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Wang M, Wang C, Zhao M, Wu S, Xue H, Liu H. BMI-based metabolic syndrome severity score and arterial stiffness in a cohort Chinese study. Nutr Metab Cardiovasc Dis 2024; 34:1761-1768. [PMID: 38555245 DOI: 10.1016/j.numecd.2024.02.012] [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: 01/17/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS To investigate the relationship between metabolic syndrome severity z score(MetS-Z) and arterial stiffness(AS). METHODS AND RESULTS A total of 7621 participants who took three physical examination and brachial-ankle pulse wave velocity(ba-pwv) test from 2006 were enrolled. Cumulative MetS-Z(cMetS-Z) was calculated by using blood pressure, triglycerides, HDL cholesterol, blood glucose and BMI. AS was assessed by ba-pwv. Cox regression model was used to evaluate the risk of AS. All participants were divided into four groups according to cMetS-Z(Q1-Q4). The average age of the participants was 43.06 ± 8.91 years old. During a median follow-up of 6.27 years, 1831cases of AS were identified. The incident rate of AS increased gradually from group Q1 to Q4. Compared with the lowest cMetS-Z(group Q1), the adjusted hazard ratio (HR) and 95% confidence interval (CI) of group Q2-Q4 for AS were 1.27 (1.09-1.47),1.28(1.10-1.48) and 1.45 (1.24-1.69) respectively. The cubic spline model indicated cMetS-Z had a liner relationship with AS and the cut-off value was lower than zero. Sub-group analysis suggested cMetS-Z was related to AS especially among participants who were younger and without obesity or hypertension or diabetes. CONCLUSION Higher cMetS-Z was associated with an increased risk of AS in this cohort community study, and this relationship seemed to be stronger among normal healthy subjects. REGISTRATION NUMBER ChiCTR-TNC-11001489. CLINICAL TRIAL January 1st 2006, ChiCTR-TNC-11001489 and 2011.
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Affiliation(s)
- Miao Wang
- The School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin 300071, China; Department of Cardiology, Chinese People's Liberation Army General Hospital, No.28 Fuxing Road, Beijing 100853, China
| | - Chi Wang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, No.28 Fuxing Road, Beijing 100853, China
| | - Maoxiang Zhao
- Department of Cardiology, Chinese People's Liberation Army General Hospital, No.28 Fuxing Road, Beijing 100853, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan 063001, China
| | - Hao Xue
- The School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin 300071, China; Department of Cardiology, Chinese People's Liberation Army General Hospital, No.28 Fuxing Road, Beijing 100853, China.
| | - Hongbin Liu
- The School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin 300071, China; Department of Cardiology, Chinese People's Liberation Army General Hospital, No.28 Fuxing Road, Beijing 100853, China.
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Koh S, Kim D, Kim M, Kim T. Aerobic exercise effects on systolic blood pressure and endothelial inflammation in obese and non-obese elderly women with isolated systolic hypertension. J Hypertens 2024:00004872-990000000-00492. [PMID: 39091233 DOI: 10.1097/hjh.0000000000003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study aimed to investigate the effects of a 16-week aerobic exercise program on systolic blood pressure, intracellular cell adhesion molecule-1, vascular cell adhesion molecule-1, and oxidized low-density lipoprotein of obese and nonobese elderly women with isolated systolic hypertension. METHODS Elderly women aged 70-85 years were recruited and grouped into the normal isolated systolic hypertension (n = 12) and obese isolated systolic hypertension groups (n = 13). The participants followed an aerobic exercise program, using a wireless heart rate monitor to maintain an appropriate heart rate reserve based on the American College of Sports Medicine exercise guidelines. The two-way repeated measures analysis of variance tested group × time interaction. Pearson's correlation and simple regression assessed the influence of each variable, which showed significant differences. RESULTS :An interaction effect for systolic blood pressure, intracellular cell adhesion molecule-1, and vascular cell adhesion molecule-1 (P < 0.05) and a main time effect for oxidized low-density lipoprotein (P < 0.05) were observed. A correlation between the rates of change in systolic blood pressure and vascular cell adhesion molecule-1 (P < 0.05) with a 42.8% influence (P < 0.001) and in intracellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 (P < 0.05) with a 21.6% influence (P < 0.05) was observed. CONCLUSIONS These findings collectively showed that the 16-week aerobic exercise program effectively lowered blood pressure in patients with isolated systolic hypertension, particularly in the normal group compared to the obese group. Thus, regular aerobic exercise for 16 weeks or more enhances vascular health, potentially improving the healthy life expectancy of elderly women.
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Affiliation(s)
- Suhan Koh
- Physical Education, Pusan National University, Busan, Republic of Korea
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Choi JY, Lee HY, Lee JH, Hong Y, Park SK, Ryu DR, Lee JH, Hwang S, Kim KH, Lee SH, Kim SY, Park JH, Kim SH, Kim HL, Choi JH, Kim CH, Cho MC, Kim KI. Characteristics According to Frailty Status Among Older Korean Patients With Hypertension. J Korean Med Sci 2024; 39:e84. [PMID: 38501181 PMCID: PMC10948261 DOI: 10.3346/jkms.2024.39.e84] [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: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status. METHODS The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed. RESULTS The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m², 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, P < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, P = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics. CONCLUSION This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor disease-related or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0003787.
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Affiliation(s)
- Jung-Yeon Choi
- Departmentof Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju-Hee Lee
- Departmentof Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Youjin Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seokjae Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Cheol-Ho Kim
- Departmentof Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myeong-Chan Cho
- Departmentof Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Kwang-Il Kim
- Departmentof Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Rossios K, Antza C, Kachtsidis V, Kotsis V. The Modern Environment: The New Secondary Cause of Hypertension? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2095. [PMID: 38138198 PMCID: PMC10744418 DOI: 10.3390/medicina59122095] [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: 08/31/2023] [Revised: 10/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
The most important risk factor for cardiovascular disease, the leading cause of death worldwide, is hypertension. Although most cases of hypertension are thought to be essential, the multifactorial associations of the environmental influence on blood pressure seem to play an important role and should be more closely investigated. This review attempts to focus on the recent literature that examines the environmental effects on arterial blood pressure and its management. Seasonal variability and the role of ambient temperature, either occupational or recreational noise pollution, as well as obesity due to environment-caused dietary habits, are recognized as important risk factors, affecting the onset as well as the regulation of hypertension. Furthermore, the effects of seasonal fluctuations in blood pressure, noise pollution, and obesity seem to share a similar pathogenesis, and as such to all further react together, leading to increased blood pressure. The activation of the autonomous nervous system plays a key role and causes an increase in stress hormones that generates oxidative stress on the vascular system and, thus, vasoconstriction. In this review, by focusing on the association of the environmental impact with arterial blood pressure, we come to the question of whether most cases of hypertension-if not all-should, indeed, be considered primary or secondary.
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Affiliation(s)
- Konstantinos Rossios
- Cardiology Clinic, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasileios Kachtsidis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
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Li L, Cheng S, Xu G. Identification of risk factors for hypertension in overweight and obese people and analysis of risk factor interactions: an R-based analysis. Front Cardiovasc Med 2023; 10:1180698. [PMID: 38028476 PMCID: PMC10644319 DOI: 10.3389/fcvm.2023.1180698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study identified the independent risk factors for hypertension in overweight and obese people and also analyzed the interaction between the risk factors. Methods A total of 5,098 overweight and obese people were enrolled in this study. First, the clinical metabolic characteristics of hypertension and control groups were compared. The logistic regression (LR) and classification and regression trees (CRT)-based decision tree (DT) models were used to screen the independent risk factors for hypertension in overweight and obese people. The multiplicative and additive scale analyses were used to analyze the two risk factors with interaction from the perspective of statistics and biological interaction. Finally, the receiver operating characteristic (ROC) and calibration curves were used to analyze the accuracy and identification ability of the LR and DT models. Results Age, UA, FPG, SBP, Cr, AST, TG, and FPG were higher in the hypertension group than in the control group (P < 0.05). The results of LR revealed that NAFLD, FPG, age, TG, LDL-c, UA, and Cr were positively correlated with hypertension in overweight and obese people, and GFR was negatively correlated with hypertension in overweight and obese people (P < 0.05). The DT model suggested that the risk factors of age, FPG, and UA interacted with each other. The multiplicative single and multiple factor analysis for FPG + UA, age + UA, age + FPG revealed a positive multiplicative interaction (P < 0.05, B ≠ 0, OR > 1). The additive single and multiple factor analysis for age + UA indicated a positive additive interaction. The ROC and calibration curve analysis indicated that the CRT decision tree, FPG + UA, age + UA, and age + FPG have certain accuracy and discrimination ability. Conclusion The independent risk factors for hypertension in overweight and obese people included NAFLD, FPG, age, TG, LDL-c, UA, and Cr. Among these, age + UA exhibited synergistic interaction, thereby providing a reference for the prevention and control of hypertension in overweight and obese people.
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Affiliation(s)
- LuWei Li
- Department of Rheumatology and Immunology, The First People’s Hospital of Nanning, Nanning, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - SiShuai Cheng
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - GuoQuan Xu
- School of Clinical Medicine, Guilin Medical University, Guilin, China
- Department of Urology, The First People’s Hospital of Qinzhou, Qinzhou, China
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Zou Q, Su C, Du W, Ouyang Y, Wang H, Zhang B, Luo S, Tan T, Chen Y, Zhong X, Zhang H. The Mediation and Moderation Effect Association among Physical Activity, Body-Fat Percentage, Blood Pressure, and Serum Lipids among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2015. Nutrients 2023; 15:3113. [PMID: 37513531 PMCID: PMC10383535 DOI: 10.3390/nu15143113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Physical activity (PA) is of benefit and particularly important for cardiovascular disease risk factors as being sedentary becomes a lifestyle habit. Research into Chinese complex association among physical activity, body-fat percentage (BF%), blood pressure, and serum lipids is limited. The present study is based on an observational study among adults (>18 years old) residing in fifteen provinces in China. Data of 10,148 adult participants in the 2015 China Health and Nutrition Survey (CHNS) were analyzed. The simple mediation effect models with covariates were utilized to assess the association among PA and blood pressure or serum lipids, and BF% was played as a mediator. The serial multiple-mediator models with covariates were constructed to the further analysis of the relationship between PA and blood pressure, and BF% was the mediator 1 and blood lipids were the mediator 2. Based on the above hypothesis, the moderated mediation models with covariates were used to analyze the association among PA, BF%, and blood pressure; in addition, BF% was used as the mediator and blood lipids played as the moderator. In the simple mediation models, the model with a dependent variable was high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C); BF% was played as the partly mediation effect and the proportion of contribution was 0.23 and 0.25, respectively. In the serial multiple-mediator models, blood lipids, as the second mediator, played the mediation effect; however, the effect was smaller than the BF%. In the moderated mediation model, blood lipids had the moderation effect as the moderator variable. HDL-C played a moderating role in the latter pathway of the "PA→BF%→SBP/DBP" mediation model, and LDL-C/TC played a moderating role in the direct effect of the "PA→BF%→DBP". In conclusion, BF% played a mediating role in the relationship between PA and blood pressure. HDL-C, LDL-C, and TC were more likely to act as moderating variables in the mediation model "PA→BF%→SBP/DBP". PA could directly and indirectly benefit to control the CVD risk factors simultaneously.
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Affiliation(s)
- Qinpei Zou
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Wenwen Du
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yifei Ouyang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shuquan Luo
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
| | - Tao Tan
- Chongqing Health Statistics Information Center, Chongqing 401120, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Xiaoni Zhong
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
| | - Huadong Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing 400042, China
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Wongsin U, Chen TY. Sex differences in the risk factors of disability among community-dwelling older adults with hypertension: Longitudinal results from the Health, Aging, and Retirement in Thailand study (HART). Front Public Health 2023; 11:1177476. [PMID: 37361180 PMCID: PMC10286628 DOI: 10.3389/fpubh.2023.1177476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hypertension poses a serious health problem among Thai older adults which could subsequently lead to disability. However, little to no research has been conducted to understand modifiable risk factors of disability among community-dwelling older adults with hypertension in Thailand. In addition, sex is an important social determinant of health, but its role in disability among older adults with hypertension is less clear. Objectives This study focused on community-dwelling older adults with hypertension in Thailand and investigated predictors of disability and examined sex differences in the risk factors that were associated with disability in this population. Methods Longitudinal data were from the Health, Aging, and Retirement in Thailand (HART) survey (2015-2017; N = 916). The outcome variable was difficulty with the activity of daily living at follow-up. Potential risk factors included sociodemographic information, health behaviors/health status, and disability at baseline. Descriptive analysis and logistic regression analysis were employed to analyze the data. Results Most of the participants were female and between aged 60 and 69 years old. Being in an older age group (OR = 1.78, 95% CI: 1.07-2.97, p < 0.05), having more chronic conditions (OR = 1.38, 95% CI: 1.10-1.73, p < 0.01), experiencing obesity (OR = 2.02, 95% CI: 1.11-3.69, p < 0.05), and having disability at baseline (OR = 2.42, 95% CI: 1.09-5.37, p < 0.05) significantly predicted disability at 2 year follow-up among community-dwelling Thai older adults with hypertension. The effects of these risk factors on disability at follow-up did not differ by sex. However, different risk factors of disability were observed across sexes. Conclusion The situations of disability among older adults with hypertension in Thailand are likely to aggravate due to the rapid aging of the population. Our analysis provided useful information regarding significant predictors of disability and sex-specific risk factors of disability. Tailored promotion and prevention programs should be readily available to prevent disability among community-dwelling older adults with hypertension in Thailand.
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Affiliation(s)
| | - Tuo-Yu Chen
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
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