High prevalence of target organ damage in young, African American inner-city men with hypertension

Acute beetroot juice reduces blood pressure in young Black and White males but not females

A complex interplay of social, lifestyle, and physiological factors contribute to Black Americans having the highest blood pressure (BP) in America. One potential contributor to Black adult's higher BP may be reduced nitric oxide (NO) bioavailability. Therefore, we sought to determine whether augmenting NO bioavailability with acute beetroot juice (BRJ) supplementation would reduce resting BP and cardiovascular reactivity in Black and White adults, but to a greater extent in Black adults. A total of 18 Black and 20 White (∼equal split by biological sex) young adults completed this randomized, placebo-controlled (nitrate (NO3-)-depleted BRJ), crossover design study. We measured heart rate, brachial and central BP, and arterial stiffness (via pulse wave velocity) at rest, during handgrip exercise, and during post-exercise circulatory occlusion. Compared with White adults, Black adults exhibited higher pre-supplementation resting brachial and central BP (Ps ≤0.035; e.g., brachial systolic BP: 116(11) vs. 121(7) mmHg, P = 0.023). Compared with placebo, BRJ (∼12.8 mmol NO3-) reduced resting brachial systolic BP similarly in Black (Δ-4±10 mmHg) and White (Δ-4±7 mmHg) adults (P = 0.029). However, BRJ supplementation reduced BP in males (Ps ≤ 0.020) but not females (Ps ≥ 0.299). Irrespective of race or sex, increases in plasma NO3- were associated with reduced brachial systolic BP (ρ = -0.237, P = 0.042). No other treatment effects were observed for BP or arterial stiffness at rest or during physical stress (i.e., reactivity); Ps ≥ 0.075. Despite young Black adults having higher resting BP, acute BRJ supplementation reduced systolic BP in young Black and White adults by a similar magnitude, an effect that was driven by males.

Does Vitamin D Provide Added Benefit to Antihypertensive Therapy in Reducing Left Ventricular Hypertrophy Determined by Cardiac Magnetic Resonance?

BACKGROUND

Left ventricular hypertrophy (LVH) and vitamin D deficiency have been linked to hypertension (HTN) and cardiovascular disease, particularly in African Americans (AAs). Our objective was to determine if the addition of vitamin D to antihypertensive therapy would lead to greater regression of LV mass index (LVMI) as determined by cardiac magnetic resonance (CMR) after 1 year in vitamin D deficient AA patients with uncontrolled HTN and LVH.

METHODS

This study was a randomized, double-blind, placebo-controlled, single-center study. AA patients with HTN (systolic blood pressure [BP] >160 mm Hg), increased LVMI, and vitamin D deficiency (<20 ng/ml) were randomized. All patients received antihypertensive therapy combined with biweekly 50,000 IU vitamin D3 (vitamin D group, n = 55) or placebo (placebo group, n = 58).

RESULTS

At 1 year, there were no statistical differences between the vitamin D and placebo groups in LVMI (-14.1 ± 14.6 vs. -16.9 ± 13.1 g/m2; P = 0.34) or systolic BP (-25.6 ± 32.1 vs. -25.7 ± 25.6 mm Hg; P = 0.99) reduction, respectively. Serum vitamin D levels increased significantly in the vitamin D group compared with placebo (12.7 ± 2.0 vs. 1.8 ± 8.2 ng/ml; P < 0.001).

CONCLUSIONS

In this high-risk cohort of AAs we did not find an association between vitamin D supplementation and differential regression of LVMI or reduction in systolic BP. However, our study suffered from a small sample size with low statistical power precluding a definitive conclusion on the therapeutic benefit of vitamin D in such patients.

CLINICAL TRIALS REGISTRATION

Trial Number NCT01360476. Full trial protocol is available from corresponding author.

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multi-factorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.

Racial Disparity in Cognitive and Functional Disability in Hypertension and All-Cause Mortality

BACKGROUND

Subjective cognitive and functional limitations are early markers of future dementia and physical disability. Hypertension may increase the risk of dementia; however, the magnitude and significance of subjective limitations in the hypertensive US population are unknown, particularly in African Americans who bear the greatest burden of hypertension. Our objectives were to assess the prevalence and racial disparity of subjective cognitive and functional limitations and their impact on mortality in the hypertensive US population.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2010 (N = 28,477; 31% with hypertension; 11% African American), which included blood pressure measurement, self-reported cognitive and functional (physical and non-physical) limitations, and all-cause mortality. Complex survey regression models were used.

RESULTS

In the United States, 8% of the hypertensive population reported cognitive and 25% reported functional limitations (vs. 5.7% and 15% respectively in the non-hypertensive population, P < 0.0001). Hypertensive African Americans carried the highest burden of cognitive (11%, P = 0.01) and functional (27%, P = 0.03) limitations compared to non-hypertensive African Americans and to non-African Americans. All-cause mortality was significantly higher in hypertensive individuals who reported cognitive or functional limitations (P < 0.0001 for both) relative to those without either.

CONCLUSIONS

The prevalence of cognitive and functional disability is larger in the US hypertensive population compared to the non-hypertensive population. African Americans with hypertension carry a disproportionate burden of these limitations. Individuals with hypertension who report cognitive or functional symptoms have higher all-cause mortality and query about these symptoms should be part of hypertension evaluation.

Relationship between Body Mass Index, Blood Pressure, and Visual Acuity in Residents of Esan West Local Government Area of Edo State, Nigeria

Aim. To study the relationship between body mass index (BMI) and blood pressure (BP) on visual acuity among apparently healthy residents of Ekpoma, Esan West Local Government Area of Edo State, Nigeria. Methodology. This is a cross-sectional descriptive study among 225 subjects (ages of 18–35 years) from whom BP, body weight, and height were collected. Visual acuity was measured using the Snellen chart following standard procedures of number of letters seen at 6-metre distance. The data were then analyzed using SPSS version 17. Results. The sampled population consists of 112 male and 113 female (mean age 31.72±14.2 years). Majority (180) of the respondents had normal visual acuity. However, compared with the respondents with normal BMI (R19.61±1.5; L19.67±1.70), visual acuity of underweight (R18.53±2.30; L18.53±2.70) and obese (R15.68±4.79; L17.73±1.70) were more deviated. Similarly, compared with respondent with normal BP (120–125/80–85 mmHg; R18.00±2.53; L18.07±3.11), hypotensive (R15.5±7.35; L15.00±10.20), and hypertensive (R15.01±21.25; L15.00±11.91) respondents had deviated visual acuity. Conclusion. Abnormal body weight (underweight and obese) and BP (hypotension and hypertension) have potential negative impacts on visual acuity. Based on the observed relationship between weights, BP, and visual acuity, eye examinations can be included as regular screening exercise for abnormal BMI and BP conditions.

Prevalence of hypertension and diabetes among Ethiopian adults

OBJECTIVE

To determine the prevalence of hypertension and diabetes among members of an Ethiopian occupational cohort; and to examine the proportion of adults who were aware of their conditions.

METHODS

A total of 2153 of subjects were included in this cross-sectional study. The World Health Organization STEPwise approach for non-communicable diseases was used to collect socio-demographic data, blood pressure measures and blood samples from participants. Prevalence estimates for hypertension and diabetes were determined separately. The 95% confidence intervals for prevalence estimates were also determined.

RESULTS

The overall prevalence of hypertension was 19.1% (95%CI: 17.1-20.8) and 22% (95%CI: 20.2-23.8) and 14.9% (95%CI: 13.4-16.4) among men and women respectively. The overall prevalence of diabetes was 6.5% (95%CI: 5.4-7.6) and 6.4% (95%CI: 5.0-7.8) and 6.6% (95%CI: 4.8-8.4) among men and women correspondingly. Notably, 15% of hypertensives reported never having had their blood pressure checked prior to the present study examination. Approximately 45% of participants who had their blood pressure checked were never diagnosed with hypertension, but were found to be hypertensive in our study. Approximately 27% of newly diagnosed diabetics (during this study) reported never having a previous blood glucose test. Among those who had their blood glucose assessed prior to this study, 17.4% were found to have diabetes but were never diagnosed.

CONCLUSION

The high prevalence of hypertension and diabetes reported in our study confirms findings from other Sub-Saharan Africa countries, and extends the literature to urban dwelling Ethiopians where non-communicable diseases are emerging as a major public health concern.

Prevalence of target organ damage in hypertensive subjects attending primary care: C.V.P.C. study (epidemiological cardio-vascular study in primary care)

Background

Except for the established risk factors, presence of target organ damage has an important role in the treatment of hypertensive subjects. The aim of the present study was to estimate the prevalence of target organ damage in primary care subjects.

Methods

This multi-centre, cross-sectional survey of 115 primary care physicians recruited 1095 consecutive subjects with hypertension: 611 men (55.8%); and 484 women (44.2%). A detailed history for the presence of cardiovascular disease and a thorough clinical examination was performed to each subject.

Results

Of the total study population, 44.5% (n = 487) had target organ damage (33.0% had left ventricular hypertrophy, 21.8% increased carotid intima media thickness, 11.0% elevated plasma creatinine levels and 14.6% microalbuminuria). Target organ damage was more prevalent in males than in females (P = 0.05). In addition, males had more often increased carotid intima media thickness than females (P = 0.009). On the contrary, females had more often microalbuminuria (P = 0.06) than males. No differences were observed between the two genders regarding left ventricular hypertrophy (P = 0.35) and elevated plasma creatinine levels (P = 0.21). Logistic regression analysis showed associations between target organ damage and dyslipidemia (P < 0.001), presence of metabolic syndrome (P = 0.005), diabetes (P < 0.001) and coronary artery disease (P < 0.001).

Conclusion

A significant proportion of hypertensive subjects in primary care had documented associated target organ damage, with left ventricular hypertrophy being the most prevalent target organ damage.

High prevalence and low awareness of hypertension in a market population in enugu, Nigeria

Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group <20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease.

Determinants of target organ damage in black hypertensive patients attending primary health care services in Cape Town: the Hi-Hi study

BACKGROUND

In South Africa (SA) cardiovascular disease (CVD) is the second leading cause of death, with hypertension (HTN) being the predominant contributor to morbidity and mortality associated with this disease. We examined the prevalence and determinants of target organ damage (TOD) among urban black hypertensive South Africans attending primary health-care (PHC) services in Cape Town.

METHODS

Patients on HTN treatment, 35-65 years of age, participated in this cross-sectional study. Data relating to sociodemographic factors, medical history, lifestyle patterns, and HTN care regimens were obtained. Blood and urine samples were analyzed and electrocardiographs (ECGs) were recorded. Sokolow-Lyon and Minnesota Code (MC) criteria were used for identifying left ventricular hypertrophy (LVH). Reduced creatinine clearance (Cockroft-Gault), microalbuminuria, proteinuria, and elevated serum creatinine levels were used for identifying "renal impairment by any criteria" (RIC). Ischemic ECG patterns were classified in terms of MC criteria. Multivariate logistic regression analyses were carried out to identify variables independently associated with TOD.

RESULTS

The study sample comprised 403 participants. RIC was identified in 26%, LVH in 35%, and ischemic ECG patterns in 49% of the participants. Uncontrolled HTN and an absence of diabetes were associated with LVH as per Sokolow-Lyon criteria. Older age, the presence of diabetes, and the use of beta-blockers were associated with RIC. Ischemic ECG patterns were associated with uncontrolled HTN, older age, male gender, the consumption of less alcohol, and higher levels of low-density lipoprotein cholesterol (LDL-C).

CONCLUSIONS

TOD is common in this group of black hypertensive patients attending PHC sites. Uncontrolled HTN and older age were most often associated with TOD. Reducing the burden of TOD will require improving the quality of HTN care in PHC settings.

Estrogen delays the progression of salt-induced cardiac hypertrophy by influencing the renin-angiotensin system in heterozygous proANP gene-disrupted mice

Left ventricular hypertrophy is considered an independent risk factor for cardiac morbidity and mortality, and many studies have shown that women have a lower incidence of left ventricular hypertrophy even after correcting for numerous risk factors. This cardio-protective effect seen in women has been attributed to estrogen, which likely modulates specific growth-promoting systems such as the renin-angiotensin system, and in turn may lead to the prevention of left ventricular hypertrophy. Furthermore, the underlying mechanisms responsible are poorly understood. The aim of the present study was to examine the effect of estrogen in relation to its impact on the development of left ventricular hypertrophy through its interaction with the renin-angiotensin system by using the proANP heterozygous (ANP +/-) mouse as a model of salt-sensitive cardiac hypertrophy. Male, female ANP +/- mice and also ovariectomized female ANP +/- mice treated with oil or estrogen, were fed either a normal or high-salt diet. All four groups exhibited a general suppression of the renin-angiotensin system under the high salt challenge. However, after the 5-week treatment period, marked left ventricular hypertrophy was noted only in the male and oil-injected ovariectomized female ANP +/- mice treated with high salt. Collectively, we provide direct evidence that the differences in cardiac hypertrophy between genders in ANP +/- mice is attributed to estrogen. Furthermore, estrogen may play a key role in slowing down the progression of salt-induced left ventricular hypertrophy in ANP +/- mice, in part, independent of the classical systemic renin-angiotensin system and possibly through other pathways.

Baseline predictors of renal disease progression in the African American Study of Hypertension and Kidney Disease

Patients with chronic kidney disease have an increased risk for progression to ESRD. The purpose of this study was to examine factors that predict increased risk for adverse renal outcomes. Cox regression was performed to assess the potential of 38 baseline risk factors to predict the clinical renal composite outcome of 50% or 25-ml/min per 1.73 m(2) GFR decline or ESRD among 1094 black patients with hypertensive nephrosclerosis (GFR 20 to 65 ml/min per 1.73 m(2)). Patients were trial participants who had been randomly assigned to one of two BP goals and to one of three antihypertensive regimens and followed for a range of 3 to 6.4 yr. In unadjusted and adjusted analyses, baseline proteinuria was consistently associated with an increased risk for adverse renal outcomes, even at low levels of proteinuria. The relationship of proteinuria with adverse renal outcomes also was evident in analyses that were stratified by level of GFR, which itself was associated with adverse renal outcomes but only at levels <40 ml/min. Other factors that were significantly associated with increased renal events after adjustment for baseline GFR, age, and gender, both with and without adjustment for baseline proteinuria, included serum creatinine, urea nitrogen, and phosphorus. In black patients with hypertensive nephrosclerosis, increased proteinuria, reduced GFR, and elevated levels of serum creatinine, urea nitrogen and phosphorus were directly associated with adverse clinical renal events. These findings identify a subset of this high-risk population that might benefit from even more aggressive treatment.

Cardiovascular risk factors in minorities

Recent clinical trials have confirmed the value of intervention on major risk factors, particularly hypertension and hyperlipidemia, in preventing the progression and clinical sequelae of atherosclerosis. Less is known about the prevalence and impact of atherosclerosis risk factors in minorities. A review of recent literature reporting the prevalence of established and new predictors of atherosclerotic events in minority populations and the inclusion of minorities in clinical trials is presented. The prevalence of risk factors differs considerably in minority populations. The role of "premature" coronary death and the level of some risk factors, particularly obesity and blood pressure in African descendants and high triglycerides, low high-density lipoproteins, and diabetes in some Hispanics, is higher than in whites. With few exceptions, however, minorities have not been included in clinical trials in sufficient numbers to determine whether significant differences in the benefit of risk factor intervention exists. Prevalence of key risk factors differs among minority groups. Risk factor intervention should be pursued in minority groups but with the understanding that clinical trials have not ruled out the possibility of qualitative or quantitative differences in response rates among different groups.

Genetic discoveries and nursing implications for complex disease prevention and management

The purpose of this article is to examine the management of patients with complex diseases, in light of recent genetic discoveries, and to explore how these genetic discoveries will impact nursing practice and nursing research. The nursing science processes discussed are not comprehensive of all nursing practice but, instead, are concentrated in areas where genetics will have the greatest influence. Advances in genetic science will revolutionize our approach to patients and to health care in the prevention, diagnosis, and treatment of disease, raising many issues for nursing research and practice. As the scope of genetics expands to encompass multifactorial disease processes, a continuing reexamination of the knowledge base is required for nursing practice, with incorporation of genetic knowledge into the repertoire of every nurse, and with advanced knowledge for nurses who select specialty roles in the genetics area. This article explores the impact of this revolution on nursing science and practice as well as the opportunities for nursing science and practice to participate fully in this revolution. Because of the high proportion of the population at risk for complex diseases and because nurses are occupied every day in the prevention, assessment, treatment, and therapeutic intervention of patients with such diseases in practice and research, there is great opportunity for nurses to improve health care through the application (nursing practice) and discovery (nursing research) of genetic knowledge.

Mechanisms and management of hypertensive heart disease: from left ventricular hypertrophy to heart failure

Hypertensive heart disease (HHD) is a spectrum of abnormalities that represents the accumulation of a lifetime of functional and structural adaptations to increased blood pressure load. Left ventricular hypertrophy (LVH), increasing vascular and ventricular stiffness,and diastolic dysfunction are prominent intermediate features of this syndrome that operate in parallel with ischemic heart disease and ultimately cause heart failure (HF) if inadequately treated. Outcomes in HHD and HF are improved by antihypertensive drugs at any stage of the condition. This review describes an integrated model of the natural history, pathogenesis, and drug treatment of hypertensive heart disease that is consistent with the recommendations of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, including an important modification to the HF guideline published by the American College of Cardiology and the American Heart Association that includes LVH and diastolic dysfunction as treatable conditions within the HHD-HF continuum.