Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults

Prevalence of Pre-Hypertension/Hypertension and Its Associated Factors Among Adults in the Wolaita Zone of Southern Ethiopia: A Cross-Sectional Study

Preventing the development of high blood pressure and resulting complication requires estimating the prevalence of prehypertension/hypertension and identifying associated risk factors. Information about pre-hypertension/hypertension in Ethiopia, especially in the southern region, is scarce, and limited knowledge exists regarding the prevalence and risk factors associated with pre-hypertension/hypertension. Objective of this study was to assess prevalence of pre-hypertension/hypertension and its associated factors among adults in Wolaita Zone of Southern Ethiopia, 2023. This cross-sectional study was conducted among adults attending outpatient departments in governmental hospitals in South Ethiopia in 2023. Face-to-face interviews were used to gather information on sociodemographic data, dietary and behavioral patterns, and medical history. Digital weighing scales, Stadiometers, and digital sphygmomanometers were used to measure height, blood pressure, and weight, respectively. Epi-Data version 3.1 was used to enter the data before exporting it to SPSS version 25 for analysis. To find factors associated with prehypertension/hypertension, binary logistic regressions were conducted and odds ratios with 95% confidence intervals were computed. The overall prevalence of prehypertension/hypertension was 42.8% (95% confidence interval: 39.56, 49.47). Factors associated with prehypertension/hypertension in this study were older age, male gender, obesity, diabetes mellitus comorbidity, alcohol drinking, and family history of hypertension. Lifestyle modification is demanded for pre-hypertensive/hypertensive patients to prevent progression to severe complications, including premature death and permanent disabilities.

Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials

Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.

Corticotropin-releasing hormone neurons in the central nucleus of amygdala are required for chronic stress-induced hypertension

AIMS

Chronic stress is a well-known risk factor for the development of hypertension. However, the underlying mechanisms remain unclear. Corticotropin-releasing hormone (CRH) neurons in the central nucleus of the amygdala (CeA) are involved in the autonomic responses to chronic stress. Here, we determined the role of CeA-CRH neurons in chronic stress-induced hypertension.

METHODS AND RESULTS

Borderline hypertensive rats (BHRs) and Wistar-Kyoto (WKY) rats were subjected to chronic unpredictable stress (CUS). Firing activity and M-currents of CeA-CRH neurons were assessed, and a CRH-Cre-directed chemogenetic approach was used to suppress CeA-CRH neurons. CUS induced a sustained elevation of arterial blood pressure (ABP) and heart rate (HR) in BHRs, while in WKY rats, CUS-induced increases in ABP and HR quickly returned to baseline levels after CUS ended. CeA-CRH neurons displayed significantly higher firing activities in CUS-treated BHRs than unstressed BHRs. Selectively suppressing CeA-CRH neurons by chemogenetic approach attenuated CUS-induced hypertension and decreased elevated sympathetic outflow in CUS-treated BHRs. Also, CUS significantly decreased protein and mRNA levels of Kv7.2 and Kv7.3 channels in the CeA of BHRs. M-currents in CeA-CRH neurons were significantly decreased in CUS-treated BHRs compared with unstressed BHRs. Blocking Kv7 channel with its blocker XE-991 increased the excitability of CeA-CRH neurons in unstressed BHRs but not in CUS-treated BHRs. Microinjection of XE-991 into the CeA increased sympathetic outflow and ABP in unstressed BHRs but not in CUS-treated BHRs.

CONCLUSIONS

CeA-CRH neurons are required for chronic stress-induced sustained hypertension. The hyperactivity of CeA-CRH neurons may be due to impaired Kv7 channel activity, which represents a new mechanism involved in chronic stress-induced hypertension.

Epidemiology of and Factors Associated with Prehypertension Among Hill Tribe Adults Aged 30-59 Years in Thailand: A Cross-Sectional Study

The study aimed to estimate the prevalence of and to determine the factors associated with prehypertension among the hill tribe aged 30-59 years. A cross-sectional study was conducted to collect data using a validated questionnaire and 5 mL blood specimens among six main hill tribe people living in 30 villages. Logistic regression was used to assess the associations between variables at a significance level of α = 0.05. A total of 1,076 individuals were recruited into the study: 67.3% were females, and 22.6% were aged 30-39 years. The overall prevalence was 67.8%. Six variables were found to be associated with prehypertension: being female; had family members ≤ 4 people; being members of Lahu, Hmong, Yao, Karen, and Lisu; had family debt; had overweight; and had a high total cholesterol. The implementation focused on encouraging active physical activity to reduce prehypertension is serious concerned and introduced.

Associations of high-normal blood pressure and impaired fasting glucose with atrial fibrillation

OBJECTIVE

To investigate the association of high-normal blood pressure (BP) and impaired fasting glucose (IFG) with the risk of atrial fibrillation (AF) in two cohorts.

METHODS

The Korean National Health Insurance Service-Health Screening (K-NHIS-HealS, 2002-2003, follow-up until 2013) Study and the UK Biobank (2007-2010, follow-up until 2021) were evaluated. We used Cox proportional hazards regression models to evaluate the associations of high-normal BP and IFG with incident AF.

RESULTS

In the K-NHIS-HealS and the UK Biobank, 2346 and 5314 incident AF events were recorded during the mean follow-up of 7.4 and 11.8 years. The adjusted HRs (95% CIs) for AF in the Korean and UK cohorts were 1.11 (1.02 to 1.21) and 1.07 (1.01 to 1.13) in individuals with high-normal BP; and 1.14 (1.04 to 1.25) and 1.10 (1.01 to 1.20) in individuals with IFG, respectively. The AF risk showed a dose-response relationship with BP and fasting blood glucose level. The risk of incident AF was increased by the combination of high-normal BP and IFG.

CONCLUSIONS

In healthy individuals, high-normal BP and IFG were important risk factors for AF. When high-normal BP and IFG were combined, the risk of new-onset AF was significantly increased. These findings may suggest that lifestyle interventions for high-normal BP and IFG should be considered to reduce the risk of AF.

Effect of Tai Chi versus aerobic exercise on blood pressure in prehypertension patients (TCOBPP): a study protocol for a 12-month single-blind randomized controlled trial

BACKGROUND

Compared with optimal blood pressure (BP), the prehypertension increases the risk of incident hypertension, cardiovascular (CV) events, and death. Moderate intensity of regular physical activity can reduce BP. However, aerobic exercise has some limitations. As a safe, low-impact, enjoyable, and inexpensive form of exercise that requires minimal equipment and space, Tai Chi is expected as a viable alternative to aerobic exercise. The study aimed to assess the effect of Tai Chi intervention program, compared with aerobic exercise, on the BP in prehypertension patients.

METHODS

This study is a 12-month, two-center, single-blind, parallel, randomized controlled trial. Three hundred forty-two patients with prehypertension [with a systolic blood pressure (SBP) in the range of 120 mmHg to 139 mmHg and/or a diastolic blood pressure (DBP) in the range of 80 mmHg to 89 mmHg] are randomized to one of two intervention groups in a 1:1 ratio: Tai Chi or aerobic exercise. BP monitoring methods of office blood pressure, ambulatory blood pressure monitoring (ABPM), and home blood pressure monitoring (HBPM) are used at the same time to detect BP in multiple dimensions. The primary outcome is the comparison of SBP change from baseline to 12 months in Tai Chi group and SBP change from baseline to 12 months in aerobic exercise group. The secondary endpoints are as following: (1) the comparison of DBP of office blood pressure change from baseline to 12 months between Tai Chi group and aerobic exercise group, (2) the comparison of BP and the variability of BP assessed through ABPM change from baseline to 12 months between Tai Chi group and aerobic exercise group, (3) the comparison of BP assessed through HBPM change from baseline to 12 months between Tai Chi group and aerobic exercise group.

DISCUSSION

This will be the first randomized controlled trial to specifically study the benefits of Tai Chi on the blood pressure control in patients with prehypertension. The successful completion of this study will help to provide evidence for whether Tai Chi is more desirable than aerobic exercise.

TRIAL REGISTRATION

Trial registration number: Chinese Clinical Trial Registry, ChiCTR1900024368. Registered on 7 July 2019, http://www.chictr.org.cn/edit.aspx?pid=39478&htm=4.

Integrating Health Data-Driven Machine Learning Algorithms to Evaluate Risk Factors of Early Stage Hypertension at Different Levels of HDL and LDL Cholesterol

Purpose: Cardiovascular disease (CVD) is a major worldwide health burden. As the risk factors of CVD, hypertension, and hyperlipidemia are most mentioned. Early stage hypertension in the population with dyslipidemia is an important public health hazard. This study was the application of data-driven machine learning (ML), demonstrating complex relationships between risk factors and outcomes and promising predictive performance with vast amounts of medical data, aimed to investigate the association between dyslipidemia and the incidence of early stage hypertension in a large cohort with normal blood pressure at baseline. Methods: This study analyzed annual health screening data for 71,108 people from 2005 to 2017, including data for 27 risk-related indicators, sourced from the MJ Group, a major health screening center in Taiwan. We used five machine learning (ML) methods—stochastic gradient boosting (SGB), multivariate adaptive regression splines (MARS), least absolute shrinkage and selection operator regression (Lasso), ridge regression (Ridge), and gradient boosting with categorical features support (CatBoost)—to develop a multi-stage ML algorithm-based prediction scheme and then evaluate important risk factors at the early stage of hypertension, especially for groups with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels within or out of the reference range. Results: Age, body mass index, waist circumference, waist-to-hip ratio, fasting plasma glucose, and C-reactive protein (CRP) were associated with hypertension. The hemoglobin level was also a positive contributor to blood pressure elevation and it appeared among the top three important risk factors in all LDL-C/HDL-C groups; therefore, these variables may be important in affecting blood pressure in the early stage of hypertension. A residual contribution to blood pressure elevation was found in groups with increased LDL-C. This suggests that LDL-C levels are associated with CPR levels, and that the LDL-C level may be an important factor for predicting the development of hypertension. Conclusion: The five prediction models provided similar classifications of risk factors. The results of this study show that an increase in LDL-C is more important than the start of a drop in HDL-C in health screening of sub-healthy adults. The findings of this study should be of value to health awareness raising about hypertension and further discussion and follow-up research.

Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles among Adults in Peru: Findings from a Nationwide Population-Based Study

Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.

Pre-Hypertension and Its Determinants in Healthy Young Adults: Analysis of Data from the Korean National Health and Nutrition Examination Survey VII

The purpose of this cross-sectional study was to identify risk factors in the normotensive and pre-hypertensive group based on the blood pressure results of healthy young adults from the Korean National Health and Nutrition Examination Survey 2018. The participants were 2225 healthy young adults between the ages of 19 and under 45, excluding those with a diagnosis of hypertension or taking antihypertensive medications. Of the 2225 participants, the normotensive group was 1498 (67.3%) and the pre-hypertensive group 727 (32.7%). Determinants of pre-hypertension were analyzed using multiple logistic regression based on a complex sample design. Factors related to pre-hypertension in young adults were age, smoking, waist circumference, diabetes, anemia, cholesterol levels including HDL cholesterol, and uric acid levels. Pre-hypertension is a pre-stage that can prevent the morbidity of hypertension through lifestyle control, so its management is very important. Furthermore, a young adult is a stage in the growth and development of human beings, in which lifestyles such as healthy behaviors, eating habits, and exercise are fixed. Therefore, it is very important to improve lifestyles such as diet, exercise, and smoking cessation and to control risk factors in young adults who are at the pre-hypertension stage for health promotion. Continuous health examinations should be conducted for young adults, and education that can be practiced based on clinical data through this should be implemented for community health.

Incidence and risk factors for progression from prehypertension to hypertension: a 12-year Korean Cohort Study

OBJECTIVES

This study evaluated the incidence and risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults.

METHODS

A total of 115 456 participants with prehypertension in 2003-2004 were selected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) Program. All participants were followed until 2015. Potential risk factors for progression to hypertension were evaluated using the chi-squared test or t-test. A Cox proportional hazards model was used to predict the risk of progression to hypertension according to sex. The incidence of hypertension in the prehypertension group was evaluated by calculating the incidence density during the entire follow-up period.

RESULTS

During the follow-up period, 48 919 participants experienced progression to hypertension, which corresponded to incidence densities of 45.82/1000 person-years among men and 53.57/1000 person-years among women. Among both men and women, progression to hypertension was predicted by an elevated BMI, family history of hypertension, history of diabetes mellitus, and older age. Among men, progression to hypertension was associated with frequent drinking and high alanine aminotransferase levels. Among women, progression to hypertension was associated with high hemoglobin levels and low household income.

CONCLUSION

This study identified various risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults. This information may help researchers develop comprehensive and effective strategies for managing prehypertension.

Association of blood pressure and BMI to corrected QT interval in young adults

Hypertension is often associated with obesity. Uncontrolled hypertension can lead to uncorrected cardiac dysautonomia that makes cardiac repolarization abnormally prolonged. Modern dietary habits, stress, and bad lifestyle habits make young adults vulnerable to hazards of health. We planned to study the association of body mass index (BMI) and blood pressure (BP) with corrected QT (QTc) intervals in young adults. After obtaining the written informed consent, 171 subjects were randomly selected in the age group of 18-35 years. A general history and physical examination were done before recording the BMI and BP. A 12-lead electrocardiogram was recorded and QTc calculated using Bazett's formula. The values obtained were compared and statistical analysis done. Of the 171 subjects 14.03% were hypertensive. The QTc interval was found to be prolonged in females and it is prolonged with age, BMI, and BP. QTc was significantly increased among the prehypertensive and hypertensive group and with the overweight and (or) obese BMI group compared with the normotensives and normal BMI group suggesting an altered autonomic homeostasis. This warrants lifestyle modification at a younger age to reduce the cardiovascular risk.

The effect of uric acid and urinary sodium excretion on prehypertension: a nationwide population-based study

Background

This study examined the effect of serum uric acid (SUA) level and urinary sodium excretion on blood pressure as well as their combined effect on prehypertension in a Korean population.

Method

Data from the 7th Korea National Health and Nutrition Examination Survey for adults (≥ 19 years of age) were used. The participants were classified into two groups, normotension and prehypertension, according to the JNC-7 definition. Logistic regression was carried out and adjusted for traditionally regarded confounders of blood pressure. All analyses considered a complex sampling design. A multivariate analysis was performed on subgroups defined according to their SUA level and urinary sodium excretion.

Results

The 4200 participants were divided into normotension (n = 2646) and prehypertension (n = 1554) groups. In the univariate analysis, patient age, male sex, concurrent comorbidity (diabetes mellitus, cardiovascular disease, stroke, dyslipidemia, and chronic kidney disease), uric acid, and urinary sodium excretion were associated with prehypertension. After adjusting for baseline covariates, both the SUA level and urinary sodium excretion were significant predictors of incident prehypertension (SUA, per 1 mg/dL increase, odds ratio [OR] 1.216, 95% confidence interval [95% CI] 1.131–1.309; urinary sodium excretion, per 1 g/day increase, OR 1.067, 95% CI 1.019–1.117). Additionally, simultaneously higher tertiles of SUA and urinary sodium excretion resulted in higher ORs for prehypertension.

Conclusion

Increased SUA is a significant risk marker for the development of prehypertension in normotensives. Simultaneously high SUA and urinary sodium excretion amplified the effect on the development of prehypertension. Our findings suggest that lowering SUA levels and reducing sodium intake will contribute to preventing hypertension.

Burden of prehypertension among adults in Kenya: a retrospective analysis of findings from the Healthy Heart Africa (HHA) Programme

Background

Hypertension is the leading risk factor for mortality globally. African countries, including Kenya, have a high and rising prevalence of hypertension. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Despite this, little is documented on the prevalence and distribution of prehypertension in sub-Saharan Africa. This study sought to estimate the overall burden of prehypertension in Kenyan adults enrolled in a large hypertension control programme, Healthy Heart Africa. The distribution and determinants of prehypertension in the sample were explored as secondary objectives.

Methods

This was a post hoc analysis of cross-sectional data obtained from population-level blood pressure (BP) screening of adults aged ≥18 years in the community and ambulatory care facilities in 17/47 sub-national administrative units in Kenya. All participants with a complete record for systolic and diastolic BP were included. Descriptive analyses were performed for sociodemographic characteristics. Pearson’s chi-square test was used to assess differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors independently associated with prehypertension.

Results

Of 5,985,185 participant records that were included in the analysis, 34% were men (mean age: 45 [SD 2.9] years). The majority (63%) lived in rural Kenya. The prevalence of prehypertension was 54.5% and that of hypertension was 20.8%. Characteristics that were independently associated with prehypertension (adjusted odds ratio [95% CI]) included male sex (1.23 [±0.0023], p <  0.001 for all age groups > 25 years) and rural residence (1.60 [±0.023], p <  0.001).

Conclusions

Approximately one in every two Kenyan adults has prehypertension. This calls for urgent development and roll-out of a national BP screening and control programme. It also provides a strong basis for the formulation of multisectoral national policies that will ensure implementation of evidence-based, low-cost public health interventions geared towards primary prevention of hypertension, especially in population groups that are traditionally considered at low risk, such as young adults and rural residents.

Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States

Importance

Health insurance is effective in preventing financial hardship from unexpected major health care events. However, it is also essential to assess whether vulnerable patients, particularly those from low-income families, are adequately protected from longitudinal health care costs for common chronic conditions such as atherosclerotic cardiovascular disease (ASCVD).

Objective

To examine the annual burden of total out-of-pocket health expenses among low-income families that included a member with ASCVD.

Design, Setting, and Participants

In this cross-sectional study of the Medical Expenditure Panel Survey from January 2006 through December 2015, all families with 1 or more members with ASCVD were identified. Families were classified as low income if they had an income under 200% of the federal poverty limit. Analyses began December 2017.

Main Outcomes and Measures

Total annual inflation-adjusted out-of-pocket expenses, inclusive of insurance premiums, for all patients with ASCVD. We compared these expenses against annual family incomes. Out-of-pocket expenses of more than 20% and more than 40% of family income defined high and catastrophic financial burden, respectively.

Results

We identified 22 521 adults with ASCVD, represented in 20 600 families in the Medical Expenditure Panel Survey. They correspond to an annual estimated 23 million or 9.9% of US adults with a mean (SE) age of 65 (0.2) years and included 10.9 million women (47.1%). They were represented in 21 million or 15% of US families. Of these, 8.2 million families (39%) were low income. The mean annual family income was $57 143 (95% CI, $55 377-$58 909), and the mean out-of-pocket expense was $4415 (95% CI, $3735-$3976). While financial burden from health expenses decreased throughout the study, even in 2014 and 2015, low-income families had 3-fold higher odds than mid/high-income families of high financial burden (21.4% vs 7.6%; OR, 3.31; 95% CI, 2.55-4.31) and 9-fold higher odds of catastrophic financial burden (9.8% vs 1.2%; OR, 9.35; 95% CI, 5.39-16.20), representing nearly 2 million low-income families nationally. Further, even among the insured, 1.6 million low-income families (21.8%) experienced high financial burden and 721 000 low-income families (9.8%) experienced catastrophic out-of-pocket health care expenses in 2014 and 2015.

Conclusions and Relevance

One in 4 low-income families with a member with ASCVD, including those with insurance coverage, experience a high financial burden, and 1 in 10 experience a catastrophic financial burden due to cumulative out-of-pocket health care expenses. To alleviate economic disparities, policy interventions must extend focus to improving not only access, but also quality of coverage, particularly for low-income families.

Factors associated with the severity of hypertension among Malaysian adults

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41-3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02-1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

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

Objectives

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

Methods

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

Result

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

Conclusion

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

Predictors of Hypertension in Mauritians with Normotension and Prehypertension at Baseline: A Cohort Study

Information on the predictors of future hypertension in Mauritians with prehypertension is scant. The aim of this study was to analyze the 5-year and 11-year risk of hypertension and its predictors in people with normotension and prehypertension at baseline in Mauritius in 1987. This was a retrospective cohort study of 883 men and 1194 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25–74 years old, free of hypertension at baseline in 1987 with follow-up examinations in 1992 and 1998 using the same methodology. The main outcome was 5- and 11-year risk of hypertension. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. The 5-year risk of hypertension was 5.4-times higher in people with prehypertension compared with normotensive individuals at baseline. The corresponding odds for prehypertensive people at baseline regarding 11-year hypertension risk was 3.39 (95% CI 2.67–4.29) in the adjusted logistic regression models. Being of Creole ethnicity (OR 1.42; 95% CI 1.09–1.86) increased the 11-year odds of hypertension compared with the Indian population. It is of importance to screen for people with prehypertension and implement strategies to reduce their systolic blood pressure levels to the recommended levels of 120/80 mmHg. Special attention needs to be given to Mauritians of Creole ethnicity.

Factors Associated with Pre-Hypertension Among Tehranian Adults: A Novel Application of Structural Equation Models

BACKGROUND

Pre-hypertension is proposed as an independent risk factor for the incidence of cardiovascular diseases.

OBJECTIVES

This study aimed to explore the main factors associated with pre-hypertension via testing a hypothesized model in Tehranian adults.

METHODS

The study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) between 2009 - 2011 on 4640 adults without hypertension, aged ≥ 20 years.

RESULTS

The mean age of participants was 38.61 ± 12.14 years and 56.6% of them were female. More than one third of the studied participants had pre-hypertension (35.4%) with significantly higher prevalence in males compared to females (46.5% vs. 26.9%; χ² = 190.7, P < 0.001). Age, waist circumference (WC), and serum triglyceride concentrations (TG) were directly associated with pre-hypertension in both men (β = 0.16, β = 0.25, and β = 0.11, respectively) and women (β = 0.16, β = 0.21 and β = 0.09, respectively). Physical activity, only in men (β = 0.07), and marital status only, in women (β = -0.06), were also directly associated with pre-hypertension. Both healthy and poor dietary patterns showed indirect associations with pre-hypertension in both genders via WC and TG. Higher age and lower education in both genders, being married only in men, and unemployed status only in women, were positively associated with pre-hypertension via behavioral and cardio-metabolic factors.

CONCLUSIONS

Level of TG and WC in both genders are direct modifiable associated factors of pre-hypertension. These findings could be considered in designing future health promotion programs aimed at preventing high blood pressure and its consequences among Tehranian adults.

Variability of metabolic risk factors associated with prehypertension in males and females: a cross-sectional study in China

INTRODUCTION

Prehypertension is highly prevalent. However, very few studies have evaluated the association of various metabolic risk factors in those with prehypertension and, more importantly, possible differences based on gender.

MATERIAL AND METHODS

Data of clinical characteristics were collected from 3891 subjects. Risk factors were analyzed by multiple logistic regression analysis. The areas under receiver operating characteristic curves were compared to assess the discriminatory value of metabolic parameters for predicting prehypertension.

RESULTS

The incidence of prehypertension was 55.9% (66.9% of men, 41.1% of women). Prehypertensives showed clusters of metabolic associations including changes in the levels of plasma high-density lipoprotein cholesterol (OR = 1.550), triglycerides (OR = 1.141) and fasting blood glucose (OR = 1.320) after adjusting for age, sex, body mass index and smoking. The metabolic associations also showed differences based on gender. For instance, higher total cholesterol (OR = 1.602) was the most evident risk factor in men with prehypertension, while higher triglycerides (OR = 1.314) and lower high-density lipoprotein cholesterol (OR = 1.729) were the main risk factors in women.

CONCLUSIONS

Our study suggests that risk associations of prehypertension show gender differences. These results emphasize the importance of health education, active management of blood pressure and timely and effective treatment of abnormal lipid profile in subjects with prehypertension.

Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea

Aims

For healthy populations without comorbidities, whether prehypertension and impaired fasting glucose (IFG) are associated with new onset atrial fibrillation (AF) is not well known.

Methods and results

We included 366 507 subjects (age ≥20 years) not diagnosed with non-valvular AF from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2003 to 2008. In total, 139 306 subjects diagnosed with AF-related comorbidities were excluded, and a 227 102 healthy population was followed up until 2013. The body mass index (BMI), blood pressure (BP), and fasting blood glucose (BG) level were acquired during National health check-ups. Subjects with IFG [hazard ratio (HR) 1.16, P = 0.017] had a higher AF risk and the diastolic BP (HR 1.11, P = 0.045) was a stronger indicator for an AF incidence than the systolic BP. After dividing the subjects into two mutually exclusive groups, AF incidence was increased dramatically by the combination effect of both prehypertension and an IFG in BMI <25 kg/m2 group, but, in BMI ≧25 kg/m2 group, did not show this tendency. An IFG related to AF risk was more prominent in the BMI <25 kg/m2 population (HR 1.18, P = 0.025) than those with a BMI ≥25 kg/m2, and subjects with both an IFG and prehypertension had a greater AF risk (HR 1.27, P = 0.016) than those without.

Conclusion

Even in a healthy Asian populations without comorbidities, prehypertension and IFG were important risk factors of AF. Specifically, when prehypertension, including systolic and diastolic BPs, was finally combined with the IFG, the risk of new onset AF was increased especially in the BMI <25 kg/m2 group.

A Physical Health Profile of Youths Living with a "Hikikomori" Lifestyle

A cross-sectional study was designed to understand the impacts of "hikikomori" lifestyle on physical health. A total of 104 eligible hikikomori cases were recruited from the social services network of Hong Kong with a mean age of 19.02 ± 3.62 (ranged 13-31) year-old, and had completed the set of questionnaires and a series of anthropometric and physical health measurements. Despite SF36 score of 84.0 indicated good physical functioning in general, participants were lived sedentarily with high incidence of hypertension at 15.4% and prehypertension at 31.7%. Occurrence of hypertension and prehypertension in cases living as hikikomori >6 months were 3 times and 1.5 times higher than those newly onset cases, respectively. The blood pressure levels were correlated with age and all obesity index parameters measured including waist circumference and body mass index. Results also observed a shift of body weight from underweight to overweight and obesity along the hikikomori duration. Half of the hypertensive cases involved the elevation of systolic blood pressure, which suggested higher odds of cardiovascular complications. In conclusion, the hikikomori lifestyle could be a risk behavior that may harm the younger generation physically by promoting obesity and hypertension and probably other chronic illnesses.

[Arterial prehypertension in slave-descendant communities in southeast Bahia State, Brazil]

Arterial prehypertension is a precursor of arterial hypertension and a risk factor for cardiovascular diseases. Vulnerable populations are more prone to this condition due to difficulties in access to health services. A previous study in quilombola communities (descendants of African slaves) reported a high prevalence of arterial hypertension. The current study aimed to estimate the prevalence of arterial prehypertension in quilombolas and to assess associated factors. This was a cross-sectional population-based study in individuals 18 years and older. Prehypertension was defined as arterial systolic pressure ≥ 121mmHg and < 140mmHg and/or diastolic ≥ 81mmHg and < 90mmHg. Multivariate Poisson regression with robust variance was used. Population-attributable fractions (PAF) were also calculated for the modifiable associated factors. Prevalence of prehypertension was 55% (95%CI: 50.2-59.7). Male gender (PR = 1.54), 1 to 4 complete years of schooling (PR = 1.44), and BMI classified as overweight (PR = 1.39) and obesity (PR = 1.87) showed positive association with prehypertension. Higher attributable fractions were observed in individuals with 1 to 4 years of schooling (13.7%) and those classified as overweight (9.35%) and obese (4.6%). Prevalence of prehypertension in quilombola communities was high, and its identification may allow screening and awareness-raising in a group with increased risk of cardiovascular disease and progression to full-blown hypertension. The study highlights the need for broad access to health services and specific measures for orientation, prevention, and health promotion in this population.

Is prehypertension more strongly associated with long-term ambient air pollution exposure than hypertension? Findings from the 33 Communities Chinese Health Study

Numerous studies have evaluated the effects of long-term exposure to ambient air pollution on hypertension. However, little information exists regarding its effects on prehypertension, a very common, but understudied cardiovascular indicator. We evaluated data from 24,845 adults (ages 18-74 years) living in three Northeastern Chinese cities in 2009. Blood pressure (BP) was measured by trained observers using a standardized mercuric-column sphygmomanometer. Three-year (from 2006 to 2008) average concentrations of particles with an aerodynamic diameter ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxides (NO₂), and ozone (O₃) were calculated using data from monitoring stations. Effects were analyzed using generalized additive models and two-level regression analyses, controlling for covariates. We found positive associations of all pollutants with prehypertension (e.g. odds ratio (OR) was 1.17 (95% confidence interval (CI), 1.09-1.25) per interquartile range (IQR) of PM₁₀) in a fully adjusted model, as compared to normotensive participants. These associations were stronger than associations with hypertension (e.g. OR was 1.03 (95% CI, 1.00, 1.07) per IQR of PM₁₀). We have also found positive associations of all studied pollutants with systolic and diastolic BP: e.g., associations with PM₁₀ per IQR were 1.24 mmHg (95% CI, 1.03-1.45) for systolic BP and 0.47 mmHg (95% CI, 0.33-0.61) for diastolic BP. Further, we observed that associations with BP were stronger in women and in older participants (systolic BP only). In conclusion, long-term exposure to ambient air pollution was more strongly associated with prehypertension than with hypertension, especially among females and the elderly. Thus, interventions to reduce air pollution are of great significance for preventing future cardiovascular events, particularly among individuals with prehypertension.

High-Sensitivity Cardiac Troponin T levels in prehypertensive patients

BACKGROUND

High-sensitivity cardiac troponin T (hs-cTNT) is an important non-invasive laboratory-based marker of subclinical myocardial injury. Prehypertension, which may be a precursor of hypertension, is a major public health issue. Our aim was to evaluate the importance of serum hs-cTnT as a marker predicting prehypertension.

METHODS

A total of 100 subjects (45 women and 55 men) consisting of 50 consecutive prehypertensive patients with blood pressures between 120/80 and 139/89 mmHg and 50 normotensive patients with blood pressures < 120/80 mmHg were enrolled prospectively. The hs-cTNT level was calculated and compared between the two groups. Echocardiographic examinations were performed in all patients.

RESULTS

The hs-cTnT level was significantly higher in the prehypertensive group (p < 0.001) and was positively correlated with prehypertension (r = 0.625, p < 0.001). Hs-cTnT was an independent predictor of prehypertension (odds ratio = 1.043, 95% confidence interval [CI] 1.019-1.067, p < 0.001). An Hs-cTnT level of 0.55 ng/L was predictive of prehypertension with a sensitivity of 86% and specificity of 60% (area under the curve = 0.861; 95% CI, 0.787-0.935; p < 0.001).

CONCLUSION

hs-cTnT may complement other diagnostic biomarkers in predicting prehypertension. Abbrevations: high-sensitivity cardiac troponin T, prehypertension, subclinical myocardial injury.

From Population Databases to Research and Informed Health Decisions and Policy

Background

In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge.

The model

To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions.

Conclusion

Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.

High normotension is associated with future metabolic syndrome but not cardiovascular disease: A 10-year longitudinal study

Hypertension and prehypertension can increase the risk of developing cardiovascular disease (CVD) and diabetes. However, whether the harmful effects of high blood pressure (BP) are also seen with high normotension remains unknown. This 10-year longitudinal follow-up study aimed to investigate the relationships among normal-range BP, metabolic syndrome (MetS), and CVD.A total of 9133 nonmedicated normotensive participants, 4634 males and 4499 females, aged 60 years or older were enrolled in a standard health examination program at 2 academic hospitals and a health screening center in Taiwan. The study subjects were divided into 3 groups according to their BP. The systolic BP (SBP) ranges of groups 1, 2, and 3 were 91 to 100, 101 to 110, and 111 to 119 mmHg, whereas the diastolic BP (DBP) ranges of groups 1, 2, and 3 were 51 to 60, 61 to 70, and 71 to 79 mmHg, respectively.In the SBP3 group, both sexes had a higher odds ratio (OR) for having MetS or abnormal MetS components, except for triglycerides. Females in the DBP3 group had a higher OR for having MetS at baseline. After the follow-up period, the SBP3 group had a significantly higher hazard ratio (HR) for developing MetS. Males in the DBP3 group and females in the DBP2 and DBP3 groups had a significantly higher HR for developing MetS. Neither the SBP3 group nor the DBP3 group had a higher HR for developing nonfatal CVD. In the Kaplan-Meier analysis, SBP and DBP in both sexes showed statistical significance as predictors of MetS, but not of nonfatal CVD.High normotensive elderly individuals have an elevated risk of developing MetS at baseline and within 10 years of follow-up, but they are not at increased risk of CVD. Preventive interventions, such as life-style modification, should be offered early even to the apparently healthy elderly.

Cold Exposure Can Induce an Exaggerated Early-Morning Blood Pressure Surge in Young Prehypertensives

Prehypertension is related to a higher risk of cardiovascular events than normotension. Our previous study reported that cold exposure elevates the amplitude of the morning blood pressure surge (MBPS) and is associated with a sympathetic increase during the final sleep transition, which might be critical for sleep-related cardiovascular events in normotensives. However, few studies have explored the effects of cold exposure on autonomic function during sleep transitions and changes of autonomic function among prehypertensives. Therefore, we conducted an experiment for testing the effects of cold exposure on changes of autonomic function during sleep and the MBPS among young prehypertensives are more exaggerate than among young normotensives. The study groups consisted of 12 normotensive and 12 prehypertensive male adults with mean ages of 23.67 ± 0.70 and 25.25 ± 0.76 years, respectively. The subjects underwent cold (16°C) and warm (23°C) conditions randomly. The room temperature was maintained at either 23°C or 16°C by central air conditioning and recorded by a heat-sensitive sensor placed on the forehead and extended into the air. BP was measured every 30 minutes by using an autonomic BP monitor. Electroencephalograms, electrooculograms, electromyograms, electrocardiograms, and near body temperature were recorded by miniature polysomnography. Under cold exposure, a significantly higher amplitude of MBPS than under the warm condition among normotensives; however, this change was more exaggerated in prehypertensives. Furthermore, there was a significant decrease in parasympathetic-related RR and HF during the final sleep transition and a higher early-morning surge in BP and in LF% among prehypertensives, but no such change was found in normotensives. Our study supports that cold exposure might increase the risk of sleep-related cardiovascular events in prehypertensives.

Beta-adrenergic receptor mediated inflammation control by monocytes is associated with blood pressure and risk factors for cardiovascular disease

Overwhelming data indicate that individuals with even mildly elevated blood pressure (BP) are at great risk for developing clinical hypertension and future cardiovascular disease (CVD). There remains a lack of consensus regarding treatment strategies for mildly elevated BP, termed prehypertension, and the knowledge of pathophysiology and mechanisms of its clinical outcomes remains limited. Our primary aim was to investigate βAR-mediated inflammation control (BARIC) responses of blood monocytes to isoproterenol (Iso) in relation to BP and CVD risk factors, including obesity, depressive mood, fasting glucose, triglycerides, and cholesterol levels in the 64 prehypertensive compared to 84 individuals with normal BP. BARIC was determined by measuring the degree of inhibition in lipopolysaccharides-stimulated monocytic intracellular TNF production by ex vivo Iso treatment (10(-8)M). Depressive mood was assessed by Beck Depression Inventory (BDI). Fasting metabolic and lipid panels were assessed, and plasma levels of inflammatory cytokines TNF, IL-1β, IL-6 were measured in a subset to confirm proinflammatory state of prehypertensive participants. Prehypertensive participants were older, heavier, included more men, and presented higher levels of fasting glucose, triglycerides, cholesterol, and plasma TNF compared to normotensive participants (p's<.05). BARIC was significantly attenuated in the prehypertensive compared to normotensive group (p<.05). BARIC was negatively associated with systolic BP, diastolic BP, age, BMI, fasting glucose, triglycerides, total and low density cholesterol levels, and somatic depressive symptoms in all participants (p's<.0001 to .05). However, among the prehypertensive individuals BARIC was positively associated with SBP even after controlling for the covariates (age, gender, race, BMI, glucose and lipid panel, somatic BDI scores) (p<.05). This differing nature of the BARIC-SBP relationship between the two BP groups may be attributed to moderating factors such as cardiorespiratory fitness or depressive symptoms that could not be clearly deciphered in this current study. Nonetheless, our findings indicate the associations between inflammation dysregulation mediated by sympathoadrenal activation and BP that is observable even among individuals with normal to mildly elevated BP. BARIC may be a useful and sensitive indicator of elevated risk for vascular inflammatory disease that can be detected even at lower BP levels, especially given its associations with traditional CVD risk factors and the critical role of monocytes in atherogenic processes.

Higher normal range of fasting plasma glucose still has a higher risk for metabolic syndrome: a combined cross-sectional and longitudinal study in elderly

INTRODUCTION

It is well known that higher fasting plasma glucose (FPG) is associated with metabolic syndrome (MetS). This relationship still exists even the FPG is within the normal range. However, most of these studies did not exclude subjects who were on medications which would affect the results of the studies. At the same time, there is no longitudinal study done to validate this correlation, especially in elderly. In this study, the relationships between normal FPG and MetS were evaluated.

METHOD

We randomly selected 57,517 subjects who were ≥ 60-years old from health screening centre. In the first part of study, subjects were enrolled in the cross-sectional study to find out the optimal cut-off value of FPG with higher chances to have MetS. In the second part of current study, subjects with MetS at baseline were excluded from the same study group, and performed a median 5.3-year longitudinal study.

RESULTS

There were 18,287 subjects enrolled in this study. In the first part of study, the cross-sectional study, optimal cut-off values of FPG were determined by the ROC curve and the sensitivity for these cut-off values were 56.6% in men and 60.9% in women, respectively. The result showed that lower FPG is healthier than the higher (log-rank test, p < 0.001). During the follow-up period, 5039 subjects showed hazard ratios of 2.09 for men and 1.884 for women developing future MetS.

CONCLUSION

Our study is the first longitudinal design in elderly and showed that older subjects with higher FPG proved to have higher risk of Mets even the FPG is still within its normal range.

Sasang constitution may act as a risk factor for prehypertension

Background

Prehypertension (pre-HTN), similar to hypertension, has been associated with an elevated risk of cardiovascular disease. The aim of this study was to determine whether the Sasang constitution (SC) types could also be independent risk factors for pre-HTN.

Methods

A total of 2,806 eligible subjects, older than 20 years old from 25 medical clinics, participated. Clinical data, including the blood pressure, age, height, weight, and data from blood tests, were collected. One-way ANOVA with Scheffé’s post-hoc analysis and the chi-square test were used, according to the SC and sex. Logistic regression was used to generate the odds ratios (ORs) and 95 % confidence interval (CI) for pre-HTN.

Results

The pre-HTN prevalence rates of the Soeumin type, Soyangin type and Tae-eumin type were 59.4 %, 60.1 % and 74.9 %, respectively, in men (p < 0.001) and 41.7 %, 44.4 % and 58.3 % in women (p < 0.001). The Soyangin type was not more associated with increased ORs than the Soeumin type in any of the subjects with pre-HTN. Even after adjusting for sex, BMI, FBG, TC, TGs, HDL, and LDL, the Tae-eumin type in men was associated with increased ORs of pre-HTN compared with the Soeumin type (OR 1.57, 95 % CI 1.03–2.39), but the Tae-eumin type in women was not associated with pre-HTN.

Conclusions

This study suggested that the Tae-eumin type combined with sex might be significantly and independently associated with pre-HTN, especially high pre-HTN.

The Prevalence of Elevated Blood Pressure in Adolescents in Nassau, The Bahamas

OBJECTIVE

To determine the prevalence of elevated blood pressure (EBP) in Bahamian adolescents.

METHODS

A cross-sectional survey employing a self-administered questionnaire, and concurrently obtaining anthropometric measurements, was conducted involving selected grades 9, 10 and 11 students of all targeted public high schools in The Bahamas.

RESULTS

The mean age of the 785 participants was 14.6 (± 1.153) years, and 87.6% were Bahamian. The prevalence of elevated systolic blood pressure (SBP) was 4.7% and 6.6% for elevated diastolic blood pressure (DBP). Elevated blood pressure prevalence was 8.9%. Elevated blood pressure was more common among grade 9 students (12-14-year olds) who had the largest proportion of EBP (55.7%). Both SBP and DBP increased with age in the males. Overall, students' prevalence of overweight/obesity was 32.2% (14.4% overweight, 17.8% obese). Body mass index (BMI), number of days per week eating fast food and perception of body weight were predictive of EBP. Body mass index, age and perception of body weight were found to be predictive of SBP (βBMI = 0.25, p < 0.001; βAge = 0.14, p < 0.001; βWeight = 0.08, p < 0.037) and DBP (βDBP = 0.192, p < 0.001). Overweight/obese students were 2.7 times more likely to have EBP. Elevated blood pressure was markedly associated with BMI, family history of hypertension and parents' overweight/obese status.

CONCLUSION

The estimated prevalence of EBP in adolescent school children in New Providence, Bahamas, was comparable with neighbouring nations.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

High prevalence of metabolic syndrome in a middle-aged and elderly population with prehypertension in Tianjin

BACKGROUND

Prehypertension has been reported as being correlated with future cardiovascular risk and end-organ damage in middle-aged and elderly persons, and also playing an important role in metabolic syndrome (MetS). The association between prehypertension and MetS has rarely been reported among urban adults in Tianjin, China.

METHODS

In this cross-sectional study, a total of 1176 participants aged 40-70 years (524 males and 652 females) were enrolled after excluding participants with hypertension or treated hypertension. Participants were divided into two groups [optimal blood pressure (BP) and prehypertension] based on the classification of BP from the JNC-7. The definition of MetS was as per the International Diabetes Federation standard. An adjusted logistic regression model was used to assess relationships between prehypertension and MetS.

RESULTS

The prehypertension group had a significantly higher odds ratio (OR) than the optimal BP group for abnormal waist circumference (WC), fasting plasma glucose (FPG) and triglycerides (TG). In addition, the prehypertension group had a higher OR (3.12; 95% confidence interval 2.34-4.18) for having MetS after adjusting for potential confounders.

CONCLUSIONS

The risk of having MetS was significantly associated with prehypertension in middle-aged and elderly persons in Tianjin. Stricter control of BP in this age group is warranted.

Pre-hypertension in Uganda: a cross-sectional study

BACKGROUND

Persons with a systolic blood pressure (BP) of 120 to < 140 or diastolic BP of 80 to < 90 mm hg are classified as having pre-hypertension. Pre-hypertension is associated with cardiovascular disease (CVD) risk factors, incident CVD and CVD mortality. Understanding determinants of pre-hypertension especially in low income countries is a pre-requisite for improved prevention and control.

METHODS

Data were analyzed for 4142 persons aged 18 years and older with BP measured in a community cross sectional survey in Uganda. The prevalence of pre-hypertension was estimated and a number of risk factors e.g. smoking, use of alcohol, overweight, obesity, physical activity, sex, age, marital status, place of residence, and consumption of vegetables and fruits were compared among different groups (normotension, pre-hypertension, and hypertension) using bivariate and multivariable logistic regression.

RESULTS

The age standardized prevalence of normal blood pressure was 37.6%, pre-hypertension 33.9%, hypertension 28.5% and raised blood pressure 62%. There was no difference between the prevalence of hypertension among women compared to men (28.9% versus 27.9%). However, the prevalence of pre-hypertension was higher among men (41.6%) compared to women (29.4%). Compared to people with normal blood pressure, the risk of pre-hypertension was increased by being 40 years and above, smoking, consumption of alcohol, not being married, being male and being overweight or obese. Compared to pre-hypertension, hypertension was more likely if one was more than 40 years, had infrequent or no physical activity, resided in an urban area, and was obese or overweight.

CONCLUSIONS

More than one in three of adults in this population had pre-hypertension. Preventive and public health interventions that reduce the prevalence of raised blood pressure need to be implemented.

Metabolic syndrome in normoglycaemic elderly men

OBJECTIVE

Type-2 diabetes is mainly the metabolic defect involving multiple organs. To conclude their intricate relationships, the term 'ominous octet' had been proposed to denote this phenomenon. In this study, we enrolled older men without any medications for MetS components to further elucidate the relationships between normoglycaemic state and MetS.

METHODS

We enrolled male subjects with FPG less than 100 mg/dl and aged 65 and older undergoing routine health check-ups in Taiwan. After excluding subjects taking medications that might affect the components of MetS, a total of 6679 men were eligible for the analysis. Study subjects were further grouped into FPG tertiles (< 91 mg/dl, 92-95 mg/dl and > 95 mg/dl for tertil 1, tertil 2 and tertil 3, respectively).

RESULTS

There was a significant trend between the FPG and percentages of subjects having MetS (p = 0.009). The relationships between the MetS components were higher in FPG 2 and FPG 3 than FPG 1. In simple correlation, all of the MetS and LDL-C were positively correlated with FPG level and multiple regression further confirmed the same result except for HDL-C that became non-significant. Subjects in FPG3 had significantly higher ORs (ORs = 1.19) for having MetS than those in FPG1.

CONCLUSIONS

In conclusion, higher FPG still had higher risk of having MetS in normoglycaemic range in elderly male. More strict FPG level control may be valuable in CVD prevention and warrants further investigations.

Prevalence and Determinants of Pre-Hypertension among Omani Adults Attending Non-Communicable Disease Screening Program in Primary Care Setting in Sohar City

OBJECTIVES

To estimate the prevalence of pre-hypertension and its association with some selected cardiovascular risk factors among the Omani adult population in the primary healthcare setting.

METHOD

A cross-sectional study involving a sample taken from a National Screening Program of chronic non-communicable diseases in primary healthcare institutions, Sohar city, Sultanate of Oman (July 2006 - December 2007). Inclusion criteria included Omanis aged 40 years or above residents of Sohar city attending primary healthcare institutions not previously diagnosed with diabetes mellitus, hypertension, or chronic kidney diseases. Descriptive statistics were used to describe the demographic, physical and metabolic characteristics. Univariate analysis was used to identify the significant association between the characteristics and normal blood pressure, pre-hypertension and hypertension. Chi-squared test was used for categorical variables analysis and independent t-test was used for continuous variables analysis. In order to examine the strength of significant associations, the multinomial logistic regression analysis was used.

RESULTS

There were 1498 participants, 41% were males and 59% were females. Overall, pre-hypertension was observed in 45% of the total study population (95% CI: 0.422 - 0.473). There were more males affected than females (46% versus 44%). About 34% of the total study population was hypertensive. The multinomial logistic regression analysis revealed that an increase of one unit of age, body mass index, fasting blood glucose and total blood cholesterol, were significantly associated with higher risk in both pre-hypertension and hypertension. High odds ratio of pre-hypertension and hypertension was found with the total blood cholesterol.

CONCLUSION

The prevalence of pre-hypertension was high among the Omani adult population. The determinants of pre-hypertension in this research age, body mass index, fasting blood glucose and total blood cholesterol. A cost-effectiveness study about the management of pre-hypertension within primary healthcare is significant in the future health system service strategies.

Prehypertension and incidence of cardiovascular disease: a meta-analysis

BACKGROUND

Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity.

METHODS

Databases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality.

RESULTS

Pooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05).

CONCLUSIONS

Prehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.

Meta-analysis of cohort studies of baseline prehypertension and risk of coronary heart disease

Prehypertension is a common condition, but the extent to which it increases the risk for coronary heart disease (CHD) is unclear. The aim of this study was to determine the association between baseline prehypertension and risk for CHD by performing a meta-analysis of prospective cohort studies. A systematic search of published research was conducted through January 2013, using electronic databases and bibliographies of retrieved reports. Studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CHD with respect to prehypertension. A random-effects model was used to combine the study-specific risk estimates. Eighteen studies, consisting of 934,106 participants and 14,952 cases, with a median follow-up period of 8.8 years, were included. Prehypertension was associated with a significantly elevated risk for CHD (RR 1.36, 95% CI 1.22 to 1.53). Eight studies consisting of 12 cohorts further provided risk estimates for low-range prehypertension (120/80 to 129/84 mm Hg) and high-range prehypertension (130/85 to 139/89 mm Hg) separately. The risk for CHD increased significantly in high-range prehypertensive populations (RR 1.53, 95% CI 1.19 to 1.97) but not in low-range prehypertensive populations (RR 1.16, 95% CI 0.96 to 1.42). In conclusion, prehypertension is associated with a significantly increased risk for developing CHD, particularly high-range prehypertension. Further well-designed randomized controlled trials are needed to clarify the efficacy of blood pressure reduction in subjects with prehypertension.

Cardiovagal modulation, oxidative stress, and cardiovascular risk factors in prehypertensive subjects: cross-sectional study

BACKGROUND

Hypertension, one of the modifiable risk factors for cardiovascular disease (CVD), is known to be associated with increased oxidative stress and reduced cardiovagal modulation. Similar to hypertension, prehypertension is associated with increased risk of adverse cardiovascular (CV) events. We planned this study to find the association between prehypertension, cardiovagal modulation, oxidative stress, and associated CV risk factors.

METHODS

We recruited 178 subjects through hypertension screening camps conducted in Puducherry, India. Subjects were grouped into prehypertensive (n = 97) and normotensive (n = 81) groups. They were further subdivided, based on age, as young (20-39 years) and middle-aged (40-60 years) adults. We measured basal physiological parameters, heart rate variability, oxidative stress (thiobarbituric acid reactive substance and total antioxidant capacity (TAC)), and CV risk factors.

RESULTS

We found significant increase in oxidative stress in prehypertensive subjects of both age groups but the cardiovagal modulation decreased significantly in young prehypertensive subjects when compared with normotensive subjects. Correlation of TAC with root mean square of the sum of successive R wave to R wave (RR) interval differences (RMSSD), a cardiovagal modulation parameter (r = 0. 437; P < 0.001), and mean arterial pressure (MAP) (r = -0.318; P < 0.001) was significant even after adjusting for CV risk factors. The correlation between MAP and RMSSD (r = 0.199; P = 0.009) was reduced after adjusting for CV risk factors.

CONCLUSIONS

Prehypertension in young adults is associated with increased oxidative stress and altered cardiovagal modulation. The risk factors for CVDs in prehypertensive young adults were found to be equivalent to that of middle-aged adults who are in the twilight zone for developing CV dysfunctions.

High normotension is associated with higher metabolic syndrome risk in postmenopausal women

AIM

Cardiovascular disease and diabetes are important causes for mortality in older people. Both hypertension and prehypertension are correlated with them. Recently, health promotion and disease prevention in postmenopausal women have become an essential issue of public health policy. The present study aimed to evaluate whether the harmful effects of blood pressure (BP) could still be found in normotensive postmenopausal women (below 120/80 mmHg).

METHODS

A total of 4539 normotensive postmenopausal women aged 51 years or older, undergoing routine health examinations, were enrolled in the cross-sectional analyses. To mitigate the effect of age on BP, participants within the same age were divided into tertiles according to their systolic BP (SBP). Then, participants in the low-SBP tertile of each age stratum were pooled together to form a larger group (low-normal SBP group [LNSBP]). Similarly, the middle- and high-normal SBP were grouped accordingly (MNSBP and HNSBP). Metabolic syndrome (MetS) was considered to be a surrogate for future cardiovascular disease and diabetes.

RESULTS

The study showed that HNSBP bore a higher likelihood of having abnormal MetS components, elevated low-density lipoprotein cholesterol levels and a higher odds ratio (1.46; 95% confidence interval 1.17-1.81) for having MetS than LNSBP. In contrast, age, body mass index, fasting plasma glucose and low-density lipoprotein cholesterol were significantly related to SBP in multiple regression analysis.

CONCLUSIONS

The risk of having MetS was significantly associated with higher SBP even within normotension. Primary prevention, such as lifestyle modification, and more strict control of BP should be stressed in postmenopausal women.

Increased incidence of metabolic syndrome in older men with high normotension

INTRODUCTION

Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest.

METHODS

In this cross-sectional study, totally 2388 normotensive older men aged 65-80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes.

RESULTS

Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55-fold OR (p < 0.001) for having MetS than Group-1.

CONCLUSIONS

In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.

Heart rate variability biofeedback decreases blood pressure in prehypertensive subjects by improving autonomic function and baroreflex

BACKGROUND

Individuals with prehypertension are at risk of hypertension and cardiovascular diseases, and yet efficient interventions are lagging behind. Studies indicate that heart rate variability-biofeedback (HRV-BF) increases HRV and baroreflex sensitivity (BRS) as well as reduces related pathological symptoms, suggesting potentially beneficial effects of HRV-BF on prehypertension, but little is known about these effects. In this study, these effects were investigated and their mechanisms were explored.

OBJECTIVES

The effect of HRV-BF on prehypertension in young adults and its potential mechanism were explored.

DESIGN

Forty-three (43) individuals with prehypertension were recruited and classified into three categories: HRV-BF group, slow abdominal breathing group, and control group. All groups were assessed with measurements of noninvasive blood pressure (BP), BRS, respiration, and galvanic skin response (GSR) at pre-intervention, in the entire process of each session, at postintervention, as well as at a 3-month follow-up.

INTERVENTIONS

Subjects participated in a 10-session HRV-BF protocol or simple slow abdominal breathing protocol conducted over 5 weeks. A 3-month follow-up was also performed on these individuals.

RESULTS

The incidence of prehypertension was as high as 14.5% in young college students. Individuals with prehypertension were lower in BRS (7.5±5.2 ms/mm Hg) and HRV (log10-transformed of the standard deviation of normal-to-normal beats [SDNN]=1.62±0.13 ms, lgTotal power of spectral density in the range of frequencies between 0 and 0.4Hz (TP)=8.02±0.55 ms2) than those with normal blood pressure (BRS=18.4±7.4 ms/mm Hg, lgSDNN=1.79±0.10 ms, lgTP=8.68±0.85 ms2). HRV-BF reduced blood pressure (from 131.7±8.7/79.3±4.7 mm Hg to 118.9±7.3 mm Hg/71.9±4.9 mm Hg, p<0.01), increased BRS (from 7.0±5.9 ms/mm Hg to 15.8±5.3 ms/mm Hg, p<0.01) and increased HRV (lgSDNN from 1.61±0.11 to 1.75±0.05 ms, and lgTP from 8.07±0.54 to 9.08±0.41 ms2, p<0.01). These effects were more obvious than those of the slow-breathing group, and remained for at least 3 months. HRV-BF also significantly increased vagus-associated HRV indices and decreased GSR (indices of sympathetic tone).

CONCLUSIONS

These effects suggest that HRV-BF, a novel behavioral neurocardiac intervention, could enhance BRS, improve the cardiac autonomic tone, and facilitate BP adjustment for individuals with prehypertension.