Characteristics of Young-Onset Hypertension Identified by Targeted Screening Performed at a University Health Check-Up

Clinical Correlates of Early-Onset Hypertension

BACKGROUND

Early-onset hypertension has been established as a heritable trait and a risk factor for cardiovascular disease outcomes. However, the clinical correlates of early-onset hypertension remain unidentified.

METHODS

In this study, we assessed the demographic characteristics and lifestyle factors related to hypertension onset age in a sample of 3,286 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (mean baseline age 25 ± 4 years, 57% women). We examined the association between the participants’ baseline characteristics and age of hypertension onset subgroups (<35, 35‒44, or ≥45 years) using a multinomial logistic regression model with those who did not develop hypertension as the reference group. Hypertension onset was defined as blood pressure ≥140/90 mm Hg or antihypertensive medication use on 2 consecutively attended follow-up visits.

RESULTS

In the multinomial logistic regression model, individuals who were black (odds ratio [OR], 5.08; 95% confidence interval [CI], 3.17–8.14), were more obese (OR, 1.57; 95% CI, 1.32–1.88), or had higher total cholesterol (OR, 1.34; 95% CI, 1.13–1.60 per SD) had increased odds of early-onset hypertension (onset at <35 years) vs. not developing hypertension. In contrast, 1-SD higher high-density lipoprotein (HDL)-cholesterol was related to decreased odds of early-onset hypertension (OR, 0.71; 95% CI, 0.57–0.89). The odds for having earlier hypertension onset increased linearly across age of onset categories in black individuals and individuals with lower HDL-cholesterol (P < 0.05 for trend for both).

CONCLUSIONS

Our findings suggest that individuals who are black, obese, have higher total cholesterol, or have lower HDL-cholesterol level, are potentially at an increased risk of having early-onset hypertension.

Exploring the effect of virtual reality relaxation environment on white coat hypertension in blood pressure measurement

A phenomenon called White Coat Hypertension (WCH) often occurs when measuring blood pressure (BP) in a real medical environment. Utilizing virtual reality (VR) technology to present appropriate relaxation scenes can isolate the real medical environments and may provide a new method to avoid WCH and improve the accuracy of BP measurement. In this study, we designed four immersive VR relaxation scenes and conducted an experiment to explore the role of VR scenes in eliminating/detecting WCH in BP measurement. Results from the current sample showed that both systolic BP and diastolic BP measured in the simulated medical environment were significantly higher than the baseline level and the VR scene condition, while there were no significant differences between the BPs measured in VR scenes and the baseline level. It can be concluded that VR provides an effective approach to avoid WCH in BP measurement by visually and aurally isolating the real environment and assisting relaxation and provides a new approach to detect the occurrence of WCH by the comparison of BPs measured in the VR scene condition and real medical environments.

Age of Hypertension Onset: Overview of Research and How to Apply in Practice

PURPOSE OF REVIEW

To review the current evidence on research related to age of hypertension onset-its definition, correlates, heritability, and association with adverse outcomes. We also propose a framework for implementing assessment of hypertension onset age into clinical practice.

RECENT FINDINGS

Prior studies have used both objective measurements and self-report to determine age of hypertension onset or early-onset hypertension. Yet, no criterion for standard definition currently exists for either. Data from epidemiological and clinical studies demonstrate that early-onset hypertension is a highly heritable trait that confers an increased risk for cardiovascular death and end-organ damage compared with late-onset hypertension. Literature to date suggests that (parental) age of hypertension onset can be feasibly assessed for estimating (1) risk of future hypertension in non-hypertensive persons; and (2) the propensity for cardiovascular disease in individuals with established hypertension.

Role of aortic stiffness and inflammation in the etiology of young-onset hypertension

Background/aim

Young-onset hypertension is a form of condition diagnosed in patients aged below 40. Cytokines such as interleukin (IL)-6 and also MCP-1 may play a role in the development of arterial hypertension. Aortic stiffness can be detected by measuring pulse wave velocity (PWV). We aimed to explore the relationship between inflammation and aortic stiffness and investigate their roles in the etiology of young-onset hypertension.

Materials and methods

We enrolled 16 patients diagnosed with young-onset hypertension and 16 volunteers without hypertension. The plasma levels of MCP-1 and IL-6 were determined using an enzyme-linked immunosorbent assay and quantitative enzyme-linked immunoassay, respectively. Carotid-femoral PWV was measured using an arteriograph device.

Results

Compared with those in normotensive controls, the plasma levels of IL-6 and MCP-1 and the PWV values were significantly higher in patients with young-onset hypertension (P < 0.001). PWV values were also positively correlated with the levels of MCP-1 and IL-6. However, no statistically significant difference was noted in intima-media thickness between the two groups (P = 0.224).

Conclusion

In this study, increased PWVs and the levels of inflammation markers were associated with aortic stiffness and inflammation in patients with young-onset hypertension, suggesting they have a role in the etiology of hypertension.

Asymptomatically elevated blood pressure in the emergency department: a finding deserving of attention by emergency physicians?

The Emergency Department (ED) may be an ideal place to screen and refer patients for blood pressure monitoring in the outpatient setting. Yet, little is known about the public health significance of asymptomatically elevated blood pressure measurements in the ED and what to tell patients when these abnormal vital signs are recorded. Since the prevalence of hypertension and inadequately treated hypertension is so high, the incidental finding of elevated blood pressure in a previously undiagnosed patient may be a pivotal moment in that patient's life. For those patients carrying the diagnosis of hypertension, it is the author's opinion that the observation of elevated blood pressures should trigger advice to see their physicians to consider medication adjustments or changes. Emergency Physicians and their staff are in a unique position to screen and refer large populations of patients to their community physicians and help abort the long-term sequelae of unidentified or inadequately managed hypertension. How best to advise physicians and their patients requires research and innovative methods for transmitting important information to patients that may be unrelated to their primary complaint in the ED.

Characteristics of young-onset white coat hypertension identified by targeted screening for hypertension at a university health check-up

Previously we estimated the prevalence of essential hypertension (EH) as around 0.1% and suggested that male gender, obesity, and strong genetic background (hypertension in parents) were risk factors for EH in a young population aged less than 30 based on targeted screening for hypertension at a university health check-up. This study also revealed a high incidence of white coat hypertension (WCH) in university students, and thus, we continued this screening for four consecutive years, and examined the prognosis and clinical characteristics of young-onset WCH. Three occasions of casual blood pressure (BP) measurement and additional home BP measurement revealed 72 WCH and 15 EH students (all males) during the 4-year study period. None of the WCH students had elevated home BP to the level of hypertension during their stay at university, and 26 out of 38 WCH students participating screening in the following years showed normal casual BP. Although WCH students showed a significantly higher pulse rate than controls, WCH could not be fully differentiated from EH either by pulse rate or by correlation between casual BP value and pulse rate. These findings indicate the requirement of longer follow-up after graduation to determine the prognosis of young-onset WCH, though EH and WCH in the young population share the same risk factors and, possibly, autonomic nervous system dysfunction. Since diagnosis of WCH has limited importance for university students, screening of EH following a general health check-up would elevate the clinical validity of casual BP measurement at the university.

Association of hypertension with changes in the body mass index of university students

BACKGROUND

There are few longitudinal studies on the associations of obesity with hypertension in young adults.

OBJECTIVES

To analyze longitudinally to what extent weight gain associates with hypertension in young adults.

METHODS

The subjects of this study consisted of 6,178 university students (male 4,098; female 2,080). The associations of hypertension with body type change were longitudinally examined by using the records of health examinations while at university. The prevalence ratios (PRs) for hypertension in their senior year were calculated on groups that changed toward obese against those that changed toward underweight. The logistic regression analyses were used to estimate odds ratios (ORs) for hypertension in their senior year of each factor. The analyses were conducted on (i) all subjects, (ii) non-hypertensive subjects in their freshman year, and (iii) by schools, in order to take into account physical activities.

RESULTS

The PRs of hypertension in subjects changed toward obese from their freshmen to seniors against ones toward underweight were 1.47 (95% CI; 1.00-2.15) for males and 3.50 (0.93-13.22) for females. In analyses limited to non-hypertensive subjects in their freshman year, results were similar to those of all subjects. The analyses by school also showed similar results to those including all subjects. In logistic regression analyses, although the factor most strongly associated with hypertension was body type in their senior year, the body type in their freshman still showed significant association with hypertension after the adjustment of senior year body type and hypertension in freshman year. The ORs for hypertension in obese subjects to normal weight ones in their senior year were 9.13 (95% CI; 5.77-14.45) for males and 22.59 (5.69-89.67) for females after adjusted by hypertension in freshman, body type in freshman and school.

CONCLUSIONS

These data suggest that the increase of BMI is linked to hypertension in university students.

NADH dehydrogenase subunit-2 237 Leu/Met polymorphism modifies the effects of alcohol consumption on risk for hypertension in middle-aged Japanese men

NADH dehydrogenase subunit-2 237 leucine/methionine (ND2-237 Leu/Met) polymorphism is associated with longevity in the Japanese population, and the ND2-237Met genotype may exert antiatherogenic effects. To investigate whether ND2-237 Leu/Met polymorphism is associated with risk of hypertension, we conducted a cross-sectional study of 398 Japanese male subjects. The frequency of hypertension was significantly higher in ND2-237Leu genotypic men than in ND2-237Met genotypic men. On analysis of covariance, the interaction between ND2-237 Leu/Met polymorphism and habitual drinking was significantly associated with both systolic blood pressure and diastolic blood pressure. Multiple logistic regression analysis revealed that the ND2-237Met genotype, particularly in younger subjects (age <60 years), had a lower odds ratio for hypertension than the ND2-237Leu genotype. Moreover, the association of ND2-237 Leu/Met polymorphism with hypertension may depend on the frequency of alcohol consumption. The odds ratio for hypertension was significantly higher in daily drinkers with ND2-237Leu when compared with non- or ex-drinkers with ND2-237Leu. However, the association between the ND2-237Met genotype and hypertension may not depend on the frequency of alcohol consumption. The present results suggest that ND2-237 Leu/Met polymorphism is associated with hypertension and that modification of hypertension risk is dependent on alcohol consumption in middle-aged Japanese men.