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Gaudieri V, Mannarino T, Zampella E, Assante R, D'Antonio A, Nappi C, Cantoni V, Green R, Petretta M, Arumugam P, Cuocolo A, Acampa W. Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease. Eur J Nucl Med Mol Imaging 2021; 48:3162-3171. [PMID: 33594472 PMCID: PMC8426234 DOI: 10.1007/s00259-021-05239-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Purpose The identification of coronary vascular dysfunction may enhance risk stratification in patients with resistant hypertension (RH). We evaluated if impaired coronary vascular function, assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) imaging, is associated with increased cardiovascular risk in patients with hypertension without overt coronary artery disease (CAD). Methods We studied 517 hypertensive subjects, 26% with RH, without overt CAD, and with normal stress-rest myocardial perfusion imaging at 82Rb PET/CT. The outcome end points were cardiac death, nonfatal myocardial infarction, coronary revascularization, and admission for heart failure. Results Over a median of 38 months (interquartile range 26 to 50), 21 cardiac events (4.1% cumulative event rate) occurred. Patients with RH were older (p < 0.05) and had a higher prevalence of left ventricular hypertrophy (p < 0.001), a lower hyperemic myocardial blood flow (MBF), and myocardial perfusion reserve (MPR) (both p < 0.001) compared to those without. Conversely, coronary artery calcium content and baseline MBF were not different between patients with and without RH. At univariable Cox regression analysis, age, RH, left ventricular ejection fraction, coronary artery calcium score, and reduced MPR were significant predictors of events. At multivariable analysis, age, RH, and reduced MPR (all p < 0.05) were independent predictors of events. Patients with RH and reduced MPR had the highest risk of events and the major risk acceleration over time. Conclusion The findings suggest that the assessment of coronary vascular function may enhance risk stratification in patients with hypertension.
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Affiliation(s)
- Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy. .,Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies. J Hypertens 2020; 37:2325-2332. [PMID: 31335511 DOI: 10.1097/hjh.0000000000002191] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the association of prehypertension (SBP 120-139 mmHg and/or DBP 80-89 mmHg) and total cardiovascular diseases (CVDs), coronary heart disease (CHD), myocardial infarction (MI), and stroke. METHODS PubMed, Embase, and Web of Science were searched for articles published up to 7 November 2018. Normal range BP was considered SBP less than 120 mmHg and DBP less than 80 mmHg. RRs and 95% CIs were pooled using fixed-effects models. Meta-regression was conducted to estimate the heterogeneity among subgroups. RESULTS We included 27 articles (47 studies including 491 666 study participants) in the analysis. Prehypertension was associated with total CVDs (RR 1.40, 95% CI 1.34-1.46), CHD (1.40, 1.28-1.52), MI (1.86, 1.50-2.32), and stroke (1.66, 1.56-1.76). Risk of total CVDs, MI, and stroke was increased with low-range prehypertension (low-range: SBP 120-129 mmHg and/or DBP 80-84 mmHg) versus normal BP - RR 1.42 (95% CI 1.29-1.55), 1.43 (1.10-1.86), and 1.52 (1.27-1.81), respectively - and risk of total CVDs, CHD, MI, and stroke was increased with high-range prehypertension (high-range: SBP 130-139 mmHg and/or DBP 85-89 mmHg) - RR 1.81 (95% CI 1.56-2.10), 1.65 (1.13-2.39), 1.99 (1.59-2.50), and 1.99 (1.68-2.36), respectively. The population-attributable risk for the association of total CVDs, CHD, MI, and stroke with prehypertension was 12.09, 13.26, 24.60, and 19.15%, respectively. CONCLUSION Prehypertension, particularly high-range, is associated with increased risk of total CVDs, CHD, MI, and stroke. Effective control of prehypertension could prevent more than 10% of CVD cases.
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Słomka T, Drelich-Zbroja A, Jarząbek M, Szczerbo-Trojanowska M. Intima-media complex thickness and carotid atherosclerotic plaque formation in Lublin's population in the context of selected comorbidities. J Ultrason 2018; 18:133-139. [PMID: 30335922 PMCID: PMC6440505 DOI: 10.15557/jou.2018.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction: Atherosclerosis (arteriosclerosis) is a chronic arterial disease of the arteries with chronic inflammatory. The pathology of atherosclerosis is complex, and the atherosclerotic process is multi-factorial, not fully understood. Risk factors of atherosclerotic lesions may include: lipid disorders, hypertension or diabetes. One of the diagnostic methods of discovering atherosclerosis covers the assessment of the intima–media complex thickness by Doppler ultrasonography. Aim: The aim of this report was an evaluation of the relationships between intima–media complex thickness in the right and left carotid arteries and the occurrence of atheromatous plaque in the Lublin population with respect to three possible concomitant medical conditions, mentioned above. Material and methods: A group of 121 subjects was included into the study, all of the participants being residential inhabitants of the Lublin Voivodship. All the participating patients were requested to fill in a questionnaire. After that, the patients were submitted to Doppler sonography concentrated on intima–media complex thickness evaluation. The occurrence of atheromatous plaque was also assessed in obtained sonographic images. Results: There were statistically significant differences for the intima–media complex thickness and for the atheromatous plaque according to all of the reported diseases: hypocholesterolaemia, hypertension and diabetes. Conclusions: The present study confirms that there is a relationship between the thickness of the intima–media complex in the right and left carotid arteries as well as the occurrence of the atherosclerotic plaque regarding the coexistence of specific disease entities in the subjects of the Lublin population.
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Affiliation(s)
- Tomasz Słomka
- Department of Information Technology and Medical Statistics, Medical University of Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
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Farsalinos K, Cibella F, Caponnetto P, Campagna D, Morjaria JB, Battaglia E, Caruso M, Russo C, Polosa R. Effect of continuous smoking reduction and abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes. Intern Emerg Med 2016; 11:85-94. [PMID: 26749533 PMCID: PMC4747988 DOI: 10.1007/s11739-015-1361-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
We present prospective blood pressure (BP) and hear rate (HR) changes in smokers invited to switch to e-cigarettes in the ECLAT study. BP and HR changes were compared among (1) different study groups (users of high, low, and zero nicotine products) and (2) pooled continuous smoking phenotype classification (same phenotype from week 12 to -52), with participants classified as quitters (completely quit smoking), reducers (≥50% reduction in smoking consumption) and failures (<50% or no reduction in smoking consumption). Additionally, the latter comparison was repeated in a subgroup of participants with elevated BP at baseline. No significant changes were observed among study groups for systolic BP, diastolic BP, and HR. In 145 subjects with a continuous smoking phenotype, we observed lower systolic BP at week 52 compared to baseline but no effect of smoking phenotype classification. When the same analysis was repeated in 66 subjects with elevated BP at baseline, a substantial reduction in systolic BP was observed at week 52 compared to baseline (132.4 ± 12.0 vs. 141.2 ± 10.5 mmHg, p < 0.001), with a significant effect found for smoking phenotype classification. After adjusting for weight change, gender and age, reduction in systolic BP from baseline at week 52 remains associated significantly with both smoking reduction and smoking abstinence. In conclusion, smokers who reduce or quit smoking by switching to e-cigarettes may lower their systolic BP in the long term, and this reduction is apparent in smokers with elevated BP. The current study adds to the evidence that quitting smoking with the use of e-cigarettes does not lead to higher BP values, and this is independently observed whether e-cigarettes are regularly used or not.
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Affiliation(s)
| | - Fabio Cibella
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Pasquale Caponnetto
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy.
| | - Davide Campagna
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Jaymin Bhagwanji Morjaria
- Division of Cardiovascular and Respiratory Studies, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, UK
| | - Eliana Battaglia
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Massimo Caruso
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Cristina Russo
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy
| | - Riccardo Polosa
- Centro Per La Prevenzione e Cura Del Tabagismo, Azienda Ospedaliero, Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.
- Dipartimento di Biomedicina Clinica e Molecolare, Università di Catania, Azienda Ospedaliero, Universitaria "Policlinico-Vittorio Emanuele", Università di Catania, Catania, Italy.
- UOC di Medicina Interna e d'Urgenza, Edificio 4, Piano 3, AOU ''Policlinico-V. Emanuele'', Via S. Sofia 78, 95123, Catania, Italy.
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Er LK, Chen YL, Pei D, Lau SC, Kuo SW, Hsu CH. Increased incidence of metabolic syndrome in older men with high normotension. Aging Male 2012; 15:227-32. [PMID: 23035946 DOI: 10.3109/13685538.2012.720742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. METHODS In this cross-sectional study, totally 2388 normotensive older men aged 65-80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. RESULTS Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55-fold OR (p < 0.001) for having MetS than Group-1. CONCLUSIONS In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.
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Affiliation(s)
- Leay-Kiaw Er
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
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Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation 2010; 121:2109-16. [PMID: 20439788 DOI: 10.1161/circulationaha.109.895292] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with exaggerated exercise blood pressure (BP) tend to develop future hypertension. It is controversial whether they have higher risk of death from cardiovascular disease (CVD). METHODS AND RESULTS A total of 6578 asymptomatic Lipid Research Clinics Prevalence Study participants (45% women; mean age, 46 years; 74% with untreated baseline BP <140/90 mm Hg [nonhypertensive]) performing submaximal Bruce treadmill tests were followed for 20 years (385 CVD deaths occurred). Systolic and diastolic BP at rest, Bruce stage 2, and maximal BP during exercise were significantly associated with CVD death. When we compared multivariate hazard ratios and 95% confidence intervals per 10/5-mm Hg BP increments, the association was strongest for rest BP (systolic, 1.21 [1.14 to 1.27]; diastolic, 1.20 [1.14 to 1.26]), then Bruce stage 2 BP (systolic, 1.09 [1.04 to 1.14]; diastolic, 1.09 [1.05 to 1.13]), then maximal exercise BP (systolic, 1.06 [1.01 to 1.10]; diastolic, 1.04 [1.01 to 1.08]). Overall, exercise BP was not significant after adjustment for rest BP. However, hypertension status modified the risk associated with exercise BP (P(interaction)=0.03). Among nonhypertensives, whether they had normal BP (<120/80 mm Hg) or prehypertension, Bruce stage 2 BP >180/90 versus < or =180/90 mm Hg carried increased risk independent of rest BP and risk factors (adjusted hazard ratio for systolic, 1.96 [1.40 to 2.74], P<0.001; diastolic, 1.48 [1.06 to 2.06], P=0.02) and added predictive value (net reclassification improvement, systolic, 12.0% [-0.1% to 24.2%]; diastolic, 9.9% [-0.3% to 20.0%]; relative integrated discrimination improvement, 14.3% and 12.0%, respectively). CONCLUSIONS In asymptomatic individuals, elevated exercise BP carried higher risk of CVD death but became nonsignificant after accounting for rest BP. However, Bruce stage 2 BP >180/90 mm Hg identified nonhypertensive individuals at higher risk of CVD death.
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Affiliation(s)
- Sandra A Weiss
- Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA
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Abstract
The guidelines of the Joint National Committee 7 from the USA on hypertension have unified the normal and high-normal blood pressure categories into a single entity termed ;prehypertension'. In contrast, The European Guidelines for the management of hypertension in 2007 considered ;prehypertensive' to be divided into normal and high-normal blood pressure. These patients with high-normal blood pressure or prehypertension might progress to hypertension over time. Previous studies have shown that high-normal blood pressure is a risk factor for cardiovascular disease (CVD) in Western countries and Japan. The combination of high-normal blood pressure and other cardiovascular risk factors increases the risks of CVD. Recently, metabolic syndrome has also been shown to be a risk factor for CVD. In Japan, the association between metabolic syndrome and CVD was also found to be significant. The risks for CVD incidence were similar among participants who had the same number of components, regardless of the presence of abdominal obesity. In the Japanese guidelines for the management of hypertension published in 2009, patients are considered to be in a high-risk group if they have diabetes, chronic kidney disease, 3 or more risk factors, target organ damage or CVD, even if they have only high-normal blood pressure, and appropriate antihypertensive therapy should be initiated.
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Affiliation(s)
- Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cardiovascular Center, Suita, Japan.
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Is prehypertension an independent predictor of target organ changes in young-to-middle-aged persons of African descent? J Hypertens 2008; 26:2279-87. [DOI: 10.1097/hjh.0b013e328311f296] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kokubo Y, Kamide K, Okamura T, Watanabe M, Higashiyama A, Kawanishi K, Okayama A, Kawano Y. Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort. Hypertension 2008; 52:652-9. [DOI: 10.1161/hypertensionaha.108.118273] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few prospective studies have examined the association between high-normal blood pressure and cardiovascular disease (CVD) in Asia. We examined the impact of high-normal blood pressure on the incidence of CVD in a general urban population cohort in Japan. We studied 5494 Japanese individuals (ages 30 to 79 years without CVD at baseline) after completing a baseline survey who received follow-up through December 2005. Blood pressure categories were defined on the basis of the ESH-ESC 2007 criteria. In 64 391 person-years of follow-up, we documented the incidence of 346 CVD events. The frequencies of high-normal blood pressure and hypertension Stage 1 and Stage ≥2 were 18.0%, 20.1%, and 10.1% for men and 15.9%, 15.6%, and 8.8% for women, respectively. Antihypertensive drug users were also classified into the baseline blood pressure categories. Compared with the optimal blood pressure group, the multivariable hazard ratios (95% confidence intervals) of CVD for normal and high-normal blood pressure and hypertension Stage 1 and Stage ≥2 were 2.04 (1.19 to 3.48), 2.46 (1.46 to 4.14), 2.62 (1.59 to 4.32), and 3.95 (2.37 to 6.58) in men and 1.12 (0.59 to 2.13), 1.54 (0.85 to 2.78), 1.35 (0.75 to 2.43), and 2.86 (1.60 to 5.12) in women, respectively. The risks of myocardial infarction and stroke for each blood pressure category were similar to those of CVD. Population-attributable fractions of high-normal blood pressure and hypertension for CVD were 12.2% and 35.3% in men and 7.1% and 23.4% in women, respectively. In conclusion, high-normal blood pressure is a risk factor for the incidence of stroke and myocardial infarction in a general urban population of Japanese men.
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Affiliation(s)
- Yoshihiro Kokubo
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Kei Kamide
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Tomonori Okamura
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Makoto Watanabe
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Aya Higashiyama
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Katsuyuki Kawanishi
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Akira Okayama
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
| | - Yuhei Kawano
- From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan
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OHARA T, KIM J, ASAKURA M, ASANUMA H, NAKATANI S, HASHIMURA K, KANZAKI H, FUNAHASHI T, TOMOIKE H, KITAKAZE M. Plasma Adiponectin Is Associated with Plasma Brain Natriuretic Peptide and Cardiac Function in Healthy Subjects. Hypertens Res 2008; 31:825-31. [DOI: 10.1291/hypres.31.825] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kwok RK, Mendola P, Liu ZY, Savitz DA, Heiss G, Ling HL, Xia Y, Lobdell D, Zeng D, Thorp JM, Creason JP, Mumford JL. Drinking water arsenic exposure and blood pressure in healthy women of reproductive age in Inner Mongolia, China. Toxicol Appl Pharmacol 2007; 222:337-43. [PMID: 17509635 DOI: 10.1016/j.taap.2007.04.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/02/2007] [Accepted: 04/09/2007] [Indexed: 11/24/2022]
Abstract
The extremely high exposure levels evaluated in prior investigations relating elevated levels of drinking water arsenic and hypertension prevalence make extrapolation to potential vascular effects at lower exposure levels very difficult. A cross-sectional study was conducted on 8790 women who had recently been pregnant in an area of Inner Mongolia, China known to have a gradient of drinking water arsenic exposure. This study observed increased systolic blood pressure levels with increasing drinking water arsenic, at lower exposure levels than previously reported in the literature. As compared to the referent category (below limit of detection to 20 microg of As/L), the overall population mean systolic blood pressure rose 1.29 mm Hg (95% CI 0.82, 1.75), 1.28 mm Hg (95% CI 0.49, 2.07), and 2.22 mm Hg (95% CI 1.46, 2.97) as drinking water arsenic concentration increased from 21 to 50, 51 to 100, and >100 microg of As/L, respectively. Controlling for age and body weight (n=3260), the population mean systolic blood pressure rose 1.88 mm Hg (95% CI 1.03, 2.73), 3.90 mm Hg (95% CI 2.52, 5.29), and 6.83 mm Hg (95% CI 5.39, 8.27) as drinking water arsenic concentration increased, respectively. For diastolic blood pressure effect, while statistically significant, was not as pronounced as systolic blood pressure. Mean diastolic blood pressure rose 0.78 mm Hg (95% CI 0.39, 1.16), 1.57 mm Hg (95% CI 0.91, 2.22) and 1.32 mm Hg (95% CI 0.70, 1.95), respectively, for the overall population and rose 2.11 mm Hg (95% CI 1.38, 2.84), 2.74 mm Hg (95% CI 1.55, 3.93), and 3.08 mm Hg (95% CI 1.84, 4.31), respectively, for the adjusted population (n=3260) at drinking water arsenic concentrations of 21 to 50, 51 to 100, and >100 microg of As/L. If our study results are confirmed in other populations, the potential burden of cardiovascular disease attributable to drinking water arsenic is significant.
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Affiliation(s)
- Richard K Kwok
- RTI International, PO Box 12194, 3040 Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA.
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12
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Abstract
Systolic blood pressure (BP) of less than 140 mm Hg and diastolic BP of less than 90 mm Hg were previously considered normal. However, there was some evidence that even BP in the high reference range was associated with an increased risk of cardiovascular disease. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defined a new BP category "prehypertension" for systolic and diastolic BP: 120 to 139 mm Hg and 85 to 89 mm Hg, respectively. This new category is a continuum to hypertension and is a risk factor for cardiovascular disease. The progression of prehypertension to hypertension can be delayed or may be prevented by lifestyle changes.
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Affiliation(s)
- M Fareed K Suri
- Cerebrovascular Program, Division of Epidemiology and Outcomes Research, Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Ohkuchi A, Iwasaki R, Suzuki H, Hirashima C, Takahashi K, Usui R, Matsubara S, Minakami H, Suzuki M. Normal and high-normal blood pressures, but not body mass index, are risk factors for the subsequent occurrence of both preeclampsia and gestational hypertension: a retrospective cohort study. Hypertens Res 2006; 29:161-7. [PMID: 16755151 DOI: 10.1291/hypres.29.161] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood pressure (BP) levels and body mass index (BMI) are known as risk factors for preeclampsia and gestational hypertension. However, there have been few investigations regarding the effects of BP and BMI levels on preeclampsia and gestational hypertension in the same cohort. In the present study, we conducted a retrospective cohort study using multiple logistic regression analysis. The cohort included 1,518 patients without nephritis. The unadjusted odds ratios (ORs) of preeclampsia and gestational hypertension were increased in pregnant women with normal BP (120-129 mmHg systolic or 80-84 mmHg diastolic), high-normal BP and hypertension in the second trimester compared to those with optimal BP. The unadjusted ORs of preeclampsia and gestational hypertension were also increased in obese women in the pre-pregnancy period compared to women with normal range BMI. When adjustment was made for both the BP levels and pre-pregnancy BMI levels, the ORs (95% confidence intervals) of normal BP, high-normal BP, hypertension and obesity for the subsequent occurrence of preeclampsia were 5.1 (2.2-12), 8.3 (3.1-22), 16 (5.0-50) and 2.0 (0.67-5.9), and those for the subsequent occurrence of gestational hypertension were 7.0 (2.6-19), 7.4 (2.1-25), 22 (6.1-83) and 1.3 (0.33-4.8), respectively. For the subsequent occurrence of preeclampsia or gestational hypertension, normal BP, high-normal BP and hypertension in the second trimester may be independent risk factors. Obesity in the pre-pregnancy period, however, may not be an independent risk factor.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Japan.
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Qureshi AI, Suri MFK, Kirmani JF, Divani AA, Mohammad Y. Is prehypertension a risk factor for cardiovascular diseases? Stroke 2005; 36:1859-63. [PMID: 16081866 DOI: 10.1161/01.str.0000177495.45580.f1] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The Joint National Committee on High Blood Pressure identified a new category of blood pressure in adults termed prehypertension. Our objective was to determine the long-term risk of cardiovascular diseases associated with this new category in a well-defined cohort of adults. METHODS We evaluated the association of prehypertension (120 to 139/80 to 89 mm Hg) and hypertension (>140/90 mm Hg) with the incidence of atherothrombotic brain infarction (ABI), all strokes, myocardial infarction (MI), and coronary artery disease (CAD) using pooled repeated measures and Cox proportional hazards analyses during follow-up after adjusting for age, gender, obesity, diabetes mellitus, hypercholesterolemia, cigarette smoking, and study period in a cohort of 5181 persons who participated in the Framingham Study. RESULTS Among the 11,116 person observations with a mean follow-up period of 9.9+/-1.0 years, prehypertension was not associated with an increased risk for ABI (relative risk [RR], 2.2; 95% CI, 0.5 to 9.3). Among the 11,802 person observations with a mean follow-up period of 9.7+/-1.5 years, prehypertension was associated with an increased risk for MI (RR, 3.5; 95% CI, 1.6 to 7.5). Prehypertension was also associated with an increased risk of CADs among the 11,570 person observations (RR, 1.7; 95% CI, 1.2 to 2.4). CONCLUSIONS Prehypertension appears to be associated with an increased risk of MI and CAD but not stroke. Further studies are required to confirm the anticipated benefits of identifying and intervening in persons with prehypertension.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, USA.
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Yamaura Y, Nishida T, Watanabe N, Akasaka T, Yoshida K. Relation of aortic valve sclerosis to carotid artery intima-media thickening in healthy subjects. Am J Cardiol 2004; 94:837-9. [PMID: 15374806 DOI: 10.1016/j.amjcard.2004.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 06/01/2004] [Accepted: 06/01/2004] [Indexed: 11/16/2022]
Abstract
We studied 252 healthy adults by echocardiography and carotid ultrasonography to determine the relation between early subclinical aortic valve sclerosis (AVS) and carotid intima-media thickness (IMT). Carotid IMT was significantly greater in subjects with AVS than in those without AVS. There was a significant correlation between the grade of AVS and carotid IMT.
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Affiliation(s)
- Yasuko Yamaura
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
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Tachibana R, Tabara Y, Kondo I, Miki T, Kohara K. Home Blood Pressure Is a Better Predictor of Carotid Atherosclerosis than Office Blood Pressure in Community-Dwelling Subjects. Hypertens Res 2004; 27:633-9. [PMID: 15750256 DOI: 10.1291/hypres.27.633] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increase in the thickness of the intima-media (IMT) of the carotid artery is associated with an increased risk of cardiovascular morbidity and mortality. Hypertension is one of the underlying mechanisms for the progression of carotid atherosclerosis. However, office blood pressure (BP) has been shown to have only a weak association with carotid IMT. Since self-measured home BP has less variation than office BP, home BP could be a better predictor of carotid atherosclerosis. To explore this hypothesis, we compared the relationships between carotid IMT and office BP or home BP in a community-dwelling population. One-hundred and one community residents, aged 50 years or older and not taking any medication, were enrolled in this study. Morning home BP was measured according to the guidelines of the Japanese Society of Hypertension. The results were recorded for 2 weeks and averaged. Carotid atherosclerosis was defined as IMT > or =0.80 mm, which corresponds to the first quartile. Home systolic BP showed a more significant association with carotid IMT (r=0.422, p <0.0001) than with office systolic BP (r=0.021, p=0.027). Logistic regression analysis for the presence of carotid atherosclerosis further showed that the relative risk of hypertension defined using home BP (> or =135/85 mmHg) was 6.3 (95% confidence interval [CI]: 2.0 to 19.6), while that using office BP was 1.5 (95% CI: 0.5 to 4.2). These results suggest that home BP is a better predictor of the development of carotid atherosclerosis than office BP.
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Affiliation(s)
- Rieko Tachibana
- Department of Geriatric Medicine, Ehime University School of Medicine, Ehime, Japan
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De Lima JJG, Vieira MLC, Viviani LF, Medeiros CJ, Ianhez LE, Kopel L, de Andrade JL, Krieger EM, Lage SG. Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients. Nephrol Dial Transplant 2002; 17:645-51. [PMID: 11917059 DOI: 10.1093/ndt/17.4.645] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to examine prospectively the impact of renal transplantation on the morphological and functional characteristics of the carotid arteries and heart in a group of end-stage renal failure patients without overt cardiovascular disease, followed up for >3 years. METHODS Twenty-two patients were evaluated 2-3 weeks after renal transplantation, and again 12 and 40 months post-transplant, using high resolution ultrasound imaging and echocardiography. RESULTS Kidney and patient survival were 100% at the end of follow-up without any major cardiovascular events. After 40+/-1.2 months, carotid morphological parameters were normalized: carotid intima-media thickness fell from 788+/-24 to 676+/-32 microm (P<0.01) and the carotid wall/lumen ratio fell from 118+/-3 to 103+/-3 microm (P<0.01). Significant reduction of left ventricular (LV) posterior wall thickness (11.5+/-0.2 to 11.3+/-0.2 mm, P<0.05) and LV mass index (172+/-9 to 158+/-8 g/m(2), P<0.01) was already observed after 12+/-0.2 months. Further reduction of LV posterior wall thickness (10.4+/-0.3 mm, P<0.01) and of LV mass index (136+/-7 g/m(2), P<0.01) also occurred after 40+/-1.2 months. However, carotid distensibility (19.5+/-2.1 vs 22+/-2.4, not significant (NS)) and LV compliance (early to atrial flow ratio: 1.2+/-0.1 vs 1.3+/-0.1, NS) remained abnormal, and normalization of the LV mass was attained by only 25% of the patients with LV hypertrophy on baseline. Multiple stepwise regression analysis showed that the rate of change of reduction of the intima-media thickness was influenced by age (negative association, P<0.001) and was positively related to white race (P<0.05), female sex (P<0.01) and to the parallel reduction of maximum carotid diameter (P<0.001). Reduction of LV mass index over time was negatively related to the duration of dialysis treatment and to the parallel increase observed in body mass index and haematocrit, and was positively related to the simultaneous reduction of diastolic blood pressure (P<0.01 for all variables). CONCLUSIONS Successful renal transplantation improves but does not cause complete regression of the cardiovascular alterations of end-stage renal disease. Only intima-media thickness was normalized by transplantation, whereas LVMI and carotid and ventricular distensibility remained abnormal. The results suggest that extended duration of dialysis, weight gain, high blood pressure and high haematocrit may adversely affect the rate of change of post-transplant cardiovascular hypertrophy.
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Moser M. A "touch" of high blood pressure. J Clin Hypertens (Greenwich) 2002; 4:10-2. [PMID: 11821632 PMCID: PMC8099345 DOI: 10.1111/j.1524-6175.2002.01101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345:1291-7. [PMID: 11794147 DOI: 10.1056/nejmoa003417] [Citation(s) in RCA: 1250] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Information is limited regarding the absolute and relative risk of cardiovascular disease in persons with high-normal blood pressure (systolic pressure of 130 to 139 mm Hg, diastolic pressure of 85 to 89 mm Hg, or both). METHODS We investigated the association between blood-pressure category at base line and the incidence of cardiovascular disease on follow-up among 6859 participants in the Framingham Heart Study who were initially free of hypertension and cardiovascular disease. RESULTS A stepwise increase in cardiovascular event rates was noted in persons with higher baseline blood-pressure categories. The 10-year cumulative incidence of cardiovascular disease in subjects 35 to 64 years of age who had high-normal blood pressure was 4 percent (95 percent confidence interval, 2 to 5 percent) for women and 8 percent (95 percent confidence interval, 6 to 10 percent) for men; in older subjects (those 65 to 90 years old), the incidence was 18 percent (95 percent confidence interval, 12 to 23 percent) for women and 25 percent (95 percent confidence interval, 17 to 34 percent) for men. As compared with optimal blood pressure, high-normal blood pressure was associated with a risk-factor-adjusted hazard ratio for cardiovascular disease of 2.5 (95 percent confidence interval, 1.6 to 4.1) in women and 1.6 (95 percent confidence interval, 1.1 to 2.2) in men. CONCLUSIONS High-normal blood pressure is associated with an increased risk of cardiovascular disease. Our findings emphasize the need to determine whether lowering high-normal blood pressure can reduce the risk of cardiovascular disease.
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Affiliation(s)
- R S Vasan
- Framingham Heart Study, Mass 01702, USA.
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