High-normal blood pressure in midlife is a stronger predictor for development of hypertension in women than in men

Background

Identification of modifiable risk factors in midlife may optimize prevention of hypertension. Sex differences in the multifactorial development of hypertension is not well understood.

Purpose

To explore the associations of health factors in midlife, with incident hypertension 26 years later, in women and men.

Methods

In the community-based Hordaland Health Study (HUSK) 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 6 and 26 years. Patients with hypertension at baseline were excluded. Attended blood pressure (BP) was measured in triplets. High-normal BP was identified as BP 130–139/85–89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the last study visit. The association of health factors at baseline and changes during midlife, with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Models were adjusted for baseline body mass index (BMI), high-normal BP, heart rate, physical activity, daily smoking, education, serum cholesterol, and serum triglycerides. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values.

Results

At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p<0.001). A high-normal BP was found in 26% of women and 47% of men (p<0.001). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p<0.05). In multivariable logistic regression analyses, high-normal BP at baseline, was the strongest predictor of incident hypertension in both sexes, but significantly stronger in women (OR 4.8, 95% CI 3.4–6.9) than in men (OR 2.1, 95% CI 1.5–2.8), p<0.01 for sex interaction (Table 1). Increase in BMI from first to second study visit was significantly associated with incident hypertension in both sexes (both p<0.01). And an increase in serum triglycerides from first to second visit was significant only in women (p<0.05).

Conclusions

High-normal BP in midlife was a particularly strong risk factor for development of hypertension later in life and significantly stronger in women. An increase in BMI in midlife was associated with incident hypertension but did not differ between sexes. Awareness of sex differences in modifiable health factors in midlife enable improved prevention of hypertension.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen

Association of markers of vascular inflammation with blood pressure in midlife: the Hordaland Health Study

Background

Hypertension is a pro-inflammatory condition. A steeper rise in blood pressure (BP) has been observed in middle-aged women than men. However, sex-specific associations of vascular inflammation with midlife BP has not been much explored.

Purpose

To test the association of markers of vascular inflammation, including neopterin, kynurenin:tryptophan ratio (KTR) and high sensitive C-reactive protein (CRP) with BP.

Methods

Circulating levels of neopterin, KTR and CRP were measured in 2042 women and 1646 men aged 47–49 years from the community-based Hordaland Health study. The associations with systolic and diastolic BP were tested in sex-specific linear regression analyses and adjusted for body mass index, serum total- and high-density lipoprotein cholesterol, triglycerides, creatinine, physical activity, daily smoking and diabetes.

Results

Compared to men, women had lower average BP (124/72 vs. 131/78 mmHg, p<0.001), higher plasma neopterin (7.5 vs 7.0 nmol/l, p<0.001) and comparable plasma KTR and serum CRP (both p>0.05). In multivariable analyses 1) higher neopterin was associated with higher diastolic BP in women, but not in men; 2) higher CRP was associated with higher systolic and diastolic BP in women, but not in men; 3) no association of higher KTR with BP was found in either sex (Table 1). A significant sex-interaction between neopterin and diastolic BP was found.

Conclusion

Among participants in the Hordaland Health study, higher circulating levels of neopterin and CRP with higher BP was found among women only, suggesting that vascular inflammation contributes to BP elevation in middle-aged women.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen

Psoriasis severity and the risk of left ventricular remodelling in psoriasis patients treated with infliximab

Background

Psoriasis is an immune mediated skin disorder with a great variation in disease severity. Chronic inflammation predisposes to subclinical cardiac damage like left ventricular (LV) remodelling. However, the association of psoriasis severity with LV remodelling is not known.

Purpose

To assess LV remodelling in patients with moderate to severe psoriasis treated with infliximab.

Methods

Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI) before initiation of treatment with the tumour necrosis factor α inhibitor infliximab in 53 patients (age 47±15 years, 30% women, body mass index (BMI) 29.2±5.5 kg/m2). Echocardiography was preformed after a mean follow-up of 4.9±3.8 years and compared to 99 control subjects (age 47±11 years, 28% women, BMI 29.9±3.9 kg/m2). LV remodelling was assessed from LV relative wall thickness and LV mass index by echocardiography.

Results

Both psoriasis patients and controls had high prevalence of hypertension (66% vs. 61%, p=0.54) and obesity (34% vs. 33% p=0.94). Psoriasis patients were more likely to be smokers than controls (37% vs. 17%, p=0.005), but other cardiovascular risk factors were similarly distributed. Psoriasis patients had higher LV relative wall thickness (0.38±0.09 vs. 0.34±0.07, p=0.001), but lower LV mass index (36.1±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.014), compared to controls. Having psoriasis remained associated with higher LV relative wall thickness (β 0.25, p=0.002) and lower LV mass index (β-0.20, p=0.02) in multivariable analyses after adjustment for age, sex, smoking, hypertension and BMI. In psoriasis patients mean PASI decreased from 16.1±11.5 to 0.8±0.8 during infliximab treatment, p<0.001. Higher PASI at start of treatment was associated with a higher LV relative wall thickness at follow-up (Table), but not with higher LV mass index in univariable analyses. After adjusting for sex, age and hypertension, higher PASI at start of treatment (β 0.36, p=0.006) still predicted greater LV relative wall thickness at follow-up in psoriasis patients (Table).

Conclusion

Higher psoriasis severity before infliximab treatment predicted presence of adverse LV remodelling after 4.9 years treatment despite nearly complete clinical remission.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.

Subclinical cardiac organ damage in patients with moderate to severe psoriasis treated with infliximab

Background

Psoriasis is an immune mediated disease that has been associated with elevated risk of cardiovascular (CV) disease. Comorbidities, psoriasis treatment and presence of subclinical cardiac organ damage can modulate CV risk in psoriasis.

Purpose

To assess the prevalence and covariables of subclinical cardiac organ damage in patients with moderate-to-severe psoriasis on infliximab treatment.

Methods

Echocardiography was performed in 53 psoriasis patients (age 47±15 years, 30% women) and 99 control subjects (age 47±11 years, 28% women). Subclinical cardiac organ damage was defined as presence of left ventricular (LV) hypertrophy, concentric LV geometry and/or dilated left atrium. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Hypertension was defined as use of antihypertensive medication/history of hypertension and/or elevated ambulatory blood pressure ≥130/80 mmHg.

Results

Hypertension was the most common comorbidity, present in 66% of patients and 61% of control subjects (p=0.54). Smoking was more prevalent in psoriasis patients than controls (37% vs 17%, p=0.005), while other CV risk factors and antihypertensive treatment did not differ between groups. Subclinical cardiac organ damage was less prevalent in psoriasis patients than controls (51% vs. 73%, p=0.007, Figure). In the total study cohort, having psoriasis was associated with lower prevalence of subclinical cardiac organ damage independent of hypertension, smoking, age and sex (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.72, p=0.007) in logistic regression analysis. Among psoriasis patients, hypertension was associated with a near seven-fold increased risk of cardiac organ damage (OR 6.88 [95% CI 1.32–35.98], p=0.022) independent of age, sex and body mass index. PASI at start of treatment or current PASI was not associated with presence of subclinical cardiac organ damage.

Conclusion

Psoriasis patients on infliximab treatment had less subclinical cardiac organ damage compared with controls, suggesting that inhibition of CV inflammation may attenuate cardiac organ damage in psoriasis. Hypertension was the strongest covariable for subclinical cardiac organ damage in psoriasis patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.