Working mostly at night has been suggested to be associated with upset of chronobiological rhythms and high blood pressure, but the evidence from epidemiological studies is weak.
In a cross-sectional survey, we evaluated the association between shift work and blood pressure, pre-hypertension and hypertension. In total, 493 nurses, nurse technicians and assistants, were selected at random in a large general hospital setting. Hypertension was diagnosed by the mean of four automatic blood pressure readings ≥140/90 mmHg or use of blood pressure lowering agents, and pre-hypertension by systolic blood pressure ≥120–139 or diastolic blood pressure ≥80–89 mmHg. Risk factors for hypertension were evaluated by a standardized questionnaire and anthropometric measurements. The association between the shift of work and blood pressure, pre-hypertension and hypertension was explored using univariate and multivariate analyses that controlled for risk factors for hypertension by covariance analysis and modified Poisson regression.
The mean age of the participants was 34.3±9.4 years and 88.2% were women. Night shift workers were older, more frequently married or divorced, and less educated. The prevalence of hypertension in the whole sample was 16%, and 28% had pre-hypertension. Blood pressure (after adjustment for confounding) was not different in day and night shift workers. The prevalence of hypertension and pre-hypertension by shift work was not different in the univariate analysis and after adjustment for confounding (all risk ratios = 1.0).
Night shift work did not increase blood pressure and was not associated with hypertension or pre-hypertension in nursing personnel working in a large general hospital.
Prevention of pre-hypertension is an important goal for primary care patients. Obesity is a risk factor for hypertension, but has not been addressed for pre-hypertension in primary care populations. The objective of this study was to assess the degree to which obesity independently is associated with risk for pre-hypertension in family medicine patients.
This study was a retrospective analysis of information abstracted from medical records of 707 adult patients. Multivariable logistic regression was used to test the relationship between body mass index (BMI) and pre-hypertension, after adjustment for comorbidity and demographic characteristics. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg.
In our sample, 42.9% of patients were pre-hypertensive. Logistic regression analysis revealed that, in comparison to patients with normal body mass, patients with BMI > 35 had higher adjusted odds of being pre-hypertensive (OR = 4.5, CI 2.55–8.11, p < .01). BMI between 30 and 35 also was significant (OR = 2.7, CI 1.61–4.63, p < 0.01) as was overweight (OR = 1.8, CI 1.14–2.92, p = 0.01).
In our sample of family medicine patients, elevated BMI is a risk factor for pre-hypertension, especially BMI > 35. This relationship appears to be independent of age, gender, marital status and comorbidity. Weight loss intervention for obese patients, including patient education or referral to weight loss programs, might be effective for prevention of pre-hypertension and thus should be considered as a potential quality indicator.
Data were collected on a cohort of 435 black medical students whose attendance at Meharry Medical College fell within the period 1958 to 1965, providing baseline measurements on multiple possible hypertension precursors. Relevant family history, sociodemographic, and clinical characteristics were obtained. Fifty percent of the students had at least one of the following possible precursors of hypertension: systolic blood pressure >120 mmHg; diastolic blood pressure >80 mmHg; pulse >80 beats/min; and relative body weight >120 percent of ideal body weight. Contrary to expectations, students from professional families were more likely to have higher systolic blood pressures. Students whose parents had a positive history of hypertension or stroke were likely to have higher diastolic blood pressures. Of the 24 students found to be hypertensive on survey (1981), 73 percent had a positive parental history of hypertension or stroke compared with only 40 percent of a control group matched by age and sex. A 17-year follow-up is currently underway to develop a risk profile for hypertension among black professionals.
This study was performed in order to investigate dietary habits, health related lifestyle and blood cadmium and lead levels in female college students. 80 college students (43 males and 37 females) participated in the survey questionnaires. Body weight and height, blood pressure, and body composition were measured. The systolic blood pressure of male and female students were 128.9 ± 13.9 and 109.8 ± 12.0, respectively. The diastolic blood pressure of male and female students were 77.1 ± 10.3 and 66.0 ± 6.9, respectively, showing that male students had significantly higher blood pressure than female students (P < 0.001). The BMI of male and female students were 23.4 ± 3.3 and 20.2 ± 2.3, respectively. Most male students were in the range of being overweight. The dietary habits score of female students was significantly higher than that of male students (P < 0.01).The blood cadmium level of male and female students were 0.54 ± 0.23 and 0.52 ± 0.36, respectively. There was no significant difference between male and female students. The blood lead level of male and female students were 1.09 ± 0.49 and 0.59 ± 0.45, respectively. The blood lead level of male students was significantly higher than that of female students (P < 0.001). The blood cadmium level of smokers and nonsmokers were 0.69 ± 0.29 and 0.49 ± 0.29 respectively (P < 0.05). The blood cadmium level of smokers was significantly higher than that of nonsmokers (P < 0.05). The blood lead level of smokers and nonsmokers were 1.09 ± 0.43 and 0.80 ± 0.54, respectively. The blood lead level of smokers was significantly higher than that of nonsmokers (P < 0.05). Therefore, proper nutritional education programs are required for college students in order to improve their dietary and health related living habits.
Dietary habit; blood cadmium; blood lead; college students
The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in 2003 created a prehypertension category for persons with blood pressures ranging from systolic blood pressure (SBP) of 120–139 mm Hg or diastolic blood pressure (DBP) from 80 to 89 mm Hg, due to increased risk of cardiovascular disease.
Our study utilized the University of California-San Diego (UCSD) Twin Hypertension Cohort. We measured comprehensive plasma cholesterol levels and metabolic (glucose, insulin, leptin) and inflammatory markers (interleukin-6 (IL-6), C-reactive protein (CRP), free fatty acids) to determine the differences between normotensive and prehypertensive subjects. Additionally, we determined whether angiotensin II receptor type-1 (AGTR1) polymorphisms, previously associated with hypertension, could predict prehypertension.
A total of 455 white subjects were included in the study (mean age 37.1 years). Prehypertensive subjects were older with greater body mass index (BMI) than the normotensives, and after adjusting for sex and age, had greater plasma glucose, insulin, and IL-6. The common AGTR1 A1166C (rs5186) polymorphism in the 3′-UTR region, particularly the presence of the 1166C allele, which fails to downregulate gene expression, predicted greater likelihood of being in the prehypertension group and higher SBP. A lesser-studied polymorphism in intron-2 of AGTR1 (A/G; rs2276736) was associated with plasma high-density lipoprotein (HDL) and apolipoprotein A-1. In a subgroup analysis of nonobese subjects (N = 405), similar associations were noted.
Prehypertensive subjects already exhibit early pathophysiologic changes putting them at risk of future cardiovascular disease, and AGTR1 may also contribute to this increased risk. Further investigation is needed to confirm these findings and the precise molecular mechanisms of action.
AGTR1; angiotensin II receptor; blood pressure; hypertension; inflammation; prehypertension
The clinical behaviour and mean peak serum aspartate aminotransferase (SGOT) values of 106 patients admitted to a coronary care unit with acute myocardial infarction who displayed acute systolic hypertension were studied. Another 106 normotensive patients with acute myocardial infarction acted as controls. Neither group had established hypertension. The mortality rate, incidence of cardiac failure, major arrhythmias, and mean peak SGOT were significantly greater in the hypertensive group, within which the duration of hypertension was correlated with mean peak SGOT levels--through there was no definite relation between the height of systolic or diastolic pressure and SGOT. Transient systolic hypertension after acute myocardial infarction was therefore associated with a relatively poor prognosis, but our observations suggest that patients with a systolic blood pressure of at least 170 mm Hg might benefit from early hypotensive treatment.
To study blood pressure and blood pressure reactivity in young offspring of normotensive or hypertensive parents who are consanguineous (first cousins) or are not blood-related.
Blood pressure, heart rate and body mass index (BMI) were measured in 9–10 year-old male offspring of 19 pairs of first-cousins normotensive, 16 pairs of first-cousin hypertensive and 12 pairs of non-blood-related hypertensive parents.
The offspring of first-cousin hypertensive parents exhibited the greatest systolic and diastolic blood pressure reactivity to their first casual blood pressure measurement, while the offspring of first-cousin normotensive parents showed the least reactivity. The offspring of the hypertensive parents who were not blood-related showed an intermediate reactivity. Basal systolic blood pressure (SBP) was also highest in the offspring of first-cousin hypertensive parents, and their basal diastolic blood pressure (DBP) was higher than that in offspring of first-cousin normotensive parents.
The augmented blood pressure response in the offspring of hypertensive parents may have prognostic implications and serve as an important and significant indicator of predisposition to hypertension later in life.
consanguineous marriage; offspring; blood pressure reactivity; Oman
To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia.
A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students.
Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9th to 12th grades, 6.9% of males and 0.5% of females were current cigarette smokers.
Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.
Cardiovascular risk factors; school students; Saudi Arabia
The Middle Eastern and North African region of developing countries is associated with poor rates of blood pressure (BP) control and antihypertensive prescribing patterns. This post hoc analysis of data from an international observational study aimed to investigate the efficacy and tolerability of long-acting nifedipine (30 mg or 60 mg; monotherapy or in combination) in the Middle Eastern and Moroccan populations defined as having high cardiovascular risk.
This was a prospective, noninterventional, multicenter observational study. Observations from patients (aged ≥ 18 years) with treated or untreated hypertension from the Middle East (Jordan, Saudi Arabia, Kuwait, Lebanon, Qatar, United Arab Emirates, and Yemen) and Morocco are presented. Hypertension grade and cardiovascular risk were defined at baseline, and systolic/diastolic BP change was defined at post-baseline visits (≤3). Adverse events and ratings of therapy efficacy and patient/physician satisfaction were recorded.
The study included 1466 patients from the Middle East and 524 from Morocco. Characteristics of the populations differed, with a more severe hypertension profile in Moroccan patients. Despite these differences, nifedipine reduced BP to a similar extent in each group, with efficacy dependent on cardiovascular risk factors such as hypertension grade and age. Few adverse drug reactions occurred and nifedipine was well-tolerated in both populations. Efficacy and satisfaction with therapy were rated highly.
Good rates of BP control were observed with nifedipine in patients with moderate-to-severe hypertension and high added risk. Published data in these countries suggest poor antihypertensive prescribing patterns and BP control; these data confirm this trend and suggest that suboptimal dosing may be prevalent.
antihypertensive; safety; tolerability; hypertension; cardiovascular risk; blood pressure
The relationship between elevated blood pressure and cardiovascular and cerebrovascular disease risk is well accepted. Both systolic and diastolic hypertension are associated with this risk increase, but systolic blood pressure appears to be a more important determinant of cardiovascular risk than diastolic blood pressure. Subjects for this study are derived from the Framingham Heart Study data set. Each subject had five records of clinical data of which systolic blood pressure, age, height, gender, weight, and hypertension treatment were selected to characterize the phenotype in this analysis.
We modeled systolic blood pressure as a function of age using a mixed modeling methodology that enabled us to characterize the phenotype for each individual as the individual's deviation from the population average rate of change in systolic blood pressure for each year of age while controlling for gender, body mass index, and hypertension treatment. Significant (p = 0.00002) evidence for linkage was found between this normalized phenotype and a region on chromosome 1. Similar linkage results were obtained when we estimated the phenotype while excluding values obtained during hypertension treatment. The use of linear mixed models to define phenotypes is a methodology that allows for the adjustment of the main factor by covariates. Future work should be done in the area of combining this phenotype estimation directly with the linkage analysis so that the error in estimating the phenotype can be properly incorporated into the genetic analysis, which, at present, assumes that the phenotype is measured (or estimated) without error.
Baroreflex sensitivity and cardiopulmonary blood volume were determined in 95 men, including normotensive and hypertensive subjects with normal renal function and balanced sodium intake and urinary output. Baroreflex sensitivity was estimated by determining the slope of the regression line relating the increase of systolic pressure to the cardiac slowing after transient rises of arterial pressure. A technique of gradual atropinisation was used to evaluate the parasympathetic mediated component of the reflex. With this method, it was possible to calculate the exact atropine dose abolishing the reflex sensitivity. This index was not dependent on age. It was negatively correlated to the diastolic pressure in normotensive patients but not in hypertensive patients. The ratio between the cardiopulmonary and the total blood volume was considered as an index of sympathetic venous tone. This ratio was positively correlated to the diastolic pressure in normotensive patients, but not in hypertensive patients. This study strongly suggests that a precise sympathetic-parasympathetic balance existed in the normotensive patients. This balance was disrupted in the hypertensive patients pointing to abnormalities in the autonomic nervous system of permanently hypertensive patients.
Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary condition that may be diagnosed in utero. Our goal was to evaluate symptoms of ADPKD in children, including left ventricular mass index (LVMI), renal volume, renal function and microalbuminuria in relation to systolic and diastolic blood pressure. Eighty-five children were stratified by blood pressure into three cohorts: hypertensive (95th percentile and over), borderline hypertensive (75–95th percentile) and normotensive (75th percentile and below). There were no differences in gender, age, height, renal function, or microalbuminuria between the groups. Both the hypertensive and borderline hypertensive children had a significantly higher LVMI than normotensive children, with no significant difference between hypertensive and borderline hypertensive groups. There was a significant correlation between renal volume and both systolic and diastolic blood pressures in all subjects. Renal volume in hypertensive children was significantly larger than in the borderline hypertensive group, with no significant difference between normotensive and borderline hypertensive groups. These findings show that an increase in LVMI may be detected earlier than an increase in renal volume in children with ADPKD and borderline hypertension, suggesting that close monitoring of cardiac status is indicated in these children.
polycystic kidney disease; children; borderline hypertension; left ventricular mass index
Several studies revealed that low calcium intake is related to high prevalence of cardiovascular diseases such as hypertension. The prevalence of hypertension is high in Koreans along with their low dietary calcium consumption. Thus, the aim of this study was to evaluate the status of calcium intake between the hypertension and normotension groups and to investigate the correlation between dietary calcium intake and blood pressure, blood lipid parameters, and blood/urine oxidative stress indices. A total of 166 adult subjects participated in this study and were assigned to one of two study groups: a hypertension group (n = 83) who had 140 mmHg or higher in systolic blood pressure (SBP) or 90 mmHg or higher in diastolic blood pressure (DBP), and an age- and sex-matched normotension group (n = 83, 120 mmHg or less SBP and 80 mmHg or less DBP). The hypertension group consumed 360.5 mg calcium per day, which was lower than that of the normotension group (429.9 mg) but not showing significant difference. In the hypertension group, DBP had a significant negative correlation with plant calcium (P < 0.01) after adjusting for age, gender, body mass index (BMI), and energy intake. In the normotension group, total calcium and animal calcium intake were significantly and positively correlated with serum triglycerides. No significant relationship was found between calcium intake and blood/urine oxidative stress indices in both groups. Overall, these data suggest reconsideration of food sources for calcium consumption in management of the blood pressure or blood lipid profiles in both hypertensive and normotensive subjects.
Dietary calcium intake; hypertension; oxidative stress indices; plant calcium
Determining which demographic and medical variables predict the development of hypertension could help clinicians stratify risk in both prehypertensive and nonhypertensive persons. Subject-level data from 2 community-based biracial cohorts were combined to ascertain the relationship between baseline characteristics and incident hypertension. Hypertension, defined as diastolic blood pressure ≥90 mm Hg, systolic blood pressure ≥140 mm Hg, or reported use of medication known to treat hypertension, was assessed prospectively at 3, 6, and 9 years. Internal validation was performed by the split-sample method with a 2:1 ratio for training and testing samples, respectively. A scoring algorithm was developed by converting the multivariable regression coefficients to integer values. Age, level of systolic or diastolic blood pressure, smoking, family history of hypertension, diabetes mellitus, high body mass index, female sex, and lack of exercise were associated with the development of hypertension in the training sample. Regression models showed moderate to high capabilities of discrimination between hypertension vs nonhypertension (area under the receiver operating characteristic curve 0.75–0.78) in the testing sample at 3, 6, and 9 years of follow-up. This risk calculator may aide health care providers in guiding discussions with patients about the risk for progression to hypertension.
Psychological distress contributes to the development of hypertension in young adults. This trial assessed the effects of a mind–body intervention on blood pressure (BP), psychological distress, and coping in college students.
This was a randomized controlled trial (RCT) of 298 university students randomly allocated to either the Transcendental Meditation (TM) program or wait-list control. At baseline and after 3 months, BP, psychological distress, and coping ability were assessed. A subgroup of 159 subjects at risk for hypertension was analyzed similarly.
Changes in systolic BP (SBP)/diastolic BP (DBP) for the overall sample were −2.0/−1.2 mm Hg for the TM group compared to +0.4/+0.5 mm Hg for controls (P = 0.15, P = 0.15, respectively). Changes in SBP/DBP for the hypertension risk subgroup were −5.0/−2.8 mm Hg for the TM group compared to +1.3/+1.2 mm Hg for controls (P = 0.014, P = 0.028, respectively). Significant improvements were found in total psychological distress, anxiety, depression, anger/hostility, and coping (P values < 0.05). Changes in psychological distress and coping correlated with changes in SBP (P values < 0.05) and DBP (P values < 0.08).
This is the first RCT to demonstrate that a selected mind–body intervention, the TM program, decreased BP in association with decreased psychological distress, and increased coping in young adults at risk for hypertension. This mind–body program may reduce the risk for future development of hypertension in young adults.
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
Low serum vitamin D levels are associated with high blood pressure (BP). Prehypertension is a preclinical stage where primary prevention efforts have been recommended for delaying or preventing the onset of hypertension. However, the majority of studies examining the association between vitamin D and BP have not accounted for kidney function or systemic inflammation.
Participants of the 3rd National Health and Nutrition Examination Survey >20 years of age and free of hypertension (n = 9,215, 53.5% women) and clinical cardiovascular disease were examined. Serum vitamin D levels were analyzed as quartiles. Prehypertension (n = 3,712) was defined as systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg.
Lower serum vitamin D levels were found to be associated with prehypertension independent of potential confounders including body mass index (BMI), serum cholesterol, C-reactive protein and estimated glomerular filtration rate. Compared to the highest quartile of serum vitamin D (referent), the odds ratio (95% confidence interval) of prehypertension associated with the lowest quartile was 1.48 (1.16–1.90; p trend <0.0001). This association persisted in subgroup analyses by gender, race-ethnicity and BMI.
Lower serum vitamin D levels are associated with prehypertension in a representative sample of US adults.
Vitamin D; Blood pressure; Prehypertension
Background and aims: Large artery stiffness and endothelial dysfunction are the predominant characteristic of isolated systolic hypertension. Recently studies have revealed MMP1, 3, 9 and TIMP3 Genes polymorphism were associated with arterial stiffness, but the relationship with isolated systolic hypertension were not further studied. This study was to investigate the associations of MMP1,3,9 and TIMP3 Genes polymorphism with isolated systolic hypertension. Methods: We identified the genotype of the genes in 503 patients with isolated systolic hypertension, 481 essential hypertension patients with elevated diastolic blood pressure and 244 age-matched normotensive controls for 5 SNPs and detected the brachial-ankle pulse wave velocity, flow-mediated dilatation, endothelin-1 and nitric oxide among the participants. Results: Multinomial logistic analyses showed that the 5A allele of rs3025058(5A/6A) in MMP3 and the T allele of rs3918242(C-1562T) in MMP9 were significantly associated with isolated systolic hypertension after adjusted by age, triglyceride, low-density lipoprotein (P<0.001, Pcorr<0.003; P=0.009, Pcorr=0.027). The 5A/G/C and 6A/A/T haplotypes were significantly associated with isolated systolic hypertension (Permutation p=0.0258; Permutation p=0.000002). In addition, the brachial-ankle pulse wave velocity of different genotypes for the 5A/6A and C-1562T polymorphisms was significantly highest in 5A or T homozygotes (P<0.01), however, the flow-mediated dilatation and nitric oxide were markedly lowest in 5A or T homozygotes (P<0.01). Conclusion: MMP3 and MMP9 genes variant seem to contribute to the development of isolated systolic hypertension by affecting arterial stiffness and endothelial function.
artery stiffness; endothelial function; gene; isolated systolic hypertension; polymorphism.
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
Aging is often associated with increased systolic blood pressure and decreased diastolic blood pressure. Isolated systolic hypertension or an elevated systolic blood pressure without an elevated diastolic blood pressure is a known risk factor for incident heart failure in older adults. In the current study, we examined whether isolated diastolic hypotension, defined as a diastolic blood pressure <60 mm Hg and a systolic blood pressure ≥100 mm Hg, is associated with incident heart failure. Of the 5795 Medicare-eligible community-dwelling adults age ≥65 years in the Cardiovascular Health Study, 5521 were free of prevalent heart failure at baseline. After excluding 145 individuals with baseline systolic blood pressure <100 mm Hg, the final sample included 5376 participants, of whom 751 (14%) had isolated diastolic hypotension. Propensity scores for isolated diastolic hypotension were calculated for each of the 5376 participants and used to match 545 and 2348 participants with and without isolated diastolic hypotension, respectively who were balanced on 58 baseline characteristics. During over 12 years of median follow-up, centrally-adjudicated incident heart failure developed in 25% and 20% of matched participants with and without isolated diastolic hypotension respectively (hazard ratio associated with isolated diastolic hypotension, 1.33; 95% confidence interval, 1.10–1.61; p=0.004). Among the 5376 pre-match individuals, multivariable-adjusted hazard ratio for incident heart failure associated with isolated diastolic hypotension was 1.29 (95% confidence interval, 1.09–1.53; p=0.003). As in isolated systolic hypertension, among community-dwelling older adults without prevalent heart failure, isolated diastolic hypotension is also a significant independent risk factor for incident heart failure.
aging; blood pressure; diastolic; heart failure; pulse pressure
Blood pressure (BP) levels below the pre-hypertension category may be associated with the risk of developing hypertension. We estimated the incidence rates of hypertension in low-income Mexican population according to several subcategories of baseline BP within normal and pre-hypertension categories.
A total of 1572 nonhypertensive men (n=632) and non-pregnant women (n=940), aged 35 to 64 years at baseline, were followed for a median of 5.8 years. Hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg, diastolic blood pressure (DBP) ≥90 mm Hg, or self-reported physician diagnosis with anti-hypertensive medications.
During follow-up, 267 subjects developed hypertension, of whom 83 were men and 184 were women. Age-adjusted incidence rate was higher in women (37.1 per 1000 person-years) than in men (23.7 per 1000 person-years). There was a significant association between BP levels at baseline and hypertension incidence even within the normal category. For the upper levels of normal SBP (110-119 mm Hg), the HR (95%CI) was 2.43 (1.50-3.93) in women and 2.44 (1.05-5.69) in men, compared with SBP <110 mm Hg. For the upper levels of normal DBP (70-79 mm Hg), the HR (95%CI) was 2.33 (1.65-3.31) in women and 1.80 (0.92-3.52) in men, compared with DBP <70 mm Hg, after adjustment for recognized predictors.
High risk of hypertension incidence was associated with levels of BP even within the normal category. This information could help define a population at high risk of progression to hypertension, in order to establish preventive measures.
Blood pressure; Hypertension; Cardiovascular risk
To determine whether cardiac findings differ between blacks and whites with essential hypertension, members of a well-defined working population in New York City were examined. Hypertensives had diastolic blood pressure ≤95, or systolic blood pressure ≤160 mmHg, or both, sustained on three occasions over three weeks. Normotensives were selected to reflect the age, sex, and race distribution of the total working population. Of 207 employees, 75 hypertensives (40 percent blacks) and 132 normotensives (53 percent blacks) under-went M-mode echocardiography. Left ventricular (LV) measurements and simultaneous blood pressure by mercury manometer were used to calculate LV mass index (LVMI), relative wall thickness (RWTd), cardiac output (CO) and total peripheral resistance (TPR). There were no differences in any variable between black and white normotensives. Black and white hypertensives were similar in age (52 ± 10 and 54 ± 12 yr, respectively) and blood pressure (151/100 ± 15/11 and 153/99 ± 18/8 mmHg). Black hypertensives had significantly higher TPR (1.80 ± 0.74 vs 1.43 ± 0.46, P<.01), lower CO (6.0 ± 2.5 vs 7.2 ± 2.4 L/min, P<.01), and higher RWTd (0.43 ± 0.11 vs 0.37 ± 0.07, P<.05) than white hypertensives. Race, per se, cannot explain these differences since they did not occur among normotensives. Rather, these findings may reflect a differing patho-physiology of hypertension in blacks and whites with similar blood pressure elevation.
Parental histories were obtained for a cohort of black medical students in a longitudinal study of hypertension precursors. At follow-up, 25 to 30 years later, initial and current parental histories for hypertension were compared with other precursor characteristics as well as resulting cohort hypertension. The number of participants having no positive parental history for hypertension as parents aged declined from 55% to 24%. Hypertension among black physicians varied according to parental history: 38.9% for both parents negative, 41.4% for mother only positive, 60.5% for father only positive, and 73.7% for both parents positive. Parental history of hypertension was an independent predictor of subject hypertension. Positive parental history in combination with weight gain and high normal baseline systolic and diastolic blood pressure produced a gradient of risk corresponding to the number of risk factors present. Having all four risk factors increased the hypertension risk by 15 times. Parental history together with weight gain, blood pressure, and smoking provide a strong predictor of hypertension. Weight and blood pressure control, along with cessation of smoking, should be considered important factors in the clinical management of such patients.
We compared patterns of blood pressure (BP) change between normotensive women, women who developed gestational hypertension or preeclampsia and women who had essential hypertension to examine how distinct these conditions are and whether rates of BP change may help to identify women at risk of hypertensive disorders. We used antenatal clinic BP measurements (median 14 per woman) of 13,016 women from the Avon Longitudinal Study of Parents and Children (ALSPAC) who had a singleton or twin live birth surviving until at least 1 year. Linear spline models were used to describe changes in systolic and diastolic BP in different periods of pregnancy (8-18, 18-30, 30-36 and 36+ weeks gestation). Women who had essential hypertension, and those who developed gestational hypertension or preeclampsia had higher BP at 8 weeks gestation (baseline) compared with normotensive women. The decrease in BP until 18 weeks was smaller in gestational hypertensive compared with normotensive pregnancies. BP rose more rapidly from 18 weeks onwards in gestational hypertensive and preeclamptic pregnancies and from 30 weeks onwards in essential hypertensive compared with normotensive pregnancies. Women who developed preeclampsia had a more rapid increase in BP from 30 weeks onwards than those who developed gestational hypertension or had essential hypertension. Our findings indicate notable patterns of BP change that distinguish women with essential hypertension, gestational hypertension and preeclampsia from each other and from normotensive women, even from early pregnancy. These distinct patterns may be useful for identifying women at risk of developing a hypertensive disorder later in pregnancy.
blood pressure; preeclampsia; gestational hypertension; pregnancy; ALSPAC
To examine the association of early adulthood blood pressure with CVD mortality, while accounting for middle-age hypertension.
Elevated blood pressure in middle-age is an established CVD risk factor, but evidence for association with measurements earlier in life is sparse.
HAHS is a cohort study of 18,881 male university students who had blood pressure measured at university entry (1914 –1952; mean age 18.3 years) and who responded to a questionnaire mailed in 1962/1966 (mean age 45.8 years) in which physician-diagnosed hypertension status was reported. Study members were subsequently followed for mortality until the end of 1998.
Following adjustment for age, BMI, smoking and physical activity at college entry, compared to men who were normotensive according to JNC-7 criteria (<120/<80mmHg) there was an elevated risk of CHD mortality (1,917 deaths) in those who were pre-hypertensive (120–139/80–89 mmHg) (hazards ratio; 95% confidence intervals: 1.21; 1.07, 1.36), stage 1 (140–159/90–99 mmHg) (1.46; 1.25, 1.70), and stage 2 hypertensive (≥160/≥100 mmHg) (1.89; 1.46, 2.45), incremental across categories (ptrend<0.001). After additional account for middle-age hypertension, estimates were somewhat attenuated but the pattern remained. Similar associations were apparent for total and CVD but not stroke mortality.
Higher blood pressure in early adulthood was associated with elevated risk of mortality from all-causes, CVD and CHD, but not stroke several decades later. Effects largely persisted after taking account of mediation by middle-age hypertension. Thus, the long-term benefits of blood pressure lowering in early adulthood are promising but supporting trial data are required.
blood pressure; cardiovascular disease mortality; epidemiology; blood pressure; lifecourse