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Hurtado MD, Saadedine M, Kapoor E, Shufelt CL, Faubion SS. Weight Gain in Midlife Women. Curr Obes Rep 2024; 13:352-363. [PMID: 38416337 PMCID: PMC11150086 DOI: 10.1007/s13679-024-00555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW To summarize the evidence and clinical implications of weight and body composition changes during midlife in women and provide an overview of weight gain prevention and management in this population. RECENT FINDINGS Aging-related changes such as decreased energy expenditure and physical activity are important culprits for weight gain in midlife women. The hormonal changes of menopause also influence body adiposity distribution and increase central adiposity. These body changes can have health consequences including the development of cardiometabolic diseases, osteoarthritis, cancer, worsening in cognition, mental health, and menopause symptoms. Midlife women experience changes related to aging, menopause, and lifestyle which favor weight gain. Clinical practice should focus on early counseling and anticipatory guidance on the importance of dietary changes and physical activity to attenuate this phenomenon. Future research should focus on the longitudinal relationship between weight trends in midlife and health consequences and mortality.
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Affiliation(s)
- Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mariam Saadedine
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Ekta Kapoor
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Center for Women's Health, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
- Mayo Clinic Center for Women's Health, Rochester, MN, USA.
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2
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Bergström G, Rosengren A, Bacsovics Brolin E, Brandberg J, Cederlund K, Engström G, Engvall JE, Eriksson MJ, Gonçalves I, Hagström E, James SK, Jernberg T, Lilja M, Magnusson M, Persson A, Persson M, Sandström A, Schmidt C, Skoglund Larsson L, Sundström J, Swahn E, Söderberg S, Torén K, Östgren CJ, Lampa E, Lind L. Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS. Atherosclerosis 2023; 373:46-54. [PMID: 36813601 DOI: 10.1016/j.atherosclerosis.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change. METHODS We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS). RESULTS The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women. CONCLUSIONS Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
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Affiliation(s)
- Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Elin Bacsovics Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabel Gonçalves
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Cardiovascular Research Translational Studies, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team HART, North-West University, Potchefstroom, South Africa
| | - Anders Persson
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anette Sandström
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Schmidt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
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Kasoma Mutebi R, Weil Semulimi A, Mukisa J, Namusobya M, Namirembe JC, Nalugga EA, Batte C, Mukunya D, Kirenga B, Kalyesubula R, Byakika-Kibwika P. Prevalence of and Factors Associated with Hypertension Among Adults on Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross Sectional Study. Integr Blood Press Control 2023; 16:11-21. [PMID: 37102123 PMCID: PMC10123006 DOI: 10.2147/ibpc.s403023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens. Methods We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents. Results The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2-31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m3 (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122-1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206-8.108, P < 0.001] and 35-44 years [aPR: 2.455, 95% CI: 1.216-4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m3 [aPR: 1.489, 95% CI: 1.072-2.067, P = 0.017] as compared with BMI < 25 kg/m3, duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001-1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064-1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205-2.484, P = 0.003] were associated with hypertension. Conclusion One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.
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Affiliation(s)
- Ronald Kasoma Mutebi
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Mengo Hospital, Kampala, Uganda
- Correspondence: Ronald Kasoma Mutebi, Department of Medicine, Mengo Hospital, PO BOX 7161, Kampala, Uganda, Email
| | - Andrew Weil Semulimi
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Kampala, Uganda
| | - Martha Namusobya
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Esther Alice Nalugga
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Batte
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Bruce Kirenga
- Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Wang F, Wang Y, Wang Y, Jia T, Chang L, Ding J, Zhou L. Urinary polycyclic aromatic hydrocarbon metabolites were associated with hypertension in US adults: data from NHANES 2009-2016. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:80491-80501. [PMID: 35716300 DOI: 10.1007/s11356-022-21391-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are widely existing organic pollutants in the environment, and their persistence in the environment makes us have to pay continuous attention to their health effects. However, since the American Heart Association updated its definition of hypertension in 2017, few studies have explored the relationship. This study aimed to investigate the relationship between PAH exposure and hypertension after the updated definition of hypertension and explore whether body mass index (BMI) moderates this relationship. A total of 6332 adult participants from the 2009-2016 National Health and Nutrition Examination Survey (NHANES) were examined. Multiple logistic regression and restricted cubic splines were used to analyze the association between urinary polycyclic aromatic hydrocarbon metabolites and hypertension, and the dose-response relationship. Weighted quantile sum (WQS) regression was applied to blood pressure to reveal multiple exposure effects and the relative weights of each PAH. The prevalence of hypertension in the study population was 48.52%. There was a positive dose-response relationship between high exposure to 1-hydroxynaphthalene, 2&3-hydroxyphenanthrene, and the risk of hypertension. Naphthalene metabolites accounted for the most significant proportion of systolic blood pressure, and phenanthrene metabolites accounted for the most significant proportion of diastolic blood pressure. Obese individuals with high PAH exposure were at greater risk for hypertension than individuals with low PAH exposure and normal BMI. Higher prevalence rate and stronger association of metabolites with outcomes were obtained in the general population of the USA under the new guideline. High levels of exposure to PAHs were positively associated with the risk of hypertension, and these effects were modified by BMI.
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Affiliation(s)
- Fang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China.
| | - Yuying Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
| | - Yu Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
| | - Teng Jia
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
| | - Li Chang
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
| | - Jie Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
| | - Li Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, No. 56, Xinjian South Road, Yingze District, Taiyuan, China
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Tucker LA, Parker K. 10-Year Weight Gain in 13,802 US Adults: The Role of Age, Sex, and Race. J Obes 2022; 2022:7652408. [PMID: 35574515 PMCID: PMC9106499 DOI: 10.1155/2022/7652408] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The primary objective of the present investigation was to identify 10-year weight gain patterns in 13,802 US adults and also to determine the extent that differences in 10-year weight gains were associated with the key demographic variables: age, sex, and race. Methods The study design was cross-sectional and included the years 2011-2018. Data for 2019-2020 were not available because of COVID. A multistage random sampling strategy was employed. Specifically, individual sample weights and randomly selected clusters and strata were used with each statistical model, allowing the results to be generalized to the US adult population. Results Mean (±SE) 10-year weight gain was 4.2 ± 0.2 kg or 6.6 ± 0.2% of initial body weight. A total of 51% of the participants gained 5% or more body weight, 36% gained 10% or more, and 16% gained 20% or more across the 10-years. Age was linearly and inversely associated with 10-year weight gain, expressed in kg (F = 166.4, P < 0.0001) or percent weight gain (F = 246.9, P < 0.0001), after adjusting for sex and race. For each 1-year increase in age, 10-year weight gain decreased by 0.20 ± 0.02 kg and 0.28 ± 0.02 percent. After adjusting for age and race, 10-year weight gain (kg) was significantly greater (F = 73.6, P < 0.0001) in women (5.4 ± 0.3) than in men (2.6 ± 0.2). Weight gain also differed across races, kg (F = 27.7, P < 0.0001) and % (F = 28.5, P < 0.0001). Non-Hispanic Blacks gained more weight and NH Asians gained less weight than the other races. Conclusion Without question, 10-year weight gain is a serious problem within the US adult population. Younger adults, women, and Non-Hispanic Blacks, particularly Black women, seem to experience the highest levels of 10-year weight gain. Consequently, obesity and weight gain prevention programs focusing on these at-risk individuals should be a public health priority.
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Affiliation(s)
- Larry A. Tucker
- College of Life Sciences, Brigham Young University, Provo, Utah 84602, USA
| | - Kayla Parker
- College of Life Sciences, Brigham Young University, Provo, Utah 84602, USA
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Terschüren C, Damerau L, Petersen EL, Harth V, Augustin M, Zyriax BC. Association of Dietary Pattern, Lifestyle and Chronotype with Metabolic Syndrome in Elderly-Lessons from the Population-Based Hamburg City Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010377. [PMID: 35010639 PMCID: PMC8744785 DOI: 10.3390/ijerph19010377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 05/05/2023]
Abstract
In aging populations, the increasing prevalence of metabolic syndrome and the resulting elevated risk of developing non-communicable diseases is a major challenge for worldwide health care. The elderly population-based Hamburg City Health Study (HCHS) allows investigating the association in the relevant age group 45-74 years. For 3513 of 10,000 participants, self-reported information on dietary patterns (DASH, MEDAS), chronotype, lifestyle, and data on metabolic syndrome parameters was available. Overall, having a "low" DASH score was a statistically significant risk factor (OR 1.23; 95% CI 1.01-1.48). Only for "late" chronotype, a slightly elevated OR (1.06) was found, but no statistically significant effect on the outcome of metabolic syndrome. Still, considering chronotype vastly improved the model. However, a trend of an increasing predicted probability from early to late chronotype was found for participants with low adherence to the DASH diet. Future research should focus on options for prevention in persons with late chronotype, so they can be supported better in adherence to, e.g., DASH diet to lower their risk.
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Affiliation(s)
- Claudia Terschüren
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (L.D.); (V.H.)
- Correspondence: (C.T.); (B.-C.Z.); Tel.: +49-(0)4042837-4326 (C.T.); +49-(0)4074105-3947 (B.-C.Z.)
| | - Lukas Damerau
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (L.D.); (V.H.)
| | - Elina Larissa Petersen
- Department of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany;
- Population Health Research Department, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (L.D.); (V.H.)
| | - Matthias Augustin
- Competence Center for Health Services Research in Vascular Diseases (CVvasc), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
| | - Birgit-Christiane Zyriax
- Midwifery Science—Health Services Research and Prevention, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Correspondence: (C.T.); (B.-C.Z.); Tel.: +49-(0)4042837-4326 (C.T.); +49-(0)4074105-3947 (B.-C.Z.)
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Lin YT, Lampa E, Fall T, Engström G, Sundström J. Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population. Blood Press 2021; 30:237-249. [PMID: 33797315 DOI: 10.1080/08037051.2021.1903302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical use, but more knowledge about the prevalence and variability in ABPM-derived phenotypes in the general population is needed. We describe these parameters in the community-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. METHODS We examined 5881 men and women aged 50-64 with 24-hour ABPM recordings using validated monitors. ABPM phenotypes were defined according to European guidelines. White coat hypertension was defined as elevated office BP (≥140/90 mmHg) with normal mean ambulatory BP (<135/85 mmHg in day-time, <120/70 mmHg in night-time, <130/80 mmHg over 24-h); and masked hypertension as normal office BP (<140/90 mmHg) with elevated mean ambulatory BP (≥135/85 mmHg in day-time, ≥120/70 mmHg in night-time, ≥130/80 mmHg over 24-h). Blood pressure variability was assessed using the coefficient of variation (CV), standard deviation (SD), and average real variability. RESULTS Based on the ABPM recordings, 36.9% of participants had 24-h hypertension, 40.7% had day-time hypertension, and 37.6% nocturnal hypertension. Among participants treated with anti-hypertensive drugs, one in three had elevated office blood pressures, and more than half had elevated 24-h, day-time or nocturnal blood pressures. Among participants without anti-hypertensive drugs, only one in six had elevated office blood pressures, but one in three had elevated 24-h, day-time or nocturnal blood pressures. Men had higher 24-h blood pressures, more masked hypertension, but less white-coat hypertension than women. The prevalence of white-coat hypertension increased with age, but not the prevalence of masked hypertension. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. The variance in ABPM on repeated measurements was substantial. CONCLUSIONS In the middle-aged general population, masked hypertension is an underappreciated problem on the population level.
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Affiliation(s)
- Yi-Ting Lin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Cardiovascular Epidemiology, Lund University, Malmö, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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