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An DW, Yu YL, Hara A, Martens DS, Yang WY, Cheng YB, Huang QF, Asayama K, Stolarz-Skrzypek K, Rajzer M, Verhamme P, Nawrot TS, Li Y, Staessen JA. Lead-associated mortality in the US 1999-2020: a time-stratified analysis of a national cohort. J Hypertens 2024; 42:1322-1330. [PMID: 38511337 PMCID: PMC11216377 DOI: 10.1097/hjh.0000000000003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/28/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES We undertook time-stratified analyses of the National Health and Nutrition Examination Survey in the US to assess time trends (1999-2020) in the associations of blood lead (BL) with blood pressure, mortality, the BL-associated population attributable fraction (PAF). METHODS Vital status of participants, 20-79 years old at enrolment, was ascertained via the National Death Index. Regressions, mediation analyses and PAF were multivariable adjusted and standardized to 2020 US Census data. RESULTS In time-stratified analyses, BL decreased from 1.76 μg/dl in 1999-2004 to 0.93 μg/dl in 2017-2020, while the proportion of individuals with BL < 1 μg/dl increased from 19.2% to 63.0%. Total mortality was unrelated to BL (hazard ratio (HR) for a fourfold BL increment: 1.05 [95% confidence interval, CI: 0.93-1.17]). The HR for cardiovascular death was 1.44 (1.01-2.07) in the 1999-2000 cycle, but lost significance thereafter. BL was directly related to cardiovascular mortality, whereas the indirect BL pathway via BP was not significant. Low socioeconomic status (SES) was directly related to BL and cardiovascular mortality, but the indirect SES pathway via BL lost significance in 2007-2010. From 1999-2004 to 2017-2020, cardiovascular PAF decreased ( P < 0.001) from 7.80% (0.17-14.4%) to 2.50% (0.05-4.68%) and number of lead-attributable cardiovascular deaths from 53 878 (1167-99 253) to 7539 (160-14 108). CONCLUSION Due to implementation of strict environmental policies, lead exposure is no longer associated with total mortality, and the mildly increased cardiovascular mortality is not associated with blood lead via blood pressure in the United States.
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Affiliation(s)
- De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Japan
| | - Dries S. Martens
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kei Asayama
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Kraków, Poland
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences
| | - Tim S. Nawrot
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jan A. Staessen
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine
- Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Wang J, Xu J, Yang L, Zhang Y, Wu R, Wang W, Gao C. Heart rate deceleration and acceleration capacities associated with circadian rhythm of blood pressure in essential hypertension. BMC Cardiovasc Disord 2024; 24:257. [PMID: 38760695 PMCID: PMC11100176 DOI: 10.1186/s12872-024-03933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This study aimed to investigate the potential association between the circadian rhythm of blood pressure and deceleration capacity (DC)/acceleration capacity (AC) in patients with essential hypertension. METHODS This study included 318 patients with essential hypertension, whether or not they were being treated with anti-hypertensive drugs, who underwent 24-hour ambulatory blood pressure monitoring (ABPM). Patients were categorized into three groups based on the percentage of nocturnal systolic blood pressure (SBP) dipping: the dipper, non-dipper and reverse dipper groups. Baseline demographic characteristics, ambulatory blood pressure monitoring parameters, Holter recordings (including DC and AC), and echocardiographic parameters were collected. RESULTS In this study, the lowest DC values were observed in the reverse dipper group, followed by the non-dipper and dipper groups (6.46 ± 2.06 vs. 6.65 ± 1.95 vs. 8.07 ± 1.79 ms, P < .001). Additionally, the AC gradually decreased (-6.32 ± 2.02 vs. -6.55 ± 1.95 vs. -7.80 ± 1.73 ms, P < .001). There was a significant association between DC (r = .307, P < .001), AC (r=-.303, P < .001) and nocturnal SBP decline. Furthermore, DC (β = 0.785, P = .001) was positively associated with nocturnal SBP decline, whereas AC was negatively associated with nocturnal SBP (β = -0.753, P = .002). By multivariate logistic regression analysis, deceleration capacity [OR (95% CI): 0.705 (0.594-0.836), p < .001], and acceleration capacity [OR (95% CI): 1.357 (1.141-1.614), p = .001] were identified as independent risk factors for blood pressure nondipper status. The analysis of ROC curves revealed that the area under the curve for DC/AC in predicting the circadian rhythm of blood pressure was 0.711/0.697, with a sensitivity of 73.4%/65.1% and specificity of 66.7%/71.2%. CONCLUSIONS Abnormal DC and AC density were correlated with a blunted decline in nighttime SBP, suggesting a potential association between the circadian rhythm of blood pressure in essential hypertension patients and autonomic nervous dysfunction.
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Affiliation(s)
- Jijing Wang
- Department of Cardiopulmonary Function, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, Henan, 450003, China
| | - Jinyi Xu
- Department of Cardiopulmonary Function, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, Henan, 450003, China
| | - Lihong Yang
- Department of Cardiopulmonary Function, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, Henan, 450003, China
| | - You Zhang
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, No. 1 Fuwai Road, Zhengzhou, Henan, 451464, China
| | - Rui Wu
- Department of Cardiopulmonary Function, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, No. 1 Fuwai Road, Zhengzhou, Henan, 451464, China
| | - Wentao Wang
- Department of Cardiopulmonary Function, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, No. 1 Fuwai Road, Zhengzhou, Henan, 451464, China
| | - Chuanyu Gao
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, No. 1 Fuwai Road, Zhengzhou, Henan, 451464, China.
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An DW, Li Y, Staessen JA. Action points for implementation of the lowest well-tolerated blood pressure. Eur J Intern Med 2024; 123:55-57. [PMID: 38433088 DOI: 10.1016/j.ejim.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- De-Wei An
- Non-Profit Research Association, Alliance for the Promotion of Preventive Medicine, Leopoldstraat 59, Mechelen BE-2800, Belgium; Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium; Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jan A Staessen
- Non-Profit Research Association, Alliance for the Promotion of Preventive Medicine, Leopoldstraat 59, Mechelen BE-2800, Belgium; Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Biomedical Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium.
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Lee J, Wang X, Liu C, Pathiravasan CH, Benjamin EJ, McManus DD, Murabito JM. Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:50-58. [PMID: 38765623 PMCID: PMC11096660 DOI: 10.1016/j.cvdhj.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. Objective To investigate the association between depressive symptoms and digital home BP. Methods Electronic Framingham Heart Study (eFHS) participants were invited to obtain a smartphone app and digital BP cuff at research exam 3 (2016-2019). Participants with ≥3 weeks of home BP measurements within 1 year were included. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear mixed models were used to test the associations of continuous CES-D score and dichotomous depressive symptoms (CES-D ≥16) (independent) with home BP (dependent), adjusting for age, sex, cohort, number of weeks since baseline, lifestyle factors, diabetes, and cardiovascular disease. Results Among 883 participants (mean age 54 years, 59% women, 91% White), the median CES-D score was 4. Depressive symptom prevalence was 7.6%. Mean systolic and diastolic BP at exam 3 were 119 and 76 mm Hg; hypertension prevalence was 48%. A 1 SD higher CES-D score was associated with 0.9 (95% CI: 0.18-1.56, P = .01) and 0.6 (95% CI: 0.06-1.07, P = .03) mm Hg higher home systolic BP and diastolic BP, respectively. Dichotomous depressive symptoms were not significantly associated with home BP (P > .2). Conclusion Depressive symptoms were not associated with clinically substantive levels of home BP. The association between depression and cardiovascular disease risk factors warrants more data, which may be supported by mobile health measures.
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Affiliation(s)
- Jasmine Lee
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Xuzhi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | | | - Emelia J. Benjamin
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - David D. McManus
- University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Joanne M. Murabito
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
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5
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Guo L, Tian F, Wang J, Xu W, Li W, Hou X, Zheng M, Yang X, Gao L, Chen S, Zhang N, Wu S. Effect of 10-year cumulative blood pressure exposure on atherosclerotic cardiovascular disease of different age groups: kailuan cohort study. Front Cardiovasc Med 2024; 11:1341097. [PMID: 38361586 PMCID: PMC10867219 DOI: 10.3389/fcvm.2024.1341097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Background The level at which cumulative blood pressure (BP) can increase the risk of ASCVD in different age groups remains unclear. This study aimed to investigate the association of 10-year cumulative BP levels with the long-term risk of ASCVD of different age groups. Methods Cumulative BP exposure was assessed using the time-weighted average (TWA) BP divided into four BP groups. The participants were also divided into four groups according to their baseline age (<50, 50-59, 60-69, or ≥70 years). The association between TWA BP and the risk of ASCVD was assessed by age group using multivariate Cox models. The China-PAR prediction model was used to assess the ability of TWA BP to predict ASCVD. Results In the group aged <50 years, the hazard ratios and 95% confidence intervals for the risk of ASCVD were 2.66 (1.04-6.80), 3.38 (1.54-7.43), and 3.13 (1.36-7.24) for the elevated BP, stage 1 hypertension, and stage 2 hypertension groups, respectively, when compared with the normal BP group. There was a significant difference in the risk of ASCVD between the age groups, with participants aged <50 years having the highest risk, followed by those aged 50-59, 60-69, and ≥70 years. Conclusions The risk of ASCVD with high cumulative BP exposure was age-dependent, with a gradual decrease in risk with increasing age.
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Affiliation(s)
- Lu Guo
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Faming Tian
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Jingyao Wang
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Wenqi Xu
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Wenjuan Li
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Xiaoli Hou
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Mengyi Zheng
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuemei Yang
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Lishu Gao
- Department of Endocrinology, Tangshan People’s Hospital, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Nan Zhang
- Department of Orthopedics, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
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An DW, Hansen TW, Aparicio LS, Chori B, Huang QF, Wei FF, Cheng YB, Yu YL, Sheng CS, Gilis-Malinowska N, Boggia J, Wojciechowska W, Niiranen TJ, Tikhonoff V, Casiglia E, Narkiewicz K, Stolarz-Skrzypek K, Kawecka-Jaszcz K, Jula AM, Yang WY, Woodiwiss AJ, Filipovský J, Wang JG, Rajzer MW, Verhamme P, Nawrot TS, Staessen JA, Li Y. Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis. Hypertension 2023; 80:1949-1959. [PMID: 37470187 PMCID: PMC10424824 DOI: 10.1161/hypertensionaha.123.21318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/08/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen). METHODS A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement. RESULTS In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome. CONCLUSIONS PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.
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Affiliation(s)
- De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
| | - Tine W. Hansen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- The Steno Diabetes Center Copenhagen, Herlev, and Center for Health, Capital Region of Denmark, Copenhagen (T.W.H.)
| | - Lucas S. Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A.)
| | - Babangida Chori
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Centre for Environmental Sciences, Hasselt University, Belgium (B.C., T.S.N.)
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Nigeria (B.C.)
| | - Qi-Fang Huang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Fang-Fei Wei
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (F.-F.W.)
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Natasza Gilis-Malinowska
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.)
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Teemu J. Niiranen
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | | | - Edoardo Casiglia
- Department of Medicine, University of Padova, Italy (V.T., E.C.)
| | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Antti M. Jula
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.)
- Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N., A.M.J.)
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, China (W.-Y.Y.)
| | - Angela J. Woodiwiss
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa (A.W.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
| | - Marek W. Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., M.R., K.K.-J)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (P.V.)
| | - Tim S. Nawrot
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Belgium (D.-W.A, Y.-L.Y., T.S.N.)
- Centre for Environmental Sciences, Hasselt University, Belgium (B.C., T.S.N.)
| | - Jan A. Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Belgium (D.-W.A, T.W.H, B.C., Y.-L.Y., J.A.S.)
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Belgium (J.A.S.)
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-W.A., Q.-F.H., Y. B.C., C. S.S., J. G.W., Y.L.)
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7
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Wang JG, Zhang W, Li Y, Liu L. Hypertension in China: epidemiology and treatment initiatives. Nat Rev Cardiol 2023; 20:531-545. [PMID: 36631532 DOI: 10.1038/s41569-022-00829-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.
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Affiliation(s)
- Ji-Guang Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wei Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
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8
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Wu J, Han X, Sun D, Zhang J, Li J, Qin G, Deng W, Yu Y, Xu H. Age-specific association of stage of hypertension at diagnosis with cardiovascular and all-cause mortality among elderly patients with hypertension: a cohort study. BMC Cardiovasc Disord 2023; 23:270. [PMID: 37221473 DOI: 10.1186/s12872-023-03250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Hypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses. METHODS This cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex. RESULTS 28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41-1.72) and 1.29(1.21-1.37) for males aged 60-69 years, 1.25(1.14-1.36) and 1.13(1.06-1.20) for males aged 70-85 years, 1.48(1.32-1.67) and 1.29(1.19-1.40) for females aged 60-69 years, and 1.19(1.10-1.29) and 1.08(1.01-1.15) for females aged 70-85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71-0.93 RERI: 0.59, 95% CI: 0.09-1.07) and females (HR: 0.81, 95% CI: 0.70-0.93 RERI: 0.66, 95% CI: 0.10-1.23). CONCLUSIONS Diagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60-69 years compared with those with age at diagnosis of 70-85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.
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Affiliation(s)
- Jingyi Wu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaojie Han
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Di Sun
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Jie Zhang
- Department of Public Health, Aarhus University, Aarhus, Denmark
- NCRR-National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Wei Deng
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- , 130 Dong'an Road, Shanghai, 200032, China.
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
- , 130 Dong'an Road, Shanghai, 200032, China.
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China.
- , 965 Zhong Yi Road, Shanghai, 201101, China.
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9
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Vinyoles E, Puig C, Roso-Llorach A, Soldevila N, de la Sierra A, Gorostidi M, Segura J, Divison-Garrote JA, Muñoz MÁ, Ruilope LM. Role of ambulatory blood pressure on prediction of cardiovascular disease. A cohort study. J Hum Hypertens 2023; 37:279-285. [PMID: 35338244 DOI: 10.1038/s41371-022-00679-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/19/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Ambulatory blood pressure (BP) is associated with mortality, but it is also interesting to expand its association with cardiovascular morbidity. This study sought to evaluate association with cardiovascular morbidity and cardiovascular mortality. Patients without cardiovascular disease who had a first 24-hour ambulatory BP monitoring were followed-up until the onset of the first event (a combined variable of cardiovascular mortality, coronary heart disease, cerebrovascular disease, peripheral arteriopathy, or hospital admission for heart failure). Changes in antihypertensive treatment couldn't be collected. Cox regression analysis was adjusted for risk factors and office BP. We included 3907 patients (mean age, 58.0, SD 13.8 years), of whom 85.5% were hypertensive. The follow up period was 6.6 (95% CI 5.0-8.5) years. A total of 496 (12.7%) events were recorded. The incidence rate was 19.3 (95% CI 17.7-21.1) cases per 1000 person-years. The patients with an event compared to the rest of patients were mostly men, older, with higher office and ambulatory systolic BP, higher prevalence of diabetes, chronic kidney disease, dyslipidemia, and non-dipper or riser circadian profile. In the fully adjusted model, office BP loses its significant association with the main variable. Ambulatory BP association remained significant with cardiovascular morbidity and mortality, HR 1.494 (1.326-1.685) and 0.767 (0.654-0.899) for 24-hour systolic and diastolic BP, respectively. Nighttime systolic BP also maintained this significant association, 1.270 (1.016-1.587). We conclude that nighttime systolic BP and 24-hour BP are significantly associated with cardiovascular events and cardiovascular mortality in patients without cardiovascular disease attended under conditions of routine clinical practice.
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Affiliation(s)
- Ernest Vinyoles
- La Mina Primary Care Center, University of Barcelona, Barcelona, Spain.
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain.
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain.
| | - Clara Puig
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
| | - Albert Roso-Llorach
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain
| | - Núria Soldevila
- La Mina Primary Care Center, University of Barcelona, Barcelona, Spain
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
| | | | - Manuel Gorostidi
- Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julián Segura
- Hypertension Unit, Doce de Octubre Hospital, Madrid, Spain
| | | | - Miguel-Ángel Muñoz
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
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10
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What did we learn from the International Databases on Ambulatory and Home Blood Pressure in Relation to Cardiovascular Outcome? Hypertens Res 2023; 46:934-949. [PMID: 36737461 PMCID: PMC10073019 DOI: 10.1038/s41440-023-01191-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
To assess in individual-person meta-analyses how out-of-office blood pressure (BP) contributes to risk stratification and the management of hypertension, an international consortium set up the International Databases on Ambulatory (IDACO) and Home (IDHOCO) Blood Pressure in Relation to Cardiovascular Outcome. This review summarizes key findings of recent IDACO/IDHOCO articles. Among various BP indexes derived from office and ambulatory BP recordings, the 24-h and nighttime BP level were the best predictors of adverse health outcomes. Second, using the 10-year cardiovascular risk associated with guideline-endorsed office BP thresholds as reference, corresponding thresholds were derived for home and ambulatory BP. Stratified by the underlying cardiovascular risk, the rate of cardiovascular events in white-coat hypertensive patients and matched normotensive controls were not substantially different. The observation that masked hypertension carries a high cardiovascular risk was replicated in Nigerian Blacks, using home BP monitoring. The thresholds for 24-h mean arterial pressure, i.e., the BP component measured by oscillometric devices, delineating normotension, elevated BP and hypertension were <90, 90 to 92 and ≥92 mmHg. At young age, the absolute risk associated with out-of-office BP was low, but the relative risk was high, whereas with advancing age, the relative risk decreased and the absolute risk increased. Using pulse pressure as an exemplary case, the relative risks of death, cardiovascular endpoints and stroke decreased over 3-fold from 55 to 75 years of age, whereas in contrast absolute risk rose 3-fold. In conclusion, IDACO/IDHOCO forcefully support the notion that the pressing need to curb the hypertension pandemic cannot be met without out-of-the-office BP monitoring.
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11
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Guo QH, Liu CH, Wang JG. Blood Pressure Goals in Acute Stroke. Am J Hypertens 2022; 35:483-499. [PMID: 35323883 PMCID: PMC9203067 DOI: 10.1093/ajh/hpac039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 01/27/2023] Open
Abstract
Antihypertensive treatment is highly effective in both primary and secondary prevention of stroke. However, current guideline recommendations on the blood pressure goals in acute stroke are clinically empirical and generally conservative. Antihypertensive treatment is only recommended for severe hypertension. Several recent observational studies showed that the relationship between blood pressure and unfavorable clinical outcomes was probably positive in acute hemorrhagic stroke but J- or U-shaped in acute ischemic stroke with undetermined nadir blood pressure. The results of randomized controlled trials are promising for blood pressure management in hemorrhagic stroke but less so in ischemic stroke. A systolic blood pressure goal of 140 mm Hg is probably appropriate for acute hemorrhagic stroke. The blood pressure goal in acute ischemic stroke, however, is uncertain, and probably depends on the time window of treatment and the use of revascularization therapy. Further research is required to investigate the potential benefit of antihypertensive treatment in acute stroke, especially with regard to the possible reduction of blood pressure variability and more intensive blood pressure lowering in the acute and subacute phases of a stroke, respectively.
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Affiliation(s)
- Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chu-Hao Liu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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12
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The association between rheumatoid arthritis and cardiovascular disease among adults in the United States during 1999-2018, and age-related effect modification in relative and absolute scales. Ann Epidemiol 2022; 71:23-30. [PMID: 35301105 DOI: 10.1016/j.annepidem.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore the rheumatoid arthritis (RA)-cardiovascular diseases (CVD) association in relative and absolute risk scales among US adults aged ≥20 years over time and the effect modification of the association by age. METHODS We analyzed aggregated data from all ten continuous National Health and Nutrition Examination Survey cycles. A sample of 43,184 complete-case subjects was considered. The design-based regressions were used to investigate the associations in relative and absolute scales. RESULTS In relative scale, the CVD odds ratio was 2.32, 2.19, and 1.97 among adults with RA than no arthritis in 1999-2006, 2007-2012, and 2013-2018 cycles, respectively. This time trend was not statistically significant. The absolute risk estimates were 11, 10, and 9 per 100 CVD events. We also observed a significant effect modification by age; the higher relative risk among younger adults (<50 years) with RA and higher absolute risk in older adults (≥80 years) with RA were consistent across survey cycles. CONCLUSIONS There is a significant association between RA and CVD among US adults in both relative and absolute risks. Moreover, age is a significant effect modifier for this association; but with opposing age-related trends in relative and absolute scales.
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13
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Ambulatory blood pressure monitoring for the management of hypertension. Chin Med J (Engl) 2022; 135:1027-1035. [PMID: 35202040 PMCID: PMC9276356 DOI: 10.1097/cm9.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ambulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.
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14
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Aparicio LS, Huang QF, Melgarejo JD, Wei DM, Thijs L, Wei FF, Gilis-Malinowska N, Sheng CS, Boggia J, Niiranen TJ, Odili AN, Stolarz-Skrzypek K, Barochiner J, Ackermann D, Kawecka-Jaszcz K, Tikhonoff V, Zhang ZY, Casiglia E, Narkiewicz K, Filipovský J, Schutte AE, Yang WY, Jula AM, Woodiwiss AJ, Bochud M, Norton GR, Wang JG, Li Y, Staessen JA. The International Database of Central Arterial Properties for Risk Stratification: Research Objectives and Baseline Characteristics of Participants. Am J Hypertens 2022; 35:54-64. [PMID: 34505630 PMCID: PMC8730480 DOI: 10.1093/ajh/hpab139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th-95th percentile interval, 1.3-12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension.
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Affiliation(s)
- Lucas S Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Qi-Fang Huang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Fang-Fei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Natasza Gilis-Malinowska
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Chang-Sheng Sheng
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Teemu J Niiranen
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland
- Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Augustine N Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jessica Barochiner
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Ackermann
- Clinic for Nephrology and Hypertension, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), South African Medical Research Council and Unit of Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Wen-Yi Yang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Antti M Jula
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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15
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An DW, Muhammad IF, Li MX, Borné Y, Sheng CS, Persson M, Cai RZ, Guo QH, Wang JG, Engström G, Li Y, Nilsson PM. Carotid-Femoral Pulse Transit Time Variability Predicted Mortality and Improved Risk Stratification in the Elderly. Hypertension 2021; 78:1287-1295. [PMID: 34565183 DOI: 10.1161/hypertensionaha.121.17891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Iram Faqir Muhammad
- Department of Clinical Science, Lund University, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.)
| | - Ming-Xuan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Yan Borné
- Department of Clinical Science, Lund University, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.)
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Margaretha Persson
- Department of Clinical Science, Lund University, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.)
| | - Ren-Zhi Cai
- Division of Health Information, Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, China (R.-Z.C.)
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Gunnar Engström
- Department of Clinical Science, Lund University, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.)
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (D.-W.A., M.-X.L., C.-S.S., Q.-H.G., J.-G.W., Y.L.)
| | - Peter M Nilsson
- Department of Clinical Science, Lund University, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (I.F.M., Y.B., M.P., G.E., P.M.N.)
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Melgarejo JD, Thijs L, Wei DM, Bursztyn M, Yang WY, Li Y, Asayama K, Hansen TW, Kikuya M, Ohkubo T, Dolan E, Stolarz-Skrzypek K, Cheng YB, Tikhonoff V, Malyutina S, Casiglia E, Lind L, Sandoya E, Filipovský J, Narkiewicz K, Gilis-Malinowska N, Kawecka-Jaszcz K, Boggia J, Wang JG, Imai Y, Verhamme P, Trenson S, Janssens S, O’Brien E, Maestre GE, Gavish B, Staessen JA, Zhang ZY. Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor. Am J Hypertens 2021; 34:929-938. [PMID: 33687055 PMCID: PMC8457427 DOI: 10.1093/ajh/hpab048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. METHODS In 4,663 young (18-49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints. RESULTS In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. CONCLUSIONS From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.
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Affiliation(s)
- Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Michael Bursztyn
- Faculty of Medicine, Hebrew University, Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Tine W Hansen
- Steno Diabetes Center Copenhagen, Gentofte and Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Eamon Dolan
- Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Yi-Bang Cheng
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | | | | | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Janssens
- Division of Cardiology, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Dublin, Ireland
| | - Gladys E Maestre
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
- Department of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
- Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
- Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | | | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Thijs L, Asayama K, Maestre GE, Hansen TW, Buyse L, Wei DM, Melgarejo JD, Brguljan-Hitij J, Cheng HM, de Souza F, Gilis-Malinowska N, Kawecka-Jaszcz K, Mels C, Mokwatsi G, Muxfeldt ES, Narkiewicz K, Odili AN, Rajzer M, Schutte AE, Stolarz-Skrzypek K, Tsai YW, Vanassche T, Vanholder R, Zhang ZY, Verhamme P, Kruger R, Mischak H, Staessen JA. Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial: rational and protocol. Blood Press 2021; 30:269-281. [PMID: 34461803 PMCID: PMC9412130 DOI: 10.1080/08037051.2021.1952061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypertension and diabetes cause chronic kidney disease (CKD) and diastolic left ventricular dysfunction (DVD) as forerunners of disability and death. Home blood pressure telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling prevention. METHODS UPRIGHT-HTM (Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform [NCT04299529]) is an investigator-initiated 5-year clinical trial with patient-centred design, which will randomise 1148 patients to be recruited in Europe, sub-Saharan Africa and South America. During the whole study, HTM data will be collected and freely accessible for patients and caregivers. The UPP, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention), but only at trial closure in 50% (control). The hypothesis is that early knowledge of the UPP risk profile will lead to more rigorous risk factor management and result in benefit. Eligible patients, aged 55-75 years old, are asymptomatic, but have ≥5 CKD- or DVD-related risk factors, preferably including hypertension, type-2 diabetes, or both. The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Demonstrating that combining UPP with HTM is feasible in a multicultural context and defining the molecular signatures of early CKD and DVD are secondary endpoints. EXPECTED OUTCOMES The expected outcome is that application of UPP on top of HTM will be superior to HTM alone in the prevention of CKD and DVD and associated complications and that UPP allows shifting emphasis from treating to preventing disease, thereby empowering patients.
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Affiliation(s)
- Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Gladys E Maestre
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Tine W Hansen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Luk Buyse
- Sports Medicine, Brussels Health Campus, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jana Brguljan-Hitij
- Department of Internal Medicine, Division of Hypertension, University Medical Centre, Ljubljana, Slovenia
| | - Hao-Min Cheng
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Fabio de Souza
- Cardiology Section, Department of Specialized Medicine, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Carina Mels
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Gontse Mokwatsi
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Elisabeth S Muxfeldt
- Department of Internal Medicine, Hypertension Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Augustine N Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Yi-Wen Tsai
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Thomas Vanassche
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.,Department of Nephrology, University Hospital Ghent, Ghent, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruan Kruger
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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19
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Body Mass Index Trajectories during 6-18 Years Old and the Risk of Hypertension in Young Adult: A Longitudinal Study in Chinese Population. Int J Hypertens 2021; 2021:6646868. [PMID: 34327015 PMCID: PMC8302370 DOI: 10.1155/2021/6646868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Overweight/obesity in childhood is suggested to increase the risk of hypertension later in life. We aimed to assess whether and how body mass index (BMI) trajectories during 6–18 years of age are associated with hypertension in young adulthood (18–37 years) in the Chinese population. Methods Based on the China Health and Nutrition Survey (CHNS), a total of 1,872 participants who received ≥2 measurements of BMI during 6–18 years and had assessment of blood pressure (BP) in young adulthood were included. BMI trajectories were explored using latent class growth mixture models, and associations between identified trajectories with hypertension in young adulthood were examined by logistic regression analyses. Results Five heterogeneous BMI trajectories were identified: the low slow-increasing (20.03%), low moderate-increasing (56.14%), low rapid-increasing (17.04%), moderate-increasing (3.63%), and elevated-decreasing (3.15%) groups. Compared with the low slow-increasing group, another three increasing groups had gradually elevated risk of hypertension, yielding maximally adjusted odds ratio (95% confidence interval) (OR (95% CI)) of 2.48 (1.39–4.42), 3.24 (1.66–6.31), and 3.28 (1.19–9.08), respectively, whereas the elevated-decreasing group reversed overweight/obesity to normal weight in childhood, rendering its association with hypertension as not statistically significant (OR (95% CI) = 2.74 (0.98–7.65)). Conclusion Our study indicates that there are varied BMI trajectories from childhood to adulthood and that an elevated BMI trajectory during childhood is related with an increased risk of hypertension in young adulthood. In contrast, weight loss of children with high initial BMI may mitigate or reverse the risk. Our findings emphasize the importance of BMI continuous monitoring during early life.
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20
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Messerli FH, Brguljan J, Rexhaj E, Sever P, Pocock S, Taddei S. Lowering systolic blood pressure to 120 mmHg or The Lancet's true grit. Eur Heart J 2021; 42:2052-2059. [PMID: 34062560 DOI: 10.1093/eurheartj/ehab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Franz H Messerli
- Swiss Cardiovascular Center, University of Bern, Inselspital, Freiburgstrasse, Bern 3010, Switzerland.,Departement for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Jana Brguljan
- University Medical Centre Ljubljana, Department of Hypertension, University of Ljubljana, Faculty of Medicine, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Emrush Rexhaj
- Swiss Cardiovascular Center, University of Bern, Inselspital, Freiburgstrasse, Bern 3010, Switzerland.,University Medical Centre Ljubljana, Department of Hypertension, University of Ljubljana, Faculty of Medicine, Vodnikova 62, 1000 Ljubljana, Slovenia
| | - Peter Sever
- Imperial College London, National Heart & Lung Institute, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56126, Italy
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21
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Zhang W, Liu CY, Ji LN, Wang JG. Age-stratified association of blood pressure with albuminuria and left ventricular hypertrophy in patients with hypertension and diabetes mellitus. Blood Press 2021; 30:180-187. [PMID: 33622108 DOI: 10.1080/08037051.2021.1889967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We investigated associations of blood pressure (BP) with albuminuria and left ventricular hypertrophy (LVH) in young, middle and older aged patients with hypertension and/or diabetes mellitus. MATERIALS & METHODS Study participants were treated patients with hypertension or diabetes, enrolled in a China nationwide registry. The 2510 patients were classified into young (<45 years, n = 345), middle (45-64 years, n = 1383) and older (≥65 years, n = 782) age groups. Clinic BP was measured three times consecutively on each of the two clinic visits. These six readings were averaged for analyses. Albuminuria was defined as a urinary albumin-to-creatinine ratio of ≥30 mg/g. LVH was assessed by the electrocardiogram (ECG) Cornell product and voltage methods. RESULTS The prevalence of albuminuria and ECG-LVH was 17.8 and 6.5%, respectively. Mean (±SD) systolic/diastolic BP was 132.0 ± 16.5/85.2 ± 11.9 mmHg, 136.8 ± 17.9/81.7 ± 11.2 mmHg, and 139.8 ± 16.7/75.8 ± 10.4 mmHg in the young, middle and older age groups. In the young age group, the prevalence of albuminuria increased from 8.8% in systolic/diastolic BP <120/80 mmHg to 14.6, 16.0% and 16.5% in 120-129/80-84, 130-139/85-89 and ≥140/90 mmHg, respectively. The corresponding values were 8.9, 7.0, 18.1 and 22.2%, respectively, in the middle age group, and 21.2, 15.5, 16.4 and 24.4%, respectively, in the older age group. Adjusted analyses confirmed the J-shaped relation between BP and albuminuria in the older but not young age group. The prevalence of ECG-LVH was significantly (p for trend ≤0.04) higher with increasing BP similarly in all age groups. CONCLUSIONS The association between BP and organ damage seems to differ in young, middle and older aged patients for albuminuria but not ECG-LVH.
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Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Shanghai, China.,Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Yuan Liu
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Shanghai, China.,Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li-Nong Ji
- Department of Endocrinology, Renmin Hospital, Peking University, Beijing, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Shanghai, China.,Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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22
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Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality. J Am Coll Cardiol 2021; 75:2921-2930. [PMID: 32527401 DOI: 10.1016/j.jacc.2020.04.038] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The relations of hypertension onset age with cardiovascular diseases (CVD) and all-cause mortality remain inconclusive. OBJECTIVES This study sought to examine the associations of hypertension onset age with CVD and all-cause mortality. METHODS This prospective study included 71,245 participants free of hypertension and CVD in the first survey (July 2006 to October 2007) of the Kailuan study, a prospective cohort study in Tangshan, China. All participants were followed biennially until December 31, 2017. A total of 20,221 new-onset hypertension cases were identified during follow-up. We randomly selected 1 control participant for each new-onset hypertensive participant, matching for age (±1 year) and sex, and included 19,887 case-control pairs. We used weighted Cox regression models to calculate the average hazard ratios of incident CVD and all-cause mortality across the age groups. RESULTS During an average follow-up of 6.5 years, we identified 1,672 incident CVD cases and 2,008 deaths. After multivariate adjustment, with the increase in hypertension onset age, the hazards of outcomes were gradually attenuated. The average hazard ratio (95% confidence interval) of CVD and all-cause mortality were 2.26 (1.19 to 4.30) and 2.59 (1.32 to 5.07) for the hypertension onset age <45 years old group, 1.62 (1.24 to 2.12) and 2.12 (1.55 to 2.90) for the 45- to 54-year age group, 1.42 (1.12 to 1.79) and 1.30 (1.03 to 1.62) for the 55- to 64-year age group, and 1.33 (1.04 to 1.69) and 1.29 (1.11 to 1.51) for the ≥65-year age group, respectively (p for interaction = 0.38 for CVD and <0.01 for death). CONCLUSIONS Hypertension was associated with a higher risk for CVD and all-cause mortality, and the associations were stronger with a younger age of onset.
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Huang QF, Yang WY, Asayama K, Zhang ZY, Thijs L, Li Y, O'Brien E, Staessen JA. Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension. Hypertension 2021; 77:254-264. [PMID: 33390042 PMCID: PMC7803442 DOI: 10.1161/hypertensionaha.120.14591] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.
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Affiliation(s)
- Qi-Fang Huang
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital (W.-Y.Y), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A.).,Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.).,Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Yan Li
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eoin O'Brien
- Conway Institute, University College Dublin, Ireland (E.O.B.)
| | - Jan A Staessen
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S).,Research Institute Alliance for the Promotion of Preventive Medicine (www.appremed.org), Mechelen, Belgium (J.A.S)
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24
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Melgarejo JD, Yang WY, Thijs L, Li Y, Asayama K, Hansen TW, Wei FF, Kikuya M, Ohkubo T, Dolan E, Stolarz-Skrzypek K, Huang QF, Tikhonoff V, Malyutina S, Casiglia E, Lind L, Sandoya E, Filipovský J, Gilis-Malinowska N, Narkiewicz K, Kawecka-Jaszcz K, Boggia J, Wang JG, Imai Y, Vanassche T, Verhamme P, Janssens S, O’Brien E, Maestre GE, Staessen JA, Zhang ZY. Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure. Hypertension 2021; 77:39-48. [PMID: 33296250 PMCID: PMC7720872 DOI: 10.1161/hypertensionaha.120.14929] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023]
Abstract
Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80-1.16), 1.32 (1.15-1.51), and 1.77 (1.59-1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk (P<0.001). Considering the 24-hour measurements, R2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.
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Affiliation(s)
- Jesus D. Melgarejo
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela (J.D.M., G.E.M)
| | - Wen-Yi Yang
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (W.-Y.Y.)
| | - Lutgarde Thijs
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., Q.-F.H., J.-G.W.)
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., M.K., T.O.)
- Tohoku Institute for Management of Blood Pressure (K.A., T.O., Y.I.)
| | - Tine W. Hansen
- Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark (T.W.H.)
| | - Fang-Fei Wei
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., M.K., T.O.)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., M.K., T.O.)
- Tohoku Institute for Management of Blood Pressure (K.A., T.O., Y.I.)
| | - Eamon Dolan
- Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland (E.D.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., K.K.-J.)
| | - Qi-Fang Huang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., Q.-F.H., J.-G.W.)
| | | | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation (S.M.)
| | - Edoardo Casiglia
- Department of Medicine, University of Padova, Italy (V.T., E.C.)
| | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Sweden (L.L.)
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | | | - Krzysztof Narkiewicz
- Department of Hypertension, Medical University of Gdańsk, Poland (N.G.-M., K.N.)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., K.K.-J.)
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., Q.-F.H., J.-G.W.)
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure (K.A., T.O., Y.I.)
| | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V., P.V.)
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V., P.V.)
| | - Stefan Janssens
- Division of Cardiology, Department of Internal Medicine, University Hospitals Leuven, Belgium (S.J.)
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Ireland (E.O.)
| | - Gladys E. Maestre
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela (J.D.M., G.E.M)
- Department of Medicine, University of Padova, Italy (V.T., E.C.)
- Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville (G.E.M.)
| | - Jan A. Staessen
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.)
| | - Zhen-Yu Zhang
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.)
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Wei FF, Raaijmakers A, Melgarejo JD, Cauwenberghs N, Thijs L, Zhang ZY, Yu CG, Levtchenko E, Struijker-Boudier HAJ, Yang WY, Kuznetsova T, Kennedy S, Verhamme P, Allegaert K, Staessen JA. Retinal and Renal Microvasculature in Relation to Central Hemodynamics in 11-Year-Old Children Born Preterm or At Term. J Am Heart Assoc 2020; 9:e014305. [PMID: 32750311 PMCID: PMC7792278 DOI: 10.1161/jaha.119.014305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Prematurity disrupts the perinatal maturation of the microvasculature and macrovasculature and confers high risk of vascular dysfunction later in life. No previous studies have investigated the crosstalk between the microvasculature and macrovasculature in childhood. Methods and Results In a case-control study, we enrolled 55 children aged 11 years weighing <1000 g at birth and 71 matched controls (October 2014-November 2015). We derived central blood pressure (BP) wave by applanation tonometry and calculated the forward/backward pulse waves by an automated pressure-based wave separation algorithm. We measured the renal resistive index by pulsed wave Doppler and the central retinal arteriolar equivalent by computer-assisted program software. Compared with controls, patients had higher central systolic BP (101.5 versus 95.2 mm Hg, P<0.001) and backward wave amplitude (15.5 versus 14.2 mm Hg, P=0.029), and smaller central retinal arteriolar equivalent (163.2 versus 175.4 µm, P<0.001). In multivariable analyses, central retinal arteriolar equivalent was smaller with higher values (+1 SD) of central systolic BP (-2.94 µm; 95% CI, -5.18 to -0.70 µm [P=0.011]) and forward (-2.57 µm; CI, -4.81 to -0.32 µm [P=0.026]) and backward (-3.20 µm; CI, -5.47 to -0.94 µm [P=0.006]) wave amplitudes. Greater renal resistive index was associated with higher backward wave amplitude (0.92 mm Hg, P=0.036). Conclusions In childhood, prematurity compared with term birth is associated with higher central systolic BP and forward/backward wave amplitudes. Higher renal resistive index likely moves reflection points closer to the heart, thereby explaining the inverse association of central retinal arteriolar equivalent with central systolic BP and backward wave amplitude. These observations highlight the crosstalk between the microcirculation and macrocirculation in children. Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT02147457.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.,Center for Molecular and Vascular Biology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.,Department of Cardiology the First Affiliated Hospital of Sun Yat-Sen University Guangzhou Guangdong China
| | - Anke Raaijmakers
- KU Leuven Department of Development and Regeneration University of Leuven Belgium
| | - Jesus D Melgarejo
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | - Nicholas Cauwenberghs
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | - Cai-Guo Yu
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.,Department of Endocrinology Beijing Luhe Hospital and Key Laboratory of Diabetes Prevention and Research Capital Medical University Beijing China
| | | | - Harry A J Struijker-Boudier
- Department of Pharmacology Maastricht University Maastricht The Netherlands.,Cardiovascular Research Institute MaastrichtMaastricht University Maastricht The Netherlands
| | - Wen-Yi Yang
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.,Department of Cardiology Shanghai General HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Tatiana Kuznetsova
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | | | - Peter Verhamme
- Center for Molecular and Vascular Biology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium
| | - Karel Allegaert
- KU Leuven Department of Development and Regeneration University of Leuven Belgium.,Department of Clinical Pharmacy Erasmus MC Rotterdam The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.,Cardiovascular Research Institute MaastrichtMaastricht University Maastricht The Netherlands.,NPA Alliance for the Promotion of Preventive Medicine Mechelen Belgium
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26
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Staessen JA, Thijs L, Yang WY, Yu CG, Wei FF, Roels HA, Nawrot TS, Zhang ZY. Interpretation of Population Health Metrics: Environmental Lead Exposure as Exemplary Case. Hypertension 2020; 75:603-614. [PMID: 32008462 PMCID: PMC8032208 DOI: 10.1161/hypertensionaha.119.14217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Our objective was to gain insight in the calculation and interpretation of population health metrics that inform disease prevention. Using as model environmental exposure to lead (ELE), a global pollutant, we assessed population health metrics derived from the Third National Health and Nutrition Examination Survey (1988 to 1994), the GBD (Global Burden of Disease Study 2010), and the Organization for Economic Co-operation and Development. In the National Health and Nutrition Examination Survey, the hazard ratio relating mortality over 19.3 years of follow-up to a blood lead increase at baseline from 1.0 to 6.7 µg/dL (10th–90th percentile interval) was 1.37 (95% CI, 1.17–1.60). The population-attributable fraction of blood lead was 18.0% (10.9%–26.1%). The number of preventable ELE-related deaths in the United States would be 412 000 per year (250 000–598 000). In GBD 2010, deaths and disability-adjusted life-years globally lost due to ELE were 0.67 million (0.58–0.78 million) and 0.56% (0.47%–0.66%), respectively. According to the 2017 Organization for Economic Co-operation and Development statistics, ELE-related welfare costs were $1 676 224 million worldwide. Extrapolations from the foregoing metrics assumed causality and reversibility of the association between mortality and blood lead, which at present-day ELE levels in developed nations is not established. Other issues limiting the interpretation of ELE-related population health metrics are the inflation of relative risk based on outdated blood lead levels, not differentiating relative from absolute risk, clustering of risk factors and exposures within individuals, residual confounding, and disregarding noncardiovascular disease and immigration in national ELE-associated welfare estimates. In conclusion, this review highlights the importance of critical thinking in translating population health metrics into cost-effective preventive strategies.
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Affiliation(s)
- Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands (J.A.S.).,NPA Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.)
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Wen-Yi Yang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (W.-Y.Y.)
| | - Cai-Guo Yu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Endocrinology, Beijing Lu He Hospital and Key Laboratory of Diabetes Prevention and Research, Capital Medical University, China (C.-G.Y.)
| | - Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Harry A Roels
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Zhen-Yu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
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