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Walle-Hansen MM, Hagberg G, Myrstad M, Berge T, Vigen T, Ihle-Hansen H, Thommessen B, Ariansen I, Lyngbakken MN, Røsjø H, Rønning OM, Tveit A, Ihle-Hansen H. Systolic blood pressure at age 40 and 30-year stroke risk in men and women. Open Heart 2024; 11:e002805. [PMID: 39179252 PMCID: PMC11344497 DOI: 10.1136/openhrt-2024-002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/11/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences. METHODS We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012-2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990-1993. We categorised participants by systolic blood pressure (SBP) at age 40 (<120 mm Hg (reference), 120-129 mm Hg, 130-139 mm Hg and ≥140 mm Hg) and compared stroke risk using Cox proportional hazard regressions adjusted for age, sex, smoking, cholesterol, physical activity, obesity and education. Fatal and non-fatal strokes were obtained from the Norwegian Cardiovascular Disease Registry from 1 January 2012 to 31 December 2020, in addition to self-reported strokes. RESULTS The mean age was 40.1±0.3 years (50.4% women) and mean SBP was 128.3±13.5 mm Hg (mean±SD). Stroke occurred in 115 (4.4%) individuals (32 (28%) women and 83 (72%) men) during 29.4±2.9 years of follow-up. SBP between 130 and 139 mm Hg was not associated with stroke (adjusted HR 1.71, 95% CI 0.87 to 3.36) while SBP ≥140 mm Hg was associated with increased stroke risk (adjusted HR 3.11, 95% CI 1.62 to 6.00). The adjusted HR of stroke was 4.32 (95% CI 1.66 to 11.26) for women and 2.66 (95% CI 1.03 to 6.89) for men, with non-significant sex interactions. CONCLUSIONS SBP ≥140 mm Hg was significantly associated with 30-year stroke risk in both sexes. A small subgroup of women had SBP ≥140 mm Hg and systolic hypertension was a strong risk factor for stroke in these women. TRIAL REGISTRATION NUMBER NCT01555411.
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Affiliation(s)
- Marte Meyer Walle-Hansen
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Guri Hagberg
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Marius Myrstad
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | - Thea Vigen
- Department of Neurology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Hege Ihle-Hansen
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Inger Ariansen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Akershus Clinical Research Center, Division of Research and Innovation, Akershus University Hospital, Lorenskog, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Neurology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Håkon Ihle-Hansen
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
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Baschat AA, Darwin K, Vaught AJ. Hypertensive Disorders of Pregnancy and the Cardiovascular System: Causes, Consequences, Therapy, and Prevention. Am J Perinatol 2024; 41:1298-1310. [PMID: 36894160 DOI: 10.1055/a-2051-2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Hypertensive disorders of pregnancy continue to be significant contributors to adverse perinatal outcome and maternal mortality, as well as inducing life-long cardiovascular health impacts that are proportional to the severity and frequency of pregnancy complications. The placenta is the interface between the mother and fetus and its failure to undergo vascular maturation in tandem with maternal cardiovascular adaptation by the end of the first trimester predisposes to hypertensive disorders and fetal growth restriction. While primary failure of trophoblastic invasion with incomplete maternal spiral artery remodeling has been considered central to the pathogenesis of preeclampsia, cardiovascular risk factors associated with abnormal first trimester maternal blood pressure and cardiovascular adaptation produce identical placental pathology leading to hypertensive pregnancy disorders. Outside pregnancy blood pressure treatment thresholds are identified with the goal to prevent immediate risks from severe hypertension >160/100 mm Hg and long-term health impacts that arise from elevated blood pressures as low as 120/80 mm Hg. Until recently, the trend for less aggressive blood pressure management during pregnancy was driven by fear of inducing placental malperfusion without a clear clinical benefit. However, placental perfusion is not dependent on maternal perfusion pressure during the first trimester and risk-appropriate blood pressure normalization may provide the opportunity to protect from the placental maldevelopment that predisposes to hypertensive disorders of pregnancy. Recent randomized trials set the stage for more aggressive risk-appropriate blood pressure management that may offer a greater potential for prevention for hypertensive disorders of pregnancy. KEY POINTS: · Optimal management of maternal blood pressure to prevent preeclampsia and its risks is undefined.. · Early gestational rheological damage to the intervillous space predisposes to preeclampsia and FGR.. · First trimester blood pressure management may need to aim for normotension to prevent preeclampsia..
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Affiliation(s)
| | - Kristin Darwin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arthur J Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Dehghan A, Jahangiry L, Khezri R, Jafari A, Pezeshki B, Rezaei F, Aune D. Framingham risk scores for determination the 10-year risk of cardiovascular disease in participants with and without the metabolic syndrome: results of the Fasa Persian cohort study. BMC Endocr Disord 2024; 24:95. [PMID: 38915041 PMCID: PMC11194982 DOI: 10.1186/s12902-024-01621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a cluster of risk factors and the Framingham risk score (FRS) is a useful metric for measuring the 10-year cardiovascular disease (CVD) risk of the population. The present study aimed to determine the 10-year risk of cardiovascular disease using the Framingham risk score in people with and without MetS in a large Iranian cohort study. METHODS This cross-sectional study was done using the Fasa cohort. Participants aged ≥ 35 years old were recruited to the study from 2015 to 2016. The FRS was calculated using age, sex, current smoking, diabetes, systolic blood pressure (SBP), total cholesterol, and high-density lipoprotein (HDL) cholesterol. MetS was defined as the presence of three or more of the MetS risk factors including triglyceride (TG) level ≥ 150 mg dl- 1, HDL level < 40 mg dl- 1 in men and < 50 mg dl- 1 in women, systolic/diastolic blood pressure ≥ 130/≥85 mmHg or using medicine for hypertension, fasting blood sugar (FBS) level ≥ 100 mg dl- 1 or using diabetes medication and abdominal obesity considered as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. Multiple logistic regressions were applied to estimate the 10- year CVD risk among people with and without MetS. RESULTS Of 8949 participants, 1928 people (21.6%) had MetS. The mean age of the participants with and without Mets was 50.4 ± 9.2 years and 46.9 ± 9.1 years respectively. In total 15.3% of participants with MetS and 8.0% of participants without MetS were in the high-risk category of 10-year CVD risk. Among participants with MetS gender, TG, SBP, FBS and in people without MetS gender, TG, SBP, FBS, and HDL showed strong associations with the predicted 10-year CVD risk. CONCLUSION Male sex and increased SBP, TG, and FBS parameters were strongly associated with increased 10-year risk of CVD in people with and without MetS. In people without MetS, reduced HDL-cholestrol was strongly associated with increased 10-year risk of CVD. The recognition of participant's TG, blood pressure (BP), FBS and planning appropriate lifestyle interventions related to these characteristics is an important step towards prevention of CVD.
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Affiliation(s)
- Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Leila Jahangiry
- Road Traffic Injury Research Center, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education and Health Promotion Department, School of Health, Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rozhan Khezri
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Babak Pezeshki
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Fatemeh Rezaei
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Oslo New University College, Oslo, Norway
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Wang H, He S, Wang J, An Y, Wang X, Li G, Sun N, Gong Q. Does high-normal blood pressure lead to excess cardiovascular disease events and deaths in Chinese people? A post-hoc analysis of the 30-year follow-up of the Da Qing IGT and Diabetes Study. Diabetes Obes Metab 2024; 26:871-877. [PMID: 38012837 DOI: 10.1111/dom.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
AIM Whether systolic/diastolic blood pressure (SBP/DBP) values of 130-139/80-89 mmHg should be defined as hypertension has been debated for decades. We aimed to characterize the effect of high-normal BP on cardiovascular disease (CVD) events and deaths. METHODS In total, 1726 individuals from the original Da Qing IGT and Diabetes Study were enrolled, and divided into the normal BP group (SBP <130 mmHg and DBP <80 mmHg), high-normal BP group (SBP 130-139 mmHg and/or DBP 80-89 mmHg) and hypertension group (SBP ≥140 mmHg and/or DBP ≥90 mmHg). CVD events and their components were assessed from 1986 to 2016. RESULTS During the 30-year follow-up, the high-normal BP group was not at higher risk for CVD events [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.84-1.30, p = .68], coronary heart disease (HR 1.12, 95% CI 0.77-1.63, p = .57), stroke (HR 1.05, 95% CI 0.82-1.34, p = .71), or CVD deaths (HR 1.15, 95% CI 0.82-1.60, p = .41) compared with the normal BP group, after adjusting for covariates. However, the hypertension group exhibited significantly increased cardiovascular risk (CVD events, HR 1.91, 95% CI 1.48-2.46, p < .0001; coronary heart disease, HR 1.73, 95% CI 1.12-2.67, p = .01; stroke, HR 1.90, 95% CI 1.43-2.52, p < .0001; CVD deaths, HR 2.07, 95% CI 1.43-3.01, p = .0001) than the normal BP group. Subgroup analyses showed that, regardless of the presence of diabetes, high-normal BP did not increase CVD events compared with normal BP. CONCLUSIONS This post-hoc study provided no evidence that the high-normal BP increased cardiovascular risk in the Da Qing study population, suggesting that it was reasonable to continue to define hypertension at 140/90 mmHg in China.
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Affiliation(s)
- Haixu Wang
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyao He
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Daqing, China
| | - Yali An
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Wang
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China-Japan Friendship Hospital, Beijing, China
| | - Ningling Sun
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Qiuhong Gong
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Endrias EE, Tesfaye Mamito T, Geta Hardido T, Ataro BA. Prevalence of Pre-Hypertension/Hypertension and Its Associated Factors Among Adults in the Wolaita Zone of Southern Ethiopia: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241246968. [PMID: 38641978 PMCID: PMC11032063 DOI: 10.1177/00469580241246968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/09/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
Preventing the development of high blood pressure and resulting complication requires estimating the prevalence of prehypertension/hypertension and identifying associated risk factors. Information about pre-hypertension/hypertension in Ethiopia, especially in the southern region, is scarce, and limited knowledge exists regarding the prevalence and risk factors associated with pre-hypertension/hypertension. Objective of this study was to assess prevalence of pre-hypertension/hypertension and its associated factors among adults in Wolaita Zone of Southern Ethiopia, 2023. This cross-sectional study was conducted among adults attending outpatient departments in governmental hospitals in South Ethiopia in 2023. Face-to-face interviews were used to gather information on sociodemographic data, dietary and behavioral patterns, and medical history. Digital weighing scales, Stadiometers, and digital sphygmomanometers were used to measure height, blood pressure, and weight, respectively. Epi-Data version 3.1 was used to enter the data before exporting it to SPSS version 25 for analysis. To find factors associated with prehypertension/hypertension, binary logistic regressions were conducted and odds ratios with 95% confidence intervals were computed. The overall prevalence of prehypertension/hypertension was 42.8% (95% confidence interval: 39.56, 49.47). Factors associated with prehypertension/hypertension in this study were older age, male gender, obesity, diabetes mellitus comorbidity, alcohol drinking, and family history of hypertension. Lifestyle modification is demanded for pre-hypertensive/hypertensive patients to prevent progression to severe complications, including premature death and permanent disabilities.
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Qu Y, Lv Y, Ji S, Ding L, Zhao F, Zhu Y, Zhang W, Hu X, Lu Y, Li Y, Zhang X, Zhang M, Yang Y, Li C, Zhang M, Li Z, Chen C, Zheng L, Gu H, Zhu H, Sun Q, Cai J, Song S, Ying B, Lin S, Cao Z, Liang D, Ji JS, Ryan PB, Barr DB, Shi X. Effect of exposures to mixtures of lead and various metals on hypertension, pre-hypertension, and blood pressure: A cross-sectional study from the China National Human Biomonitoring. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 299:118864. [PMID: 35063540 DOI: 10.1016/j.envpol.2022.118864] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
We aimed to explore the effects of mixtures of lead and various metals on blood pressure (BP) and the odds of pre-hypertension (systolic blood pressure (SBP) 120-139 mmHg, and/or diastolic blood pressure (DBP) 80-89 mmHg) and hypertension (SBP/DBP ≥140/90 mmHg) among Chinese adults in a cross-sectional study. This study included 11,037 adults aged 18 years or older from the 2017-2018 China National Human Biomonitoring. Average BP and 13 metals (lead, antimony, arsenic, cadmium, mercury, thallium, chromium, cobalt, molybdenum, manganese, nickel, selenium, and tin) in blood and urine were measured and lifestyle and demographic data were collected. Weighted multiple linear regressions were used to estimate associations of metals with BP in both single and multiple metal models. Weighted quantile sum (WQS) regression was performed to assess the relationship between metal mixture levels and BP. In the single metal model, after adjusting for potential confounding factors, the blood lead levels in the highest quartile were associated with the greater odds of both pre-hypertension (odds ratio (OR): 1.56, 95% CI: 1.22-1.99) and hypertension (OR:1.75, 95% CI: 1.28-2.40) when compared with the lowest quartile. We also found that blood arsenic levels were associated with increased odds of pre-hypertension (OR:1.31, 95% CI:1.00-1.74), while urinary molybdenum levels were associated with lower odds of hypertension (OR:0.68, 95% CI:0.50-0.93). No significant associations were found for the other 10 metals. WQS regression analysis showed that metal mixture levels in blood were significantly associated with higher SBP (β = 1.56, P < 0.05) and DBP (β = 1.56, P < 0.05), with the largest contributor being lead (49.9% and 66.8%, respectively). The finding suggests that exposure to mixtures of metals as measured in blood were positively associated with BP, and that lead exposure may play a critical role in hypertension development.
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Affiliation(s)
- Yingli Qu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Saisai Ji
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Liang Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Ying Zhu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Wenli Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Xiaojian Hu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yifu Lu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Yawei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Xu Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Mingyuan Zhang
- School of Public Health, Jilin University, 2699 Qianjin Street, Changchun, Jilin, 130012, China
| | - Yanwei Yang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Chengcheng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Miao Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Zheng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Lei Zheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Heng Gu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Huijuan Zhu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Qi Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Jiayi Cai
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Shixun Song
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Bo Ying
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Shaobin Lin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Zhaojin Cao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Street, Haidian, Beijing, 100084, China; Environmental Research Center, Duke Kunshan University, 8 Duke Avenue, Kunshan, Jiangsu, 215316, China; Nicholas School of the Environment, Duke University, 2080 Duke University Road, Durham, NC, 27708, United States
| | - P Barry Ryan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, United States
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Chaoyang, Beijing, 100021, China.
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Stage 1 hypertension and risk of cardiovascular disease mortality in United States adults with or without diabetes. J Hypertens 2022; 40:794-803. [PMID: 35102086 DOI: 10.1097/hjh.0000000000003080] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to investigate the association of S1 hypertension, classified according to the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline, with cardiovascular disease (CVD) mortality in adults with or without diabetes from the general United States population. METHODS This cohort study included 40 518 United States adults (including 3555 with diabetes) naive to antihypertensive drugs who attended the National Health and Nutrition Examination Surveys from 1988 to 2014. RESULTS Participants were followed up for 489 679 person-years (mean follow-up, 12.1 years) with 1569 CVD deaths being recorded. S1 hypertension was neither associated with an increased CVD mortality risk in the whole cohort nor in participants with or without diabetes after full adjustment. In age-stratified analyses, compared with normal BP, S1 hypertension was associated with increased CVD mortality in young adults, unrelated to CVD mortality in midlife, and associated with lower CVD mortality in the elderly. In older participants (≥70 years), people with S1 hypertension had a 23% lower multivariate-adjusted CVD mortality risk compared with those with normal BP (hazard ratio 0.77; 95% confidence interval 0.61-0.98). In younger (<70 years) adults without diabetes, people with normal BP had the lowest CVD mortality risk; however, in younger adults with diabetes, it was people with elevated BP who had the lowest CVD mortality risk. CONCLUSION In this representative sample of United States adults not on BP-lowering medications, S1 hypertension was associated with elevated CVD mortality in younger adults and with lower CVD mortality in those 70 or more years of age.
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Ye Q, Wing-Kuen Ling B, Xu N, Lin Y, Hu L. Multi-model fusion of classifiers for blood pressure estimation. IET Syst Biol 2021; 15:184-191. [PMID: 34469063 PMCID: PMC8675793 DOI: 10.1049/syb2.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
Prehypertension is a new risky disease defined in the seventh report issued by the Joint National Commission. Hence, detecting prehypertension in time plays a very important role in protecting human lives. This study proposes a method for categorising blood pressure values into two classes, namely the class of healthy blood pressure values and the class of prehypertension blood pressure values, as well as estimating the blood pressure values continuously only by employing photoplethysmograms. First, the denoising of photoplethysmograms is performed via a discrete cosine transform approach. Then, the features of the photoplethysmograms in both the time domain and the frequency domain are extracted. Next, the feature vectors are categorised into the two classes of blood pressure values by a multi‐model fusion of the classifiers. Here, the support vector machine, the random forest and the K‐nearest neighbour classifier are employed for performing the fusion. There are two types of blood pressure values. They are the systolic blood pressure values and the diastolic blood pressure values. For each class and each type of blood pressure values, support vector regression is used to estimate the blood pressure values. Since different classes and different types of blood pressure values are considered separately, the proposed method achieves an accurate estimation. The computed numerical simulation results show that the proposed method based on the multi‐model fusion of the classifiers achieves both higher classification accuracy and higher regression accuracy than the individual classification methods.
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Affiliation(s)
- Qi Ye
- Information Engineering, Guangdong University of Technology, Guangzhou, China
| | | | - Nuo Xu
- Information Engineering, Guangdong University of Technology, Guangzhou, China
| | - Yuxin Lin
- Information Engineering, Guangdong University of Technology, Guangzhou, China
| | - Lingyue Hu
- Information Engineering, Guangdong University of Technology, Guangzhou, China
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Magno AL, Herat LY, Kiuchi MG, Schlaich MP, Ward NC, Matthews VB. The Influence of Hypertensive Therapies on Circulating Factors: Clinical Implications for SCFAs, FGF21, TNFSF14 and TNF-α. J Clin Med 2020; 9:jcm9092764. [PMID: 32858953 PMCID: PMC7576485 DOI: 10.3390/jcm9092764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023] Open
Abstract
Studying the role of circulatory factors in the pathogenesis of diseases has been key to the development of effective therapies. We sought to examine the effect of antihypertensive therapies on numerous circulatory factors including short chain fatty acids and growth factors in a human cohort. A subset of participants from an earlier study was characterized by their hypertensive and/or treatment status and separated into three groups: (i) normotensives; (ii) untreated hypertensive and (iii) treated hypertensive subjects. Circulating levels of short chain fatty acids, FGF21 and TNF superfamily members were measured as part of this study. Both F2-isoprostane and circulating lipid levels were reanalysed as part of this current study. We found that antihypertensive treatment increased butyrate levels and decreased acetate levels to levels similar to normotensives. We also found that antihypertensive treatments reduced levels of circulating FGF21, TNFSF14 and TNF-α. In conclusion, we identified several circulatory factors that are altered in hypertension.
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Affiliation(s)
- Aaron L. Magno
- Research Centre, Royal Perth Hospital, Perth, WA 6000, Australia;
| | - Lakshini Y. Herat
- Dobney Hypertension Centre, School of Biomedical Science—Royal Perth Hospital Unit, University of Western Australia, Crawley, WA 6009, Australia;
| | - Márcio G. Kiuchi
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Unit, University of Western Australia, Crawley, WA 6009, Australia; (M.G.K.); (M.P.S.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Unit, University of Western Australia, Crawley, WA 6009, Australia; (M.G.K.); (M.P.S.)
- Department of Cardiology and Department of Nephrology, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Natalie C. Ward
- School of Public Health, Curtin University, Perth, WA 6102, Australia;
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Vance B. Matthews
- Dobney Hypertension Centre, School of Biomedical Science—Royal Perth Hospital Unit, University of Western Australia, Crawley, WA 6009, Australia;
- Correspondence: ; Tel.: +61-8-9224-0239
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10
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Smart analysis of a ternary mixture of amlodipine, hydrochlorothiazide and telmisartan by manipulation of UV spectra: Development, validation and application to formulations. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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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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12
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Serum Level of HLDF24 Peptide as an Objective Marker of Prehypertension. Bull Exp Biol Med 2020; 168:305-308. [PMID: 31938910 DOI: 10.1007/s10517-020-04696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 10/25/2022]
Abstract
The concentrations of the key factors of molecular pathogenesis of prehypertension (angiotensin II, HLDF24, S100b, endothelin, autoantibodies to these molecules, and VEGF) were analyzed in subjects with optimal BP (<120/80 mm Hg) and prehypertension (120-139/80-89 mm Hg). Comparative and correlation analysis of the levels of these molecules was performed. A statistically significant decrease in HLDF24 level in prehypertension in comparison optimal BP was observed. Specific features and interactions between the studied factors in optimal BP and in prehypertension were studied. The mechanisms underlying the observed associations between serum concentration of HLFF24 and the development of prehypertension were discussed.
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13
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Fonkoue IT, Le N, Kankam ML, DaCosta D, Jones TN, Marvar PJ, Park J. Sympathoexcitation and impaired arterial baroreflex sensitivity are linked to vascular inflammation in individuals with elevated resting blood pressure. Physiol Rep 2019; 7:e14057. [PMID: 30968587 PMCID: PMC6456445 DOI: 10.14814/phy2.14057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 12/31/2022] Open
Abstract
Elevated Resting Blood Pressure (ERBP) in the prehypertensive range is associated with increased risk of hypertension and cardiovascular disease, the mechanisms of which remain unclear. Prior studies have suggested that ERBP may be associated with overactivation and dysregulation of the sympathetic nervous system (SNS). We hypothesized that compared to normotensives (≤120/80 mmHg), ERBP (120/80-139/89 mmHg) has higher SNS activity, impaired arterial baroreflex sensitivity (BRS), and increased vascular inflammation. Twenty-nine participants were studied: 16 otherwise healthy individuals with ERBP (blood pressure (BP) 130 ± 2/85 ± 2 mmHg) and 13 matched normotensive controls (mean BP 114 ± 2/73 ± 2 mmHg). We measured muscle sympathetic nerve activity (MSNA), beat-to-beat BP, and continuous electrocardiogram at rest and during arterial BRS testing via the modified Oxford technique. Blood was analyzed for the following biomarkers of vascular inflammation: lipoprotein-associated phospholipase A2 (Lp-PLA2), E-selectin, and intercellular adhesion molecule 1 (ICAM-1). Resting MSNA burst frequency (22 ± 2 vs. 16 ± 2 bursts/min, P = 0.036) and burst incidence (36 ± 3 vs. 25 ± 3 bursts/100 heart beats, P = 0.025) were higher in ERBP compared to controls. Cardiovagal BRS was blunted in ERBP compared to controls (13 ± 2 vs. 20 ± 3 msec/mmHg, P = 0.032), while there was no difference in sympathetic BRS between groups. Lp-PLA2 (169 ± 8 vs. 142 ± 9 nmol/min/mL, P = 0.020) and E-selectin (6.89 ± 0.6 vs. 4.45 ± 0.51 ng/mL, P = 0.004) were higher in ERBP versus controls. E-selectin (r = 0.501, P = 0.011) and ICAM-1 (r = 0.481, P = 0.015) were positively correlated with MSNA, while E-selectin was negatively correlated with cardiovagal BRS (r = -0.427, P = 0.030). These findings demonstrate that individuals with ERBP have SNS overactivity and impaired arterial BRS that are linked to biomarkers of vascular inflammation.
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Affiliation(s)
- Ida T. Fonkoue
- Renal DivisionDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
- Research Service LineAtlanta VA Healthcare SystemDecaturGeorgia
| | - Ngoc‐Anh Le
- Biomarker Core LaboratoryAtlanta VA Healthcare SystemDecaturGeorgia
| | - Melanie L. Kankam
- Renal DivisionDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
- Research Service LineAtlanta VA Healthcare SystemDecaturGeorgia
| | - Dana DaCosta
- Renal DivisionDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
- Research Service LineAtlanta VA Healthcare SystemDecaturGeorgia
| | - Toure N. Jones
- Renal DivisionDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
- Research Service LineAtlanta VA Healthcare SystemDecaturGeorgia
| | - Paul J. Marvar
- Department of Pharmacology and PhysiologyInstitute for NeuroscienceGeorge Washington UniversityWashingtonDistrict of Columbia
| | - Jeanie Park
- Renal DivisionDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
- Research Service LineAtlanta VA Healthcare SystemDecaturGeorgia
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14
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Shin KM, Park JE, Yook TH, Kim JU, Kwon O, Choi SM. Moxibustion for prehypertension and stage I hypertension: a pilot randomized controlled trial. Integr Med Res 2019; 8:1-7. [PMID: 30596012 PMCID: PMC6309023 DOI: 10.1016/j.imr.2018.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prehypertension and hypertension are associated with cardiovascular disease, ischemic heart disease, and stroke morbidity. The purpose of this study is to evaluate the effectiveness and safety of moxibustion in patients with prehypertension or hypertension. METHODS Forty-five subjects with prehypertension or stage I hypertension were randomized into three groups: moxibustion treatment group A (2 sessions/week for 4 weeks), moxibustion treatment group B (3 sessions/week for 4 weeks), and control group (nontreated group). The primary outcome measure was the change in blood pressure after 4 weeks of treatment. Safety was assessed at every visit. RESULTS There were no significant differences in systolic blood pressure (SBP) or diastolic blood pressure (DBP) among three groups after 4 weeks of treatment (p = 0.4798 and p = 0.3252, respectively). In treatment group B, there was a significant decrease in SBP and DBP from baseline to 4 weeks of treatment (mean difference (MD) -9.55; p = 0.0225, MD -7.55; p = 0.0098, respectively). There were no significant differences among groups in secondary outcome measures after 4 weeks of treatment. Six adverse events (AEs) in the treatment group A and 12 AEs in the treatment group B occurred related to the moxibustion treatment. CONCLUSION In conclusion, the results of this study show that moxibustion (3 sessions/week for 4 weeks) might lower blood pressure in patients with prehypertension or stage I hypertension and treatment frequency might affect effectiveness of moxibustion in BP regulation. Further randomized controlled trials with a large sample size on prehypertension and hypertension should be conducted. TRIAL REGISTRATION This study was registered with the 'Clinical Research Information Service (CRIS)', Republic of Korea (KCT0000469), and the protocol for this study was presented orally at the 15th International Council of Medical Acupuncture and Related Techniques (ICMART) in Athens, 25-27 May 2012.
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Key Words
- AE, adverse event
- BMI, body mass index
- BP, blood pressure
- CI, confidence interval
- DBP, diastolic blood pressure
- EQ-5D, EuroQol-5 Dimensions
- FSS, Fatigue Severity Scale
- HRV, heart rate variability
- Hypertension
- MD, mean difference
- Moxibustion
- NDI, neck disability index
- PSQI, Pittsburgh Sleep Quality Index
- Prehypertension
- RCT, randomized controlled trial
- SAE, serious adverse event
- SBP, systolic blood pressure
- SRI-MF, Modified Form of the Stress Response Inventory
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Affiliation(s)
- Kyung-Min Shin
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ji-Eun Park
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Tae-Han Yook
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
| | - Jong-Uk Kim
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Sun-Mi Choi
- Korea Institute of Oriental Medicine, Daejeon, South Korea
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15
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Abstract
Hypertension, among the common conditions encountered in primary care, is known to have a causal link with cardiovascular disease. With new thresholds for diagnosing hypertension, its prevalence is expected to increase. Currently, a high percentage of patients have suboptimal or inadequately controlled blood pressure, thus placing them at risk for cardiovascular disease. Among the best strategies for improved outcomes are inclusion of the patient in decision-making as well as provision of individualized treatment plans.
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Affiliation(s)
- Parvathi Perumareddi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, ME-104, Room 213, Boca Raton, FL 33431, USA.
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16
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Baschat AA, Dewberry D, Seravalli V, Miller JL, Block-Abraham D, Blitzer MG. Maternal blood-pressure trends throughout pregnancy and development of pre-eclampsia in women receiving first-trimester aspirin prophylaxis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:728-733. [PMID: 29266502 DOI: 10.1002/uog.18992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/14/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study women who initiated aspirin in the first trimester for high risk of pre-eclampsia, and compare blood-pressure trends throughout pregnancy between those with normal outcome and those who subsequently developed pre-eclampsia. METHODS Women were enrolled into a prospective observational study at 9-14 weeks' gestation. This was a secondary analysis of those who started daily doses of 81 mg of aspirin before 16 weeks for increased risk of pre-eclampsia based on maternal history and bilateral uterine artery notching. Enrollment characteristics and blood-pressure measurements throughout gestation were compared between women who did and those who did not develop pre-eclampsia. RESULTS Of the 237 women who initiated first-trimester aspirin prophylaxis, 29 (12.2%) developed pre-eclampsia. A total of 2881 serial blood-pressure measurements obtained between 4 and 41 weeks' gestation (747 in the first trimester, 1008 in the second and 1126 in the third) showed that women with pre-eclampsia started pregnancy with higher blood pressure and maintained this trend despite taking aspirin (mean arterial blood pressure in women with pre-eclampsia = (0.13 × gestational age (weeks)) + 93.63, vs (0.11 × gestational age (weeks)) + 82.61 in those without; P < 0.005). First-trimester diastolic and second-trimester systolic blood pressure were independent risk factors for pre-eclampsia (β = 1.087 and 1.050, respectively; r2 = 0.24, P < 0.0001). When average first-trimester diastolic blood pressure was >74 mmHg, the odds ratio for pre-eclampsia was 6.5 (95% CI, 2.8-15.1; P < 0.001) and that for pre-eclampsia before 34 weeks was 14.6 (95% CI, 1.72-123.5; P = 0.004). If, in addition, average second-trimester systolic blood pressure was >125 mmHg, the odds ratio for pre-eclampsia was 9.4 (95% CI, 4.1-22.4; P < 0.001) and that for early-onset disease was 34.6 (95% CI, 4.1-296.4; P = 0.004). CONCLUSION In women treated with prophylactic aspirin from the first trimester, those who develop pre-eclampsia have significantly and sustained higher blood pressure from the onset of pregnancy compared with those who do not develop pre-eclampsia. This raises the possibility that mildly elevated blood pressure predisposes women to abnormal placentation, which then acts synergistically with elevated blood pressure to predispose such women to pre-eclampsia to a degree that is incompletely mitigated by aspirin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Baschat
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D Dewberry
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Seravalli
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J L Miller
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D Block-Abraham
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M G Blitzer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Son JS, Choi S, Kim K, Kim SM, Choi D, Lee G, Jeong SM, Park SY, Kim YY, Yun JM, Park SM. Association of Blood Pressure Classification in Korean Young Adults According to the 2017 American College of Cardiology/American Heart Association Guidelines With Subsequent Cardiovascular Disease Events. JAMA 2018; 320:1783-1792. [PMID: 30398603 PMCID: PMC6248107 DOI: 10.1001/jama.2018.16501] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Among young adults, the association of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Clinical Practice Guidelines with risk of cardiovascular disease (CVD) later in life is uncertain. OBJECTIVE To determine the association of blood pressure categories before age 40 years with risk of CVD later in life. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study from the Korean National Health Insurance Service consisted of 2 488 101 adults aged 20 through 39 years with blood pressure measurements taken twice from 2002 through 2005. Starting from January 1, 2006, participants were followed up until the date of CVD diagnosis, death, or December 31, 2015. EXPOSURES Participants were categorized by blood pressure readings: normal (systolic, <120 mm Hg; diastolic, <80 mm Hg), elevated (sytolic, 120-129 mm Hg; diastolic, <80 mm Hg), stage 1 hypertension (systolic, 130-139 mm Hg; diastolic, 80-89 mm Hg), and stage 2 hypertension (systolic, ≥140 mm Hg; diastolic, ≥90 mm Hg). MAIN OUTCOMES AND MEASURES The primary outcome was CVD defined as 2 or more days of hospitalization due to CVD or death due to CVD. The secondary outcomes were coronary heart disease (CHD) and stroke. RESULTS The study population consisted of 2 488 101 participants (median age, 31 years [interquartile range, 27-36 years], 789 870 women [31.7%]). A total of 44 813 CVD events were observed during a median follow-up duration of 10 years. Men with baseline stage 1 hypertension compared with those with normal blood pressure had higher risk of CVD (incidence, 215 vs 164 per 100 000 person-years; difference, 51 per 100 000 person-years [95% CI, 48-55]; adjusted hazard ratio [HR], 1.25 [95% CI, 1.21-1.28]), CHD (incidence, 134 vs 103 per 100 000 person-years; difference, 31 per 100 000 person-years [95% CI, 28-33]; adjusted HR, 1.23 [95% CI, 1.19-1.27]), and stroke (incidence, 90 vs 67 per 100 000 person-years; difference, 23 per 100 000 person-years [95% CI, 21-26]; adjusted HR, 1.30 [95% CI, 1.25-1.36]). Women with baseline stage 1 hypertension compared with those with normal blood pressure had increased risk of CVD (incidence, 131 vs 91 per 100 000 person-years; difference, 40 per 100 000 person-years [95% CI, 35-45]; adjusted HR, 1.27 [95% CI, 1.21-1.34]), CHD (incidence, 56 vs 42 per 100 000 person-years; difference, 14 per 100 000 person-years [95% CI, 11-18]; adjusted HR, 1.16 [95% CI, 1.08-1.25]), and stroke (incidence, 79 vs 51 per 100 000 person-years; difference, 28 per 100 000 person-years [95% CI, 24-32]; adjusted HR [1.37, 95% CI, 1.29-1.46]). Results for state 2 hypertension were consistent. CONCLUSIONS AND RELEVANCE Among Korean young adults, stage 1 and stage 2 hypertension, compared with normal blood pressure, were associated with increased risk of subsequent cardiovascular disease events. Young adults with hypertension, defined by the 2017 ACC/AHA criteria, may be at increased risk of cardiovascular disease.
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Affiliation(s)
- Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Daein Choi
- Pyeongchang Bongpyeong Public Health Center, Pyeongchang, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Health Promotion Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seong Yong Park
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, South Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
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18
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Fonkoue IT, Norrholm SD, Marvar PJ, Li Y, Kankam ML, Rothbaum BO, Park J. Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1272-R1280. [PMID: 30303706 DOI: 10.1152/ajpregu.00173.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by increased sympathetic nervous system (SNS) activity, blunted parasympathetic nervous system (PNS) activity, and impaired baroreflex sensitivity (BRS), which contribute to accelerated cardiovascular disease. Patients with PTSD also have chronic stress-related elevations in resting blood pressure (BP), often in the prehypertensive range; yet, it is unclear if elevated resting blood pressure (ERBP) augments these autonomic derangements in PTSD. We hypothesized that compared with normotensive PTSD (N-PTSD), those with ERBP (E-PTSD) have further increased SNS, decreased PNS activity, and impaired BRS at rest and exaggerated SNS reactivity, PNS withdrawal, and pressor responses during stress. In 16 E-PTSD and 17 matched N-PTSD, we measured continuous BP, ECG, muscle sympathetic nerve activity (MSNA), and heart rate variability (HRV) markers reflecting cardiac PNS activity [standard deviation of R-R intervals (SDNN), root mean square of differences in successive R-R intervals (RMSSD), and high frequency power (HF)] during 5 min of rest and 3 min of mental arithmetic. Resting MSNA ( P = 0.943), sympathetic BRS ( P = 0.189), and cardiovagal BRS ( P = 0.332) were similar between groups. However, baseline SDNN (56 ± 6 vs. 78 ± 8 ms, P = 0.019), RMSSD (39 ± 6 vs. 63 ± 9 ms, P = 0.018), and HF (378 ± 103 vs. 693 ± 92 ms2, P = 0.015) were lower in E-PTSD versus N-PTSD. During mental stress, the systolic blood pressure response ( P = 0.011) was augmented in E-PTSD. Although MSNA reactivity was not different ( P > 0.05), the E-PTSD group had an exaggerated reduction in HRV during mental stress ( P < 0.05). PTSD with ERBP have attenuated resting cardiac PNS activity, coupled with exaggerated BP reactivity and PNS withdrawal during stress.
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Affiliation(s)
- Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Barbara O Rothbaum
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
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19
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Wu S, Chen D, Zeng X, Wen J, Zhou C, Xiao K, Hu P, Chen W. Arterial stiffness is associated with target organ damage in subjects with pre-hypertension. Arch Med Sci 2018; 14:1374-1380. [PMID: 30393492 PMCID: PMC6209717 DOI: 10.5114/aoms.2017.69240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/01/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Present study was to evaluate whether increased arterial stiffness was associated with target organ damage in pre-hypertensive subjects. MATERIAL AND METHODS Pre-hypertensive subjects enrolled and echocardiography was used to evaluate left ventricular hypertrophy (LVH) and the first morning urine was collected to evaluate albumin and creatinine ratio (ALB/Cr ratio). Carotid-femoral pulse wave velocity (cf-PWV) was measured. RESULTS A total of 420 subjects were recruited and mean age was 42.6 years. Mean systolic/diastolic blood pressure (SBP/DBP) were 130 ±9 mm Hg and 85 ±4 mm Hg. The prevalence of albuminuria and left ventricular hypertrophy was 8.6 % and 11.7 %. Mean cf-PWV was 9.2 ±1.0 m/s, with arterial stiffness prevalence was 8.8%. Subjects with arterial stiffness had higher cf-PWV value (10.6 ±0.4 m/s vs. 8.7 ±0.6 m/s, p < 0.05), and ALB/Cr ratio (28.3 ±13.2 µg/mg vs. 23.1 ± 11.4 µg/mg, p < 0.05). Overall, with multivariate regression analysis, aging and arterial stiffness were significantly associated with pre-hypertension. With stepwise adjusted for potential covariates including age, male gender, fasting plasma glucose, presence of current cigarette smoking, dyslipidemia, statins and SBP, increased cf-PWV remained independently associated with left ventricular hypertrophy and albuminuria, with an increased odds of 41 % and 24 % (p < 0.05), respectively. CONCLUSIONS In pre-hypertensive subjects, arterial stiffness is independently associated with LVH and albuminuria and cf-PWV may be a useful marker to identify target organ damage in pre-hypertensive subjects.
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Affiliation(s)
- Shaoyun Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dubo Chen
- Department of Laboratory Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xun Zeng
- Department of Outpatient, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junmin Wen
- Department of Intensive Unit, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Chuzhi Zhou
- Department of Intensive Unit, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Ke Xiao
- Department of Cardiology, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Peng Hu
- Department of Cardiology, the Fifth subsidiary Sun Yat-sen University Hospital, Zhuhai, China
| | - Weixin Chen
- Department of Intensive Unit, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
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Thapliyal V, Singh K, Joshi A. Prevalence and Associated Factors of Hypertension among Adults in Rural Uttarakhand: A Community Based Cross Sectional Study. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2018. [DOI: 10.12944/crnfsj.6.2.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
India is in a state of transition epidemiological, economic, and demographic and nutrition transition. And all these transitions are leading to non communicable diseases like obesity, hypertension and insulin resistance. The study was aimed to estimate the Prevalence of hypertension and its associated risk factors among adults of rural Uttrakhand.
It is a cross sectional community based study. Survey was conducted in rural areas of Uttrakhand, to make a sample size of 300 adults (18-45yr), using WHO STEPS questionnaire. Waist Circumference, Blood pressure, Body Mass Index of the participants was calculated. P value < 0.05 was considered significant.
In the sample population based on systolic BP, 61.3% were non-hypertensive, 29.7% were pre-hypertensive and 9% were hypertensive. Based on diastolic BP, 43.3% were non-hypertensive, 32.7% were pre-hypertensive and 24% were hypertensive. Subjects with hypertension and pre-hypertension have higher BMI and waist circumference.
A high prevalence rate of pre-hypertension and hypertension was depicted in rural areas of Uttrakhand region.4.8% of the female participants had systolic high blood pressure compared to the 11.9% of the male participants. On the other hand, 21.8% of the female participants had diastolic high blood pressure compared to the over 25% of the male participants.
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Affiliation(s)
| | - Karuna Singh
- Amity Institute of Food Technology, Amity University, Noida
| | - Anil Joshi
- Himalayan Environmental Studies and Conservation Organization (HESCO)
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Khosravi A, Emamian MH, Hashemi H, Fotouhi A. Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study. Epidemiol Health 2018; 40:e2018026. [PMID: 30056646 PMCID: PMC6178362 DOI: 10.4178/epih.e2018026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes. METHODS In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education. RESULTS The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively. CONCLUSIONS Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.
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Affiliation(s)
- Ahmad Khosravi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hassan Emamian
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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22
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Kanegae H, Oikawa T, Suzuki K, Okawara Y, Kario K. Developing and validating a new precise risk-prediction model for new-onset hypertension: The Jichi Genki hypertension prediction model (JG model). J Clin Hypertens (Greenwich) 2018; 20:880-890. [PMID: 29604170 DOI: 10.1111/jch.13270] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 02/28/2018] [Indexed: 11/28/2022]
Abstract
No integrated risk assessment tools that include lifestyle factors and uric acid have been developed. In accordance with the Industrial Safety and Health Law in Japan, a follow-up examination of 63 495 normotensive individuals (mean age 42.8 years) who underwent a health checkup in 2010 was conducted every year for 5 years. The primary endpoint was new-onset hypertension (systolic blood pressure [SBP]/diastolic blood pressure [DBP] ≥ 140/90 mm Hg and/or the initiation of antihypertensive medications with self-reported hypertension). During the mean 3.4 years of follow-up, 7402 participants (11.7%) developed hypertension. The prediction model included age, sex, body mass index (BMI), SBP, DBP, low-density lipoprotein cholesterol, uric acid, proteinuria, current smoking, alcohol intake, eating rate, DBP by age, and BMI by age at baseline and was created by using Cox proportional hazards models to calculate 3-year absolute risks. The derivation analysis confirmed that the model performed well both with respect to discrimination and calibration (n = 63 495; C-statistic = 0.885, 95% confidence interval [CI], 0.865-0.903; χ2 statistic = 13.6, degree of freedom [df] = 7). In the external validation analysis, moreover, the model performed well both in its discrimination and calibration characteristics (n = 14 168; C-statistic = 0.846; 95%CI, 0.775-0.905; χ2 statistic = 8.7, df = 7). Adding LDL cholesterol, uric acid, proteinuria, alcohol intake, eating rate, and BMI by age to the base model yielded a significantly higher C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement, especially NRInon-event (NRI = 0.127, 95%CI = 0.100-0.152; NRInon-event = 0.108, 95%CI = 0.102-0.117). In conclusion, a highly precise model with good performance was developed for predicting incident hypertension using the new parameters of eating rate, uric acid, proteinuria, and BMI by age.
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Affiliation(s)
- Hiroshi Kanegae
- Genki Plaza Medical Center for Health Care, Tokyo, Japan.,Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Kenji Suzuki
- The Japan Health Promotion Foundation, Tokyo, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Attimarad M, Nagaraja SH, Nair AB, Aldhubaib BE, Katharigatta VN. Development of validated RP HPLC method with fluorescence detection for simultaneous quantification of sacubitril and valsartan from rat plasma. J LIQ CHROMATOGR R T 2018. [DOI: 10.1080/10826076.2018.1436070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mahesh Attimarad
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al Ahsa, Saudi Arabia
| | - Sree Harsha Nagaraja
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al Ahsa, Saudi Arabia
| | - Anroop Balachandran Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al Ahsa, Saudi Arabia
| | - Bandar Essa Aldhubaib
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al Ahsa, Saudi Arabia
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Yoo I, No M, Kong HJ, Hong J. Effects of Aging and Sarcopenic Obesity Type on Metabolic Syndrome Risk Factors in Elderly Women. THE ASIAN JOURNAL OF KINESIOLOGY 2018. [DOI: 10.15758/ajk.2018.20.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S. Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey. PLoS One 2017; 12:e0188619. [PMID: 29267338 PMCID: PMC5739392 DOI: 10.1371/journal.pone.0188619] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/10/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment. METHODS A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements. RESULTS Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8-41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5-42.2%), 9.2% (8.4-10.0%) and 6.5% (5.9-7.2%) respectively. Age group (45-69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes. CONCLUSIONS The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up.
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Affiliation(s)
- Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Jarnail Singh Thakur
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gursimer Jeet
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sohan Chawla
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Askin L, Yesiltepe Y. High-Sensitivity Cardiac Troponin T levels in prehypertensive patients. Clin Exp Hypertens 2017; 40:332-336. [PMID: 28952796 DOI: 10.1080/10641963.2017.1377216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTNT) is an important non-invasive laboratory-based marker of subclinical myocardial injury. Prehypertension, which may be a precursor of hypertension, is a major public health issue. Our aim was to evaluate the importance of serum hs-cTnT as a marker predicting prehypertension. METHODS A total of 100 subjects (45 women and 55 men) consisting of 50 consecutive prehypertensive patients with blood pressures between 120/80 and 139/89 mmHg and 50 normotensive patients with blood pressures < 120/80 mmHg were enrolled prospectively. The hs-cTNT level was calculated and compared between the two groups. Echocardiographic examinations were performed in all patients. RESULTS The hs-cTnT level was significantly higher in the prehypertensive group (p < 0.001) and was positively correlated with prehypertension (r = 0.625, p < 0.001). Hs-cTnT was an independent predictor of prehypertension (odds ratio = 1.043, 95% confidence interval [CI] 1.019-1.067, p < 0.001). An Hs-cTnT level of 0.55 ng/L was predictive of prehypertension with a sensitivity of 86% and specificity of 60% (area under the curve = 0.861; 95% CI, 0.787-0.935; p < 0.001). CONCLUSION hs-cTnT may complement other diagnostic biomarkers in predicting prehypertension. Abbrevations: high-sensitivity cardiac troponin T, prehypertension, subclinical myocardial injury.
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Affiliation(s)
- Lutfu Askin
- a Department of cardiology , Palandoken State Hospital , Erzurum , Turkey
| | - Yener Yesiltepe
- b Department of biochemistry , Palandoken State Hospital , Erzurum , Turkey
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27
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Accuracy of Cuff-Measured Blood Pressure. J Am Coll Cardiol 2017; 70:572-586. [DOI: 10.1016/j.jacc.2017.05.064] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 12/20/2022]
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Kanegae H, Oikawa T, Okawara Y, Hoshide S, Kario K. Which blood pressure measurement, systolic or diastolic, better predicts future hypertension in normotensive young adults? J Clin Hypertens (Greenwich) 2017; 19:603-610. [PMID: 28444926 PMCID: PMC8030768 DOI: 10.1111/jch.13015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Abstract
The impact of age-related differences in blood pressure (BP) components on new-onset hypertension is not known. A follow-up examination of 93 303 normotensive individuals (mean age 41.1 years) who underwent a health checkup in 2005 was conducted every year for 8 years. The primary end point was new-onset hypertension (systolic BP [SBP]/diastolic BP [DBP] ≥140/90 mm Hg and/or the initiation of antihypertensive medications with self-reported hypertension). During the mean 4.9 years of follow-up, 14 590 subjects developed hypertension. The impact of DBP on the risk of developing hypertension compared with optimal BP (SBP <120 mm Hg and DBP <80 mm Hg) was significantly greater than that of SBP in subjects younger than 50 years (hazard ratios, 17.5 for isolated diastolic high-normal vs 10.5 for isolated systolic high-normal [P<.001]; 8.0 for isolated diastolic normal vs 4.1 for isolated systolic normal [P<.001]). Among the subjects 50 years and older, the corresponding effects of DBP and SBP were similar. Regarding the risk of new-onset hypertension, high DBP is more important than SBP in younger adults (<50 years) with normal or high-normal BP.
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Affiliation(s)
- Hiroshi Kanegae
- Genki Plaza Medical Center for Health CareTokyoJapan
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Yukie Okawara
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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Shim KS, Kim JW. The effect of resistance exercise on fitness, blood pressure, and blood lipid of hypertensive middle-aged men. J Exerc Rehabil 2017; 13:95-100. [PMID: 28349040 PMCID: PMC5332006 DOI: 10.12965/jer.1734894.447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/04/2017] [Indexed: 01/19/2023] Open
Abstract
The purpose of this study is to investigate the effect of resistance exercise on fitness, blood pressure, and blood lipid of hypertensive middle-aged men. To achieve the goal of the study, a total of 23 subjects were selected. Among them, 14 subjects who exercised regularly were selected as the exercise group, while the remaining 9 subjects were selected as the control group. In terms of data processing, the IBM SPSS Statistics ver. 21.0 software was used to calculate the mean and standard deviation. Regarding the verification of difference on the change of means between the groups, analysis of covariance was used for statistical process. As a result, significant differences were found in cardiovascular endurance, muscle endurance, flexibility, and triglyceride. These results indicate that the resistance exercise only had slight effect on hypertensive middle-aged men.
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Affiliation(s)
- Kyu-Sik Shim
- Department of Physical Education, Busan National University of Education, Busan, Korea
| | - Jong-Won Kim
- Department of Physical Education, Busan National University of Education, Busan, Korea
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Kim M, Yoo HJ, Kim M, Ahn HY, Park J, Lee SH, Lee JH. Associations among oxidative stress, Lp-PLA 2 activity and arterial stiffness according to blood pressure status at a 3.5-year follow-up in subjects with prehypertension. Atherosclerosis 2017; 257:179-185. [PMID: 28142077 DOI: 10.1016/j.atherosclerosis.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/12/2016] [Accepted: 01/12/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS We aimed to determine changes in oxidative stress, lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and arterial stiffness in subjects with persistent prehypertensive symptoms during a 3.5-year follow-up period. METHODS We divided 254 subjects with prehypertension according to their blood pressure (BP) status at 3.5 years of follow-up into three groups: reversed normotensive, persistent prehypertensive and developed hypertensive group. BP, serum lipid profile, oxidized LDL (ox-LDL), Lp-PLA2 activity and brachial-ankle pulse wave velocity (ba-PWV) were measured at baseline and the 3.5-year follow-up. RESULTS The reversed normotensive group showed a significant reduction in average BP (14.7/10.1 mmHg), whereas the developed hypertensive group showed a significant increase in average BP (15.2/11.5 mmHg). The persistent prehypertensive group showed increases in serum lipid profiles, circulating levels of Lp-PLA2 activity, ox-LDL and arterial stiffness as measured by ba-PWV at 3.5 years. The persistent prehypertensive and developed hypertensive groups showed greater increases in ox-LDL than the reversed normotensive group. The developed hypertensive group showed greater increases in Lp-PLA2, 8-epi-PGF2α, and ba-PWV than those observed in the reversed normotensive and persistent prehypertensive groups. In all subjects, changes (Δ) in systolic blood pressure (SBP) positively correlated with Δ Lp-PLA2, Δ ox-LDL, Δ urinary 8-epi-PGF2α and Δ ba-PWV. CONCLUSIONS This study indicates that in persistent prehypertension, increased ox-LDL hydrolysis by Lp-PLA2 enhances arterial stiffness without an age-related increase in BP.
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Affiliation(s)
- Minkyung Kim
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea
| | - Hye Jin Yoo
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Minjoo Kim
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea
| | - Hyeon Yeong Ahn
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea
| | - Jiyeong Park
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Sang-Hyun Lee
- Department of Family Practice, National Health Insurance Corporation, Ilsan Hospital, Goyang, South Korea
| | - Jong Ho Lee
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, South Korea; National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, South Korea; Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea.
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Lin HY, Tung CJ, Xu GX, Wang CC, Chen HY, Chuang YJ, Li WF, Lin PJ. Blood pressure change during phacoemulsification and femtosecond laser-assisted cataract surgery. Int J Ophthalmol 2016; 9:1614-1618. [PMID: 27990364 DOI: 10.18240/ijo.2016.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 05/06/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate blood pressure (BP) changes during phacoemulsification (PC) and femtosecond laser (FSL)-assisted cataract surgery. METHODS A retrospective chart review was performed for all patients who received traditional phacoemulsification surgery (PC group) and FSL-assisted cataract surgery (FS group) from July 2013 to December 2014. Totally 206 eyes from 133 patients receiving the two types of procedures were included. Patient characteristics (age, gender, and hypertension history), pre- and post-operative BPs were collected. RESULTS The pro-operative systolic and diastolic BPs (mm Hg) were 124.89±20.48 vs 126.98±16.85, and 71.88±9.81 vs 73.56±10.03, in PC and FS groups, respectively. While the post-operative systolic and diastolic BPs (mm Hg) were 130.13±22.59 vs 134.77±17.52, and 73.41±11.62 vs 78.89±12.2, in PC and FS groups, respectively. Paired-sample t-tests showed obvious systolic and diastolic BP elevations in FS group after surgery (P=0.001 and 0.007) and no reliability in PC group (P=0.094 and 0.359). A linear regression model revealed systolic and diastolic BP elevations, which were related to longer surgical times for FS group (P=0.008 and 0.021). Age, gender, and hypertension history were not correlated with blood pressure elevation in either group. CONCLUSION BP increases but at a limited level after FSL-assisted cataract surgery compared to traditional phacoemulsification.
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Affiliation(s)
- Hung-Yuan Lin
- Department of Ophthalmology, Universal Eye Center, Zhong-Li, Taiwan, China; Department of Optometry, Central Taiwan University of Science and Technology, Taiwan, China; Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350003, Fujian Province, China
| | - Ching-Jen Tung
- Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China
| | - Guo-Xing Xu
- Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350003, Fujian Province, China
| | - Chun-Chi Wang
- Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China
| | - Hsin-Yang Chen
- Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China; Department of Ophthalmology, Ningbo First Hospital, Ningbo 315000, Zhejiang Province, China
| | - Ya-Jung Chuang
- Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China
| | - Wen-Fu Li
- Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China
| | - Pi-Jung Lin
- Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350003, Fujian Province, China; Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, China
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Al-Azzam SI, Najjar RB, Khader YS. Awareness of physicians in Jordan about the treatment of high blood pressure according to the seventh report of the Joint National Committee (JNC VII). Eur J Cardiovasc Nurs 2016; 6:223-32. [PMID: 17142103 DOI: 10.1016/j.ejcnurse.2006.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 01/21/2023]
Abstract
Background Control of blood pressure remains suboptimal worldwide. High rates of undiagnosed and untreated hypertensive patients raise the need of searching for the basis of this situation among prescribing physicians. Aim To evaluate the awareness of medical residents and practicing physicians in Jordan about the treatment of high blood pressure according to the seventh report of the Joint National Committee (JNC VII). Method A written questionnaire was distributed to 200 physicians from different areas of Jordan during the period from November 2005 till February 2006. Recruitment of physicians in this study was in general, military, private hospitals and in clinics. A rigorously developed questionnaire on changes seen in JNC VII, target blood pressure goals, and the treatment of high blood pressure options was administered by trained medical personnel. Results One hundred and forty five physicians (72.5%) consented to complete the questionnaire. The practices of recent graduates from medical school were not better than those of older graduates. As a general rule, physicians in Jordan under treat high blood pressure. Conclusion Our findings highlight the need for the revision of the teaching curricula in medical schools with regard to the management of hypertension, as well as the initiation of a widespread and intensive continuing medical education for all physicians involved in the management of patients with hypertension. Particular efforts are needed to encourage the use of low-cost thiazides and the use of angiotension converting enzyme inhibitors in heart failure patients and other compelling indications.
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Affiliation(s)
- Sayer Ibrahim Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
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Tabrizi JS, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz L, Nikniaz Z. Prevalence and Associated Factors of Prehypertension and Hypertension in Iranian Population: The Lifestyle Promotion Project (LPP). PLoS One 2016; 11:e0165264. [PMID: 27783691 PMCID: PMC5082665 DOI: 10.1371/journal.pone.0165264] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This population-based study aimed at investigating the prevalence and associated factors of prehypertension/hypertension in Iran. METHODS AND FINDINGS The data (n = 2818) for this study were collected in 2015 as a part of the major Lifestyle Promotion Project (LPP) conducted in East Azerbaijan (urban and regional parts). The data for socio-demographic status, dietary information, and physical activity and anxiety levels were collected through validated questionnaires. Then, physical examination including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI) and conicity index was performed. First-morning spot urine (SU) sample was collected to assume salt intake. The One-way ANOVA, logistic regression, chi-square test and independent t-test were used for statistical analysis. The prevalence of prehypertension, stage I and stage II hypertension, and overall hypertension was 47.3%, 13.6%, 5.45% and 22.6% respectively. The mean systolic (p = 0.004) and diastolic (p<0.001) blood pressure in men were significantly higher than women. Results of logistic regression analysis showed that in both sexes, family history of hypertension, obesity, abdominal obesity, anxiety and having high levels of sodium intake were associated with high blood pressure (p< 0.05). Additionally, 45.8% of the hypertensive patients were aware of their disease, 10.0% of the aware patients, and 44.5% of everyone with high blood pressure were receiving antihypertensive medication. CONCLUSIONS Our data showed that prehypertension/hypertension is a major health problem in Iran. Focusing on identifying risk factors to hypertension, regular drug intake, good nutrition, physical activity, and changing lifestyles of patients with hypertension are essential.
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Affiliation(s)
- Jafar Sadegh Tabrizi
- Tabriz Health services management research center, Faculty of management and medical informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road and Traffic Injury Research Center, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Research center of psychiatry and behavioral sciences, Tabriz University of medical sciences, Tabriz, Iran
| | - Leila Nikniaz
- Tabriz Health services management research center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and gastrointestinal disease research center, Tabriz University of Medical Sciences, Tabriz, Iran
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NALP3-Inflammasome-Related Gene Polymorphisms in Patients with Prehypertension and Coronary Atherosclerosis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7395627. [PMID: 27446957 PMCID: PMC4944040 DOI: 10.1155/2016/7395627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 01/06/2023]
Abstract
Objectives. Prehypertension is an early stage of hypertension that is characterized by inflammatory factors. Inflammation also plays an essential role in the development of coronary atherosclerosis (CAS). The present study evaluated the NALP3-inflammasome and its related genes, NLRP3, NOD2, and CARD8, using SNP linkage and gene haplotypes in prehypertensive patients. Methods. A total of 576 patients with prehypertension and suspected coronary heart disease (CHD) were enrolled. According to coronary angiography, patients were divided into two groups: arterial stenosis <50% of the diameter (control) and arterial stenosis >50% of the diameter (case). Fifteen polymorphisms in the NOD2, NLRP3, and CARD8 genes were analyzed, and serum levels of C-reactive protein (CRP) were measured. Results. When comparing allele frequencies, none of these 15 SNPs in NOD2, CARD8, and NLPR3 genes showed a significant difference using multiple logistic regression. However, the CTACATAA (p = 0.0064) and CCACATAG (p = 0.0126) haplotypes of the NOD2 gene SNPs were significantly different between cases and controls. Conclusions. Although our study excludes a significant association of selected SNPs in these genes with CHD in prehypertension patients, this work suggests that the CTACATAA and CCACATAG haplotypes were associated with CHD in the NOD2 locus. This work suggests that the CTACATAA and CCACATAG haplotypes were associated with CHD in prehypertension patients in the NOD2 locus.
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Davinelli S, Scapagnini G. Polyphenols: a Promising Nutritional Approach to Prevent or Reduce the Progression of Prehypertension. High Blood Press Cardiovasc Prev 2016; 23:197-202. [PMID: 27115149 DOI: 10.1007/s40292-016-0149-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/13/2016] [Indexed: 02/05/2023] Open
Abstract
Diet plays a crucial role in maintaining healthy blood pressure. Functional foods are increasingly popular among health-conscious consumers to reduce cardiovascular risk factors and improve vascular health. In particular, dietary polyphenols represent an extraordinary inventory of structurally different compounds that may represent promising candidate chemical entities to prevent or delay the onset of hypertension. In recent years, it has been recognized that prehypertension may be a predictor of clinical hypertension and consequently of cardiovascular risk. Moreover, prehypertension status is associated with increased levels of several inflammatory markers and it is also characterized by structural changes, including endothelial dysfunction and arteriolar hypertrophy. Despite the low bioavailability of polyphenols and the lack of clinical data from nutritional intervention studies, the antihypertensive role of polyphenols to control blood pressure and reduce inflammation and endothelial dysfunction has been subject of recent debate. The purpose of this article is to discuss the potential benefits of dietary polyphenols as a promising and effective nutritional strategy for the management of prehypertension.
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Affiliation(s)
- Sergio Davinelli
- Department of Medicine and Health Sciences, University of Molise, Via De Sanctis snc, 86100, Campobasso, Italy.
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences, University of Molise, Via De Sanctis snc, 86100, Campobasso, Italy
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Block-Abraham DM, Adamovich D, Turan OM, Doyle LE, Blitzer MG, Baschat AA. Maternal blood pressures during pregnancy and the risk of delivering a small-for-gestational-age neonate. Hypertens Pregnancy 2016; 35:350-60. [DOI: 10.3109/10641955.2016.1150487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Dana M. Block-Abraham
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dasha Adamovich
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M. Turan
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lauren E. Doyle
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miriam G. Blitzer
- Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahmet A. Baschat
- Gynecology & Obstetrics, Center for Fetal Therapy, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Hering D, Kara T, Kucharska W, Somers VK, Narkiewicz K. Longitudinal tracking of muscle sympathetic nerve activity and its relationship with blood pressure in subjects with prehypertension. Blood Press 2015; 25:184-92. [PMID: 26654200 DOI: 10.3109/08037051.2015.1121708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prehypertension is associated with increased cardiovascular events. While the "tracking phenomenon" is an important longitudinal characteristic of blood pressure (BP), changes in muscle sympathetic nerve activity (MSNA) over time remain unclear. This study tested the hypothesis that MSNA tracking contributes to BP trends in prehypertension. BP and MSNA were assessed in 13 prehypertensive males at rest, during hand grip and mental stressors at baseline and after 8 years. Baseline office BP averaged 127 ± 2/81 ± 2 mmHg and MSNA 24 ± 4 bursts/min. BP increased by 7 ± 2/5 ± 2 mmHg (P < 0.01) and MSNA by 11 ± 2 bursts/min (P < 0.001) at follow-up. SBP and DBP were interrelated at baseline (r = 0.65, P = 0.02) and at follow-up (r = 0.78, P = 0.002). MSNA tracking (r = 0.82; P < 0.001) was similar to BP. MSNA was strongly related to DBP at baseline (r = 0.73; P < 0.01) and follow-up (r = 0.64; P = 0.01), more so than SBP. BMI increased (P < 0.001) at follow-up but was unrelated to BP or MSNA. Despite comparable pressor and cardiac increases to handgrip and mental stressors, sympathetic responses were blunted, more pronounced to isometric test (P < 0.006) at follow-up. In conclusion, the trend in MSNA corresponds with BP changes over time suggesting that tonic sympathetic activation may contribute to time-related increase in resting BP and the development of sustained hypertension in prehypertension.
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Affiliation(s)
- Dagmara Hering
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland ;,b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic
| | - Tomas Kara
- b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic ;,c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
| | - Wiesława Kucharska
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
| | - Virend K Somers
- c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland ;,b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic ;,c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
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Nandeesha H, Bobby Z, Selvaraj N, Rajappa M. Pre-hypertension: Is it an inflammatory state? Clin Chim Acta 2015; 451:338-42. [DOI: 10.1016/j.cca.2015.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 01/09/2023]
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Hong S, Dimitrov S, Cheng T, Redwine L, Pruitt C, Mills PJ, Ziegler MG, Green JM, Shaikh F, Wilson K. Beta-adrenergic receptor mediated inflammation control by monocytes is associated with blood pressure and risk factors for cardiovascular disease. Brain Behav Immun 2015; 50:31-38. [PMID: 26300225 PMCID: PMC4631657 DOI: 10.1016/j.bbi.2015.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/01/2022] Open
Abstract
Overwhelming data indicate that individuals with even mildly elevated blood pressure (BP) are at great risk for developing clinical hypertension and future cardiovascular disease (CVD). There remains a lack of consensus regarding treatment strategies for mildly elevated BP, termed prehypertension, and the knowledge of pathophysiology and mechanisms of its clinical outcomes remains limited. Our primary aim was to investigate βAR-mediated inflammation control (BARIC) responses of blood monocytes to isoproterenol (Iso) in relation to BP and CVD risk factors, including obesity, depressive mood, fasting glucose, triglycerides, and cholesterol levels in the 64 prehypertensive compared to 84 individuals with normal BP. BARIC was determined by measuring the degree of inhibition in lipopolysaccharides-stimulated monocytic intracellular TNF production by ex vivo Iso treatment (10(-8)M). Depressive mood was assessed by Beck Depression Inventory (BDI). Fasting metabolic and lipid panels were assessed, and plasma levels of inflammatory cytokines TNF, IL-1β, IL-6 were measured in a subset to confirm proinflammatory state of prehypertensive participants. Prehypertensive participants were older, heavier, included more men, and presented higher levels of fasting glucose, triglycerides, cholesterol, and plasma TNF compared to normotensive participants (p's<.05). BARIC was significantly attenuated in the prehypertensive compared to normotensive group (p<.05). BARIC was negatively associated with systolic BP, diastolic BP, age, BMI, fasting glucose, triglycerides, total and low density cholesterol levels, and somatic depressive symptoms in all participants (p's<.0001 to .05). However, among the prehypertensive individuals BARIC was positively associated with SBP even after controlling for the covariates (age, gender, race, BMI, glucose and lipid panel, somatic BDI scores) (p<.05). This differing nature of the BARIC-SBP relationship between the two BP groups may be attributed to moderating factors such as cardiorespiratory fitness or depressive symptoms that could not be clearly deciphered in this current study. Nonetheless, our findings indicate the associations between inflammation dysregulation mediated by sympathoadrenal activation and BP that is observable even among individuals with normal to mildly elevated BP. BARIC may be a useful and sensitive indicator of elevated risk for vascular inflammatory disease that can be detected even at lower BP levels, especially given its associations with traditional CVD risk factors and the critical role of monocytes in atherogenic processes.
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Affiliation(s)
- Suzi Hong
- Department of Psychiatry, University of California San Diego, USA; Department of Family Medicine and Public Health, University of California San Diego, USA.
| | - Stoyan Dimitrov
- Department of Psychiatry, University of California San Diego, USA
| | - Tiefu Cheng
- Department of Psychiatry, University of California San Diego, USA
| | - Laura Redwine
- Department of Psychiatry, University of California San Diego, USA
| | | | - Paul J Mills
- Department of Psychiatry, University of California San Diego, USA; Department of Family Medicine and Public Health, University of California San Diego, USA
| | | | - J Michael Green
- Department of Psychiatry, University of California San Diego, USA
| | - Farah Shaikh
- Department of Psychiatry, University of California San Diego, USA
| | - Kathleen Wilson
- Department of Psychiatry, University of California San Diego, USA
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Senthil S, Krishndasa SN. Pre-Hypertension in Apparently Healthy Young Adults: Incidence and Influence of Haemoglobin Level. J Clin Diagn Res 2015; 9:CC10-2. [PMID: 26675286 DOI: 10.7860/jcdr/2015/14970.6847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/14/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prehypertension is a precursor of clinical hypertension and consequently of the cardiovascular disease. Recent studies have found positive correlation between Haemoglobin Level (Hb) and Blood Pressure (BP). But the presumed association between Hb and BP has not been investigated in healthy young adults. AIM This study aimed to estimate the incidence of prehypertension and the influence of Hb level on BP in healthy young adults. MATERIALS AND METHODS This was a cross-sectional study done in 84 apparently healthy undergraduate medical students aged between 18-23 years, of either sex. In study subjects, BP and haemoglobin content was measured. Prehypertension was defined as BP levels of 120 to 139/80 to 89 mm Hg. Statistical analysis was done by unpaired t-test and Pearson correlation Coefficient tests. RESULTS Incidence of prehypertension was 50%. In 24% of the study subjects both systolic and diastolic BP was in prehypertensive state. In another 26% of study subjects only systolic BP was above normal. There was positive correlation between systolic BP and Hb level (p = 0.0015). CONCLUSION High incidence of prehypertension especially systolic prehypertension prevails inapparently healthy medical undergraduate students. In them, positive correlation between Hb and systolic BP persists.
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Affiliation(s)
- Sunandha Senthil
- MBBS Student, Kasturba Medical College, Manipal University Mangalore , Karnataka, India
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Jang E, Baek Y, Kim Y, Park K, Lee S. Sasang constitution may act as a risk factor for prehypertension. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:231. [PMID: 26169174 PMCID: PMC4501065 DOI: 10.1186/s12906-015-0754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/30/2015] [Indexed: 11/10/2022]
Abstract
Background Prehypertension (pre-HTN), similar to hypertension, has been associated with an elevated risk of cardiovascular disease. The aim of this study was to determine whether the Sasang constitution (SC) types could also be independent risk factors for pre-HTN. Methods A total of 2,806 eligible subjects, older than 20 years old from 25 medical clinics, participated. Clinical data, including the blood pressure, age, height, weight, and data from blood tests, were collected. One-way ANOVA with Scheffé’s post-hoc analysis and the chi-square test were used, according to the SC and sex. Logistic regression was used to generate the odds ratios (ORs) and 95 % confidence interval (CI) for pre-HTN. Results The pre-HTN prevalence rates of the Soeumin type, Soyangin type and Tae-eumin type were 59.4 %, 60.1 % and 74.9 %, respectively, in men (p < 0.001) and 41.7 %, 44.4 % and 58.3 % in women (p < 0.001). The Soyangin type was not more associated with increased ORs than the Soeumin type in any of the subjects with pre-HTN. Even after adjusting for sex, BMI, FBG, TC, TGs, HDL, and LDL, the Tae-eumin type in men was associated with increased ORs of pre-HTN compared with the Soeumin type (OR 1.57, 95 % CI 1.03–2.39), but the Tae-eumin type in women was not associated with pre-HTN. Conclusions This study suggested that the Tae-eumin type combined with sex might be significantly and independently associated with pre-HTN, especially high pre-HTN.
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Bhatt H, Safford M, Stephen G. Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Curr Hypertens Rep 2015; 17:541. [PMID: 25794955 PMCID: PMC4443695 DOI: 10.1007/s11906-015-0541-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Monika Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Glasser Stephen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
- 1717 11th Avenue South, MT 634, Birmingham, AL 35205, USA
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Zhen Y, Xiao S, Ren Z, Shen H, Su H, Tang Y, Zeng H. Increased endothelial progenitor cells and nitric oxide in young prehypertensive women. J Clin Hypertens (Greenwich) 2015; 17:298-305. [PMID: 25688720 PMCID: PMC8031957 DOI: 10.1111/jch.12493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
Abstract
This study investigated the effect of sex differences on circulating endothelial progenitor cells (EPCs) in prehypertension and its underlying mechanism. The authors found that premenopausal women show increased number and activity of circulating EPCs when compared with men, which was similar to enhanced nitric oxide (NO) level in plasma or culture medium. There was no difference in the number and activity of circulating EPCs and NO level between normotensive and prehypertensive premenopausal women. There was also no difference seen in levels of vascular endothelial growth factor and granulocyte macrophage colony-stimulating factor. Both number and activity of circulating EPCs were correlated with the level of NO. The present study firstly demonstrated that the number and activity of circulating EPCs were preserved in prehypertensive premenopausal women, which was related to the restoration of NO production. The sex differences in EPCs in prehypertension may be involved in the mechanism underlying vascular protection in premenopausal women.
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Affiliation(s)
- Yang Zhen
- Department of CardiologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Songhua Xiao
- Department of NeurologySun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuanzhouChina
| | - Zi Ren
- Department of Obstetrics and GynaecologyGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Hong‐wei Shen
- Department of Obstetrics and GynaecologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese MedicineInstitute of Chinese Medical SciencesUniversity of MacauMacauChina
| | - Yong‐Bo Tang
- Department of PharmacologyZhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Haitao Zeng
- Center for Reproductive MedicineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Abstract
Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) prehypertension; only stage 2 prehypertension increases cardiovascular mortality. Among individuals with prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of prehypertension. Data on primary prevention of CVD with pharmacotherapy in prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.
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Diehl KJ, Weil BR, Greiner JJ, Wright KP, Stauffer BL, DeSouza CA. Impaired endogenous fibrinolytic capacity in prehypertensive men. J Hum Hypertens 2015; 29:468-72. [PMID: 25566873 PMCID: PMC4762274 DOI: 10.1038/jhh.2014.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 12/14/2022]
Abstract
Prehypertension (BP 120–139/80–89 mmHg) is associated with an increased risk for future atherothrombotic events. Although the mechanisms underlying this elevated risk are not completely understood, one possibility is that prehypertension is associated with impaired endothelial fibrinolytic capacity. We tested the hypothesis that vascular endothelial release of t-PA is impaired in prehypertensive men. Net endothelial release of t-PA was determined, in vivo, in response to intrabrachial infusions of bradykinin (12.5, 25, 50 ng/100 mL tissue/min) and sodium nitroprusside at (1.0, 2.0, 4.0 µg/100 mL tissue/min) in 42 middle-age and older men: 16 normotensive (BP range: 100–119/57–79 mmHg); 16 prehypertensive (BP range: 120–139/76–89 mmHg); and 10 hypertensive (BP range: 140–150/74–100 mmHg). Net release of t-PA antigen was ~25% lower (P < 0.05) in the prehypertensive (−0.9 ± 0.8 to 42.4 ± 5.3 ng/100 mL tissue/min) compared with the normotensive (0.5 ± 1.0 to 53.9 ± 6.5 ng/100 mL tissue/min) men. There was no significant difference in t-PA release between the hypertensive (−1.8±1.6 to 40.8±6.6 ng/100 mL tissue/min) and prehypertensive groups. Sodium nitroprusside did not significantly alter t-PA release in any group. These data indicate that endothelial t-PA release is diminished in prehypertensive men. Further, the level of impairment in t-PA release seen with clinical hypertension is already apparent in the prehypertensive state. Impaired endothelial fibrinolytic function may underlie the increased atherothrombotic risk associated with blood pressure in the prehypertensive range.
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Affiliation(s)
- K J Diehl
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - B R Weil
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - J J Greiner
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - K P Wright
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - B L Stauffer
- 1] Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA [2] Department of Medicine, University of Colorado, Denver, CO, USA [3] Denver Health Medical Center, Denver, CO, USA
| | - C A DeSouza
- 1] Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA [2] Department of Medicine, University of Colorado, Denver, CO, USA
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Hageman PA, Pullen CH, Hertzog M, Boeckner LS. Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial. Int J Behav Nutr Phys Act 2014; 11:148. [PMID: 25480461 PMCID: PMC4264247 DOI: 10.1186/s12966-014-0148-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 11/17/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40-69, with prehypertension. METHODS 289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity. RESULTS Mean blood pressure reduction ranged from 3.8 (SD = 9.8) mm Hg to 8.1 (SD = 10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p = .11 and p = .09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p = .017 and p = .016, respectively); % daily calories from fat (p = .018 and p = .030) and saturated fat (p = .049 and p = .013); daily servings of fruit and vegetables (p = .008 and p < .005); and low fat dairy (p < .001 and p = .002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p = .048) and estimated VO2max (p = .037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups. CONCLUSIONS Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status. TRIAL REGISTRATION ClinicalTrials.gov NCT00580528.
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Affiliation(s)
- Patricia A Hageman
- Physical Therapy Education, School of Allied Health Professions, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, 68198-4420, USA.
| | - Carol H Pullen
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, 68198-5330, USA.
| | - Melody Hertzog
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, 68588-0220, USA.
| | - Linda S Boeckner
- Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68583-0806, USA.
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Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med 2014; 44:345-56. [PMID: 24174307 DOI: 10.1007/s40279-013-0118-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hypertension, or the chronic elevation in resting arterial blood pressure (BP), is a significant risk factor for cardiovascular disease and estimated to affect ~1 billion adults worldwide. The goals of treatment are to lower BP through lifestyle modifications (smoking cessation, weight loss, exercise training, healthy eating and reduced sodium intake), and if not solely effective, the addition of antihypertensive medications. In particular, increased physical exercise and decreased sedentarism are important strategies in the prevention and management of hypertension. Current guidelines recommend both aerobic and dynamic resistance exercise training modalities to reduce BP. Mounting prospective evidence suggests that isometric exercise training in normotensive and hypertensive (medicated and non-medicated) cohorts of young and old participants may produce similar, if not greater, reductions in BP, with meta-analyses reporting mean reductions of between 10 and 13 mmHg systolic, and 6 and 8 mmHg diastolic. Isometric exercise training protocols typically consist of four sets of 2-min handgrip or leg contractions sustained at 20-50 % of maximal voluntary contraction, with each set separated by a rest period of 1-4 min. Training is usually completed three to five times per week for 4-10 weeks. Although the mechanisms responsible for these adaptations remain to be fully clarified, improvements in conduit and resistance vessel endothelium-dependent dilation, oxidative stress, and autonomic regulation of heart rate and BP have been reported. The clinical significance of isometric exercise training, as a time-efficient and effective training modality to reduce BP, warrants further study. This evidence-based review aims to summarize the current state of knowledge regarding the effects of isometric exercise training on resting BP.
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Affiliation(s)
- Philip J Millar
- Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
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Tenekecioglu E, Yilmaz M, Yontar OC, Karaagac K, Agca FV, Tutuncu A, Kuzeytemiz M, Bekler A, Senturk M, Aydin U, Demir Ş. Microalbuminuria in untreated prehypertension and hypertension without diabetes. Int J Clin Exp Med 2014; 7:3420-3429. [PMID: 25419378 PMCID: PMC4238513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 08/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Hypertension (HT) and prehypertension (preHT) were independent predictors of cardiovascular diseases. Urinary albumin leakage is a manifestation of generalized vascular damage. B-type natriuretic peptide (BNP) is a vasoactive peptide secreted by left ventricle in response to myocytic stretch. We aimed to investigate relationship between microalbuminuria (MA) and BNP in untreated elevated blood pressures. METHODS Of 105 untreated prehypertensive subjects (53 men, 52 women), 100 hypertensive subjects (51 men, 49 women) and 57 normotensive subjects (32 men, 25 women) none had history of diabetes. Urine albumin excretion was measured by immunoradiometric assay in morning urine sample. RESULTS The prevalence of MA was higher in hypertensive group than in prehypertensive group and in normotensive group (Hypertensive group; 33.9%, prehypertensive; 25.9%, normotensive; 10%). Subjects with HT had higher prevalence of microalbminuria; larger body mass index, higher levels of triglycerides, blood glucose and creatinin were more common in subjects with HT than in those with preHT. In hypertensive group; patients with microalbuminuria had higher systolic blood pressure (SBP), BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.361; P < 0.001), LVMII (β: 0.267; P = 0.011) and BNP (β: 0.284; P = 0.005) were independent variables associated with MA in hypertensives. In prehypertensive group; patients with microalbuminuria had higher SBP, BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.264; P = 0.002), LVMI (β: 0.293; P = 0.001) and BNP (β: 0.168; P = 0.045) were associated with MA in prehypertensives. CONCLUSIONS In preHT and HT, SBP, BNP and LVMI are associated with MA. In the evaluation of increased blood pressures, in case of increased BNP and LVMI, MA should be investigated even in prehypertensive stages. The subjects with increased blood pressures should get medical treatment to prevent the effects on vascular structure and myocardium even in prehypertensive phase.
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Affiliation(s)
- Erhan Tenekecioglu
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Mustafa Yilmaz
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Osman Can Yontar
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Kemal Karaagac
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | | | - Ahmet Tutuncu
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Mustafa Kuzeytemiz
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Adem Bekler
- Çanakkale Onsekiz Mart University, CardiologyÇanakkale, Turkey
| | - Muhammed Senturk
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Ufuk Aydin
- Bursa Yuksek Ihtisas Education and Resarch Hospital, Cardiovascular SurgeryBursa, Turkey
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