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Tsai KZ, Chu CC, Huang WC, Sui X, Lavie CJ, Lin GM. Prediction of various insulin resistance indices for the risk of hypertension among military young adults: the CHIEF cohort study, 2014-2020. Cardiovasc Diabetol 2024; 23:141. [PMID: 38664804 PMCID: PMC11046748 DOI: 10.1186/s12933-024-02229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Non-insulin-based insulin resistance (NI-IR) indices have been reported to have an association with prevalent hypertension, however, no cohort studies to date have compared their prediction of hypertension among young adults. METHODS A total of 2,448 military men and women, aged 18-39 years, without baseline hypertension in Taiwan were followed for incident hypertension events from 2014 until the end of 2020. All subjects underwent annual health examinations including measurements of blood pressure (BP) in mmHg. Systolic BP (SBP) 130-139/diastolic BP (DBP) < 80, SBP < 130/DBP 80-89, and SBP 130-139/DBP 80-89 were respectively defined as stage I isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined hypertension (CH). The cut-off levels of stage II hypertension for SBP and DBP were 140-159 and 90-99, respectively. Four NI-IR indices included the ratio of serum triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), TyG index defined as ln[TG* fasting glucose (FG)/2], Metabolic Score for IR (METS-IR) defined as ln[(2* FG) + TG)* body mass index (BMI)/(ln(HDL-C))], and ZJU index defined as BMI + FG + TG + 3* alanine transaminase/aspartate transaminase (+ 2 if female). Multivariable Cox regression analysis was performed with adjustments for baseline age, sex, body mass index, BP, substance use, family history for early onset cardiovascular diseases or hypertension, low-density lipoprotein cholesterol, kidney function, serum uric acid and physical activity to determine the associations. RESULTS During a median follow-up of 6.0 years, there were 920 hypertension events (37.6%). Greater TyG, TG/HDL-C and METS-IR indices were associated with a higher risk of stage I IDH (hazard ratios (HRs) and 95% confidence intervals: 1.376 (1.123-1.687), 1.082 (1.039-1.127) and 3.455 (1.921-6.214), respectively), whereas only greater ZJU index was associated with a higher risk of stage II IDH [HRs: 1.011 (1.001-1.021)]. In addition, greater ZJU index was associated with a higher risk of stage II ISH [HR: 1.013 (1.003-1.023)], and greater TyG index was associated with a higher risk of stage II CH [HR: 2.821 (1.244-6.395)]. CONCLUSION Insulin resistance assessed by various NI-IR indices was associated with a higher risk of hypertension in young adults, while the assessment ability for specific hypertension category may differ by NI-IR indices.
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Affiliation(s)
- Kun-Zhe Tsai
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jinfeng St, Hualien City, 970, Taiwan
- Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Chen-Chih Chu
- Department of Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chun Huang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jinfeng St, Hualien City, 970, Taiwan.
- Department of Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
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Shi Z, D Langleben D, Rott D, Albanese M, Elman I. Blood pressure response to extended-release naltrexone in heroin and prescription opioid users and its implications for cardiovascular morbidity. J Addict Dis 2024:1-11. [PMID: 38555861 DOI: 10.1080/10550887.2024.2327739] [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] [Indexed: 04/02/2024]
Abstract
BACKGROUND Consuming opioid agonists is a risk factor for cardiovascular disease particularly in intravenous heroin users. The monthly injectable extended-release opioid antagonist, naltrexone (XR-NTX) is an effective treatment for opioid use disorder. The impact of opioid receptor blockade through XR-NTX on blood pressure, a critical risk factor for cardiovascular morbidity, has not yet been characterized. METHODS The study evaluated the change in blood pressure during XR-NTX treatment among 14 patients who predominately used intravenous heroin and 24 patients who used prescription oral opioids, all with opioid use disorder. Blood pressure was measured in each patient immediately before the first XR-NTX injection and ∼two weeks after the first injection. The change in diastolic and systolic pressure was compared between the heroin users and the prescription opioids users using analysis of variance. RESULTS XR-NTX treatment was associated with significant decreases in diastolic blood pressure in the heroin group, but not in the prescription opioids group. Systolic blood pressure values in the heroin users showed a decline at trend level only. CONCLUSIONS Further research is warranted to replicate our findings and to determine whether XR-NTX effect is relatively specific to blood pressure or generalizes to other components of metabolic syndrome. Distinguishing between heroin and prescription opioid users could shed light on the unique clinical and pharmacological profiles of opioid drugs, particularly regarding their cardiovascular safety. This information can be useful in developing personalized therapeutic strategies based on the route of opioid administration.
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Affiliation(s)
- Zhenhao Shi
- Department of Psychiatry, Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel D Langleben
- Department of Psychiatry, Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Rott
- Department of Cardiology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Mark Albanese
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
- Physician Health Services, Massachusetts Medical Society, Waltham, MA, USA
| | - Igor Elman
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
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周 亚, 熊 海, 钟 怀, 万 洋, 张 玉. [Prevalence and Influencing Factors of Isolated Diastolic Hypertension in Tibetan Population in Tibet]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:360-366. [PMID: 38645841 PMCID: PMC11026888 DOI: 10.12182/20240360501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 04/23/2024]
Abstract
Objective To investigate the prevalence and influencing factors of isolated diastolic hypertension (IDH) in the Tibetan population in Tibet and to provide some evidence for the prevention and control of hypertension and other related diseases in high-altitude areas. Methods A multistage stratified whole-group random sampling method was used to enroll participants from Ngari Prefecture, Nagqu City, Shannan City, and Lhasa City, Tibet. A total of 3918 native Tibetans with complete data were enrolled in the survey between June 2020 and August 2023. The participants were aged from 18 to 80. The demographic data, life habits, and chronic disease prevalence of the participants were collected. Fasting venous blood samples were collected to perform the routine blood tests and blood biochemistry tests. The prevalence of IDH in subgroups with different characteristics was analyzed and the influencing factors were analyzed by multivariate logistic regression, accordingly. The predictive value of influencing factors on the prevalence of IDH was analyzed by the receiver operating characteristic (ROC) curve and the findings were compared with those of the previous prediction models for IDH. Results The prevalence of hypertension in the participants was 33.7% (n=1321), among which, 395 had IDH, accounting for 29.9% of the hypertensive patients. The results of multivariate regression showed that age, heart rate, body mass index, waist circumference, hemoglobin, and low-density lipoprotein cholesterol were associated with risks of developing IDH (P<0.05). The area under the ROC curve (AUC) was 0.71, which indicated improved accuracy for predicting the risks for IDH in comparison with previous predictive models for IDH. Among the influencing factors, BMI showed the best predictive value for IDH risks. Conclusion The prevalence of IDH is high among Tibetans in Tibet, suggesting the necessity for rational allocation of health resources in accordance. Compared with the previous IDH prediction models, the model proposed in this study is more suited for the Tibetan population. Targeted interventions should be carried out for the high-risk populations, such as young and middle-aged adults and populations suffering from overweight/obesity, central obesity, high-altitude polycythemia, and dyslipidemia, so as to effectively control the occurrence and development of IDH.
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Affiliation(s)
- 亚希 周
- 四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 (成都 610041)Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 海 熊
- 四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 (成都 610041)Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 西藏大学医学院 (拉萨 850000)Medical College of Tibet University, Lhasa 850000, China
| | - 怀昌 钟
- 四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 (成都 610041)Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 洋 万
- 四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 (成都 610041)Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 玉飞 张
- 四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 (成都 610041)Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Kinguchi S, Tamura K. Triglyceride-glucose index is a good indicator for early prediction of future chronic kidney disease development in all blood pressure subtypes. Hypertens Res 2024; 47:805-807. [PMID: 38228751 DOI: 10.1038/s41440-023-01577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Sho Kinguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Hauspurg A, Bryan S, Jeyabalan A, Davis EM, Hart R, Shirriel J, Muldoon M, Catov J. Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy. Hypertension 2024; 81:302-310. [PMID: 38073563 PMCID: PMC10872368 DOI: 10.1161/hypertensionaha.123.22231] [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: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are associated with cardiovascular disease; however, patterns of blood pressure (BP) recovery are understudied. We compared pregnancy and postpartum BP trajectories among individuals with hypertensive disorders of pregnancy who developed persistent hypertension at 1-year postpartum compared with individuals with normalization of BP. METHODS We used data from a randomized clinical trial of individuals with overweight, obesity, and hypertensive disorders of pregnancy conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits; postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of antihypertensive medications) at 1 year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines. RESULTS We included 129 individuals; 75 (58%) individuals progressed to hypertension by 1-year postpartum. Individuals with hypertension were older, delivered at earlier gestational ages, and had higher body mass index at 1-year postpartum compared with those with normalization. Individuals with hypertension had similar BP trajectories during pregnancy to those with BP normalization but a significantly different BP trajectory (P<0.01 for systolic and diastolic BPs) in the first year postpartum. These differences persisted in multivariable models after adjustment for early pregnancy body mass index, age, and severity of hypertensive disorder of pregnancy (P<0.01 for systolic and diastolic BPs). CONCLUSIONS BP trajectories in the first year postpartum, but not during pregnancy, may provide important information for risk stratification after a hypertensive disorder of pregnancy. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT03749746.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Samantha Bryan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Esa M. Davis
- University of Maryland School of Medicine, Baltimore, PA
| | - Renee Hart
- University of Maryland School of Medicine, Baltimore, PA
| | - Jada Shirriel
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Janet Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Sakoda T, Akasaki Y, Sasaki Y, Kawasoe S, Kubozono T, Ikeda Y, Miyahara H, Tokusige K, Ohishi M. Triglyceride-glucose index predicts future chronic kidney disease development in all populations, including normotensive and isolated diastolic hypertension. Hypertens Res 2024; 47:149-156. [PMID: 37989912 DOI: 10.1038/s41440-023-01507-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
Hypertension and insulin resistance are established risk factors for chronic kidney disease. However, the association between chronic kidney disease and insulin resistance in detailed hypertension pattern groups such as isolated diastolic hypertension remains unclear. Triglyceride-glucose index has been noted as an indicator of insulin resistance. This study investigated the association between the triglyceride-glucose index and chronic kidney disease in four blood pressure groups: isolated diastolic hypertension, isolated systolic hypertension, systolic diastolic hypertension, and normotension. Using a database of 41,811 middle-aged men who had two or more annual health checkups from 2007 to 2019, those with chronic kidney disease at the first visit, antihypertensive/diabetes/dyslipidemia medication users, and incomplete data were excluded. Four groups were categorized using the 140/90 mmHg threshold. A COX proportional hazards model was used to assess the triglyceride-glucose index with incident chronic kidney disease. Participants were divided: isolated diastolic hypertension: 2207 (6.72%), isolated systolic hypertension: 2316 (7.06%), systolic-diastolic hypertension: 3299 (10.05%), normal: 24,996 (76.17%). The follow-up period was 6.78 years. Adjusted hazard ratios (HRs) and 95% CIs per unit increase in triglyceride-glucose index: isolated diastolic hypertension (HR = 1.31, 95% CI (1.06-1.62)), isolated systolic hypertension (HR = 1.36, 95% CI (1.12-1.64)), systolic-diastolic hypertension (HR = 1.40, 95% CI (1.19-1.64)), normal (HR = 1.18, 95% CI (1.09-1.28)). Triglyceride-glucose index is relevant for predicting chronic kidney disease development in all subtypes of hypertension. The results may lead to early prediction and prevention of the development of chronic kidney disease.
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Affiliation(s)
- Takashi Sakoda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Yuichi Sasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Al Saleh S, Dobre M, DeLozier S, Perez J, Patil N, Rahman M, Pradhan N. Isolated Diastolic Hypertension and Kidney and Cardiovascular Outcomes in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Kidney Med 2023; 5:100728. [PMID: 38046908 PMCID: PMC10692726 DOI: 10.1016/j.xkme.2023.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Rationale & Objective The clinical significance of isolated diastolic hypertension in patients with chronic kidney disease (CKD) is unclear. We assessed the prevalence of isolated diastolic hypertension and its association with adverse kidney and cardiovascular outcomes in participants in the Chronic Renal Insufficiency Cohort (CRIC) study. Study Design Prospective cohort study. Setting & Population CRIC study participants with complete baseline data on systolic blood pressure (SBP) and diastolic BP (DBP) (N=5,621). Exposure Isolated diastolic hypertension defined as SBP ≤ 130 mm Hg and DBP >80 mm Hg. Reference Group Normotension, defined as SBP ≤ 130 mm Hg and DBP ≤ 80 mm Hg. Outcomes Composite kidney events (50% decline in estimated glomerular filtration rate or onset of kidney failure), composite cardiovascular events (myocardial infarction, heart failure, stroke, or peripheral arterial disease), and all-cause mortality. Analytical Approach Cox proportional hazards models adjusted for demographic, health behavior, and clinical covariates. Results Of the 5,621 participants, 347 (6.2%) had isolated diastolic hypertension. Among the 347 participants with isolated diastolic hypertension, there was no association between isolated diastolic hypertension and the composite kidney outcome (HR, 1.17; 95% CI, 0.93-1.47; P = 0.18), composite cardiovascular events (HR, 0.91; 95% CI, 0.65-1.27; P = 0.58), or all-cause mortality (HR, 0.82; 95% CI, 0.57-1.19; P = 0.30). Limitations Older age of cohort and low number of participants of Asian ethnicity limit generalizability of findings. A relatively small sample size is inadequate to detect modest associations with outcomes. Conclusions Isolated diastolic hypertension was not associated with the risk of adverse kidney and cardiovascular events in participants with CKD. Plain Language Summary Clinicians frequently encounter patients with kidney disease who have controlled systolic blood pressure (BP) but high diastolic BP and do not know whether they should intensify BP treatment in an attempt to control the diastolic BP. We examined whether having controlled systolic BP but uncontrolled diastolic BP leads to worse heart and kidney outcomes in patients with chronic kidney disease. We did not find any such association. However, our study was relatively small and had a number of limitations. Till larger studies confirm or refute this finding, we recommend not increasing blood pressure medications to improve the diastolic BP control if the systolic BP is already well controlled in patients with chronic kidney disease.
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Affiliation(s)
- Saud Al Saleh
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland OH
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland OH
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals, Cleveland, OH
| | - Jaime Perez
- Clinical Research Center, University Hospitals, Cleveland, OH
| | - Nirav Patil
- Clinical Research Center, University Hospitals, Cleveland, OH
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland OH
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland OH
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Zhang X, Wang X, Wang M, Qu H, Hu B, Li Q. Prevalence, awareness, and treatment of isolated diastolic hypertension in the United States. Eur J Intern Med 2023; 112:93-99. [PMID: 37002149 DOI: 10.1016/j.ejim.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Isolated diastolic hypertension (IDH) is recognized as a risk factor for cardiovascular disease, yet its clinical epidemiology remains poorly understood due to insufficient recognition. This study aims to describe the trend in the prevalence, awareness, and treatment of IDH in the United States from 2001 to 2018. METHODS This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in nine consecutive two-year cycles from 2001-2002 to 2017-2018, comprising a sample of 48,742 adults aged over 18 years. IDH was defined as a diastolic blood pressure ≥ 80 mm Hg with a systolic BP < 130 mm Hg by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. RESULTS In the nationally representative dataset, 8.9% of participants had IDH in 2017-2018, a decreased of 3.6% (95% confidence interval [CI], -2.6% to -5.0%, P<0.0002) since 2001-2002. IDH prevalence was highest among Mexican American (10.5%), individuals aged 40-59 (12.3%), increased with body mass index (BMI) (11.2% among those BMI ≥30.0 kg/m2), and tended to be higher in men (12.3%). A multiple regression analysis showed that men, white race/ethnicity, young and middle-aged people (aged 18-59), and increasing BMI were independently associated with increased risks of IDH. Among IDH patients, there was a modest increase in awareness (P<0.0002), from 22.4% (95%CI, 18.4% to 27.1%) in 2001-2002 to 35.0% (95%CI, 28.2% to 42.5%) in 2017-2018, with the largest percentage increases among non-Hispanic white and men. IDH treatment increased by 7.6% (95%CI, 3.1% to 12.1%) between 2001-2002 and 2017-2018, with the greatest increases occurring in Mexican American and men. CONCLUSION IDH prevalence is decreasing from 2001-2002 to 2017-2018 in the United States. Despite the significantly increased in both awareness and treatment, they remain below 50%.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | | | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Greater Protection of Lower Dietary Carbohydrate to Fiber Ratio (CFR) against Poor Blood Pressure Control in Patients with Essential Hypertension: A Cross-Sectional Study. Nutrients 2022; 14:nu14214443. [PMID: 36364706 PMCID: PMC9653798 DOI: 10.3390/nu14214443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Carbohydrate combined with dietary fiber (DF) applied as a surrogate marker of overall carbohydrate quality is a more essential determinant of cardiometabolic health. However, to date, no studies have applied this metric to analyze its associations with poor blood pressure control in hypertensive patients. (2) Methods: A cross-sectional design was implemented in one tertiary hospital and one community hospital in China. Using Feihua Nutrition Software to analyze participants' two-day dietary log, the quantity of carbohydrate and fiber was obtained and the carbohydrate to fiber ratio (CFR) was calculated. The participants were divided into Q1, Q2, Q3, and Q4 groups by quartile method, from low to high according to CFR. The poor systolic and diastolic blood pressure (SBP and DBP) controls were defined as ≥140 mmHg and ≥90 mmHg, respectively. (3) Results: A convenience sample of 459 participants was included and the mean CFR was 29.6. Taking Q1 as reference, after adjusting for covariates, the CFR in Q4 was associated with higher poor SBP-controlled rate (OR, 4.374; 95% CI, 2.236-8.559). Taking Q2 as reference, after adjusting for covariates, the CFRs in Q3 and Q4 were associated with higher poor DBP-controlled rates [(OR = 1.964, 95% CI: 1.016-3.795) and (OR = 4.219, 95% CI: 2.132-8.637), respectively]. The CFR was the stronger protective determinant of SBP and DBP than DF or carbohydrate alone. (4) Conclusions: A higher CFR is a stronger risk factor for blood pressure (BP) control, and low CFR foods or a combination of corresponding food components, should be recommended in the dietary management of hypertensive patients.
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Yue L, Chen H, Sun Q, Shi L, Sun J, Li G, Xing L, Liu S. Prevalence of isolated diastolic hypertension and the risk of cardiovascular mortality among adults aged 40 years and older in northeast China: a prospective cohort study. BMJ Open 2022; 12:e061762. [PMID: 36115666 PMCID: PMC9486366 DOI: 10.1136/bmjopen-2022-061762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Little is known about the prevalence and impact of isolated diastolic hypertension (IDH) in northeast China. We aimed to investigate the current epidemiology of IDH and to illustrate whether IDH accounted for cardiovascular disease (CVD) mortality. DESIGN A prospective cohort study. SETTING A population-based study carried out in northeast China. PARTICIPANTS We built a community-based study of 18 796 residents aged ≥40 years who were living in northeast China with blood pressure measurements between September 2017 and March 2019. OUTCOME MEASURES Information on CVD death was obtained from baseline until 31 July 2021. IDH was defined as a diastolic blood pressure ≥90 mm Hg together with systolic blood pressure <140 mm Hg among hypertensive population. RESULTS The overall prevalence of IDH was 3.9%, which decreased significantly with advancing age (p<0.001) and ranged from 7.2% (95% CI: 6.3% to 8.2%) among participants 40-49 years to 1.5% (95% CI: 1.1% to 2.0%) among participants ≥70 years. Moreover, the IDH prevalence was higher in men than in women (5.2% vs 3.1%, p<0.001). The awareness and treatment rates of IDH were 25.7% and 17.7%, respectively, which were significantly lower than those of patients with non-IDH (50.1% and 21.7%, p=0.009, respectively). During a median follow-up of 3.2 years, 314 subjects died due to CVD (rate 4.84/1000 person-years). IDH and non-IDH were both significantly associated with an increased risk of CVD death (HR: 2.55, 95% CI: 1.35 to 4.82; HR: 2.48, 95% CI: 1.81 to 3.38) when compared with participants with non-hypertension. CONCLUSIONS IDH was mainly prevalent among young and middle-aged populations, and the awareness and treatment rates in IDH were lower than those in non-IDH hypertension. Additionally, IDH and non-IDH were significantly related to an increased risk of CVD mortality. Early management of IDH is urgently required in northeast China.
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Affiliation(s)
- Ling Yue
- Department of Ultrasound, The Fourth Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Hongyun Chen
- Department of Cardiology, Dalian Municipal Central Hospital, Dalian, Liaoning, People's Republic of China
| | - Qun Sun
- Department of Chronic Disease, Disease Control and Prevention of Chao Yang City, Chaoyang, Liaoning, People's Republic of China
| | - Lei Shi
- Department of Chronic Disease, Disease Control and Prevention of Liao Yang City, Liaoyang, Liaoning, People's Republic of China
| | - Jixu Sun
- Department of Chronic Disease, Disease Control and Prevention of Dan Dong City, Dandong, Liaoning, People's Republic of China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Liying Xing
- Department of Chronic Disease Preventive and Control, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Ultrasound, The Fourth Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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11
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Tang L, Zhang J, Xu Y, Xu T, Yang Y, Wang J. Novel insights into the association between seasonal variations, blood pressure, and blood pressure variability in patients with new-onset essential hypertension. BMC Cardiovasc Disord 2022; 22:401. [PMID: 36076170 PMCID: PMC9461197 DOI: 10.1186/s12872-022-02840-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Blood pressure (BP) exhibits seasonal variations, with peaks reported in winter. However, the association between seasonal variations and blood pressure variability in patients with new-onset essential hypertension is not fully understood. This study evaluated the potential association of seasonal variations with new-onset essential hypertension. Methods This retrospective observational study recruited a total of 440 consecutive patients with new-onset essential hypertension who underwent 24-h ambulatory electrocardiograph (ECG) and BP measurement at our department between January 2019 and December 2019. Demographic and baseline clinical data including BP variability, heart rate variability, and blood tests were retrieved. Multivariate linear regression analysis was performed to identify factors independently associated with mean BP and BP variability. Results Among the 440 patients recruited, 93 cases were admitted in spring, 72 in summer, 151 in autumn, and 124 in winter. Univariate analysis revealed that systolic BP (SBP), diastolic BP (DBP), high-sensitivity C-reactive protein, SBP drop rate, DBP drop rate, 24-h standard deviation of SBP, 24-h standard deviation of DBP, 24-h SBP coefficient of variation, and 24-h DBP coefficient of variation were associated with patients admitted in winter (P < 0.05 for all). Multivariate linear regression analysis showed that winter was the influencing factor of 24-h standard deviation of SBP (B = 1.851, t = 3.719, P < 0.001), 24-h standard deviation of DBP (B = 1.176, t = 2.917, P = 0.004), 24-h SBP coefficient of variation (B = 0.015, t = 3.670, P < 0.001), and 24-h DBP coefficient of variation (B = 0.016, t = 2.849, P = 0.005) in hypertensive patients. Conclusions Seasonal variations are closely associated with BP variability in patients with new-onset essential hypertension. Our study provides insight into the underlying pathogenesis of new-onset essential hypertension.
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Affiliation(s)
- Long Tang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Jingshui Zhang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Yanan Xu
- Respiratory medicine department, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Tingting Xu
- Dermatology department, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Yi Yang
- Department of Cardiology Fourth Ward, the Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, Ürümqi, 830011, China.
| | - Jun Wang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China.
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12
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Gupta P, Sarkar PG, Verma V, Kumar A, Arora S, Kotwal A, Raj S, Goel S, Malhotra S. Prevalence and determinants of isolated systolic and isolated diastolic hypertension in India: Insights from the national family health survey (NFHS)- 4. J Family Med Prim Care 2022; 11:5738-5745. [PMID: 36505625 PMCID: PMC9730961 DOI: 10.4103/jfmpc.jfmpc_165_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH) are often the ignored forms of hypertension and are determinants of future cardiac and neurological events and contribute to mortality. However, the nationally representative estimates of both these forms of hypertension remain unknown from India. Aim To estimate the ISH and IDH from a nationally representative survey of India. Material and Methods The present study used data from 7,23,181 people (15-54 years), recorded during the fourth round (2015-2016) of the National Family Health Survey (NFHS), India. The prevalence of ISH and IDH was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of both types of hypertension. Results The prevalence of ISH and IDH was found to be 1.2% (95% CI 1.0-1.4) and 5.7% (95% CI 5.2-6.2), respectively. The prevalence of both ISH and IDH increased with age, with a more significant increase in systolic pressure towards the higher age. Northeastern states of India (Assam, Meghalaya, and Arunachal Pradesh) had the highest prevalence of both forms of hypertension. On multilevel logistic regression, male gender, increasing age groups (highest odds ratio (OR) being in 45-49 year age group), alcohol, and diabetes positively predicted both ISH and IDH. Urban residence, literacy, and tobacco were positive predictors of IDH, whereas urban residence, smoking, and literacy negatively predicted ISH. Conclusion ISH and IDH have a significant presence among the population of India. This data provides insights to formulate strategies at the primary and primordial prevention levels.
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Affiliation(s)
- Puneet Gupta
- Assistant Professor (Cardiology), Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Vivek Verma
- Department of Statistics, Assam University, Silchar, Assam, India
| | - Amit Kumar
- Department of Neurology, RIMS, Ranchi, Jharkhand, India
| | - Sameer Arora
- Fellow, Division of Cardiology, University of North Carolina, Chapel Hill, USA
| | - Atul Kotwal
- Executive Director, National Health Systems Resource Centre, New Delhi, India
| | - Sonika Raj
- Public Health Masters Program, School of Medicine, University of Limerick, Limerick, Ireland
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Adjunct Clinical Associate Professor, Public Health Master’s Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. Honorary Professor, Faculty of Human and Health Sciences, Swansea University, United Kingdom. E-mail:
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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13
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Vorobeľová L, Falbová D, Candráková Čerňanová V. Contribution of environmental factors and female reproductive history to hypertension and obesity incidence in later life. Ann Hum Biol 2022; 49:236-247. [PMID: 35867530 DOI: 10.1080/03014460.2022.2105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hypertension (HT) and obesity, which are important risk factors for cardiovascular diseases, are complex traits determined by multiple biological and behavioural factors. However, the role of female reproductive history in evaluating HT and obesity is still unclear. AIM To investigate the long-term effects of reproductive factors on the probability of obesity and HT in later life after adjusting for socio-demographic and lifestyle behaviour factors. SUBJECTS AND METHODS A total of 503 women (39 - 65 years) were recruited from different localities in Slovakia. Multivariable logistic regression analyses were performed to test the associations. RESULTS Early menarche age of 11 years and under was associated with twice higher probability of obesity at midlife, independent of environmental confounders (OR = 2.27, CI = 1.35 - 3.81, p = 0.002). Breastfeeding (Bf) women had a lower likelihood of obesity in later life than non-Bf parous women, independent of environmental confounders (OR = 0.35, CI = 0.17 - 0.72, p = 0.004). Finally, age at menarche was associated with obesity-associated HT. CONCLUSION Reproductive factors are significantly associated with obesity and obesity-associated HT in later life. The age at menarche and Bf can be risk factors for early identification of women with increased likelihood of adult cardiovascular risk.
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Affiliation(s)
- Lenka Vorobeľová
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia
| | - Darina Falbová
- Department of Anthropology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia
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14
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Liao Y, Chu C, Wang Y, Zheng W, Ma Q, Hu J, Yan Y, Yang J, Yang R, Wang K, Yuan Y, Chen C, Sun Y, Mu J. Isolated diastolic hypertension in childhood and risk of adult subclinical target organ damage: a 30-year prospective cohort study. J Hypertens 2022; 40:1556-1563. [PMID: 35730419 PMCID: PMC9415198 DOI: 10.1097/hjh.0000000000003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on the association of isolated diastolic hypertension (IDH) in childhood with adult cardiovascular risk are scarce. This study aimed to estimate the prevalence of IDH in adolescents and to explore the impact of IDH in childhood on adult subclinical target organ damage (STOD). METHODS This longitudinal study consisted of 1738 school children (55.4% boys) aged 6-15 years from rural areas of Hanzhong, Shaanxi, who were followed for 30 years. Their blood pressure was recorded to define the hypertension subtypes: normotension, IDH, isolated systolic hypertension (ISH) and mixed hypertension. Tracked STOD included arterial stiffness ( n = 1738), albuminuria ( n = 1652) and left ventricular hypertrophy (LVH) ( n = 1429). RESULTS Overall, the prevalence of IDH, ISH and mixed hypertension was 5.4, 2.2 and 3%, respectively, and there was no gender difference. Over 30 years, 366 (21.1%) of participants developed arterial stiffness, 170 (10.3%) developed albuminuria and 68 (4.8%) developed LVH. Compared with normotensive participants, IDH in childhood had higher risk ratio (RR) of experiencing arterial stiffness (RR, 1.66; 95% CI, 1.01-2.76) and albuminuria (RR, 2.27; 95% CI, 1.35-4.16) in adults after being fully adjusted but not LVH. However, if the elevated blood pressure in children was used as the reference standard, IDH in childhood was associated with adult LVH (RR, 2.48; 95% CI, 1.28-4.84). CONCLUSION IDH accounts for a higher proportion of adolescent hypertension subtypes and can increase the risk of adult STOD. These results highlight the necessity of improving the prevention, detection and treatment of IDH in adolescents.
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Affiliation(s)
- Yueyuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Wenling Zheng
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Jiawen Hu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Jun Yang
- Institute of Cardiovascular Sciences, Hanzhong People's Hospital, Hanzhong
| | - Ruihai Yang
- Institute of Cardiovascular Sciences, Hanzhong People's Hospital, Hanzhong
| | - Keke Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Yue Yuan
- Department of Cardiovascular Medicine, Jiangsu Province Hospital, Nanjing, China
| | - Chen Chen
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
| | - Jianjun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi’an Jiaotong University
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an
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15
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Yano Y, Kim HC, Lee H, Azahar N, Ahmed S, Kitaoka K, Kaneko H, Kawai F, Mizuno A, Viera AJ. Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Pro Side of the Argument. Hypertension 2022; 79:1563-1570. [PMID: 35861749 DOI: 10.1161/hypertensionaha.122.18459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated diastolic hypertension (IDH), defined as diastolic blood pressure in the hypertensive range but systolic blood pressure not in the hypertensive range, is not uncommon (<20%) among adults with hypertension. IDH often manifests in concurrence with other cardiovascular risk factors. Individuals with IDH tend to have lower awareness of their hypertension compared with those with both systolic and diastolic hypertension. IDH appears to be a largely underrated risk factor for cardiovascular disease events, which may be explained by inconsistent association of IDH with cardiovascular disease events. The inconsistency suggests that IDH is heterogeneous. One size does not seem to fit all in the clinical management of individuals with IDH. Rather than treating IDH as a monolithic low-risk condition, detailed phenotyping in the context of individual comprehensive cardiovascular risk would seem to be most useful to assess an individual's expected net benefit from therapy. In this review, we highlight that the clinical relevance of IDH differs by individual clinical characteristics, and elucidate groups of individuals with IDH that should be wary of cardiovascular disease risks.
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Affiliation(s)
- Yuichiro Yano
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.).,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (Y.Y.).,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Nazar Azahar
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Malaysia (N.A.)
| | - Sabrina Ahmed
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Kaori Kitaoka
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine and the Department of Advanced Cardiology, Departments of Cardiovascular Medicine (H.K.), The University of Tokyo, Japan.,Advanced Cardiology (H.K.), The University of Tokyo, Japan
| | - Fujimi Kawai
- Library, Center for Academic Resources (F.K.), St. Luke's International University, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan (A.M.).,Department of Cardiovascular Medicine (A.M.), St. Luke's International University, Tokyo, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.)
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16
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Mai H, Li C, Chen K, Wu Z, Liang X, Wang Y, Chen T, Chen F. Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines. Front Med (Lausanne) 2022; 9:814215. [PMID: 35865177 PMCID: PMC9295617 DOI: 10.3389/fmed.2022.814215] [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] [Received: 11/12/2021] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Aim: To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults. Methods We used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model. Results The increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35). Conclusion Adoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.
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Affiliation(s)
- Hui Mai
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- *Correspondence: Chao Li
| | - Kangyu Chen
- Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xuanyi Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Yongjuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Tao Chen
- Department of Public Health, Policy and Systems, Institute of Population Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool, United Kingdom
- Tao Chen
| | - Fengjian Chen
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
- Fengjian Chen
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17
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Zhang L, Yang L, Wang C, Yuan T, Zhang D, Wei H, Li J, Lei Y, Sun L, Li X, Hua Y, Che H, Li Y. Mediator or moderator? The role of obesity in the association between age at menarche and blood pressure in middle-aged and elderly Chinese: a population-based cross-sectional study. BMJ Open 2022; 12:e051486. [PMID: 35618334 PMCID: PMC9137347 DOI: 10.1136/bmjopen-2021-051486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We investigated the moderation/mediation between the age of menarche and obesity parameters in predicting blood pressure (BP) in middle-aged and elderly Chinese. DESIGN Our study is a population-based cross-sectional study. SETTING Participants in this study came from the China Health and Retirement Longitudinal Study (CHARLS). PARTICIPANTS The analytical sample included 4513 participants aged 45-96 years. MAIN OUTCOME MEASUREMENTS Data were selected from the CHARLS, a cross-sectional study. Between-group differences were evaluated using χ2, t-test and one-way analysis of variance. The trend of related variables by characteristics was also tested using contrast analysis, as appropriate. Then, correlations between characteristics, moderator, mediator, and independent and dependent variables were used by Spearman's correlation test and Pearson's correlation test. Finally, the mediation analysis was performed by model 4 in PROCESS V3.3 macro for SSPSS, and moderation analysis was used by model 1 for assessment. All covariates were adjusted in the moderation or mediation models. RESULTS In the correlation analysis, body mass index (BMI) and waist circle (WC) level were positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women (BMI and DBP: r=0.221, p<0.001; WC and DBP: r=0.183, p<0.001; BMI and SBP: r=0.129, p<0.001; WC and SBP: r=0.177, p<0.001). Age of menarche was negatively correlated with DBP (r=-0.060, p<0.001). However, the age of menarche was not significantly correlated with SBP (r=-0.014, p=0.335). In the moderator analysis, after controlling for the potential confounders, the interaction term of obesity parameters×age of menarche was not significant for predicting either DBP (BMI: B=0.0260, SE=0.0229, p=0.2556, 95% CI -0.0189 to 0.071; WC: B=0.0099, SE=0.0074, p=0.1833, 95% CI -0.0047 to 0.0244) or SBP (BMI: B=0.0091, SE=0.0504, p=0.8561, 95% CI -0.0897 to 0.108; WC: B=-0.0032, SE=0.0159, p=0.8427, 95% CI -0.0343 to 0.028). All correlations were significant correlation between age of menarche, obesity parameters and BP except the path of the menarche age→SBP (with the addition of the BMI indicator: β=-0.0004, B=-0.0046, p=0.9797, 95% CI -0.3619 to 0.3526; with the addition of the WC indicator: β=0.0004, B=0.0044, p=0.9804, 95% CI -0.3439 to 0.3526) in crude model. In general, after controlling for potential confounders, BMI (DBP: β=-0.0471, B= -0.2682, p=0.0021, 95% CI -0.4388 to -0.0976; SBP: β=-0.0515, B=-0.6314, p<0.001, 95% CI -0.9889 to -0.2739) and WC (DBP: β=-0.0474, B= -0.2689, p<0.001, 95% CI -0.4395 to -0.0984; SBP: β=-0.0524, B=-0.6320, p<0.001, 95% CI -0.9832 to -0.2807) partly mediated the relationship between age of menarche and BP. CONCLUSIONS The interaction term of obesity parameters×age of menarche was not significant for predicting either DBP or SBP in women. Moreover, obesity parameters partly mediated the relationship between the age of menarche and BP.
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Affiliation(s)
- Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
- School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Hengying Che
- Department of Nursing, Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Yuanzhen Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
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18
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Huang M, Long L, Tan L, Shen A, Deng M, Peng Y, Yang W, Li H, Wei Y, Li M, Liao F, Liu C, Lu A, Qu H, Fu C, Chen K. Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants. Front Cardiovasc Med 2022; 8:810105. [PMID: 35071370 PMCID: PMC8766994 DOI: 10.3389/fcvm.2021.810105] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q-test and I 2 statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test. Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07-1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07-1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04-2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18-2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97-1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87-2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events. Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians. Trial Registration: PROSPERO, Identifier: CRD42021254108.
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Affiliation(s)
- Mingyan Huang
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Linzi Long
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Tan
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Aling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Mi Deng
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Yuxuan Peng
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Wenwen Yang
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Hongzheng Li
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Wei
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Meng Li
- Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Feifei Liao
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Liu
- Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Aimei Lu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hua Qu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Changgeng Fu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Keji Chen
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
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19
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Guo YJ, Hu XY, Ji HJ, Wang LY, Zhou XY, Tang J, Zhao Q. The status and predictors of self-care among older adults with hypertension in China using the Chinese version of Self-Care of Hypertension Inventory - A cross-sectional study. Nurs Open 2022; 9:1241-1261. [PMID: 35014206 PMCID: PMC8859094 DOI: 10.1002/nop2.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/23/2021] [Accepted: 11/16/2021] [Indexed: 11/06/2022] Open
Abstract
AIM To investigate the status and predictors of self-care among older adults with hypertension in China by the Chinese version of Self-Care of Hypertension Inventory. DESIGN A cross-sectional questionnaire survey. METHODS A convenience sampling of 544 older adults with hypertension was surveyed using the Chinese version of Self-Care of Hypertension Inventory. SPSS25.0 software was used for statistical analysis of the data. Generalized liner model univariate analysis and the optimal scaling regression analysis were performed to investigate the predictors of self-care. RESULTS The status of self-care was poor with the median and inter-quartile range of total scores of self-care (140.00 ± 67), the scores of self-care maintenance (50 ± 24.76), the scores of self-care management (56.25 ± 29.41) and the scores of self-care confidence (54.79 ± 29.17). Age, family model, primary caregiver, maximum systolic blood pressure, coverage of medical insurance, disease duration, receiving self-care education, education level, economic burden and family history of hypertension were the most powerful predictors of self-care among older adults with hypertension.
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Affiliation(s)
- Yu-Jie Guo
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Xiao-Yun Hu
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hong-Juan Ji
- Department of Rehabilitation, Affiliated Hospital of Nantong University, Nantong, China
| | - Long-Yuan Wang
- Second School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | | | - Jue Tang
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Qiao Zhao
- First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
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20
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Zhang S, Liu S, Jiao Y, Zheng L, Sun Y, Sun Z. Association of isolated diastolic hypertension based on different guideline definitions with incident cardiovascular risk in a Chinese rural cohort. J Clin Hypertens (Greenwich) 2021; 24:18-25. [PMID: 34913260 PMCID: PMC8783363 DOI: 10.1111/jch.14349] [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] [Received: 04/29/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the threshold (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] ≥80 mm Hg) for isolated diastolic hypertension (IDH), whereas the 2018 Chinese guideline still recommends the old threshold (SBP <140 mm Hg and DBP ≥90 mm Hg). This study aimed to investigate the association between IDH, as defined by both guidelines, and the risk of incident cardiovascular disease (CVD) in rural areas of northeast China. This prospective study included participants whose baseline data were collected between 2004 and 2006. The exclusion criteria were baseline CVD, incomplete data, and systolic hypertension. The primary end point was incident CVD, a composite end point including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death. Multivariate Cox models were used to evaluate the association of IDH with CVD risk. The authors analyzed 19 688 participants (7140 participants with IDH) according to the ACC/AHA guideline. Compared with normotensive participants, individuals with ACC/AHA‐defined IDH were at a high risk of CVD (HR = 1.177, 95% CI: 1.035–1.339). A similar difference in CVD risk was noted when normotensive participants were compared with those with IDH, determined based on the 2018 Chinese guideline (HR = 1.218, 95% CI: 1.050–1.413). Similar results were found in participants who did not take antihypertensives at baseline. Moreover, IDH defined by either guideline was significantly associated with nonfatal MI. ACC/AHA‐defined IDH was associated with a risk of CVD, implying that blood pressure management should be improved in rural areas of China.
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Affiliation(s)
- Shiru Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Sitong Liu
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Liqiang Zheng
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Yingxian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P. R. China
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21
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The Dose-Response Relationships of Different Dimensions of Physical Activity with Daily Physical Function and Cognitive Function in Chinese Adults with Hypertension: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312698. [PMID: 34886423 PMCID: PMC8657437 DOI: 10.3390/ijerph182312698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the dose-response relationships of different dimensions of physical activity (intensity, time, frequency, capacity, and metabolic equivalent) with daily physical function (DPF) and cognitive function (CF) in Chinese adults with hypertension. METHODS The 6216 hypertensive patients included in this study were from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015. Physical activity (PA) was divided into vigorous PA (VPA), moderate PA (MPA), and light PA (LPA). Linear regression models and binary logistic regression models were established to assess the associations with indicators. RESULTS Patients with VPA have a lower probability of impaired DPF; however, patients with VPA had lower CF scores. Patients with nearly all the aspects of MPA have lower rates of impaired DPF and higher CF scores (p < 0.05). Patients with LPA have a lower probability of impaired DPF and higher CF scores. In addition, patients with between 1800 and 2999 MET-minutes per week had the lowest rates of impaired DPF (OR = 0.10, 95% CI 0.02, 0.39) and the highest CF scores (β = 3.28, 95% CI 2.25, 4.31). CONCLUSIONS This study found that patients with hypertension with moderate-intensity physical activity (nearly all aspects) and LPA had better DPF and CF. The best daily physical function and CF was with METs of 1800-2999 min per week. However, VPA should be recommended with caution in Chinese adults with hypertension.
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22
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Lee SR, Han KD, Choi EK, Ahn HJ, Oh S, Lip GYH. Risk of Atrial Fibrillation in Young Adults With Isolated Diastolic, Isolated Systolic, and Systolic-Diastolic Hypertension. Hypertension 2021; 78:1248-1258. [PMID: 34538103 DOI: 10.1161/hypertensionaha.121.17399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.)
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.-D.H.)
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (E.-K.C., S.O., G.Y.H.L.)
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.)
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (E.-K.C., S.O., G.Y.H.L.)
| | - Gregory Y H Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (E.-K.C., S.O., G.Y.H.L.).,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom (G.Y.H.L.).,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
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23
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Li Y, Teng D, Shi X, Teng X, Teng W, Shan Z, Lai Y. Changes in the prevalence of obesity and hypertension and demographic risk factor profiles in China over 10 years: two national cross-sectional surveys. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100227. [PMID: 34528008 PMCID: PMC8342963 DOI: 10.1016/j.lanwpc.2021.100227] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022]
Abstract
Background Previous studies have shown increases in the prevalence of obesity and hypertension, but nationally representative data on recent changes in prevalence adjusted for population structure changes are lacking. Two nationwide surveys were conducted in 2007 and 2017 to assess the prevalence changes of these conditions in China. Methods A multistage stratified random sampling method was used to obtain a nationally representative sample of adults aged 20 years and older in mainland China in 2007 and 2017. Temporal changes in the prevalence of hypertension and obesity were investigated. Changes in blood pressure, body mass index (BMI) and waist circumference were also assessed. Logistic regression models were constructed to assess the changes in prevalence over time. Findings The weighted prevalence of hypertension (25.7% vs. 31.5%, P=0.04), high-normal blood pressure (11.7% vs. 14.3%, P<0.0001), general obesity (31.9% vs. 37.2%, P=0.008), and central obesity (25.9% vs. 35.4%, P=0.0002) was significantly higher in 2017 (n=72824) than in 2007 (n=45956) in the overall population. No significant changes in the prevalence of overweight and grade 1 or grade 2 hypertension were observed in the overall population, but a significantly higher prevalence was observed among participants aged 20-29 years for grade 1 hypertension (P=0.002) and among participants aged 70 years and older for grade 2 hypertension (P=0.046) in 2017. Interpretation Compared with 2007, the prevalence of hypertension and obesity was significantly higher among adults in mainland China after adjusting for demographic confounding factors in 2017. More targeted interventions and prevention strategies are needed to offset the increasing risk of cardiovascular disease due to increases in the prevalence of hypertension and obesity. Funding The Clinical Research Fund of the Chinese Medical Association (Grant No. 15010010589), the National Natural Science Foundation of China (Grant No. 82000753), and the Chinese Medical Association Foundation and Chinese Diabetes Society (Grant No. 07020470055).
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Affiliation(s)
- Yongze Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Di Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
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24
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Xie K, Gao X, Bao L, Shan Y, Shi H, Li Y. The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey. BMC Public Health 2021; 21:1672. [PMID: 34521364 PMCID: PMC8442452 DOI: 10.1186/s12889-021-11686-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tends to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) to find a more efficient way to improve the management. Methods Patients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017–2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg. Results A total of 8548 patients were screened, and 8475 participants were included. The average age was 63.67 ± 12.78 years, and males accounted for 54.4%. Among them, 361 (4.3%) had IDH, and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) were much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Multivariate logistic regression analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05–1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95–1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04–1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90–1.21, p = 0.653). Conclusions Patients with IDH were much younger, and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH. Trial registration NCT03862183, retrospectively registered on March 5, 2019.
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Affiliation(s)
- Kun Xie
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Xiufang Gao
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Liwen Bao
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Ying Shan
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Haiming Shi
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Yong Li
- Cardiology Department, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, 200040, China.
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25
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Kim S, Kim JS, Kim W, Ahn JC. Clinical and central hemodynamic characteristics of early adulthood isolated diastolic hypertension: a comparison with isolated systolic hypertension. Blood Press Monit 2021; 26:263-270. [PMID: 33734118 DOI: 10.1097/mbp.0000000000000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Knowledge on early adulthood isolated diastolic hypertension (IDH) is limited. We compared the clinical and central hemodynamic characteristics of early adulthood IDH, isolated systolic hypertension (ISH) and normotension. METHODS A total of 509 untreated young adults (18-35 years) who underwent ambulatory blood pressure monitoring (ABPM; ABPM cohort), 148 who underwent both ABPM and applanation tonometry (ABPM-tonometry cohort) and 26 newly recruited normotensives were analyzed. Their pulse wave images were analyzed after categorizing them into type A vs. B vs. C. RESULTS In the ABPM cohort (men, 86.6%), systolic-diastolic hypertension was the most common subtype (68.0%), while IDH was the rarest (5.1%). The subtype composition showed age-dependency; the proportion of IDH and systolic-diastolic hypertension increased across the age tertiles, while that of ISH declined. Patients with IDH were significantly older and shorter than those with ISH. Despite having a significantly lower 24-h average systolic blood pressure (SBP), patients with IDH exhibited discordantly high central systolic blood pressures at levels comparable to those of patients with ISH. Pulse pressure amplification was the lowest in patients with IDH and highest in those with ISH (P < 0.001), accounting for the discordance. Augmentation index differed significantly between them (P < 0.016). The waveform composition differed across the subtypes (type A vs. B/C: IDH = 61.5 vs. 38.5%; ISH = 3.0 vs. 97.0%; normotension = 30.8 vs. 69.2%, P < 0.001); the averaged waveform plots demonstrated a clear morphological disparity between IDH (type A) and ISH (type B/C). CONCLUSIONS Early adulthood IDH is a unique entity clearly distinguishable from ISH in terms of clinical and central hemodynamic characteristics.
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Affiliation(s)
- Sunwon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si
| | - Woohyeun Kim
- Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jeong-Cheon Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si
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26
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Li S, Fong DYT, Wong JYH, McPherson B, Lau EYY, Huang L, Mary Sau Man IP. Indoor nocturnal noise is associated with body mass index and blood pressure: a cross-sectional study. BMC Public Health 2021; 21:815. [PMID: 33910532 PMCID: PMC8082630 DOI: 10.1186/s12889-021-10845-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have demonstrated that noise is associated with various health problems, such as obesity and hypertension. Although the evidence of the associations of noise with obesity and hypertension is inconsistent, there seems to be a stronger association of the latter. This study aimed to investigate the associations of noise with body mass index (BMI) and blood pressure in adults living in multi-story residential buildings. METHODS A cross-sectional study was conducted in Hong Kong from February 2018 to September 2019. The Weinstein Noise Sensitivity Scale, Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered to the participants. BMI and blood pressure were assessed. Nocturnal noise exposure and total sleep duration were measured for a week. RESULTS Five hundred adults (66.4% female), with an average age of 39 years (range: 18-80), completed the study. The average levels of nocturnal noise, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 51.3 dBA, 22.2 kg/m2, 116.0 mmHg, and 75.4 mmHg, respectively. After adjusting for sociodemographic characteristics, nocturnal noise was associated with BMI (b = 0.54, 95% CI: 0.01 to 1.06, p = 0.045) and SBP (b = 2.90, 95% CI: 1.12 to 4.68, p = 0.001). No association was detected between nocturnal noise and DBP (b = 0.79, 95% CI: - 0.56 to 2.13, p = 0.253). Specifically, higher nocturnal noise was associated with higher BMI (b = 0.72, 95% CI: 0.07 to 1.38, p = 0.031) and SBP (b = 3.91, 95% CI: 2.51 to 5.31, p < 0.001) in females but only higher SBP (b = 3.13, 95% CI: 1.35 to 4.92, p < 0.001) in males. The association between noise and SBP remained significant (b = 2.41, 95% CI: 0.62 to 4.20, p = 0.008) after additionally adjusting for lifestyle, diagnosis of hypertension, psychometric constructs, and sleep. CONCLUSIONS Indoor nocturnal noise was associated with BMI and blood pressure in females but only blood pressure in males. It is important to control nocturnal noise or use soundproofing materials in buildings to reduce noise exposure.
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Affiliation(s)
- Sha Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Janet Yuen Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Esther Yuet Ying Lau
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong, China
- Centre for Psychosocial Health, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong, China
| | - Lixi Huang
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - I P Mary Sau Man
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
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Mahajan S, Feng F, Hu S, Lu Y, Gupta A, Murugiah K, Gao Y, Lu J, Liu J, Zheng X, Spatz ES, Zhang H, Krumholz HM, Li J. Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China. JAMA Netw Open 2020; 3:e209743. [PMID: 33289843 PMCID: PMC7724558 DOI: 10.1001/jamanetworkopen.2020.9743] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Isolated systolic hypertension (ISH) is increasing in prevalence among young and middle-aged adults. However, most studies of ISH are limited to older individuals, and a substantial knowledge gap exists regarding younger adults with ISH. OBJECTIVE To assess the prevalence, awareness, and characteristics of ISH among younger and middle-aged adults in China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed as part of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, which enrolled 3.1 million community residents aged 35 to 75 years from all of the 31 provinces in China between December 15, 2014, and May 15, 2019. The present analysis included only participants younger than 50 years. Data were analyzed from May to November 2019. MAIN OUTCOMES AND MEASURES Prevalence and awareness of ISH (defined as systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of less than 90 mm Hg) and individual characteristics of participants with ISH. RESULTS Among 898 929 participants aged 35 to 49 years, the mean (SD) age was 43.8 (3.9) years; 548 657 participants (61.0%) were women, and 235 138 participants (26.2%) had hypertension. Of those with hypertension, 62 819 participants (26.7%; 95% CI, 26.5%-26.9%) had ISH (mean [SD] age, 45.0 [3.5] years; 41 417 women [65.9%]), and 54 463 of those with ISH (86.7%; 95% CI, 86.4%-87.0%) had not received treatment. The prevalence of ISH was higher among individuals who were older, were female, were farmers, resided in the eastern region of China, and had an educational level of primary school or lower. Women and older individuals were more likely to have ISH than to be normotensive or to have other hypertension subtypes. Participants who were obese, currently used alcohol, had diabetes, and experienced previous cardiovascular events were more likely to have other types of hypertension and less likely to have normotension than to have ISH. Among the 54 463 participants with ISH who had not received treatment, only 3682 individuals (6.8%; 95% CI, 6.6%-7.0%) were aware of having hypertension, and awareness rates remained low even among those with systolic blood pressure of 160 mm Hg or higher (7135 individuals [13.1%; 95% CI, 12.4%-13.9%]). CONCLUSIONS AND RELEVANCE In this study, ISH was identified in 1 of 4 young and middle-aged adults with hypertension in China, most of whom remained unaware of having hypertension. These results highlight the increasing need for better guidance regarding the management of ISH in this population.
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Affiliation(s)
- Shiwani Mahajan
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Fang Feng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Yuan Lu
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Aakriti Gupta
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Karthik Murugiah
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Erica S. Spatz
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
| | - Harlan M. Krumholz
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Yale School of Medicine, Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases
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Isolated diastolic hypertension as defined by the 2017 American College of Cardiology/American Heart Association blood pressure guideline and incident cardiovascular events in Chinese. J Hypertens 2020; 39:519-525. [PMID: 33031180 DOI: 10.1097/hjh.0000000000002659] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The new arterial hypertension guidelines by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) changed the definition of isolated diastolic hypertension (IDH). We assessed and compared in a Chinese population the IDH prevalence, newly defined by the 2017 ACC/AHA guidelines versus the former definition by the Joint National Committee 7 (JNC7) criteria, and examined longitudinal associations of IDH with cardiovascular disease (CVD) outcomes. METHODS The prospective community-based Kailuan Study included participants aged 18-98 years who underwent a detailed medical examination at baseline in 2006/2007 and who were biennially re-examined till 2017. History of antihypertensive medication at baseline was an exclusion criterion. RESULTS The study population consisted of 87 346 individuals (mean age: 50.9 years; range: 18-98 years). Prevalence of IDH was 7.79% [95% confidence interval (CI): 7.62, 7.97] by JNC7 guidelines and 24.72% (95% CI: 24.43, 25.01) by 2017 ACC/AHA criteria [difference: 19.93% (95% CI: 16.81, 17.04)]. Applying the 2017 ACC/AHA guidelines, the prevalence of IDH-recommended antihypertensive therapy was 7.73% (95% CI: 7.55, 7.90). In multivariable analysis, IDH by JNC7 criteria was significantly associated with incident myocardial infarction [n = 93 events; hazard ratio: 1.30 (95 CI: 1.02, 1.66)], cerebral hemorrhage [n = 73 events; hazard ratio: 1.79 (95% CI: 1.35, 2.38)], and total CVD [n = 373 events; hazard ratio: 1.15 (95% CI: 1.02, 1.30)], when compared with normotension. IDH based on 2017 ACC/AHA guidelines was associated with incident cerebral hemorrhage [n = 129 events; hazard ratio: 1.47 (95% CI: 1.12, 1.94)] and total CVD [n = 828 events; hazard ratio: 1.13 (95% CI: 1.02, 1.26)]. CONCLUSION In this adult Chinese community, 2017 ACC/AHA-defined IDH was associated with the incidence of cerebral hemorrhage and total CVD, and as compared with JNC7-defined IDH, it was more prevalent.
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Tomiyama H, Shiina K, Nakano H, Iwasaki Y, Matsumoto C, Fujii M, Chikamori T, Yamashina A. Arterial stiffness and pressure wave reflection in the development of isolated diastolic hypertension. J Hypertens 2020; 38:2000-2007. [PMID: 32890276 DOI: 10.1097/hjh.0000000000002519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This prospective study was conducted to clarify the significance of augmented pressure wave reflection without accompanying increased arterial stiffness in the development of isolated diastolic hypertension (IDHT). METHODS A total of 3022 Japanese men without hypertension at the start of this study were included in the analyses. The blood pressure, brachial--ankle pulse wave velocity (brachial-ankle PWV), and radial augmentation index (rAI) were measured annually from year 2007 through year 2015. RESULTS At the end of the study period, 129 participants were diagnosed as having systolic/diastolic hypertension (SDHT), 112 as having isolated systolic hypertension (ISHT), and 74 as having IDHT. Both the brachial--ankle PWV and rAI showed significant individual odds ratios for new onset of SDHT and new onset of ISHT. However, only rAI, but not the brachial--ankle PWV, showed a significant odds ratio (1.44, P < 0.01) for new onset of IDHT. This association was significant in participants without elevated brachial--ankle PWV values at the start of the study, but not in those with elevated brachial--ankle PWV at the start of the study. Generalized estimating equation analyses demonstrated a significant longitudinal association of the rAI, but not brachial--ankle PWV, with the development of IDHT. CONCLUSION Although increased arterial stiffness and augmented pressure wave reflection present concomitantly may be associated with the development of SDHT and ISHT, augmented pressure wave reflection alone, which may be related to isolated peripheral vascular damage, in the absence of accompanying increase of the arterial stiffness, may be a significant factor in the development of IDHT.
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Affiliation(s)
- Hirofumi Tomiyama
- Division of Preemptive Medicine for Vascular Damage, Department of Cardiology, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan
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Abstract
The prevalence of isolated diastolic hypertension (IDH) has been increased in hypertensive subjects with the new 2017 ACC/AHA blood pressure treatment guidelines to 6.5% from 1.3% by the JNC-7 guidelines. However, its clinical significance as a cause of adverse cardiovascular (CV) events especially in older subjects has been debated by several investigators, who have demonstrated no adverse CV effects of untreated IDH, but not by others. It is also more common in the young subjects who are at low CV risk and quite rare in the older subjects, who are at increased CV risk. Treatment of IDH in the older subjects could increase the CV complications due to a J-curve effect and, in addition, could increase the incidence of stroke from further lowering the normal systolic blood pressure (SBP). Very low SBP and DBP cannot be sustained by the cerebral blood flow autoregulation and could lead to cerebral ischemia. In order to get a better perspective of the current status of the treatment of IDH, a review of the English language literature of the available studies was conducted and 12 papers with pertinent information were retrieved. The analysis of results from these studies suggests that IDH is associated with adverse CV events in younger persons and it should be treated. In contrast, the prevalence of IDH is low in older subjects and is not associated with adverse CV events in the majority of cases. Thus, its further lowering should be avoided to prevent further decrease in normal SBP and prevent the onset of adverse CV events. However, the decision to treat IDH in older subjects should be individualized.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center , Oklahoma City, OK, USA
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Chiva-Blanch G, Badimon L. Benefits and Risks of Moderate Alcohol Consumption on Cardiovascular Disease: Current Findings and Controversies. Nutrients 2019; 12:nu12010108. [PMID: 31906033 PMCID: PMC7020057 DOI: 10.3390/nu12010108] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 02/06/2023] Open
Abstract
Alcohol has a hormetic physiological behavior that results in either increased or decreased cardiovascular risk depending on the amount consumed, drinking frequency, pattern of consumption, and the outcomes under study or even the type of alcoholic beverage consumed. However, the vast majority of studies elucidating the role of alcohol in cardiovascular and in the global burden of disease relies on epidemiological studies of associative nature which carry several limitations. This is why the cardiovascular benefits of low–moderate alcohol consumption are being questioned and perhaps might have been overestimated. Thus, the aim of this review was to critically discuss the current knowledge on the relationship between alcohol intake and cardiovascular disease. Besides new evidence associating low and moderate alcohol consumption with decreased risk of cardiovascular disease, several questions remain unanswered related to the concrete amount of safe consumption, the type of alcoholic beverage, and the age-, sex-, and genetic/ethnical-specific differences in alcohol consumption.
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Affiliation(s)
- Gemma Chiva-Blanch
- Cardiovascular Program ICCC; Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
| | - Lina Badimon
- Cardiovascular Program ICCC; Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-935565882
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Mahajan S, Zhang D, He S, Lu Y, Gupta A, Spatz ES, Lu J, Huang C, Herrin J, Liu S, Yang J, Wu C, Cui J, Zhang Q, Li X, Nasir K, Zheng X, Krumholz HM, Li J. Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project. J Am Heart Assoc 2019; 8:e012954. [PMID: 31566101 PMCID: PMC6806046 DOI: 10.1161/jaha.119.012954] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Characterizing and assessing the prevalence, awareness, and treatment patterns of patients with isolated diastolic hypertension (IDH) can generate new knowledge and highlight opportunities to improve their care. Methods and Results We used data from the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project, which screened 2 351 035 participants aged 35 to 75 years between 2014 and 2018. IDH was defined as systolic and diastolic blood pressure of <140 and ≥90 mm Hg; awareness as self-reported diagnosis of hypertension; and treatment as current use of antihypertensive medications. Of the 2 310 184 participants included (mean age 55.7 years; 59.5% women); 73 279 (3.2%) had IDH, of whom 63 112 (86.1%) were untreated, and only 6512 (10.3%) of the untreated were aware of having hypertension. When compared with normotensives, participants who were <60 years, men, at least college educated, had body mass index of >28 kg/m2, consumed alcohol, had diabetes mellitus, and prior cardiovascular events were more likely to have IDH (all P<0.01). Among those with IDH, higher likelihood of awareness was associated with increased age, women, college education, body mass index of >28 kg/m2, higher income, diabetes mellitus, prior cardiovascular events, and Central or Eastern region (all P<0.05). Most treated participants with IDH reported taking only 1 class of antihypertensive medication. Conclusions IDH affects a substantial number of people in China, however, few are aware of having hypertension and most treated participants are poorly managed, which suggests the need to improve the diagnosis and treatment of people with IDH.
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Affiliation(s)
- Shiwani Mahajan
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Danwei Zhang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Siyun He
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Department of Biostatistics School of Public Health Yale University New Haven CT
| | - Yuan Lu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Aakriti Gupta
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Columbia University New York NY
| | - Erica S Spatz
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Jiapeng Lu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chenxi Huang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Jeph Herrin
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Shuling Liu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Jingwei Yang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chaoqun Wu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jianlan Cui
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qiuli Zhang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xi Li
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
| | - Khurram Nasir
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Xin Zheng
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
| | - Harlan M Krumholz
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
| | - Jing Li
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
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