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Eikås JG, Gerdts E, Halland H, Midtbø H, Cramariuc D, Kringeland E. Arterial Stiffness in Overweight and Obesity: Association with Sex, Age, and Blood Pressure. High Blood Press Cardiovasc Prev 2023; 30:435-443. [PMID: 37505440 PMCID: PMC10600283 DOI: 10.1007/s40292-023-00593-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Obesity has been associated with increased arterial stiffness. Sex-differences in arterial stiffness in obesity have been less explored. AIM To explore sex-differences in arterial stiffness by applanation tonometry in 323 women and 225 with overweight and obesity, free of cardiovascular disease. METHODS Covariables of arterial stiffness were identified in multivariable linear regression analyses in the total cohort and separately in women and men. RESULTS In the total study cohort, women had higher augmentation pressure (AP) and augmentation index (AIx), and lower carotid-femoral pulse wave velocity (cf-PWV) than men, independent of confounders (all p < 0.001). In sex-specific analyses, higher AP was associated with higher age and 24-hours systolic blood pressure (BP), and with lower heart rate in women (all p < 0.001), and with higher age and BP in men (all p < 0.001). Similarly, higher AIx was associated with higher age and BP, and lower body mass index (BMI) and heart rate in women (all p < 0.05), and with higher age in men (all p < 0.001). Higher cf-PWV correlated with higher age and BP in women (all p < 0.005), and additionally with higher heart rate and non-smoking in men (all p < 0.05). When replacing BMI with waist-hip ratio, higher waist-hip ratio was associated with higher cf-PWV in men only (p < 0.05). CONCLUSIONS Among subjects with overweight and obesity, AP and AIx were higher in women, and cf-PWV was higher in men. Age and 24-hours systolic BP were the main factors associated with arterial stiffness in both sexes, while measures of adiposity had little impact on arterial stiffness.
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Affiliation(s)
- John G Eikås
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hilde Halland
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Helga Midtbø
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Dana Cramariuc
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ester Kringeland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Clark CE. Hypertension and hypotension: getting the balance right. Br J Gen Pract 2023; 73:6-7. [PMID: 36543552 PMCID: PMC9799343 DOI: 10.3399/bjgp23x731493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter
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Meng H, Guo L, Kong B, Shuai W, Huang H. Nomogram based on clinical features at a single outpatient visit to predict masked hypertension and masked uncontrolled hypertension: A study of diagnostic accuracy. Medicine (Baltimore) 2022; 101:e32144. [PMID: 36626526 PMCID: PMC9750695 DOI: 10.1097/md.0000000000032144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Patients with masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are easily overlooked, and both cause target organ damage. We propose a prediction model for MH and MUCH patients based on clinical features at a single outpatient visit. Data collection was planned before the index test and reference standard were after. Thus, we retrospectively collect analyzed 804 subjects who underwent ambulatory blood pressure monitoring (ABPM) at Renmin Hospital of Wuhan University. These patients were divided into normotension/controlled hypertension group (n = 121), MH/MUCH (n = 347), and sustained hypertension (SH)/sustained uncontrolled hypertension group (SUCH) (n = 302) for baseline characteristic analysis. Models were constructed by logistic regression, a nomogram was visualized, and internal validation by bootstrapping. All groups were performed according to the definition proposed by the Chinese Hypertension Association. Compared with normotension/controlled hypertension, patients with MH/MUCH had higher office blood pressure (BP) and were more likely to have poor liver and kidney function, metabolic disorder and myocardial damage. By analysis, [office systolic blood pressure (OSBP)] (P = .004) and [office diastolic blood pressure (ODBP)] (P = .007) were independent predictors of MH and MUCH. By logistic regression backward stepping method, office BP, body mass index (BMI), total cholesterol (Tch), high-density lipoprotein cholesterol (HDL-C), and left ventricular mass index are contained in this model [area under curve (AUC) = 0.755] and its mean absolute error is 0.015. Therefore, the prediction model established by the clinical characteristics or relevant data obtained from a single outpatient clinic can accurately predict MH and MUCH.
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Affiliation(s)
- Hong Meng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, PR China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, PR China
| | - Liang Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, PR China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, PR China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, PR China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, PR China
| | - Wei Shuai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, PR China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, PR China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, PR China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, PR China
- * Correspondence: He Huang, Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei, PR China (e-mail: )
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Fu M, Hu X, Yi S, Sun S, Zhang Y, Feng Y, Geng Q, Zhou Y, Dong H. Using Latent Class Analysis to Identify Different Risk Patterns for Patients With Masked Hypertension. Front Cardiovasc Med 2021; 8:680083. [PMID: 34513942 PMCID: PMC8424076 DOI: 10.3389/fcvm.2021.680083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background: There is controversy whether masked hypertension (MHT) requires additional intervention. The aim of this study is to evaluate whether MHT accompanied with high-risk metabolic syndrome (MetS), as the subphenotype, will have a different prognosis from low-risk MetS. Methods: We applied latent class analysis to identify subphenotypes of MHT, using the clinical and biological information collected from High-risk Cardiovascular Factor Screening and Chronic Disease Management Programme. We modeled the data, examined the relationship between subphenotypes and clinical outcomes, and further explored the impact of antihypertensive medication. Results: We included a total of 140 patients with MHT for analysis. The latent class model showed that the two-class (high/low-risk MetS) model was most suitable for MHT classification. The high-risk MetS subphenotype was characterized by larger waist circumference, lower HDL-C, higher fasting blood glucose and triglycerides, and prevalence of diabetes. After four years of follow-up, participants in subphenotype 1 had a higher non-major adverse cardiovascular event (MACE) survival probability than those in subphenotype 2 (P = 0.016). There was no interaction between different subphenotypes and the use of antihypertensive medications affecting the occurrence of MACE. Conclusions: We have identified two subphenotypes in MHT that have different metabolic characteristics and prognosis, which could give a clue to the importance of tracing the clinical correlation between MHT and metabolic risk factors. For patients with MHT and high-risk MetS, antihypertensive therapy may be insufficient.
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Affiliation(s)
- Ming Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shixin Yi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Shuo Sun
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Ying Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology, Guangzhou, China
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[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. Ann Cardiol Angeiol (Paris) 2021; 71:6-10. [PMID: 34140143 DOI: 10.1016/j.ancard.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.
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6
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Huang JF, Li Y, Shin J, Chia YC, Sukonthasarn A, Turana Y, Chen CH, Cheng HM, Ann Soenarta A, Tay JC, Wang TD, Kario K, Wang JG. Characteristics and control of the 24-hour ambulatory blood pressure in patients with metabolic syndrome. J Clin Hypertens (Greenwich) 2021; 23:450-456. [PMID: 33629806 PMCID: PMC8029521 DOI: 10.1111/jch.14229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/30/2022]
Abstract
Asian countries are facing an increasing prevalence of metabolic syndrome (MetS), which may aggravate the burden of cardiovascular diseases in this region. MetS is closely associated with ambulatory blood pressure (BP). Patients with MetS, compared to those without, had a twofold higher risk of new-onset office, home, or ambulatory hypertension. Furthermore, the risk of new-onset MetS in patients with white-coat, masked and sustained hypertension was also doubled compared to normotensives. High-risk masked hypertension and blunted nighttime BP dipping are common in patients with MetS, suggesting perfect 24-hour BP control with long-acting antihypertensive drugs and early initiation of combination therapy might be especially important for patients with MetS.
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Affiliation(s)
- Jian-Feng Huang
- Department of Cardiovascular Medicine, Shanghai Key Lab of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Lab of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinho Shin
- Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Cardiology Division, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yuda Turana
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Chen-Huan Chen
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hao-Min Cheng
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medical Education, Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tzung-Dau Wang
- Department of Internal Medicine, Cardiovascular Center and Division of Cardiology, National Taiwan University Hospital, Taipei City, Taiwan.,Department of Internal Medicine, Division of Hospital Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kazuomi Kario
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Lab of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Villar R, Sánchez RA, Boggia J, Peñaherrera E, Lopez J, Barroso WS, Barbosa E, Cobos L, Hernández Hernández R, Octavio JA, Parra Carrillo JZ, Ramírez AJ, Parati G. Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper. J Clin Hypertens (Greenwich) 2020; 22:544-554. [DOI: 10.1111/jch.13815] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 12/24/2022]
Affiliation(s)
| | - Ramiro A. Sánchez
- Arterial Hypertension and Metabolic Unit University Hospital Favaloro Foundation Buenos Aires Argentina
| | - José Boggia
- Unidad de Hipertensión Centro de Nefrología Hospital Dr. Manuel Quintela Universidad de la República Montevideo Uruguay
| | | | - Jesús Lopez
- Unidad de Hipertension Arterial Hospital Universitario Dr. Jose M. Vargas San Cristobal Venezuela
| | | | - Eduardo Barbosa
- Hypertension League Hospital San Francisco Complexo Ermandade Santa Casa de Porto Alegre Porto Alegre Brazil
| | | | - Rafael Hernández Hernández
- Hypertension and Cardiovascular Risk Factors Clinic School of Medicine Universidad Centro Occidental Lisandro Alvarado Barquisimeto Venezuela
| | - José Andrés Octavio
- Department of Experimental Cardiology Tropical Medicine Institute Universidad Central de Venezuela Caracas Venezuela
| | | | - Agustín J. Ramírez
- Arterial Hypertension and Metabolic Unit University Hospital Favaloro Foundation Buenos Aires Argentina
| | - Gianfranco Parati
- Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
- Cardiology Unit San Luca Hospital IRCCSIstituto Auxologico Italiano Milan Italy
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8
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9
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Natsis M, Antza C, Doundoulakis I, Stabouli S, Kotsis V. Hypertension in Obesity: Novel Insights. Curr Hypertens Rev 2019; 16:30-36. [PMID: 30987571 DOI: 10.2174/1573402115666190415154603] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND The relationship between obesity and hypertension has been established in both adults and children. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the likelihood of adverse cardiovascular effects and raises concerns about aggressive treatment strategies. OBJECTIVE Despite the impressive elements which indicate an important role for excessive weight gain in increasing blood pressure, not all obese patients are hypertensive. A subgroup of obese people may not develop hypertension. Furthermore, masked hypertension occurs more common among obese patients, and body fat distribution has a major role in the development of hypertension. METHOD We conducted a research of the relevant literature regarding obesity-induced hypertension and possible treatment strategies. RESULTS Successful weight loss is correlated with blood pressure reduction and requires a multidisciplinary approach that includes personalized dietary interventions combined with regular exercise and cognitive behavioral therapy. CONCLUSION Pharmacological therapy may be considered as part of a comprehensive obesity management strategy. More research and new treatment therapies are required in this field.
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Affiliation(s)
- Michail Natsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Doundoulakis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Stabouli
- 1st Department of Pediatrics, Hippokration Hospital, Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Scheppach JB, Raff U, Toncar S, Ritter C, Klink T, Störk S, Wanner C, Schlieper G, Saritas T, Reinartz SD, Floege J, Janka R, Uder M, Schmieder RE, Eckardt KU, Schneider MP. Blood Pressure Pattern and Target Organ Damage in Patients With Chronic Kidney Disease. Hypertension 2019; 72:929-936. [PMID: 30354716 DOI: 10.1161/hypertensionaha.118.11608] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In patients with chronic kidney disease, data on blood pressure (BP) pattern and its association with target organ damage, which indicates elevated cardiovascular risk, are sparse. In 305 treated hypertensive chronic kidney disease patients, we assessed BP pattern, left ventricular mass (magnetic resonance imaging), intima-media thickness (ultrasound), 24-hour-pulse wave velocity and 24-hour-central augmentation index (Mobil-O-Graph). Controlled hypertension (normal office and ambulatory BP) was found in 41% and sustained uncontrolled hypertension (elevated office and ambulatory BP) in 30% of patients. Misclassification of BP status occurred in 29%: white coat uncontrolled hypertension (elevated office but normal ambulatory BP) was detected in 11% and masked uncontrolled hypertension (normal office but elevated ambulatory BP) in 18% of patients. Left ventricular mass was increased in white coat uncontrolled hypertension (+11.2 g), masked uncontrolled hypertension (+9.4 g), and sustained uncontrolled hypertension (+16.6 g) compared with controlled hypertension. Intima-media thickness was similar across all 4 BP groups. Twenty-four hour-pulse wave velocity and 24-hour-central augmentation index were increased in masked uncontrolled hypertension (+0.5 m/sec and +2.5%) and sustained uncontrolled hypertension (+0.5 m/sec and +2.9%) compared with controlled hypertension. In conclusion, based on office BP measurements, misclassification of true BP status occurred in almost one-third of chronic kidney disease patients. Both types of misclassification (white coat uncontrolled hypertension and masked uncontrolled hypertension) were associated with parameters of target organ damage. Ambulatory BP monitoring should be used routinely to identify chronic kidney disease patients at high cardiovascular risk.
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Affiliation(s)
- Johannes B Scheppach
- From the Department of Nephrology and Hypertension (J.B.S., U.R., R.E.S., K.-U.E., M.P.S.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Ulrike Raff
- From the Department of Nephrology and Hypertension (J.B.S., U.R., R.E.S., K.-U.E., M.P.S.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sebastian Toncar
- Division of Nephrology, Department of Medicine, University of Würzburg, Germany (S.T., C.W.)
| | - Christian Ritter
- Department of Diagnostic and Interventional Radiology, University Medicine Göttingen, Germany (C.R.)
| | - Thorsten Klink
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany (T.K.)
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg and Department of Medicine I, Cardiology, University Hospital Würzburg, Germany (S.S.)
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University of Würzburg, Germany (S.T., C.W.)
| | - Georg Schlieper
- Division of Nephrology and Clinical Immunology (G.S., T.S., J.F.), University Hospital RWTH Aachen, Germany
| | - Turgay Saritas
- Division of Nephrology and Clinical Immunology (G.S., T.S., J.F.), University Hospital RWTH Aachen, Germany
| | - Sebastian D Reinartz
- Department of Diagnostic and Interventional Radiology (S.D.R.), University Hospital RWTH Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology (G.S., T.S., J.F.), University Hospital RWTH Aachen, Germany
| | - Rolf Janka
- Department of Radiology (R.J., M.U.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Michael Uder
- Department of Radiology (R.J., M.U.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Roland E Schmieder
- From the Department of Nephrology and Hypertension (J.B.S., U.R., R.E.S., K.-U.E., M.P.S.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Kai-Uwe Eckardt
- From the Department of Nephrology and Hypertension (J.B.S., U.R., R.E.S., K.-U.E., M.P.S.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.,Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Germany (K.-U.E.)
| | - Markus P Schneider
- From the Department of Nephrology and Hypertension (J.B.S., U.R., R.E.S., K.-U.E., M.P.S.), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.,Department of Nephrology and Hypertension, Klinikum Nürnberg, Paracelsus Private Medical University, Germany (M.P.S.)
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11
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Halland H, Lønnebakken MT, Pristaj N, Saeed S, Midtbø H, Einarsen E, Gerdts E. Sex differences in subclinical cardiac disease in overweight and obesity (the FATCOR study). Nutr Metab Cardiovasc Dis 2018; 28:1054-1060. [PMID: 30177273 DOI: 10.1016/j.numecd.2018.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Subclinical cardiac disease, like abnormal left ventricular (LV) geometry or left atrial (LA) dilatation, is common in obesity. Less is known about sex differences in the prevalence and type of subclinical cardiac disease in obesity. METHODS AND RESULTS Clinical and echocardiographic data from 581 women and men without established cardiovascular disease and body mass index (BMI) > 27.0 kg/m2 participating in the FAT associated CardiOvasculaR dysfunction (FATCOR) study was analyzed. LA dilatation was recognized as LA volume indexed for height2 ≥16.5 ml/m2 in women and ≥18.5 ml/m2 in men, and abnormal LV geometry as LV hypertrophy and/or increased relative wall thickness. On average, the participants were 48 years old, 60% women and mean BMI was 32.1 kg/m2. Overall, the prevalence of subclinical cardiac disease was higher in women than men (77% vs. 62%, p < 0.001). Women had a higher prevalence of LA dilatation than men (74% vs. 56%, p < 0.001), while men had a higher prevalence of abnormal LV geometry (30% vs. 21%, p = 0.011). After adjusting for confounders in multivariable logistic regression analysis, female sex was associated with a 2-fold higher risk of subclinical cardiac disease, in particular LA dilatation (confidence interval [CI] 1.67-3.49, p < 0.001), while male sex was associated with a 2-fold higher risk of abnormal LV geometry (CI 1.30-3.01, p = 0.001). CONCLUSION The majority of overweight and obese participants in the FATCOR study had subclinical cardiac disease, which may contribute to the impaired prognosis observed in obesity. Women had a higher prevalence of subclinical cardiac disease than men. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.govNCT02805478.
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Affiliation(s)
- H Halland
- Department of Clinical Science, University of Bergen, Bergen, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
| | - M T Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - N Pristaj
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - H Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - E Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - E Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Left ventricular mass independently associates with masked hypertension in young healthy adults. J Hypertens 2018; 36:1689-1696. [DOI: 10.1097/hjh.0000000000001740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Chen C, Yuan Z. Prevalence and risk factors for prehypertension and hypertension among adults in Central China from 2000-2011. Clin Exp Hypertens 2018. [PMID: 29513624 DOI: 10.1080/10641963.2018.1431252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertension is frequently studied in surveys; however, prehypertension, a new blood pressure status between normotension and hypertension, is rarely reported. METHODS All data were derived from the China Health and Nutrition Survey (CHNS) and were analysed by logistic regression for correlation. RESULTS The prehypertension prevalence was 27.4%, with a hypertension rate of 36.9%. The awareness, treatment, and uncontrolled rates among all hypertension participates were 19.8%, 83.6%, and 55.0%, respectively. The epidemic rate of hypertension increased with increasing age (p < 0.001), and prehypertension appeared to have an epidemic peak in the age group of 38-57 years (p < 0.001). In general, the incidence of hypertension in urban participants was higher than in rural subjects (p < 0.001), and prehypertension in urban subjects was lower than that in rural subjects (p < 0.001). According to the results of logistic regression, hypertension and prehypertension were associated with age, gender, location, body mass index (BMI), body fat rate (BFR), waist circumference (WC), education, and the intake of energy-yielding nutrients<0.05). CONCLUSION The current study reveals a high epidemic rate of hypertension and prehypertension in Central China. These results indicate the urgent need to develop strategies to improve the prevention of hypertension and prehypertension in Central China.
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Affiliation(s)
- Chaoying Chen
- a School of Health Sciences , Wuhan University , Wuhan , Hubei , P. R. of China
| | - Zhanpeng Yuan
- a School of Health Sciences , Wuhan University , Wuhan , Hubei , P. R. of China
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Özkan S, Ata N, Yavuz B. Increased masked hypertension prevalence in patients with obesity. Clin Exp Hypertens 2018; 40:780-783. [PMID: 29420079 DOI: 10.1080/10641963.2018.1431262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. METHODS The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. CONCLUSION This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.
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Affiliation(s)
- Selçuk Özkan
- a Department of Cardiology , Medical Park Ankara Hospital , Ankara , Turkey
| | - Naim Ata
- b Department of Internal Medicine , 29 Mayis Government Hospital , Ankara , Turkey
| | - Bunyamin Yavuz
- c Medical Park Ankara Hospital, Department of Cardiology , Kemerburgaz University , Ankara , Turkey
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Halland H, Lønnebakken MT, Saeed S, Midtbø H, Cramariuc D, Gerdts E. Does fitness improve the cardiovascular risk profile in obese subjects? Nutr Metab Cardiovasc Dis 2017; 27:518-524. [PMID: 28528703 DOI: 10.1016/j.numecd.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects. METHODS AND RESULTS Clinical data from 491 participants in the FAT associated CardiOvasculaR dysfunction (FATCOR) study were analyzed. Physical fitness was assessed by ergospirometry, and subjects with at least good level of performance for age and sex were classified as fit. HT subtypes were identified from clinic and 24-h ambulatory blood pressure in combination. Diabetes was diagnosed by oral glucose tolerance test. MetS was defined by the American Heart Association and National Heart, Lung and Blood Institute criteria. The participants were on average 48 years old (60% women), and mean body mass index (BMI) was 32 kg/m2. 28% of study participants were classified as fit. Fitness was not associated with lower prevalences of HT or HT subtypes, diabetes, MetS or individual MetS components (all p > 0.05). In multivariable regression analysis, being fit was characterized by lower waist circumference, BMI < 30 kg/m2, non-smoking and a higher muscle mass (all p < 0.05). CONCLUSION In the FATCOR population, fitness was not associated with a lower prevalence of major cardiovascular risk factors like HT, diabetes or MetS. Given the strong association of cardiovascular risk factor burden with risk of clinical cardiovascular disease, these findings challenge the notion that fitness alone is associated with lower risk of cardiovascular disease in obesity.
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Affiliation(s)
- H Halland
- Department of Clinical Science, University of Bergen, Bergen, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - M T Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - H Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - D Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - E Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
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