Relationship between psychosocial stress and hypertension among Ghanaians in Amsterdam, the Netherlands--the GHAIA study

Association of psychological stress with wives' hypertension across over 10 million Chinese married female population aged 20-49 years

BACKGROUND

Psychological stress has been reported to be a potential risk factor for hypertension among females, but it remains unclear whether spousal chronic stress levels alter the risk of hypertension among women. We examined the associations between stress within the family and hypertension among married women.

METHODS

Reproductive-aged women who were planning for pregnancy and their husbands were recruited from the National Free Pre-pregnancy Checkup Projects (NFPCP) across 31 provinces in China in 2016 and 2017. Perceived stress of wives or husbands was measured with a 5-point Likert-type scale, and assessed from three domains: work/life-related stress, economic stress, and overall stress. Multivariable-adjusted logistic regression models were used to assess the associations between stress status and the prevalence of hypertension.

RESULTS

Of 10,027,644 couples, 261,098 (2.60%) women had hypertension. The results showed that higher stress levels among themselves or their husbands were associated with a higher prevalence of hypertension in women ( Pfor trend <0.001). Compared with non-stressed participants, female participants with the highest stress themselves were at a greater risk of hypertension, with adjusted odds ratio (OR) of 1.31 (95% confidence interval [CI]: 1.25-1.37); and compared with participants whose husbands had no stress, those whose husbands had the highest stress level were at a higher risk of hypertension with adjusted OR of 1.24 (95% CI: 1.20-1.29). Moreover, compared with non-stressed status for both couples, only-wife-stressed, only-husband-stressed, and both-stressed couples were found to be significantly associated with increased risks of wives' hypertension, with adjusted ORs of 1.28 (95% CI: 1.25-1.31), 1.19 (95% CI: 1.17-1.21), and 1.28 (95% CI: 1.26-1.31), respectively.

CONCLUSION

Moderate to severe stress in both spouses might be associated with female hypertension prevalence, which highlights the importance of paying attention to the psychological stresses of couples within the family.

The association of psychological stress with metabolic syndrome and its components: cross-sectional and bidirectional two-sample Mendelian randomization analyses

Background

Metabolic syndrome (MetS) is a group of co-occurring conditions that increase the risk of cardiovascular disease, which include the conditions of hypertension, overweight or obesity, hyperglycemia, and dyslipidemia. Psychological stress is gradually being taken seriously, stemming from the imbalance between environmental demands and individual perceptions. However, the potential causal relationship between psychological stress and MetS remains unclear.

Method

We conducted cross-sectional and bidirectional Mendelian randomization (MR) analyses to clarify the potential causal relationship of psychological stress with MetS and its components. Multivariable logistic regression models were used to adjust for potential confounders in the cross-sectional study of the Chinese population, including 4,933 individuals (70.1% men; mean age, 46.13 ± 8.25). Stratified analyses of sexual characteristics were also performed. Bidirectional MR analyses were further carried out to verify causality based on summary-level genome-wide association studies in the European population, using the main analysis of the inverse variance-weighted method.

Results

We found that higher psychological stress levels were cross-sectionally associated with an increased risk of hypertension in men (odds ratio (OR), 1.341; 95% confidence interval (CI), 1.023-1.758; p = 0.034); moreover, higher levels of hypertension were cross-sectionally associated with an increased risk of psychological stress in men and the total population (men: OR, 1.545 (95% CI, 1.113-2.145); p = 0.009; total population: OR, 1.327 (95% CI, 1.025-1.718); p = 0.032). Genetically predicted hypertension was causally associated with a higher risk of psychological stress in the inverse-variance weighted MR model (OR, 2.386 (95% CI, 1.209-4.710); p = 0.012). However, there was no association between psychological stress and MetS or the other three risk factors (overweight or obesity, hyperglycemia, and dyslipidemia) in cross-sectional and MR analyses.

Conclusion

Although we did not observe an association between psychological stress and MetS, we found associations between psychological stress and hypertension both in cross-sectional and MR studies, which may have implications for targeting hypertension-related factors in interventions to improve mental and metabolic health. Further study is needed to confirm our findings.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis

BACKGROUND

Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population.

METHODS

We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I² statistic was used to measure heterogeneity.

RESULTS

Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I² >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only.

CONCLUSION

Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Hypertensive patients’ knowledge and practices on lifestyle modification in Extension 6, Middelburg

Background

Hypertension (HTN) is one of the most common chronic diseases affecting the majority of patients worldwide, including in South Africa. The control of HTN and prevention of complications are major challenges for patients and healthcare workers. The proper control of the disease requires a multifactorial approach consisting of medical treatment, as well as lifestyle modification, with the assistance of healthcare workers. Addressing patients’ beliefs, the practice of lifestyle and acceptance of change are some of the ways of aiding control.

Methods

The researchers used a cross-sectional and descriptive survey to establish the knowledge and practices of lifestyle modifications in patients with hypertension. A validated questionnaire was adopted. A total of 250 participants from the Extension 6 Clinic in Middelburg, Mpumalanga, constituted the study population.

Results

Most of the participants had borderline high blood pressure (37.2%) or uncontrolled high blood pressure (46%). The participants’ knowledge of HTN and its complications was not adequate. The study established that increased age and long duration of HTN were associated with high numbers of uncontrolled HTN. Most of the participants (88.8%) had difficulty exercising. Also, most of the participants (90.8%) did not have a place or facility for exercises. Fifty per cent of the participants were unable to maintain a balanced healthy diet which included fruits and vegetables.

Conclusion

The study explored the participants’ knowledge and practice of lifestyle modification. The participants lacked knowledge regarding the definition of HTN and the meaning of controlled HTN. To assist the patients and improve on the identified pitfalls, each consultation session should include some methods of education, and motivation for healthy behaviours and lifestyle modification. This should be extended to all the people visiting the health facilities for them to adopt a healthier diet, greater intake of vegetables and availability of fitness facilities for the community.

The Cardiometabolic Health of African Immigrants in High-Income Countries: A Systematic Review

In recent decades, the number of African immigrants in high-income countries (HICs) has increased significantly. However, the cardiometabolic health of this population remains poorly examined. Thus, we conducted a systematic review to examine the prevalence of cardiometabolic risk factors among sub-Saharan African immigrants residing in HICs. Studies were identified through searches in electronic databases including PubMed, Embase, CINAHL, Cochrane, Scopus, and Web of Science up to July 2021. Data on the prevalence of cardiometabolic risk factors were extracted and synthesized in a narrative format, and a meta-analysis of pooled proportions was also conducted. Of 8655 unique records, 35 articles that reported data on the specific African countries of origin of African immigrants were included in the review. We observed heterogeneity in the burden of cardiometabolic risk factors by African country of origin and HIC. The most prevalent risk factors were hypertension (27%, range: 6-55%), overweight/obesity (59%, range: 13-91%), and dyslipidemia (29%, range: 11-77.2%). The pooled prevalence of diabetes was 11% (range: 5-17%), and 7% (range: 0.7-14.8%) for smoking. Few studies examined kidney disease, hyperlipidemia, and diagnosed cardiometabolic disease. Policy changes and effective interventions are needed to improve the cardiometabolic health of African immigrants, improve care access and utilization, and advance health equity.

Relationship Between Psychosocial Stress and Blood Pressure: The National Heart, Lung, and Blood Institute Family Heart Study

Introduction

Various domains of psychosocial stress have been significantly related to blood pressure. However, ambiguity is present in how these relationships are defined in the literature.

Objective

To add to the existing literature and examine the relationship between psychosocial stress (financial strain and job strain) and other cofactors on blood pressure.

Methods

This secondary analysis is designed to analyze the relationship between levels of job and financial stress and blood pressure outcomes among participants in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study 2004-2008. The descriptive, cross-sectional design uses data from a subset of study participants, 350 White and 195 Black (n = 545), 338 female (62%), and all aged 18-56 years. Psychosocial stress was measured using the Singh Stress Scale. Resting systolic (SBP) and diastolic (DBP) blood pressure values obtained on a stress reactivity protocol day in the primary study, as well as calculated mean arterial pressure (MAP) were used for this analysis. Multivariate linear regression analyses were used to explore the relationship between psychosocial stress and blood pressure.

Results

In this young cohort, self-report of either financial strain or job strain was associated with lower blood pressure levels than those of participants who reported neither stressor. Differential sex and race effects appear to contribute to these results. Blood pressure levels were not significantly associated with self-report of both stressors.

Conclusion

Understanding the effects of various forms of stress on blood pressure may inform more precise HTN risk-factor screening and interventions to improve BP management.

Impact of Sociodemographic Characteristics, Lifestyle, and Obesity on Coexistence of Diabetes and Hypertension: A Structural Equation Model Analysis amongst Chinese Adults

Background

In general, given the insufficient sample size, considerable literature has been found on single studies of diabetes and hypertension and few studies have been found on the coexistence of diabetes and hypertension (CDH) and its influencing factors with a large range of samples. This study aimed to establish a structural equation model for exploring the direct and indirect relationships amongst sociodemographic characteristics, lifestyle, obesity, and CDH amongst Chinese adults.

Methods

A cross-sectional study was conducted in a representative sample of 25356 adults between June 1, 2015, and September 30, 2018, in Hubei province, China. Confirmatory factor analysis was initially conducted to test the latent variables. A structural equation model was then performed to analyse the association between latent variables and CDH.

Results

The total prevalence of CDH was 2.8%. The model paths indicated that sociodemographic characteristics, lifestyle, and obesity were directly associated with CDH, and the effects were 0.187, 0.739, and 0.353, respectively. Sociodemographic characteristics and lifestyle were also indirectly associated with CDH, and the effects were 0.128 and 0.045, respectively. Lifestyle had the strongest effect on CDH (β = 0.784, P < 0.001), followed by obesity (β = 0.353, P < 0.001) and sociodemographic characteristics (β = 0.315, P < 0.001). All paths of the model were significant (P < 0.001).

Conclusion

CDH was significantly associated with sociodemographic characteristics, lifestyle, and obesity amongst Chinese adults. The dominant predictor of CDH was lifestyle. Targeting these results might develop lifestyle and weight loss intervention to prevent CDH according to the characteristics of the population.

Association between prehypertension and psychological distress among adults in Saudi Arabia: A population-based survey

BACKGROUND

Prehypertension is a precursor to hypertension status. Psychological distress has been identified earlier among hypertensives; however, there is little evidence for the presumptive relationship between prehypertension and psychological distress.

OBJECTIVE

The study aimed to assess the psychological wellbeing of the Al-Kharj, Saudi Arabia population, using the General Health Questionnaire (GHQ-12) and correlating it with prehypertensive patients in the same population.

METHODS

A cross-sectional analysis of the population of Al-Kharj, Saudi Arabia, was carried out between January and June of 2016. With an 85 percent response rate, a total of 1016 participants participated in the study. A multiple linear regression analysis was performed to assess the relationship between prehypertension and psychological distress.

RESULTS

The findings of the adjusted analysis demonstrated that, on average prehypertensive patients were more distressed psychologically than non-hypertensive patients (unstandardized Beta regression coefficient = 3.600; P-value 0.025). Similarly, on average women were found to be more psychologically distressed than men (unstandardized Beta = 1.511, P-value 0.002). Civil workers and unemployed individuals were more psychologically distressed than employed individuals (unstandardized Beta = 1.326, P-value 0.041) while adjusting for the sociodemographic and other variables such as BMI, diabetes status, cholesterol, and smoking status.

CONCLUSION

The current study shows that as compared to normotensive patients, self-rated mental wellbeing and psychological wellbeing are all considerably poorer among prehypertensive patients. To prevent individuals from having negative psychological outcomes and their long-term complications, the Government of Saudi Arabia needs to concentrate on prehypertensive, female, and unemployed individuals. Well-designed longitudinal studies, primarily in Saudi Arabia, are needed in the future to research the cause and impact of poor mental health and prehypertension.

Health literacy and hypertension outcomes in a multi-ethnic population: the HELIUS study

BACKGROUND

Hypertension disproportionately affects ethnic minority groups. Although health literacy may play role in these ethnic inequalities, little is known about the extent to which health literacy affects hypertension prevalence, awareness, treatment and control in different ethnic groups. Therefore, we assessed these associations in a multi-ethnic population.

METHODS

Baseline data from the HELIUS study were used including participants of Dutch (n = 1948), South-Asian Surinamese (n = 2054) and African Surinamese (n = 1932) origin aged 18-70 years, who lived in Amsterdam, the Netherlands, were fluent in Dutch and underwent health literacy assessment through the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D). The REALM-D was categorized either as low (<60 sumscore) or adequate (≥60 sumscore) health literacy. Participants completed questionnaires and underwent physical examination.

RESULTS

After adjusting for confounding variables, Dutch [odds ratio (OR) 2.02; 95% confidence interval (CI), 1.11-3.64] and African Surinamese (OR 1.36; 1.03-1.79) with low health literacy were more likely than those with adequate health literacy to have hypertension, whereas in South-Asian Surinamese this association was not significant. No significant associations were found between health literacy and hypertension awareness, treatment and control in any of the ethnic groups.

CONCLUSION

Findings indicate that health literacy is associated with hypertension prevalence in selected ethnic groups, but not with hypertension awareness, treatment and control. Targeting health literacy might be an entry point for tackling ethnic inequalities in hypertension prevalence. To substantially reduce these inequalities, further research is needed to explore other factors and pathways through which health literacy may impact hypertension outcomes in different ethnic groups.

Noise annoyance predicts symptoms of depression, anxiety and sleep disturbance 5 years later. Findings from the Gutenberg Health Study

BACKGROUND

Cross-sectional studies have shown that noise annoyance is strongly associated with mental distress, however, its long-term effects on mental health is unknown. We therefore investigated whether noise annoyance predicts depression, anxiety and sleep disturbance in a large, representative sample 5 years later.

METHODS

We investigated longitudinal data of N = 11 905 participants of the Gutenberg Health Study, a population-based, prospective, single-centre cohort study in mid-Germany (age at baseline 35-74 years). Noise annoyance was assessed at baseline and 5-year follow-up (sources: road traffic, aircraft, railways, industrial, neighbourhood indoor and outdoor noise; and day vs. nighttime). Depression, anxiety and sleep disturbance were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-2. Participants suffering from depression, anxiety or sleep disturbance at baseline were excluded from the respective multivariate analyses of new onset at follow-up.

RESULTS

General noise annoyance remained stable. Daytime noise annoyance predicted new onset of depressive, anxiety symptoms (also nighttime annoyance) and sleep disturbance (beyond respective baseline scores). Additional predictors were female sex, lower age and low socioeconomic status (SES). Regarding specific sources, daytime baseline aircraft annoyance predicted depression and anxiety. Sleep disturbance was most consistently predicted by neighbourhood annoyance (baseline and follow-up) and follow-up annoyance by aircraft (night) and road traffic (day and night).

CONCLUSIONS

We identified current and past noise annoyances as risk factors for mental distress and sleep disturbance. Furthermore, women, younger adults and those with lower SES are particularly susceptible to noise annoyance. Our results indicate the need to provide regulatory measures in affected areas to prevent mental health problems.

Psychosocial stressors among Ghanaians in rural and urban Ghana and Ghanaian migrants in Europe

Psychosocial stressors have significant health and socio-economic impacts on individuals. We examined the prevalence and correlates of psychosocial stressors among non-migrant and migrant Ghanaians as there is limited research in these populations. The study was cross-sectional and quantitative in design. A majority of the study participants had experienced stress, discrimination and negative life events. Increased age, female sex, strong social support and high sense of mastery were associated with lower odds of experiencing psychosocial stressors in both populations. Interventions should be multi-level in design, focusing on the correlates which significantly influence the experience of psychosocial stressors.

Perceived Discrimination, Psychological Distress and Cardiovascular Risk in Migrants in Spain

The aim of the present study is to determine the effect of discrimination and psychological distress on the cardiovascular health of immigrants, as well as to analyse potential differences based on age, gender, length of residence in host country and geographic origin. The sample was formed by 1714 immigrants from Africa, Eastern Europe and Latin America. Of the sample, 48.7% were men and 51.3% were women. Most relevant results show that discrimination (t = 4.27; p = 0.000) and psychological distress (t = 4.35; p = 0.000) experienced by immigrants predict their cardiovascular risk. Furthermore, psychological distress mediates the relation between discrimination and risk (t = 4.03; p = 0.000). Significant differences between men and women were found, as well as differences based on ethnicity, although to a lesser extent. Age affects the relation between discrimination, psychological distress and arterial hypertension and hypercholesterolemia. Results are notably relevant for the design of preventive health programmes for immigrants and intervention strategies in order to prevent diseases that may imply cardiovascular risks and seriously affect immigrants' health.

Differential associations between psychosocial stress and obesity among Ghanaians in Europe and in Ghana: findings from the RODAM study

PURPOSE

Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana.

METHODS

Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex.

RESULTS

Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI 0.34-1.22) and WC (β = 1.96, 95% CI 0.79-3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (β = 0.28, 95% CI 0.00-0.56) and WC (β = 0.84, 95% CI 0.05-1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β = - 0.66, 95% CI - 1.03 to - 0.28; β = - 1.71 95% CI - 2.69 to - 0.73, respectively) and females (β = - 0.81, 95% CI - 1.20 to - 0.42; β = - 1.46, 95% CI - 2.30 to - 0.61, respectively).

CONCLUSIONS

Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.

The relationship between chronic stress, hair cortisol and hypertension

Inconsistencies in studies of chronic psychosocial stress and hypertension may be explained by the use of stress markers greatly influenced by circadian rhythm and transient stressors. We assessed whether hair cortisol, a marker that captures systemic cortisol over months, was independently associated with hypertension. We measured hair cortisol and blood pressure in 75 consecutive participants in the Survey of the Health of Wisconsin, using an ELISA test. Individuals with values ​≥ ​median (78.1 ​pg/mg) were considered exposed. We used approximate Bayesian logistic regression, with a prior odds ratio of 1.0–4.0, to quantify the multivariate-adjusted hair cortisol-hypertension association. Participants' average age was 46.9 years; 37.3% were male; and 25.3% were hypertensive. Hypertension prevalence was 2.23 times higher in exposed (95% CI: 1.69–3.03). This finding was unlikely explained by differential measurement errors, since we conducted blinded measurements of exposure and outcome. Sensitivity analyses showed the association was unlikely explained by an unmeasured confounder, survival bias, or reverse causality bias. Findings suggest elevated hair cortisol is a risk factor for hypertension. Although feasible, the clinical value of hair cortisol as a tool for hypertension risk stratification or for monitoring the effect of chronic psychosocial stress management interventions is still uncertain.

Impact of acculturation on depression, perceived stress and self-esteem in young Middle Eastern American adults

BACKGROUND

Human biologists have a longstanding interest in understanding the biological and health impacts of migration. Acculturation, the cultural adjustment that a group or individual experiences when previously separate cultures interact, has been found to be one pathway through which migration may impact human biology and health, not only for the migrants themselves, but also their descendants.

AIM

The authors conducted a pilot study to examine the relationship between acculturation and perceived stress, self-esteem and depression among young Middle-Eastern American adults.

SUBJECT AND METHODS

Survey data were collected from 48 young Middle-Eastern American adults. Participants were divided into one of two acculturation categories, integrated (American and Middle Eastern culture oriented) and assimilated (American culture oriented). Health measures were compared between these acculturation categories.

RESULTS

Integrated individuals had significantly lower stress (F = 8.1, p < 0.01) and depression (F = 10.8, p < 0.01) than assimilated individuals. Integrated individuals had lower self-esteem than assimilated individuals (F = 5.0, p < 0.05). Generational status, a proxy used for acculturation, was only significantly associated with self-esteem (F = 3.15, p = 0.05).

CONCLUSION

This pilot study furthers understanding of the effects acculturation can have on perceived stress and mental health among young Middle-Eastern Americans. Future research should incorporate biological measures of stress to determine the physiological impacts of acculturation.

Migration and Cardiovascular Disease Risk Among Ghanaian Populations in Europe: The RODAM Study (Research on Obesity and Diabetes Among African Migrants)

BACKGROUND

For migrant populations from sub-Saharan Africa, adverse cardiovascular disease (CVD) risk factors have been observed to be higher than found in their home country-based counterparts or among the host populations in high-income countries. Differences in absolute overall CVD risk, however, remain largely unexplained. We, therefore, predicted the differences in 10-year CVD risk among sub-Saharan African migrants (Ghanaians) living in 3 European cities and Ghana.

METHODS AND RESULTS

For 3864 subjects aged 40 to 70 years from the multicenter RODAM study (Research on Obesity and Diabetes Among African Migrants) conducted among Ghanaian adults residing in rural and urban Ghana and 3 European cities (Amsterdam, Berlin, and London), 10-year risk of CVD was estimated using the Pooled Cohort Equations with estimates ≥7.5% defining high CVD risk. Logistic regressions were used to determine the association of migration on CVD risk. The proportion with CVD risk ≥7.5% among Ghanaian men was 34.7% in rural Ghana, 45.4% in urban Ghana, 53.9% in Amsterdam, 61.0% in Berlin, and 52.2% in London. Compared with rural Ghana, CVD risk was significantly increased for Ghanaian men living in Berlin (adjusted odds ratio, 2.80; 95% confidence interval, 1.76-4.45) and Amsterdam (1.88; 1.25-2.84). Increased risk observed for men was largely not seen for women. CVD risk increased with longer stay in Europe.

CONCLUSIONS

Knowledge about predictors of increased CVD risk among sub-Saharan African migrants in Europe and nonmigrants in urban centers will inform and support targeted health care and interventions to these populations.

Role of Magnesium Deficiency in Promoting Atherosclerosis, Endothelial Dysfunction, and Arterial Stiffening as Risk Factors for Hypertension

Arterial hypertension is a disease with a complex pathogenesis. Despite considerable knowledge about this socially significant disease, the role of magnesium deficiency (MgD) as a risk factor is not fully understood. Magnesium is a natural calcium antagonist. It potentiates the production of local vasodilator mediators (prostacyclin and nitric oxide) and alters vascular responses to a variety of vasoactive substances (endothelin-1, angiotensin II, and catecholamines). MgD stimulates the production of aldosterone and potentiates vascular inflammatory response, while expression/activity of various antioxidant enzymes (glutathione peroxidase, superoxide dismutase, and catalase) and the levels of important antioxidants (vitamin C, vitamin E, and selenium) are decreased. Magnesium balances the effects of catecholamines in acute and chronic stress. MgD may be associated with the development of insulin resistance, hyperglycemia, and changes in lipid metabolism, which enhance atherosclerotic changes and arterial stiffness. Magnesium regulates collagen and elastin turnover in the vascular wall and matrix metalloproteinase activity. Magnesium helps to protect the elastic fibers from calcium deposition and maintains the elasticity of the vessels. Considering the numerous positive effects on a number of mechanisms related to arterial hypertension, consuming a healthy diet that provides the recommended amount of magnesium can be an appropriate strategy for helping control blood pressure.

The Associations Between Mental Health Status, Hypertension, and Hospital Inpatient Visits in Women in the United States

BACKGROUND

Poor mental health status is more prevalent in women and may be related to poor hypertension outcomes and increased hospital inpatient visits. This study aims to find the association between mental health status and hypertension in women and the combined effect of mental health status and hypertension on hospital inpatient visits in women in the United States.

METHODS

The household component of 2014 Medical Expenditure Panel Surveys (MEPS) was analyzed (N = 9,137). Kessler (K6) scale for mental health status (poor, good/excellent), hypertension (yes, no), and hospital inpatient visits (yes, no) were examined. A combined effect variable for mental health status and hypertension was created. Multiple logistic regression analysis was conducted and adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were calculated.

RESULTS

After adjusting for confounders, women who reported poor mental health had significantly higher odds of hypertension compared to women who reported good/excellent mental health (AOR = 1.39, 95% CI = 1.16, 1.68). Further, women who reported hypertension coupled with poor mental health had higher odds of having hospital inpatient visits compared to women who reported no hypertension coupled with good/excellent mental health in the adjusted analysis (AOR = 3.03, 95% CI = 1.96, 4.69).

CONCLUSIONS

There is a significant association between mental health status and hypertension in women. Further, poor mental health status coupled with hypertension leads to increase hospital inpatient visits for women. It is important that health professionals focus on utilizing available screening tools to assess mental health status of women for early detection and to manage the disorder.

Human genome evolution and development of cardiovascular risk factors through natural selection

Impressive advances in molecular genetic techniques allow to analyze the effects of natural selection on the development of human genome. For example, the trend towards blonde hair and blue eyes was documented. The approach to analyze possible effects of natural selection on the evolution of recent phenotypes with high risk of cardiovascular disease has not been described yet. A possible effect on the evolution of two main risk factors - hypercholesterolemia and hypertension - is presented. The close relationship of non-HDL cholesterol blood concentration to the proportion of pro-inflammatory macrophages in human visceral adipose tissue might be a result of long-lasting natural selection. Individuals with higher proportion of this phenotype might also display a higher ability to fight infection, which was very common in human setting from prehistory until Middle Ages. Successful battle against infections increased the probability to survive till reproductive age. Similar hypothesis was proposed to explain frequent hypertension in African Americans. A long-lasting selection for higher ability to conserve sodium during long-term adaptation to low sodium intake and hot weather was followed by a short-term (but very hard) natural selection of individuals during transatlantic slave transport. Only those with very high capability to retain sodium were able to survive. Natural selection of phenotypes with high plasma cholesterol concentration and/or high blood pressure is recently potentiated by high-fat high-sodium diet and overnutrition. This hypothesis is also supported by the advantage of familial hypercholesterolemia in the 19th century (at the time of high infection disease mortality) in contrast to the disadvantage of familial hypercholesterolemia during the actual period of high cardiovascular disease mortality.

Chronic mild stress exacerbates severity of experimental autoimmune encephalomyelitis in association with altered non-coding RNA and metabolic biomarkers

The causal factors determining the onset and severity of multiple sclerosis (MS) are not well understood. Here, we investigated the influence of chronic stress on clinical symptoms, metabolic and epigenetic manifestations of experimental autoimmune encephalomyelitis (EAE), a common animal model of MS. Lewis rats were immunized for monophasic EAE with MBP_69-88 and were exposed to chronic stress for 37days starting 7days prior to immunization. The exposure to stress accelerated and exacerbated the clinical symptoms of EAE. Both stress and EAE also disrupted metabolic status as indicated by trace elemental analysis in body hair. Stress particularly exacerbated chlorine deposition in EAE animals. Moreover, deep sequencing revealed a considerable impact of stress on microRNA expression in EAE. EAE by itself upregulated microRNA expression in lumbar spinal cord, including miR-21, miR-142-3p, miR-142-5p, miR-146a, and miR-155. Stress in EAE further up-regulated miR-16, miR-146a and miR-155 levels. The latter two microRNAs are recognized biomarkers of human MS. Thus, stress may synergistically exacerbate severity of EAE by altering epigenetic regulatory pathways. The findings suggest that stress may represent a significant risk factor for symptomatic deterioration in MS. Stress-related metabolic and microRNA signatures support their value as biomarkers for predicting the risk and severity of MS.