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American Journal of Kidney Diseases :... Jan 2016Whether blood pressure (BP) plays an independent predictive role in the onset of decreased glomerular filtration rate (GFR) remains ill-defined because existing... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Whether blood pressure (BP) plays an independent predictive role in the onset of decreased glomerular filtration rate (GFR) remains ill-defined because existing meta-analyses have incorporated data from studies that included individuals with low GFRs at baseline. This question is critical to optimize chronic kidney disease prevention in the general population.
STUDY DESIGN
Systematic review and meta-analysis of longitudinal cohort studies.
SETTING & POPULATION
Adults from general population.
SELECTION CRITERIA FOR STUDIES
We identified in PubMed, EMBASE, and the Cochrane Library database all cohort studies evaluating the role of BP in the incidence of decreased estimated GFR (eGFR; defined as eGFR<60 mL/min/1.73 m2) in individuals without decreased kidney function at baseline.
PREDICTORS
Hypertension (BP>140/90 mmHg), prehypertension (systolic BP of 120-139 and/or diastolic BP of 80-89 mmHg), and BP as a continuous variable.
OUTCOMES
Risk for decreased eGFR reported as relative risk (RR) and 95% CI. Heterogeneity (I2) was also evaluated.
RESULTS
Data from 16 cohorts (315,321 participants) were analyzed. All studies had a Newcastle-Ottawa score in the range of 6 to 8, denoting high quality. During a mean follow-up of 6.5 years, decreased eGFR occurred in 6.6% of participants. The presence of prehypertension and hypertension increased renal risk (RRs of 1.19 [95% CI, 1.07-1.33; I2=23.8%] and 1.76 [95% CI, 1.58-1.97; I2=37.7%], respectively). Similarly, we found that every 10-mm Hg increase in systolic and diastolic BPs associated with higher risk for decreased eGFR (RRs of 1.08 [95% CI, 1.04-1.11; I2=60.0%] and 1.12 [95% CI, 1.04-1.20; I2=51.4%], respectively). Metaregression analysis showed greater risk with older age (P=0.03), whereas other covariates were not significant.
LIMITATIONS
No individual patient-level data.
CONCLUSIONS
Prehypertension and hypertension, as BP levels, are independent predictors of decreased GFR in the general population, with the effect being more pronounced in the elderly. These findings are important for improving risk stratification in the general population.
Topics: Cohort Studies; Glomerular Filtration Rate; Humans; Hypertension; Prehypertension
PubMed: 26475392
DOI: 10.1053/j.ajkd.2015.08.027 -
Blood Pressure 2015Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized.
BACKGROUND
Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized.
METHODS
All individuals aged 30-45 years who were insured by Clalit Health services in the Tel Aviv district and had their blood pressure (BP) measured from January 2006 to December 2010 were evaluated. Individuals were divided into three groups based on their initial BP value: optimal (< 120/80 mmHg), normal (systolic BP 120-129 or diastolic 80-84 mmHg) and borderline (130-139/85-89 mmHg). Groups were compared regarding clinical and laboratory follow-up performed by their PCP.
RESULTS
Of the 20,214 individuals included in the study, 6576 (32.5%) had values in the pHT range. Of these, 2126 (32.3% of those with pHT) had BP values defined as "borderline" and 4450 (67.6% of those with pHT) had BP values defined as "normal". The number of follow-up visits by the PCP and repeat BP measurement were similar in those with "optimal" BP and pHT. A third and fourth BP measurement were recorded more frequently in those with pHT. In those with pHT, there were more recorded BP measurements than in those with borderline BP (3.35 ± 3 vs. 3.23 ± 2.6), but the time from the initial to the second measurement and a record of a third and fourth measurement were the same in the two groups.
CONCLUSION
Identification of pHT does not lead to a significant change in follow-up by PCPs, irrespective of BP values in the pHT range.
Topics: Adult; Blood Pressure; Blood Pressure Determination; Cohort Studies; Female; Humans; Male; Middle Aged; Prehypertension; Primary Health Care
PubMed: 25875919
DOI: 10.3109/08037051.2015.1032515 -
Current Hypertension Reports Jan 2014African Americans have a higher burden of hypertension, more severe blood pressure (BP) elevations, more concurrent risk-enhancing co-morbidities (e.g., diabetes),... (Review)
Review
African Americans have a higher burden of hypertension, more severe blood pressure (BP) elevations, more concurrent risk-enhancing co-morbidities (e.g., diabetes), sub-clinical vascular injury at lower non-hypertensive BP levels, lower BP control rates, and significantly greater risk for adverse pressure-related clinical complications (e.g., stroke, heart failure) than whites. Randomized prospective data from hypertension endpoint trials show a virtually identical percentage reduction in CVD risk for a given magnitude of BP lowering, irrespective of the presence or absence of pre-treatment CVD across a broad range of BP down to pre-treatment BP levels of 110/70 mm Hg. These data, mostly emanating from white populations, do not necessarily inform practitioners as to the level below which BP should be lowered in those with established, long-standing hypertension; however, these data do provide support for initiating hypertension treatment at lower than conventional BP thresholds. A Mendelian randomized study examining the impact of life-long lower SBP levels showed that lifelong exposure to 10 mm Hg lower SBP was associated with an 82 % lesser rate of SBP rise per decade and a 58 % lower CHD risk that was much greater than the 22 % reduction in CHD reported for the same magnitude of SBP reduction in clinical trials. Arguably, it is the hypertension treatment paradigm that merits reexamination. Earlier hypertension treatment in all populations prior to the onset of significant pressure-related target organ injury might conceivably prevent, or at least significantly attenuate, the well documented age-related rise in BP seen in most Western societies. In addition, this treatment paradigm might also reduce the significant residual CVD risk observed under the current recommended approach to hypertension treatment. This new approach to therapy would likely have substantial clinical and public health benefits in the high-risk, under-treated African American population that suffers outsized devastating consequences from inadequate control of BP.
Topics: Antihypertensive Agents; Black People; Cardiovascular Diseases; Clinical Trials as Topic; Diabetes Mellitus; Humans; Hypertension; Prehypertension; Renal Insufficiency, Chronic; United States
PubMed: 24370966
DOI: 10.1007/s11906-013-0409-5 -
High Blood Pressure & Cardiovascular... Aug 2019Treatment strategies for patients with pre-hypertension and low-moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs). (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCION
Treatment strategies for patients with pre-hypertension and low-moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs).
AIM
To investigate the efficacy and safety of a new-generation of NC in lowering BP values and improving metabolic profile, in a group of hyper-cholesterolemic subjects with pre-hypertension.
METHODS
131 subjects with pre-hypertension (systolic BP 130-139 mmHg and/or diastolic BP 85-89 mmHg) without organ damage and history of CV diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NC (red yeast rice, Berberine, Coenzyme Q10, folic acid and chrome) added to diet for 3 months, while 65 patients followed a diet only. Differences in serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG), glycemia, creatine phosphokinase (CPK), aspartate aminotransferase (AST) alanine aminotransferase (ALT) and body mass index (BMI) were evaluated.
RESULTS
At the end of treatment, significant reductions of TC, LDLC, TG glucose levels were observed in both treatment groups, while HDLC values increased in the active treatment group only. A greater reduction of TC, LDLC and glycemia was observed in the treatment group. TG levels were not different within the two groups. BP and BMI levels remained unchanged, as well AST, ALT; CPK slightly increased in both groups, but it remained in the normal range.
CONCLUSIONS
In patients with pre-hypertension, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose levels and in preventing the progression to overt hypertension.
Topics: Aged; Antihypertensive Agents; Biomarkers; Blood Glucose; Blood Pressure; Dietary Supplements; Disease Progression; Female; Humans; Hypercholesterolemia; Hypoglycemic Agents; Hypolipidemic Agents; Italy; Lipids; Male; Middle Aged; Prehypertension; Prospective Studies; Time Factors; Treatment Outcome
PubMed: 31352663
DOI: 10.1007/s40292-019-00332-6 -
Bulletin of Experimental Biology and... Mar 2015We studied concentrations of angiotensin II, HLDF24 peptide, endothelin proteins, S100B, and autoantibodies to them and serum levels of blood natriuretic peptide in...
We studied concentrations of angiotensin II, HLDF24 peptide, endothelin proteins, S100B, and autoantibodies to them and serum levels of blood natriuretic peptide in patients with different categories of "normal" arterial BP and hypertension. The relationship between blood levels of the above factors and normotony, pre-hypertension, and hypertension in the examined groups was analyzed. The results suggest that the studied molecular factors can serve as potential predictors of arterial hypertension and used for personalized hypertension risk assessment.
Topics: Adult; Angiotensin II; Biomarkers; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged; Prehypertension; S100 Calcium Binding Protein beta Subunit
PubMed: 25778642
DOI: 10.1007/s10517-015-2816-x -
Current Hypertension Reviews 2016Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main... (Review)
Review
INTRODUCTION
Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension.
RESULTS AND DISCUSSION
The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events.
CONCLUSION
The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.
Topics: Brazil; Cardiovascular Diseases; Endothelium, Vascular; Humans; Prehypertension; Risk Factors; Vasoconstriction; Vasodilation
PubMed: 26264814
DOI: 10.2174/1573402111666150812143827 -
Trials Oct 2012Hypertension is a risk factor for cardiovascular disease, and the prevalence of hypertension tends to increase with age. Current treatments for hypertension have adverse... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hypertension is a risk factor for cardiovascular disease, and the prevalence of hypertension tends to increase with age. Current treatments for hypertension have adverse side effects and poor adherence. The purpose of this study is to evaluate the effects of moxibustion on blood pressure in individuals with pre- or stage I hypertension.
METHODS/DESIGN
Forty-five subjects with pre- or stage I hypertension will be randomized into three groups: treatment group A (2 times/week), treatment group B (3 times/week), and the control group (non-treated group). The inclusion criteria will be as follows: (1) aged between 19 and 65 years; (2) prehypertension or stage I hypertension (JNC 7, Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure); (3) the participants are volunteers and written consent obtained.The participants in the treatment group A will undergo indirect moxibustion 2 times per week for 4 weeks, and the participants in the treatment group B will undergo indirect moxibustion 3 times per week for 4 weeks. The participants in the control group (non-treated group) will maintain their current lifestyle, including diet and exercise. The use of antihypertensive medication is not permitted. The primary endpoint will be a change in patient blood pressure. The secondary endpoints will be the body mass index, lipid profile, EuroQol and Heart Rate Variability. The data will be analyzed with the Student's t-test and analysis of variance (ANOVA) (p < 0.05).
DISCUSSION
The results of this study will help to establish the optimal approach for the care of adults with pre- or stage I hypertension.
TRIAL REGISTRATION
Clinical Research Information Service KCT0000469.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Moxibustion; Pilot Projects; Prehypertension; Republic of Korea; Research Design; Surveys and Questionnaires
PubMed: 23043965
DOI: 10.1186/1745-6215-13-188 -
PloS One 2021Hypertension is a global public health challenge. There is a lack of evidence on the prevalence of hypertension, prehypertension, and related factors among adult...
INTRODUCTION
Hypertension is a global public health challenge. There is a lack of evidence on the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia.
AIM
To assess the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia.
METHODS
A community-based cross-sectional study was conducted on 2483 adult residents, selected using a two-stage random sampling technique. The quantitative data collected from structured questionnaires; anthropometric and biochemical measurements were entered into EpiData version 3.1 using double-entry systems. We determined the weighted prevalence of hypertension and pre-hypertension for the two-stage survey. The multivariate logistic regression analysis was used to assess factors associated with hypertension and carried out after declaring the data set as survey data to account for the effect of clustering. An adjusted coefficient with 95% CI was used to ascertain the significance of the association.
RESULTS
The weighted prevalence of hypertension and prehypertension in the Wolaita area was 31.3% (27.7%-35.1%) and 46.4% (42.9%-50.0%) respectively. The weighted prevalence of hypertension of those who were not aware of their hypertension until the time of the survey was 29.8%% (26.5%-33.3%). Where the weighted prevalence of self-reported cases of hypertension was 2.2% (1.2%-3.8%). Obesity, sugar-sweetened food consumption, male sex, elevated total cholesterol, raised fasting blood sugar, and advancing age were positively associated with hypertension.
CONCLUSION
The prevalence of hypertension among adults in Wolaita was high. A small proportion of the affected people are aware of their high blood pressure. This study reported a high prevalence of pre-hypertension; which indicates a high percentage of people at risk of hypertension. It is essential to develop periodic screening programs, and primary intervention strategies such as the prevention of obesity, and reduction of sugar-sweetened food consumption.
Topics: Adult; Age Factors; Blood Glucose; Blood Pressure; Body Mass Index; Cholesterol; Cross-Sectional Studies; Ethiopia; Feeding Behavior; Female; Humans; Hypertension; Logistic Models; Male; Middle Aged; Prehypertension; Prevalence; Risk Factors
PubMed: 34910760
DOI: 10.1371/journal.pone.0260403 -
Medicine Oct 2020Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin - a significant prognostic factor of IgAN. In children, similar to...
Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin - a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets.This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed.Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004).HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression.
Topics: Adolescent; Age Factors; Antihypertensive Agents; Biomarkers; Child; Creatinine; Disease Progression; Female; Fibrinolytic Agents; Glomerular Filtration Rate; Glomerulonephritis, IGA; Glomerulosclerosis, Focal Segmental; Humans; Hypertension; Immunosuppressive Agents; Male; Prehypertension; Prognosis; Prothrombin Time; Retrospective Studies; Risk Factors
PubMed: 33019406
DOI: 10.1097/MD.0000000000022310 -
Annales de Cardiologie Et D'angeiologie Jun 2018There are insufficient researches aimed at evaluating biochemical markers of mechanisms of formation of AH and lesion of target organs in hypertension and...
OBJECTIVE
There are insufficient researches aimed at evaluating biochemical markers of mechanisms of formation of AH and lesion of target organs in hypertension and prehypertension. The aim of that research was to study the level of endothelial dysfunction markers and damage to the cardiovascular system in hypertension and prehypertension.
PATIENTS AND METHODS
A cross-sectional study was performed among 938 people aged 18 to 65 years. All respondents were surveyed, blood pressure measured, for glucose, cholesterol, interleukin-6, sFAS, LIGHT, hFABP, NT-ProBNP and an Endocan concentrations were tested. Depending on the level of blood pressure participants were splitted into groups with normotension, prehypertension and hypertension.
RESULTS
Comparing the markers of inflammation, apoptosis and target organ damage in the prehypertensive group, the level of the LIGHT protein was Me=265.2pg/ml (Q-Q: 197.7-444.3), in the control group - Me=251.1pg/ml (Q-Q: 176.6-376.6), the Endocan level was Me=660.6pg/ml (Q-Q: 419.6-867.4) and in the control group Me=587.5pg/ml (Q-Q: 401.9-838.1). In the AH group, the level of the LIGHT Me=273.1pg/ml (Q-Q: 195.1-455.2), Endocan Me=668.2pg/ml (Q-Q: 434.8-977.3), heart-type fatty-acid-binding protein Me=2233.1pg/ml (Q-Q: 1518.4-3391.1) exceeded the control group.
CONCLUSION
Thus, the development of prehypertension and hypertension is characterized by an increase in the activity of biochemical markers of endothelial dysfunction and damage to target organs, more expressed in the presence of hypertension.
Topics: Adolescent; Adult; Aged; Biomarkers; Cross-Sectional Studies; Female; Humans; Hypertension; Male; Middle Aged; Prehypertension; Young Adult
PubMed: 29786510
DOI: 10.1016/j.ancard.2018.04.023