use of proper combinations of antihypertensive medications. If this approach fails to result in a safe level of blood pressure then the patient should be referred to a board-certified clinical hypertension specialist.

Alcohol Consumption in Vietnam, and the Use of 'Standard Drinks' to Measure Alcohol Intake

AIMS

To provide nationally representative data on alcohol consumption in Vietnam and to assess whether reported numbers of 'standard drinks' consumed have evidence of validity (particularly in rural areas where home-made alcohol is consumed from cups of varying size).

METHODS

A nationally representative population-based survey of 14,706 participants (46.5% males, response proportion 64.1%) aged 25-64 years in Vietnam. Measurements were made in accordance with WHO STEPS protocols. Data were analysed using complex survey methods.

RESULTS

Among men, 80% reported drinking alcohol during the last year, and 40% were hazardous/harmful drinkers. Approximately 60% of men and <5% of women had consumed alcohol during the last week, with one-in-four of the men reporting having consumed at least five standard drinks on at least one occasion. Numbers of standard drinks reported by men were associated with blood pressure/hypertension, particularly in rural areas (P < 0.001 for trend). Most of the calibration and discrimination possible from self-reported information on alcohol consumption was provided by binary responses to questions on whether or not alcohol had been consumed during the reference period.

CONCLUSION

Alcohol use and harmful consumption were common among Vietnamese men but less pronounced than in Western nations. Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas. However, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.

Drug therapy for the patient with resistant hypertension

ABSTRACT 

Resistant hypertension is associated with high morbidity and mortality. Resistant hypertension is defined as blood pressure above targets despite treatment with at least three antihypertensive drugs in adequate dose and combination. Nonadherence is a frequent cause of uncontrolled hypertension and can be improved by providing fixed dose (of two or three agents) single pill combination. Triple combination of the most widely used antihypertensive agents (renin–angiotensin–aldosterone system antagonists, calcium channel blockers and diuretics) is a safe and effective therapy. Fourth line therapy is the use of an aldosterone antagonist. Renal denervation and baroreceptor stimulation can be considered in patients who remained uncontrolled despite optimal medical therapy.

National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults

BACKGROUND

Hypertension has recently been identified as the leading risk factor for global mortality. This study aims to present the national prevalence of hypertension and prehypertension and, their determinants in Vietnamese adults.

METHODS

Nationally representative data were obtained from the National Adult Overweight Survey 2005. This one visit survey included 17,199 subjects aged 25-64 years, with a mean body mass index (BMI) of 20.7 kg/m(2).

RESULTS

The overall census-weighted JNC7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) defined prevalence of hypertension was 20.7% (95% confidence interval (CI) = 19.4-22.1); the prevalence of prehypertension was 41.8% (95% CI = 40.4-43.1). Hypertension and prehypertension were more prevalent in men. Higher age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher physical activity and education level were inversely associated. Age, BMI, and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, 25.9% were aware of their hypertension, 12.2% were being treated, and 2.8% had their blood pressure under control; among the treated hypertensives, 32.4% had their blood pressure controlled.

CONCLUSIONS

Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. The findings suggest that lifestyle modifications, including the prevention of overweight, the promotion of physical activity particularly in urban areas, and the reduction of high alcohol consumption, may help to prevent hypertension in Vietnam. Furthermore, increased efforts regarding education, detection, and treatment could be important in management of hypertension and cardiovascular disease risk prevention.

Predictive value for the rural Chinese population of the Framingham hypertension risk model: results from Liaoning Province

BACKGROUND

A prediction model from the US Framingham Heart Study (FHS) population has been established to estimate an individual's risk of developing hypertension. However, this model has not been widely tested in other cohorts. In this study, we examined the predictive capability of the FHS prediction model in a rural Chinese population.

METHODS

A total of 24,434 rural Chinese adults aged ≥35 years, without prevalent hypertension, diabetes mellitus, stroke, and coronary heart disease at baseline, were followed for the incidence of hypertension. Standard clinical examinations of blood pressure, weight and height, smoking status, and parental history of hypertension were observed biennially.

RESULTS

The mean age was 47.9 (SD = 10.2) years, and 49.5% of subjects were women. During a median 4.8 years of follow-up, we recorded a total of 8,675 incident hypertension cases. The cumulative 2-year and 4-year hypertension incidence rates were 7.7% and 25.6%, respectively. The C statistics for the 2-year and 4-year incidences of hypertension were 0.537 (95% confidence interval (CI) = 0.524-0.550) and 0.610 (95% CI = 0.602-0.618) for the FHS model, respectively. The Hosmer-Lemeshow χ(2) test results for 2-year and 4-year incidence of hypertension were 2,287.7 (P < 0.0001) and 8,227.1 (P < 0.0001), respectively. Sensitivity analysis indicates that the FHS prediction model still has a poor performance, although the predictive ability was better than for the overall population.

CONCLUSIONS

The FHS hypertension prediction model is not a valid tool with which to estimate the risk of incidence of hypertension among the rural Chinese population. A new hypertension risk equation for the rural Chinese population is needed.

Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students

OBJECTIVE

This study evaluates the impact of a number of demographic, biological, behavioural and lifestyle health risk factors on the incidence of hypertension in Thailand over a 4-year period.

DESIGN

A 4-year prospective study of health risk factors and their effects on the incidence of hypertension in a national Thai Cohort Study from 2005 to 2009.

SETTING

As Thailand is transitioning from a developing to a middle-income developed country, chronic diseases (particularly cardiovascular disease) have emerged as major health issues. Hypertension is a major risk factor for heart attack and stroke and cross-sectional studies have indicated that the prevalence is increasing.

STUDY PARTICIPANTS

A total of 57 558 Sukhothai Thammathirat Open University students who participated in both the 2005 and 2009 questionnaire surveys and who were normotensive in 2005 were included in the analysis.

MEASURES

Adjusted relative risks associating each risk factor and incidence of hypertension by sex, after controlling for confounders such as age, socioeconomic status, body mass index (BMI) and underlying diseases.

RESULTS

The overall 4-year incidence of hypertension was 3.5%, with the rate in men being remarkably higher than that in women (5.2% vs 2.1%). In both sexes, hypertension was associated with age, higher BMI and comorbidities but not with income and education. In men, hypertension was associated with physical inactivity, smoking, alcohol and fast food intake. In women, hypertension was related to having a partner.

CONCLUSIONS

In both men and women, hypertension was strongly associated with age, obesity and comorbidities while it had no association with socioeconomic factors. The cohort patterns of socioeconomy and hypertension reflect that the health risk transition in Thais is likely to be at the middle stage. Diet and lifestyle factors associate with incidence of hypertension in Thais and may be amenable targets for hypertension control programmes.

Identifying patients with resistant hypertension and options for clinical management

In addition to the increasing prevalence of hypertension, the number of patients with treatment-resistant hypertension is also rising. It is important to identify these patients in order to improve the treatment outcomes and to screen for potential secondary causes. Clinical characteristics of patients with resistant hypertension include advanced age, male gender, obesity, high salt intake and alcohol consumption. Those with high baseline blood pressure, diabetes, chronic kidney disease or obstructive sleep apnea are also prone to developing resistant hypertension. Physicians should initiate close monitoring and aggressive treatment for those patients, as resistant hypertension is associated with a higher risk of cardiovascular morbidities, regardless of the control of blood pressure. However, treatment of resistant hypertension is currently a great challenge in clinical practice as all of these patients are already taking multiple antihypertensive medications, including the first-line treatments advocated in guidelines. In patients who have been presented multiple drugs, the room for further titration is often limited. Spironolactone has been demonstrated to be effective as an add-on therapy for patients with resistant hypertension. In addition to drug treatment, baroreceptor stimulation therapy and renal sympathetic denervation are promising new approaches in this group of patients. Further studies on the pathogenesis and the treatment of resistant hypertension would help to improve the outcome of this patient subgroup.

Relations of drinking motives and alcohol consumption in Korean male office workers

The relation between alcohol consumption and drinking motives was investigated among male office workers, 270 adult Korean men (M age = 38.6 yr., SD = 9.2) who were current drinkers. Heavy alcohol drinking was reported by 30.7% of the participants. Social motives had the highest mean score on the drinking motive questionnaire. Participants ages 20 to 29 yr. were more likely to drink for social and enhancement motives than those ages 40 to 49 yr. Participants without spouses reported greater importance of social motives and enhancement motives than those with spouses. Social motives, coping motives, and age-predicted alcohol consumption were regressed on the Quantity-Frequency index. This index score explained 30.5% of the variance in social motives, coping motives, and age. These findings suggest that there is high prevalence of heavy alcohol consumption among Korean office workers, who were likely to drink alcohol to increase sociability and reduce tension.

Common variants at 12q24 are associated with drinking behavior in Han Chinese

BACKGROUND

Alcohol consumption is heritable, but genetic susceptibility to drinking behavior has not been investigated widely in genome-wide association studies.

OBJECTIVE

We aimed to identify susceptibility loci for drinking behavior (drinkers compared with nondrinkers) in Han Chinese.

DESIGN

We performed 2 genome-wide association studies including 1420 drinkers and 3590 nondrinkers in discovery, followed by a de novo replication analysis comprising 4896 drinkers and 13,293 nondrinkers. DNA samples of the subjects were collected for genotyping.

RESULTS

The association results of drinking behavior (drinkers or nondrinkers) showed a cluster of single nucleotide polymorphisms at 12q24 in discovery (P < 5 × 10(-8)), with the strongest association for rs11066280 near C12orf51 (P-combined = 3.26 × 10(-215)). Moreover, we observed the association with drinking behavior for a functional variant in ALDH2 at 12q24 (rs671, P-discovery = 5.17 × 10(-35)). We also identified the association between rs11066280 and daily alcohol intake among drinkers (P-combined = 4.01 × 10(-21)).

CONCLUSION

Our data indicate that common variants at 12q24 may contribute to the susceptibility of drinking behavior in Han Chinese.

Interaction of current alcohol consumption and abdominal obesity on hypertension risk

The high prevalence of alcohol consumption and abdominal obesity and increased incidence of essential hypertension (EH) in China indicates that there may be an interaction between alcohol consumption and abdominal obesity on EH risk. Therefore, we aimed to examine the independent and combined effects of alcohol consumption and abdominal obesity on risk of EH in a Chinese cohort. We analyzed data from a population-based prospective cohort of 2778 participants aged 35-74 years from Jiangsu China who were free of hypertension, diabetes and CVD at enrollment and were followed for hypertension events. Cox proportional hazards regression model was used to calculate the hazard ratio (HR) of hypertension and corresponding 95% confidence interval (CI). Logistic regression model was used to examine the interaction between alcohol consumption and abdominal obesity on risk of hypertension. After adjusting for age, sex, smoking status, family history of hypertension, current alcohol consumption significantly increased EH risk. Compared with those without alcohol consumption, the hazard ratio of EH for participants with alcohol consumption was 1.65 (95% confidence interval 1.29-2.12). There was a statistically significant additive interaction between current alcohol consumption and abdominal obesity on EH risk. The risk of EH for current alcohol consumers with abdominal obesity was 4.49 times as high as the sum of risks in participants with a single condition alone. Both alcohol consumption and abdominal obesity are strong risk factors of EH in the Chinese population. Moreover, this study further demonstrates an additive interaction of alcohol consumption and abdominal obesity on EH risk.

Risk factors related to hazardous alcohol consumption among Korean men with hypertension

The present study examines the alcohol consumption behaviors and risk factors related to hazardous alcohol consumption in men with hypertension in South Korea. The participants were 490 Korean hypertensive men > 20 years of age. The Alcohol Use Disorders Identification Test was used to detect hazardous alcohol consumption. The majority of the participants were current drinkers, and 37.4% were hazardous drinkers. However, very few participants had received consultation about alcohol consumption. Of the participants, 37.7% were current smokers, and almost half of them smoked more than one pack of cigarettes daily. The hazardous drinkers smoked much more than the normal drinkers, and their stress levels were higher than that of normal drinkers. Participants aged 40-49 and 50-59 years (odds ratio = 7.91, 95% confidence interval = 1.50-41.70; odds ratio = 7.57, 95% confidence interval = 1.31-43.70), those without stroke (odds ratio = 4.86, 95% confidence interval = 1.33-17.77), and current smokers (odds ratio = 4.24, 95% confidence interval = 2.00-8.98) were more likely to be involved in hazardous alcohol consumption. Successful blood pressure management will necessitate the education of such hypertensive men with consideration of their risk factors.

Epidemiology of resistant hypertension

Resistant hypertension is an entity that has gained a lot of attention in recent years. The prevalence and prognosis of resistant hypertension have not yet been examined by proper population studies, but data from several sources suggest that this entity is not uncommon and is associated with an elevated risk of hypertensive complications. Moreover, several factors and conditions that can interfere with blood pressure control such as excess sodium intake, obesity, diabetes, older age, kidney disease, and certain identifiable causes of hypertension were shown to be common among patients with resistance to antihypertensive treatment. Importantly, the prevalence of several of these conditions has been increasing continuously during the past years, suggesting a future increase in the frequency of resistant hypertension. This article will discuss current knowledge and associated future implications relevant to the epidemiology of resistant hypertension.

Resistant hypertension workup and approach to treatment

Resistant hypertension is defined as blood pressure above the patient's goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with pseudoresistance such as white coat hypertension, suboptimal blood pressure measurement technique, poor adherence to prescribed medication, suboptimal dosing of antihypertensive agents or inappropriate combinations, the white coat effect, and clinical inertia. Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Pharmacological treatment should be tailored to the patient's profile and focus on the causative pathway of resistance. Patients with uncontrolled hypertension despite receiving an optimal therapy are candidates for newer interventional therapies such as carotid baroreceptor stimulation and renal denervation.

The effect of nutrition on blood pressure

The incidence and severity of hypertension are affected by nutritional status and intake of many nutrients. Excessive energy intake and obesity are major causes of hypertension. Obesity is associated with increased activity of the renin-angiotensin-aldosterone and sympathetic nervous systems, possibly other mineralcorticoid activity, insulin resistance, salt-sensitive hypertension and excess salt intake, and reduced kidney function. High sodium chloride intake strongly predisposes to hypertension. Increased alcohol consumption may acutely elevate blood pressure. High intakes of potassium, polyunsaturated fatty acids, and protein, along with exercise and possibly vitamin D, may reduce blood pressure. Less-conclusive studies suggest that amino acids, tea, green coffee bean extract, dark chocolate, and foods high in nitrates may reduce blood pressure. Short-term studies indicate that specialized diets may prevent or ameliorate mild hypertension; most notable are the Dietary Approaches to Stop Hypertension (DASH) diet, which is high in fruits, vegetables, and low-fat dairy products, and the DASH low-sodium diet. Long-term compliance to these diets remains a major concern.

Predictors of progression from prehypertension to hypertension among rural Chinese adults: results from Liaoning Province

BACKGROUND

Individuals with prehypertension are at a high risk of developing hypertension. Little is known about the predictors of progression from prehypertesion to hypertension in rural Chinese adults.

METHODS

A population-based sample of 15 061 rural Chinese aged > or =35 years with prehypertension free cardiovascular diseases at baseline were followed-up from 2004-2006 to 2008. Incident hypertension was defined as systolic blood pressure (BP) > or =140 mmHg, diastolic BP > or =90 mmHg, or current use of antihypertensive medications.

RESULTS

During the 28-month follow-up period, 4917 individuals (32.6%) with prehypertension developed hypertension, in which only 1.5% (n = 73) of incident cases reached BP control target. After Cox stepwise regression analysis, baseline age (per 5 years) [hazard ratio (HR): 1.111; 95% confidence interval (CI): 1.095-1.126], Mongolian (HR: 1.079; 95% CI: 1.010-1.152), alcohol drinking, overweight and obese (HR: 1.349; 95% CI: 1.261-1.444), salt intake everyday, inappropriate physical activity, and family history of hypertension were associated with incident hypertension independent of initial systolic and diastolic BP. Among these predictors, current alcohol drinking (odds ratio: 1.126; 95% CI: 1.049-1.209), salt intake, and overweight and obese were associated only with increased systolic BP, whereas inappropriate physical activity contributed only to increase diastolic BP.

CONCLUSION

These data suggest a high incidence of hypertension in individuals with prehypertension. Lifestyle modifications such as cessation of drinking, healthy diet, and moderate physical activity are advised to prevent or delay the progression of prehypertension to hypertension in rural areas of China.

Evaluating the risk of hypertension using an artificial neural network method in rural residents over the age of 35 years in a Chinese area

Hypertension (HTN) has been proven to be associated with an increased risk of cardiovascular diseases. The purpose of the study was to examine risk factors for HTN and to develop a prediction model to estimate HTN risk for rural residents over the age of 35 years. This study was based on a cross-sectional survey of 3054 rural community residents (N=3054). Participants were divided into two groups: a training set (N1=2438) and a validation set (N2=616). The differences between the training set and validation set were not statistically significant. The predictors of HTN risk were identified from the training set using logistic regression analysis. Some risk factors were significantly associated with HTN, such as a high educational level (EL) (odds ratio (OR)=0.744), a predominantly sedentary job (OR=1.090), a positive family history of HTN (OR=1.614), being overweight (OR=1.525), dysarteriotony (OR=1.101), alcohol intake (OR=0.760), a salty diet (OR=1.146), more vegetable and fruit intake (OR=0.882), meat consumption (OR=0.787) and regular physical exercise (OR=0.866). We established the predictive models using logistic regression model (LRM) and artificial neural network (ANN). The accuracy of the models was compared by receiver operating characteristic (ROC) when the models were applied to the validation set. The ANN model (area under the curve (AUC)=0.900+/-0.014) proved better than the LRM (AUC=0.732+/-0.026) in terms of evaluating the HTN risk because it had a larger area under the ROC curve.

Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research

Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.

Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research

Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.

Alcohol consumption and the risk of end-stage renal disease among Chinese men

We examined the relationship between alcohol consumption and incidence of end-stage renal disease (ESRD) in a prospective cohort of 65 601 Chinese men aged 40 years and older. Information on the amount and type of alcohol consumed was collected at a baseline examination with follow-up evaluations conducted 8-9 years later. During the 500 876 person-years of follow-up, 176 participants initiated renal replacement therapy or died from renal failure. Compared to non-drinkers, the relative risk of ESRD was 0.67 among men consuming less than 21 drinks per week and 0.52 among men consuming this amount or more after adjustment for age, geographic region, urbanization, education, body mass index, physical activity, and cigarette smoking. The inverse association between alcohol consumption and ESRD existed even after adjustment for systolic blood pressure, and history of diabetes and cardiovascular disease. Our results suggest an inverse relationship between alcohol consumption and risk of ESRD in Chinese men. Heavy alcohol consumption, however, may lead to increased risk of morbidity and mortality from other causes; therefore, the implications from these findings should be interpreted cautiously.

Incidence and predictors of hypertension over 8 years among Chinese men and women

OBJECTIVE

To determine the 8-year incidence of hypertension and its risk factors among Chinese adults.

METHODS

A population-based sample of 10,525 Chinese adults aged > or = 40 years and free from hypertension at baseline was followed up from 1991 to 1999-2000. Incident hypertension was defined as systolic pressure > or = 140 mmHg, diastolic pressure > or = 90 mmHg, or current use of antihypertensive medication.

RESULTS

Over a mean of 8.2 years of follow-up, 28.9% of men and 26.9% of women developed hypertension. Among men, independent predictors of incident hypertension were baseline age [relative risk (RR) per 5 years: 1.10; 95% confidence interval (CI): 1.07, 1.13], living in urban regions versus rural regions (RR: 0.74; 95% CI: 0.64, 0.85), alcohol drinking versus non-drinking (RR: 1.13; 95% CI: 1.02, 1.24), prehypertension versus normotension (RR: 1.70; 95% CI: 1.53, 1.88), heart rate (RR of third versus first tertile: 1.27; 95% CI: 1.13, 1.44), body mass index (RR of third versus first tertile: 1.28; 95% CI: 1.12, 1.46) and low versus high physical activity (RR: 1.27; 95% CI: 1.10, 1.47). Results were similar for women, with current smoking in place of alcohol drinking and opposite results for region. The population-attributable risk of modifiable risk factors was between 25 and 50%.

CONCLUSIONS

These data indicate that the incidence of hypertension is high among these Chinese adults, and suggest that 25-50% of new hypertension cases could be prevented with risk factor modification. Given the excess cardiovascular mortality associated with hypertension, these data call for urgent improvements in hypertension prevention and control programs in China.

Common variation in KLKB1 and essential hypertension risk: tagging-SNP haplotype analysis in a case-control study

The human plasma kallikrein gene (KLKB1) encodes plasma kallikrein, a serine protease that catalyzes the release of kinins and other vasoactive peptides and may be involved in the pathogenesis of hypertension. In this study, we performed a haplotype-based study to assess the effect of common genetic variation in the KLKB1 gene on the risk of essential hypertension. Eight common single nucleotide polymorphisms (SNPs) were selected from the HapMap database and used to determine the pattern of linkage disequilibrium (LD) and haplotype structure within the KLKB1 gene. Four tag SNPs were then identified with over 85% power to predict both common haplotypes and remaining common SNPs, and genotyped in 1,317 cases with essential hypertension and 1,269 healthy controls. Single SNP analyses indicated that SNPs rs2304595 and rs4253325 were significantly associated with hypertension, adjusted for covariates. Compared with the most common Hap2 CAGC, Hap1 AGAC and Hap3 CGAC, which carry the susceptible rs2304595 G allele and rs4253325 A allele, were found to significantly increase the risk of essential hypertension with adjusted odds ratios equal to 1.37 and 1.17, respectively (P < 0.0001 and 0.028). A strongly significant interaction with gene-drinking was also observed. Among drinkers, the adjusted OR for Hap1 relative to Hap2 was increased to 2.50 (95% CI, 2.40 to 2.61; P < 0.0001). This was the first study to perform association analysis of the KLKB1 gene with essential hypertension. Our findings suggested that common genetic variation in the KLKB1 gene might contribute to the risk of hypertension in the northern Han Chinese population.

Resistant or Difficult‐to‐Treat Hypertension

Resistant hypertension, defined as uncontrolled hypertension on three medications, is becoming an increasingly common problem. In most cases, blood pressure remains elevated because of persistently high systolic blood pressure levels. Common characteristics of patients with resistant hypertension include older age, obesity, excessive dietary salt ingestion, and presence of sleep apnea. The evaluation of patients with resistant hypertension is focused on identifying contributing and secondary causes of hypertension. Treatment should include both lifestyle changes (weight loss, exercise, dietary salt restriction) and the use of effective multidrug regimens, including a diuretic. Recent data indicate that aldosterone antagonists may be effective when added to existing antihypertensive regimens even in the absence of primary aldosteronism.

ALCOHOL IS BAD FOR BLOOD PRESSURE

1. The regular consumption of alcohol elevates blood pressure, with global estimates that the attributable risk for hypertensive disease from alcohol is 16%. 2. The increase in blood pressure is approximately 1 mmHg for each 10 g alcohol consumed and is largely reversible within 2-4 weeks of abstinence or a substantial reduction in alcohol intake. 3. This increase in blood pressure occurs irrespective of the type of alcoholic beverage. In particular, the postulated effects of vasodilator flavonoid components of red wine to lessen or reverse alcohol-related hypertension have not been borne out in intervention studies. 4. Heavy drinking, especially a binge pattern of drinking, is linked to a higher incidence of cerebral thrombosis, cerebral haemorrhage and coronary artery disease deaths, although a role for alcohol-related hypertension in the causal pathway is not well defined. 5. In contrast, the light to moderate intake of alcohol has been consistently linked to a reduced risk of atherosclerotic vascular disease end-points. Such a protective effect may also extend to hypertensive subjects. 6. However, the magnitude of any protective effect appears to have been exaggerated because of unmeasured confounders, especially diet, lifestyle and patterns of drinking. Furthermore, a decrease in overall mortality with drinking appears confined to older subjects and to populations with a high background cardiovascular risk profile. 7. Any putative cardiovascular benefits from drinking need to be carefully considered against the effects of alcohol to elevate blood pressure, together with many other adverse health consequences from drinking. Maximum cardiovascular benefit occurs at relatively low levels of consumption (i.e. one to two standard drinks a day in men (10-20 g alcohol) and up to one a day in women (10 g alcohol)). In hypertensive subjects, consumption beyond these levels would be unwise.

Alcohol and its relationship to blood pressure

Ethanol is a molecule of enduring research interest because its consumption has important social as well as medical implications. With excessive ethanol consumption, there is higher prevalence for hypertension, stroke, cardiomyopathy, and arrhythmias. A principal mechanism by which ethanol exerts these cardiovascular effects is through modulation of blood pressure. In this article, we focus on recent research that pursues information on the effects of alcohol on blood pressure in human subjects, regardless of whether they have hypertension or not. Known means by which alcohol exerts hemodynamic effects are briefly covered, and insights on novel biomediators, such as endothelin and gene-based mechanisms, are presented. Newer tools, such as the Alcohol Use Disorders Identification Test-Consumption Questions (AUDIT-C) survey and carbohydrate-deficient transferrin (CDT) serum test, are also covered. Reducing excessive alcohol intake can produce a reduction in blood pressure of up to 4 mm Hg, on average, which could substantially affect the rates of stroke and ischemic heart disease.