"Take It to Heart" is a community health screening and education project jointly sponsored by the National Medical Association (NMA) and Bayer Corporation, Pharmaceutical Division. The project was designed to increase awareness of the prevalence of hypertension and the risks of coronary heart disease in the African-American community. Free health testing for hypertension and cholesterol was provided in six communities. Participants received an individualized coronary risk assessment outlining key risk areas, followed by consultation with an NMA physician. A total of 1651 individuals between the ages of 18 and 82 participated in the health screenings. Ninety-five percent of those tested were African American. In a preliminary health history, 76% reported insufficient exercise, 23% reported a history of high blood pressure, and 19% had a positive family history of early cardiovascular disease. Screening test results revealed 40% of participants had a blood pressure > 140/90 mmHg, 52% had a cholesterol level > 200 mg, and 42% had a body mass index > 27. Based on these results, more than 76% were calculated to have a moderate to high coronary risk profile. Hypertension and cardiovascular disease are major public health problems associated with an increased incidence of death in the African-American community. The Take It to Heart Project is an important mechanism of providing health information to the public and encouraging those at highest risk to take steps to improve their health status.
Dietary intake among other lifestyle factors influence blood pressure. We examined the associations of an “a priori” diet score with incident high normal blood pressure (HNBP; systolic blood pressure (SBP) 120–139 mmHg, or diastolic blood pressure (DBP) 80–89 mmHg and no antihypertensive medications) and hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or taking antihypertensive medication). We used proportional hazards regression to evaluate this score in quintiles (Q) and each food group making up the score relative to incident HNBP or hypertension over nine years in the Atherosclerosis Risk of Communities (ARIC) study of 9913 African-American and Caucasian adults aged 45–64 years and free of HNBP or hypertension at baseline. Incidence of HNBP varied from 42.5% in white women to 44.1% in black women; and incident hypertension from 26.1% in white women to 40.8% in black women. Adjusting for demographics and CVD risk factors, the “a priori” food score was inversely associated with incident hypertension; but not HNBP. Compared to Q1, the relative hazards of hypertension for the food score Q2–Q5 were 0.97 (0.87–1.09), 0.91 (0.81–1.02), 0.91 (0.80–1.03), and 0.86 (0.75–0.98); ptrend = 0.01. This inverse relation was largely attributable to greater intake of dairy products and nuts, and less meat. These findings support the 2010 Dietary Guidelines to consume more dairy products and nuts, but suggest a reduction in meat intake.
diet pattern; healthy food score; hypertension; high normal blood pressure
THE MEXICAN-AMERICAN POPULATION in the United States has generally elevated frequencies of several chronic conditions, including non-insulin-dependent diabetes mellitus (NIDDM), gallbladder disease, and obesity. Prevalence of cardiovascular disease and hypertension is less clear. To document prevalence and risk factors of hypertension in this population, we measured blood pressure in 1004 randomly selected Mexican Americans in Starr County, Texas, ages 15 to 74. We defined hypertension as systolic blood pressure greater than or equal to 140 mmHg or diastolic pressure greater than or equal to 90 mmHg or current (within the last 48 hours) use of antihypertensive medications. Prevalences by age and gender are elevated in this population group compared with those in the general population. In addition to age and gender, body mass and diabetes status were also predictors of hypertension. Comparison of the Starr County results with those reported from the Third National Health and Nutrition Examination Survey (NHANES III) sampling of Mexican Americans indicates a slight increase in frequency of hypertension in Starr County, while comparison with results from San Antonio Mexican Americans indicates a marked increase in frequency in Starr County. These differences are not simple functions of measurement protocols, but are likely to be caused by differences in population structure, employment and socioeconomic status, education, and other such factors.
Hypertension affects nearly one-third of the U.S. population overall, and the prevalence rises sharply with age. In spite of public educational campaigns and professional education programs to encourage blood pressure measurement and control of both systolic and diastolic control to < 140/90 mmHg (or 130/80 mmHg if diabetic), 43% of treated hypertensives do not achieve the recommended JNC VII target. Among African-Americans, 48% are uncontrolled on treatment. The majority of persons classified as poorly controlled hypertensives have mild systolic blood pressure elevation (in the range of 140–160 mmHg). We hypothesized that physician uncertainty regarding the patient’s usual blood pressure, as well as uncertainty regarding the extent of medication non-adherence represent an important barrier to further reductions in the proportion of uncontrolled hypertensives in the U.S.
Using cluster randomization, ten primary care clinics (six from a public health care system and four from a private clinic system) were randomized to either the uncertainty reduction intervention condition or to usual care. An average of 68 patients per clinic were recruited to serve as units of observation. Physicians in the five intervention clinics were provided with a specially designed study form that included a graph of recent blood pressure measurements in their study patients, a check box to indicate their assessment of the adequacy of the patient’s blood pressure control, and a menu of services they could order to aid in patient management. These menu options included: 24-hour ambulatory blood pressure monitoring (ABPM); electronic bottle cap assessment of medication adherence, followed by medication adherence counseling in patients found to be non-adherent; and lifestyle assessment and counseling followed by 24-hour ABPM. Physicians in the five usual practice clinics did not have access to these services, but were informed of which patients had been enrolled in the study. Substudies carried out to further characterize the study population and interpret intervention results included ABPM and electronic bottle cap monitoring in a random subsample of patients at baseline, and audio recording of patient-physician encounters after intervention implementation.
The primary study endpoint was defined as the proportion of patients with controlled blood pressure (BP < 140/90 mmHg or < 130/80 mmHg if diabetic). Secondary endpoints include actual measured clinic systolic and diastolic blood pressure, patient physician communication patterns, physician prescribing patient self-reported lifestyle and medication adherence, physician knowledge, attitude and beliefs regarding the utility of intervention tools to achieve blood pressure control, and the cost-effectiveness of the intervention. Six-hundred eighty patients have been randomized, and 675 remain in active follow-up after 1.5 years. Patient closeout will be complete in March of 2009. Analysis of the baseline data is in progress.
Office-based blood pressure measurement error and bias, as well as physician and patient beliefs about the need for treatment intensification may be important factors that limit further progress in blood pressure control. This trial will provide data on the extent to which available technologies not widely used in primary care will change physician prescribing behavior and patient adherence to prescribed treatment.
Hypertension Control; African-Americans; Cluster-randomized Trial; 24-hour Ambulatory Blood Pressure Monitoring; electronic bottle cap monitoring
Although obesity is known to increase the risk of hypertension, few studies have prospectively evaluated body mass index (BMI) across the range of normal weight and overweight as a primary risk factor.
In this prospective cohort, we evaluated the association between BMI and risk of incident hypertension. We studied 13,563 initially healthy, non-hypertensive men who participated in the Physicians’ Health Study. We calculated BMI from self-reported weight and height and defined hypertension as self-reported systolic blood pressure (BP) ≥140 mmHg, diastolic BP ≥90 mmHg, or new antihypertensive medication use.
After a median 14.5 years, 4920 participants developed hypertension. Higher baseline BMI, even within the “normal” range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (<22.4 kg/m2), the relative risks (95% confidence interval) of developing hypertension for men with a BMI of 22.4–23.6, 23.7–24.7, 24.8–26.4, and >26.4 kg/m2 were 1.20 (1.09–1.32), 1.31 (1.19–1.44), 1.56 (1.42–1.72), and 1.85 (1.69–2.03), respectively (P for trend, <0.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. We found similar associations using other BMI categories and after excluding men with smoking history, those who developed hypertension in the first 2 years, and those with diabetes, obesity, or high cholesterol at baseline.
In this large cohort, we found a strong gradient between higher BMI and increased risk of hypertension, even among men within the “normal” and mildly “overweight” BMI range. Approaches to reduce the risk of developing hypertension may include prevention of overweight and obesity.
hypertension; obesity; body mass index
To describe the prospective relationship of retinal vessel diameters with risk of hypertension in a multiethnic population-based cohort.
The Multi-Ethnic Study of Atherosclerosis is a population-based study of subclinical cardiovascular disease among white, African–American, Hispanic, and Chinese American adults aged 45–84 years. Retinal vessel diameters were measured using a standardized imaging software at the second examination (considered baseline in this analysis) and summarized as the central retinal artery/vein equivalent. Presence of retinopathy and retinal focal arteriolar narrowing and arteriovenous nicking was assessed by trained graders. Incidence of hypertension was defined among participants at risk as systolic blood pressure at least 140 mmHg, diastolic blood pressure at least 90 mmHg, or use of an antihypertensive medication.
Of the initial 6237 participants at baseline, 2583 were at risk of hypertension. After 3.2±0.5 years of follow-up, 448 (17.3%) participants developed hypertension. After adjusting for age, sex, race/ethnicity, the average of mean arterial blood pressure in the first and second examination, and other vascular risk factors, persons with narrower retinal arteriolar diameter and wider venular diameter at baseline were more likely to develop hypertension [odds ratio per SD decrease in central retinal artery equivalent 1.20, 95% confidence intervals 1.02, 1.42; and odds ratio per SD increase in central retinal vein equivalent 1.18, 95% confidence interval 1.02, 1.37]. Persons with focal arteriolar narrowing were also more likely to develop hypertension (odds ratio 1.80, 95% confidence interval 1.09, 2.97).
Findings from this multiethnic population confirm that narrower retinal arteriolar diameter and wider venular diameter are associated with the development of hypertension independent of traditional risk factors.
hypertension; microcirculation; retinal vessel diameter; retinopathy; the Multi-Ethnic Study of Atherosclerosis
Racial disparities in several facets of healthcare have been widely documented, showing that African Americans face disproportionately high health risks when compared to whites. With respect to hypertension, 40% of the > or = 36 million African Americans are affected. We examined the correlation between the patient-physician relationship and the racial disparities in healthcare. We hypothesized that increased physician counseling would lead to higher patient trust and, thus, a greater likelihood of having controlled blood pressure. Four-hundred-sixty black and 333 white Veteran Affairs (VA) patients previously diagnosed with hypertension were included. Patients with a systolic reading > or = 140 mmHg and/or a diastolic reading > or = 90 mmHg at a recent doctor visit were considered to have uncontrolled blood pressure. By using patient exit interviews (PEIs), we quantified the number of counseling behaviors performed by physicians. Patient trust in physician was measured by validated questions answered on a 1-5 agreement scale. Results showed no racial disparity in blood pressure control. While blacks were found to receive more counseling, whites reported higher trust. Controlling for sociodemographic factors, we found that regardless of race, higher PEI scores were associated with higher trust; however, they were also associated with uncontrolled blood pressure. The association of physician behavior with blood pressure was not mediated by trust. We were unable to make direct cause-and-effect conclusions because the measures were recorded from a one-time questionnaire. Future research should focus on uncovering causal relationships, allowing physicians to work towards ending the established healthcare disparities.
The prevalence of hypertension is higher among African-Americans than whites. However, inconsistent findings have been reported on the incidence of hypertension among middle-aged and older African-Americans and whites and limited data are available on the incidence of hypertension among Hispanics and Asians in the US. Therefore, this study investigated the age-specific incidence of hypertension by ethnicity for 3,146 participants from the Multi-Ethnic Study of Atherosclerosis. Participants, age 45–84 years at baseline, were followed for a median of 4.8 years for incident hypertension, defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or the initiation of antihypertensive medications. The crude incidence rate of hypertension, per 1,000 person-years, was 56.8 for whites, 84.9 for African-Americans, 65.7 for Hispanics, and 52.2 for Chinese. After adjustment for age, gender, and study site, the incidence rate ratio (IRR) for hypertension was increased for African-Americans age 45–54 (IRR=2.05, 95% CI=1.47, 2.85), 55–64 (IRR=1.63, 95% CI=1.20, 2.23), and 65–74 years (IRR=1.67, 95% CI=1.21, 2.30) compared with whites, but not for those 75–84 years of age (IRR=0.97, 95% CI=0.56, 1.66). Additional adjustment for health characteristics attenuated these associations. Hispanic participants also had a higher incidence of hypertension compared with whites; however, hypertension incidence did not differ for Chinese and white participants. In summary, hypertension incidence was higher for African-Americans compared with whites between 45 and 74 years of age but not after age 75 years. Public health prevention programs tailored to middle-age and older adults are needed to eliminate ethnic disparities in incident hypertension.
hypertension; race/ethnicity; epidemiology; incidence
To determine whether racial differences exist between consistency of medical care and blood pressure (BP) control over time among elderly, hypertensive African Americans and whites.
Participants included 1,402 African Americans and 1,058 whites from the Piedmont Health Survey of the Elderly who were hypertensive (SBP >140 mmHg, DBP >90 mmHg, or used anti-hypertensive medications) at baseline (1987). Consistency of care was assessed based on self-reported receipt of physician care at each wave and categorized as consistent (care at each wave), inconsistent (care at some, but not all waves), and no standard care (no care at any wave). BP control was defined as SBP < 140 mmHg and DBP < 90 mmHg at subsequent waves of participation (1990, 1994, 1998). Repeated measures regression was used to longitudinally assess the association between consistency of care and BP control.
African Americans had a less favorable health profile and significantly less consistency of care over time (p<0.0001). In analyses adjusted for demographic factors, participants with consistent or inconsistent care had greater odds of BP control (OR=1.34, 95% CI: 1.09, 1.64 and OR=1.41, 95% CI: 1.12, 1.78) than those with no standard care, but these associations were attenuated after additional adjustment for health care characteristics and co-morbidities.
Compared to no standard care, receipt of consistent or inconsistent physician care was associated with BP control among the elderly. These associations did not differ by race, although African Americans were more likely to report inconsistent or no standard care which suggests disparities in health care access remain.
Hypertension; Race; Epidemiology; Elderly; Continuity of Care
Incidence of type 2 diabetes might be associated with preexisting hypertension. There is no information on whether incident diabetes is predicted by blood pressure control. We evaluated the hazard of diabetes in relation to blood pressure control in treated hypertensive patients.
RESEARCH DESIGN AND METHODS
Nondiabetic, otherwise healthy, hypertensive patients (N = 1,754, mean ± SD age 52 ± 11 years, 43% women) participated in a network over 3.4 ± 1 years of follow-up. Blood pressure was considered uncontrolled if systolic was ≥140 mmHg and/or diastolic was ≥90 mmHg at the last outpatient visit. Diabetes was defined according to American Diabetes Association guidelines.
Uncontrolled blood pressure despite antihypertensive treatment was found in 712 patients (41%). At baseline, patients with uncontrolled blood pressure were slightly younger than patients with controlled blood pressure (51 ± 11 vs. 53 ± 12 years, P < 0.001), with no differences in sex distribution, BMI, duration of hypertension, baseline blood pressure, fasting glucose, serum creatinine and potassium, lipid profile, or prevalence of metabolic syndrome. During follow-up, 109 subjects developed diabetes. Incidence of diabetes was significantly higher in patients with uncontrolled (8%) than in those with controlled blood pressure (4%, odds ratio 2.08, P < 0.0001). In Cox regression analysis controlling for baseline systolic blood pressure and BMI, family history of diabetes, and physical activity, uncontrolled blood pressure doubled the risk of incident diabetes (hazard ratio [HR] 2.10, P < 0.001), independently of significant effects of age (HR 1.02 per year, P = 0.03) and baseline fasting glucose (HR 1.10 per mg/dl, P < 0.001).
In a large sample of treated nondiabetic hypertensive subjects, uncontrolled blood pressure is associated with twofold increased risk of incident diabetes independently of age, BMI, baseline blood pressure, or fasting glucose.
Although basic research has implicated abnormal glucose metabolism in the pathogenesis of hypertension, epidemiologic studies are limited.
We assessed whether baseline hemoglobin A1c was prospectively associated with hypertension in the Women’s Health Study. We analyzed 19,858 women initially free of hypertension, diabetes, and cardiovascular disease with baseline blood samples. We considered quintiles and clinical cutpoints of hemoglobin A1c for the risk of hypertension, defined as either a new physician diagnosis, the initiation of antihypertensive treatment, or systolic blood pressure ≥ 140 or diastolic blood pressure ≥ 90 mmHg.
During a median follow-up of 11.6 years, 9408 (47.5%) women developed hypertension. In models adjusted for traditional cardiovascular risk factors, the hazard ratios (HRs) from the lowest (<4.8 %, referent) to the highest (≥ 5.2%) quintile of hemoglobin A1c were 1.0 (referent), 0.99, 1.06, 1.08, and 1.21 (p, linear trend <.0001). However, additional adjustment for body mass index eliminated the relation (extreme quintile comparison HR 1.04; p, linear trend 0.10). For clinical cutpoints, a similar pattern emerged although a positive association between hemoglobin A1c and hypertension remained in the highest category.
Hemoglobin A1c in women without diabetes was associated with an increased risk of hypertension in models controlling for the majority of traditional hypertension and coronary risk factors, but this relation was no longer significant after adjustment for body mass index. These findings underscore the need for additional studies to delineate the important inter-relationships between glycemia and adiposity with the risk of hypertension in other study populations.
epidemiology; diabetes; body mass index
Hypertension is both a cause and consequence of chronic kidney disease, but the prevalence of chronic kidney disease throughout the diagnostic spectrum of blood pressure has not been established. We determined the prevalence of chronic kidney disease within blood pressure categories in 17,794 adults surveyed by the National Health and Nutrition Examination Survey during 1999–2006. Diagnosed hypertension was defined as self-reported provider diagnosis (n=5,832); undiagnosed hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, without report of provider diagnosis (n=3,046); pre-hypertension was defined as systolic blood pressure ≥120 and < 140 mmHg or diastolic blood pressure ≥80 and < 90 mmHg (n=3,719); and normal was defined as systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg (n=5,197). Chronic kidney disease was defined as estimated glomerular filtration rate 15–60 ml/min/1.73m2 or urinary albumin-creatinine ratio > 30 mg/g. Prevalence of chronic kidney disease among those with pre- and undiagnosed hypertension was 17.3% and 22.0%, respectively, compared to 27.5% with diagnosed hypertension and 13.4% with normal blood pressure, after adjustment for age, gender and race in multivariable logistic regression. This pattern persisted with varying definitions of kidney disease; macro-albuminuria (urinary albumin-creatinine ratio > 300 mg/g) had the strongest association with increasing blood pressure category [odds ratio 2.37 (95% confidence interval, 2.00–2.81)]. Chronic kidney disease is prevalent in undiagnosed and pre-hypertension. Earlier identification and treatment of both these conditions may prevent or delay morbidity and mortality from chronic kidney disease.
epidemiology; albuminuria; renal; prevention; awareness; surveillance
Hypertension is one of the most important and common cardiovascular risk factors. Defining the level at which blood pressure starts causing end-organ damage is challenging, and is not easily answered. The threshold of blood pressure defining hypertension has progressively been reduced over time, from systolic >160 mmHg to >150 mmHg, then to >140 mmHg; and now even blood pressures above 130 to 120 mmHg are labeled as ‘pre-hypertension’ by some expert committees. Are interest groups creating another ‘pseudodisease’ or is this trend scientifically justified? A recent meta-analysis published in BMC Medicine by Huang et al. clearly indicates that pre-hypertension (120 to 140/80 to 90 mmHg) is a significant marker of increased cardiovascular risk. This raises the question as to whether we now need to lower the threshold of ‘hypertension’ (as opposed to ‘pre-hypertension’) to >120/80 mmHg, redefining a significant proportion of currently healthy people as ‘patients’ with an established disease. These data need to be interpreted with some caution. It is controversial whether pre-hypertension is an independent risk factor or just a risk marker and even more controversial whether treatment of pre-hypertension will lower cardiovascular risk.
Please see related research: http://www.biomedcentral.com/1741-7015/11/177.
Hypertension; Pre-hypertension; Prevention; Cardiovascular
Disparities in hypertension between African Americans and non-Hispanic whites have been well-documented, yet an explanation for this persistent disparity remains elusive. Since African Americans and non-Hispanic white Americans tend to live in very different social environments, it is not known whether race disparities in hypertension would persist if non-Hispanic whites and African Americans were exposed to similar social environments. We compared data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) Study with the National Health and Nutrition Examination Survey (NHANES) 1999–2004 to determine if race disparities in hypertension in the USA were attenuated in EHDIC-SWB, which is based in a raciallyintegrated community without race differences in income. Hypertension was defined as systolic Blood Pressure (BP)>= 140 millimeters of mercury (mmHg) and/or diastolic BP >= 90 mm Hg or respondent’s report of taking antihypertensive medications. Of the 1408 study participants, 835 (59.3%) were African American, 628 (44.6%) were men, and the mean age was 40.6 years. After adjustment for potential confounders, various analytic models from EHDIC-SWB and NHANES 1999–2004 data, we found the race odds ratio was between 29.0% and 34% smaller in the EHDIC-SWB sample. We conclude that social and environmental exposures explained a substantial proportion of the race difference in hypertension.
Racial disparities; hypertension; residential segregation; confounding race and socioeconomic status (SES); Integrated community; USA
Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population.
In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects.
The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension.
The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population.
Socioeconomic Factor; High Blood Pressure; Control
This study was designed to assess the effects of moxonidine on blood pressure and aspects of the metabolic syndrome in racially diverse population of patients encountered in routine medical practice. Physicians collected data on a minimum of three consecutive patients with uncontrolled essential hypertension and criteria for metabolic syndrome, eligible to receive moxonidine (0.2–0.4 mg once daily) for 6 months, either as monotherapy or as adjunct therapy to current antihypertensive treatment. Systolic and diastolic blood pressure (BP) declined by an average of 24.5 + 14.3 mmHg and 12.6 + 9.1 mmHg, respectively. BP responder rates defined as attaining BP < 140/90 mmHg were significantly (P < 0.001) and substantially higher among younger patients, nonpostmenopausal women, and patients receiving monotherapy. While potentially relevant improvements in the entire cohort were observed in regard to body weight (−2.1 ± 5.4 kg), fasting plasma glucose (from 6.8 to 6.2 mmol/L), and triglycerides (2.4 to 2.0 mmol/L), statistically significant changes in metabolic parameters could only be detected in subgroup analyses. Moxonidine therapy reduced blood pressure and improved rates of blood pressure control in this group of patients. While the observed trend towards improvement in various metabolic parameters merits further investigation, the overall effect of moxonidine treatment is consistent with a reduction of total cardiovascular risk in this hypertensive metabolic syndrome cohort.
Serum cystatin has been shown to be associated with hypertension in the general population. Little is known on the relationship of serum cystatin C with the long-term hypertension incidence in persons with diabetes. We examined the association of serum cystatin C with the incidence of hypertension over a 15-year period in people with type 1 diabetes mellitus.
The 15-year cumulative incidence of hypertension was measured in Wisconsin Epidemiologic Study of Diabetic Retinopathy participants. Hypertension was defined as a systolic blood pressure of ≥140 mmHg and/or a diastolic blood pressure of ≥90 mmHg and/or history of use of antihypertensive treatment. The relation of cystatin C and other risk factors to hypertension incidence was determined with generalized linear modeling with the complementary log-log link function.
After controlling for age, gender, diabetes duration, body mass index, glycosylated haemoglobin and baseline systolic and diastolic blood pressure, the baseline serum cystatin C was associated with the 15-year cumulative incidence of hypertension (Hazard Ratio per mg/L of cystatin C 3.43, and 95% Confidence Interval, 1.36, 8.63).
These findings show a relationship of serum cystatin C with the incidence of hypertension in type 1 diabetes mellitus. The underlying biological processes remain to be determined.
cystatin C; type 1 diabetes; epidemiology
In Peru, cardiovascular disease was the second most common cause of death in those aged 65 years or more in 2000. Hypertension is a major modifiable risk factor for cardiovascular disease, and if treated can significantly reduce cardiovascular disease risk. The objectives of this study were to investigate the prevalence of hypertension and levels of awareness, treatment and control in a deprived urban area of Peru.
A cross-sectional study was completed. Blood pressure measurements were recorded in triplicate. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or self report of receiving antihypertensive medication at the time of interview.
The study sample was 584 adults (29.1% male, mean age 35.3 years). Age standardized prevalence of hypertension was 19.5% (95% CI 9.9%, 29.1%) in men, 11.4% (95% CI 3.7%, 19.1%) in women, and 13.2% (95% CI 5.0%, 21.5%) overall. Among those with hypertension 38.3% (95% CI 22.7%, 53.9%, n = 18/47) were aware of their condition with greater awareness among women than men. Of those aware, 61.1% (n = 11/18) were treated, equating to 23.4% (95% CI 10.1%, 36.7%, n = 11/47) of all adults with hypertension. Of those treated 63.6% (n = 7/11) had controlled hypertension, equating to 14.9% (95% CI 3.0%, 26.8%, n = 7/47) of all adults with hypertension.
Levels of awareness and control in this population were low. Lack of control is likely to be due to both a failure to diagnose hypertension, especially among men, and initiate or comply with treatment, especially among women. These results suggest a considerable burden of undiagnosed hypertension, and poor levels of control in those treated, in a deprived urban area of Lima, Peru.
To describe the frequency of orthostatic hypotension and hypertension and associations with risk factors in a cohort of persons with long term type 1 diabetes (n=440) participating in the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR).
Evaluations included detailed medical history, electrocardiography (ECG), and laboratory tests. Blood pressure (BP) was measured in supine and standing positions. Standing decrease in systolic (SBP) or diastolic (DBP) BP of at least 20 mmHg or 10 mmHg, respectively, was defined as orthostatic hypotension; increase of SBP from <140 to ≥ 140mmHg or DBP from < 90 to ≥ 90mmHg was defined as orthostatic hypertension.
Prevalence of orthostatic hypotension and orthostatic hypertension was 16.1% and 15.2%, respectively. Some ECG measurements of cardiac autonomic dysfunction were significantly associated with orthostatic hypotension. Association between SBP and orthostatic hypotension and orthostatic hypertension were significant (Odds Ratio (95% CI), 1.02 (1.01–1.05) and 1.02 (1.01–1.04), respectively) after adjusting for confounders. Interaction between SBP and age was observed. SBP was significantly associated with orthostatic hypotension and orthostatic hypertension in people ≤ 40 years old (1.35 (1.02–1.78) and 1.12 (1.05–1.18), respectively).
Results showed that measurements derived from the ECG can help describe an individual at increased risk of having postural BP changes. Moreover, SBP was associated with postural BP changes among individuals who were < 40 years of age with long-term type 1 diabetes.
diabetes complications; hypertension; hypotension; prevalence; risk
High sugar intake has been suggested to be related to hypertension. To examine the associations between intakes of sugar and sugar-sweetened beverages (SSBs) and the prevalence of hypertension, we used the US National Health and Nutrition Examination Survey (NHANES) 2003-2006. A total of 3,044 participants aged ≥19 years were included. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic regression model. Prevalent hypertension cases were defined as systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥90 mmHg. In the multivariate adjusted models, we observed no association between sugar consumption and the prevalence of hypertension. In the model where we adjusted for age, gender, NHANES period and BMI, those who consumed ≥3 times per day of sugar-sweetened beverages had an OR of 1.87 (95% confidence interval, CI = 1.06-3.26) for the prevalence of hypertension compared with those who consumed <1 time per month of these beverages. Further adjustment for other factors attenuated the association; ORs (95% CIs) were 1.21 (0.81-1.81) for 1 time per month-<3 times per week, 1.39 (0.86-2.24) for 3 times per week-<1 times per day, 1.26 (0.80-1.98) for 1-<3 times per day, and 1.50 (0.84-2.68) for ≥3 times per day of sugar-sweetened beverages compared to the <1 time per month (p for trend = 0.33). In conclusion, we found that sugar consumption was not associated with the prevalence of hypertension, however there was suggestion that high sugar-sweetened beverage consumption was associated with high prevalence of hypertension in the US.
Hypertension; Dietary sugars; Sugar-sweetened beverages; NHANES
Recent guidelines recommending more aggressive blood pressure control in patients with chronic kidney disease have unknown impact. We assessed trends in and predictors of blood pressure control in 8,829 adult NHANES 1999–2006 participants with hypertension (self-report, measured blood pressure, or use of anti-hypertensive medications), without (n=7,178) and with (n=1,651) chronic kidney disease. Uncontrolled blood pressure was defined as: general definition, systolic blood pressure ≥140/diastolic blood pressure ≥90 mmHg; disease-specific definition, ≥130/≥85 (1999–2002) and ≥130/≥80 (2003–2006) mmHg for those with chronic kidney disease (estimated GFR <60 ml/min/1.73 m2) or diabetes (self-report). Proportions with uncontrolled blood pressure in 1999–2006 were greater in those with chronic kidney disease versus those without chronic kidney disease [51.5% vs. 48.7% (general definition, P=0.122) and 68.8% vs. 51.7% (disease-specific definition; P<0.001)]. In those with chronic kidney disease, there were significant decreases in uncontrolled blood pressure over time [55.9% to 47.8% (general definition, P=0.011)]. With adjustment for demographic, socioeconomic, and clinical variables, older age (P<0.001) and lack of anti-hypertensive treatment (P<0.001) were associated with uncontrolled blood pressure, regardless of chronic kidney disease status; non-white race (P=0.002) was associated in those without chronic kidney disease, whereas female sex (P=0.030) was associated in those with chronic kidney disease. Multiple medications (P<0.001) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (P=0.001) were associated with less uncontrolled blood pressure. Although some improvement has occurred over time, uncontrolled blood pressure remains highly prevalent, especially in chronic kidney disease and in non-whites, older persons, and females. Therapy appears suboptimal.
blood pressure control; prevalence; trends; risk factors; treatment guidelines; chronic kidney disease
To assess the association of cardiovascular risk factors, ocular perfusion pressure with early and advanced age-related macular degeneration (AMD) in Latinos.
Population-based, cross-sectional study.
Data were collected from a population-based sample of self-identified adult Latinos using standardized protocols for assessing blood pressure and intraocular pressure (IOP) measurement and stereoscopic macular photography. Hypertension was defined as either a history of hypertension or systolic blood pressure (SBP) >140mmHg +/− diastolic blood pressure (DBP) ≥85mmHg. Ocular perfusion pressure (OPP) was defined as the difference between mean arterial blood pressure and IOP. AMD was diagnosed from photographic grading by masked trained graders. Logistic regression was used to assess associations.
Gradable retinal photographs were available in 5875 participants. After adjusting for age, sex, and cigarette smoking, higher DBP and uncontrolled diastolic hypertension were associated with exudative AMD (Odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1−2.8; and OR, 3.3; CI, 1.2−9.3, respectively). Higher OPP was associated with a decreased risk of GA (OR, 0.4 per 10mmHg; CI, 0.3−0.5). Low pulse pressure was associated with a lower risk of exudative AMD (OR, 0.2; CI, 0.1−0.6). Obesity was associated with increased retinal pigment (OR, 1.6; CI, 1.0−2.3).
These data suggest that in Latinos cardiovascular risk factors may play a role in advanced AMD. Given that Latinos have a high prevalence of cardiovascular risk factors, an intervention aimed at reducing these risk factors may also have a beneficial impact on the risk of having early and advanced AMD.
Type 2 diabetes mellitus (T2DM) and hypertension frequently occur together. We examined whether blood pressure (BP) levels predict eight-year incident diabetes. Participants were community-dwelling older adults who had BP measured twice and an oral glucose tolerance test at baseline and again 8.3 years later. At baseline, participants were classified as normotensive [systolic (SBP) <120 mmHg and diastolic (DBP) <80 mmHg; n=242]; prehypertensive (SBP ≥120 and <140 mmHg or DBP ≥80 and <90 mmHg; n=426); or hypertensive (SBP ≥140 mmHg or DBP ≥90 mmHg or using anti-hypertensive medication; n=457). There were 1125 participants (mean age 66.0 years; 44.3% men) who attended the baseline and follow-up visit, of whom 85 had new onset T2DM. Participants who developed T2DM had higher mean body mass index (BMI) and BP levels than those who did not develop diabetes. In logistic regression models adjusted for age, sex, BMI, and physical activity, the odds of incident T2DM was greater in prehypertensives (OR2.32 95%CI 1.05–5.1, P=0.03) and hypertensives (OR3.5 95%CI 1.50–8.0, P=0.002) compared to normotensives. Excluding participants who used anti-hypertensive medications did not change results. In conclusion, mid-life hypertension and prehypertension predicted future diabetes, independent of BMI. Glucose surveillance should be encouraged in adults with prehypertension or hypertension.
blood pressure; diabetes; hypertension; obesity; prospective
Minorities have a higher prevalence of hypertension, a major risk factor for cardiovascular disease, which contributes to racial/ethnic disparities in morbidity and mortality in the US. Many modifiable health behaviors have been associated with improved blood pressure control, but it is unclear how racial/ethnic differences in these behaviors are related to the observed disparities in blood pressure control.
Cross-sectional analyses were conducted among 21,489 US adults aged >20 years participating in the National Health and Nutrition Examination Survey from 2001–2006. Secondary analyses were conducted among those with a self-reported diagnosis of hypertension. Blood pressure control was defined as systolic values <140 mmHg and diastolic values <90 mmHg (or <130 mmHg and <80 mmHg among diabetics, respectively).
In primary analyses, Non-Hispanic Blacks had 90% higher odds of poorly controlled blood pressure compared to non-Hispanic Whites after adjustment for sociodemographic and clinical characteristics (p <0.001). In secondary analyses among hypertensive subjects, non-Hispanic Blacks and Mexican-Americans had 40% higher odds of uncontrolled blood pressure compared to non-Hispanic Whites after adjustment for sociodemographic and clinical characteristics (p <0.001). For both analyses, the racial/ethnic differences in blood pressure control persisted even after further adjustment for modifiable health behaviors, which included medication adherence in secondary analyses (p <0.001 for both analyses).
Although population-level adoption of healthy behaviors may contribute to reduction of the societal burden of cardiovascular disease in general, these findings suggest that racial/ethnic differences in some health behaviors do not explain the disparities in hypertension prevalence and control.
Hypertension; blood pressure; health disparities; minority health; health behavior; exercise; diet
There are limited data about the role of gender on the relationship between sleep duration and blood pressure (BP) from rural populations.
We conducted a cross-sectional rural population-based study. This report includes 1,033 men and 783 women aged 18–65 years from a cohort of twins enrolled in Anhui, China, between 2005 and 2008. Sleep duration was derived from typical bedtime, wake-up time, and sleep latency as reported on a standard sleep questionnaire. Primary outcomes included measured systolic blood pressure (SBP) and diastolic blood pressure (DBP). High blood pressure (HBP) was defined as SBP≥130 mmHg, DBP ≥85 mmHg, or physician diagnosed hypertension. Linear and logistic regression models were used to assess gender-specific associations between sleep duration and BP or HBP, respectively, with adjustment for known risk factors including adiposity and sleep-related disorder risk from the questionnaires. Generalized estimating equations were used to account for intra-twin pair correlations.
Compared with those sleeping 7 to less than 9 hours, women sleeping <7 hours had a higher risk of HBP (odds ratios [ORs] 3.0, 95% confidence interval [CI], 1.4–6.6); men sleeping ≥9 hours had a higher risk of HBP (ORs=1.5, 95%CI: 1.1–2.2).
Among rural Chinese adults, a gender-specific association of sleep duration with BP exists such that HBP is associated with short sleep duration in women and long sleep duration in men. Longitudinal studies are needed to further examine the temporal relationship and biological mechanisms underlying sleep duration and BP in this population. Our findings underscore the potential importance of appropriate sleep duration for optimal blood pressure.
sleep duration; high blood pressure; gender difference; rural Chinese