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Journal of the American Heart... Oct 2020Background The Life's Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure,...
Background The Life's Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure, cholesterol, glucose) to estimate an individual's level of cardiovascular health. The association between cardiovascular health and incident hypertension is unresolved. Hypertension's threshold was recently lowered and it is unclear if better cardiovascular health is associated with lower risk of incident hypertension with the updated threshold or in a multirace cohort. We sought to assess the association between better LS7 score and risk of incident hypertension among Black and White adults using a 130/80 mm Hg hypertension threshold. Methods and Results We determined the association between LS7 metric and incident hypertension in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) study, including participants free of baseline hypertension (2003-2007) who completed a second visit between 2013 and 2016. Hypertension was defined as systolic/diastolic blood pressure ≥130/80 mm Hg or antihypertensive medication use. Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points. We generated a 14-point score by summing points. Among 2930 normotensive participants (20% Black, 80% White), the median (25th-75th percentiles) LS7 total score was 9 (8-10) points. Over a median follow-up of 9 years, 42% developed hypertension. In the fully adjusted model, each 1-point higher LS7 score had a 6% lower risk of incident hypertension (risk ratio, 0.94 per 1 point; 95% CI, 0.92-0.96). Conclusions Better cardiovascular health was associated with lower risk of incident hypertension using a 130/80 mm Hg hypertension threshold among Black and White adults.
Topics: Black or African American; Cardiovascular Diseases; Female; Health Behavior; Humans; Hypertension; Incidence; Male; Middle Aged; Prevalence; Risk Factors; Risk Reduction Behavior; United States; White People
PubMed: 32928039
DOI: 10.1161/JAHA.120.016482 -
European Heart Journal. Cardiovascular... Sep 2023To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations.
AIMS
To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations.
METHODS AND RESULTS
We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health record linkage. Associations between hypertension and CMR metrics were estimated using multivariable linear regression adjusting for major vascular risk factors. Stratified analyses were performed by sex, ethnicity, time since hypertension diagnosis, and blood pressure (BP) control. Results are standardized beta coefficients, 95% confidence intervals, and P-values corrected for multiple testing. Hypertension was associated with concentric left ventricular (LV) hypertrophy (increased LV mass, wall thickness, concentricity index), poorer LV function (lower global function index, worse global longitudinal strain), larger left atrial (LA) volumes, lower LA ejection fraction, and lower aortic distensibility. Hypertension was linked to significantly lower myocardial native T1 and increased LV ejection fraction. Women had greater hypertension-related reduction in aortic compliance than men. The degree of hypertension-related LV hypertrophy was greatest in Black ethnicities. Increasing time since diagnosis of hypertension was linked to adverse remodelling. Hypertension-related remodelling was substantially attenuated in hypertensives with good BP control.
CONCLUSION
Hypertension was associated with concentric LV hypertrophy, reduced LV function, dilated poorer functioning LA, and reduced aortic compliance. Whilst the overall pattern of remodelling was consistent across populations, women had greater hypertension-related reduction in aortic compliance and Black ethnicities showed the greatest LV mass increase. Importantly, adverse cardiovascular remodelling was markedly attenuated in hypertensives with good BP control.
Topics: Male; Humans; Female; Middle Aged; Aged; Biological Specimen Banks; Hypertension; Hypertrophy, Left Ventricular; Ventricular Function, Left; Heart Atria; Phenotype; United Kingdom
PubMed: 37309807
DOI: 10.1093/ehjci/jead123 -
Hypertension Research : Official... Jun 1996In this article, some of our findings of epidemiologic and clinical studies on the actual state of insulin resistance in hypertension occurring in Japanese were... (Review)
Review
In this article, some of our findings of epidemiologic and clinical studies on the actual state of insulin resistance in hypertension occurring in Japanese were described. In epidemiologic studies, a high prevalence of concomitant hypertension and impaired glucose tolerance was observed, and a significant positive correlation was found between blood pressure and blood glucose levels, even at a low degree, in two towns, the agricultural districts of Hokkaido. In clinical studies, insulin sensitivity, which was measured as M-values by the euglycemic hyperinsulinemic glucose clamp method, was significantly lower in essential hypertensives than in normotensive subjects. Moreover, this suppression of insulin sensitivity was also observed in young normotensive subjects with an apparent family history of hypertension, preceding the manifestation of hypertension. At the same time, obesity and aging were definitely correlated to the decrease in insulin sensitivity. On the assumed criterion that the normal range of M-values is mean +/- 1 SD of non-obese, non-diabetic young normotensive subjects, the prevalence of individuals with lowered M-value, which means existence of insulin resistance, was calculated as 45.4% in essential hypertensives and as 16.3% in normotensive subjects in this study. Increases in plasma norepinephrine levels and plasma renin activity, and decreases in urinary excretion of sodium and fractional excretion of sodium were observed during hyperinsulinemia produced by glucose clamp test. These responses to hyperinsulinemia were not different from those in normotensive subjects and, therefore, not specific to essential hypertensives. From these results, it was concluded that insulin resistance definitely exists among Japanese essential hypertensives, and that it plays an important role in the pathophysiology of essential hypertension.
Topics: Humans; Hypertension; Insulin Resistance; Japan; Prevalence
PubMed: 9240755
DOI: 10.1291/hypres.19.supplementi_s1 -
EuroIntervention : Journal of EuroPCR... May 2013In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of... (Review)
Review
In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.
Topics: Arterial Pressure; Humans; Hypertension; Predictive Value of Tests; Prevalence; Prognosis; Risk Factors
PubMed: 23732151
DOI: 10.4244/EIJV9SRA5 -
BMC Public Health Apr 2021Heavy occupational lifting is prevalent in the general working population and is sparsely reported to associate with hypertension, especially among older and...
BACKGROUND
Heavy occupational lifting is prevalent in the general working population and is sparsely reported to associate with hypertension, especially among older and hypertensive workers. We investigated if heavy occupational lifting is associated with hypertension and blood pressure (BP) in both cross-sectional and prospective study designs in the Copenhagen General Population Study, stratified by age, and use of anti-hypertensives.
METHODS
Participation was conducted following the declaration of Helsinki and approved by the ethical committee (H-KF-01-144/01). By multivariable logistic and linear regression models, we investigated the association between heavy occupational lifting and hypertension, in a cross-sectional design (n = 67,363), using anti-hypertensives or BP ≥140/≥90 mmHg as outcome, and in a prospective design (n = 7020) with an above-median change in systolic BP (SBP) from baseline to follow-up and/or a shift from no use to use of anti-hypertensives as outcome, with and without stratification by age and use of anti-hypertensives.
RESULTS
The odds ratio for hypertension was estimated at 0.97 (99% CI: 0.93-1.00) in the cross-sectional analysis, and at 1.08 (99% CI: 0.98-1.19) in the prospective analysis. The difference in SBP among workers with versus without heavy occupational lifting was estimated at - 0.29 mmHg (99% CI -0.82 - 0.25) in the cross-sectional and at 1.02 mmHg (99% CI -0.41 - 2.45) in the prospective analysis. No significant interaction between heavy occupational lifting and age, nor use of anti-hypertensives were shown.
CONCLUSIONS
Only the prospective analysis indicated heavy occupational lifting to increase the risk of hypertension. Further research on the association between occupational lifting and hypertension are needed.
Topics: Antihypertensive Agents; Blood Pressure; Cross-Sectional Studies; Humans; Hypertension; Lifting; Prospective Studies; Risk Factors
PubMed: 33853574
DOI: 10.1186/s12889-021-10651-w -
Journal of the American Board of Family... 2020Examining the anti-hypertensive regimens of individuals with different comorbidities may offer insights into how we can improve hypertension management.
BACKGROUND
Examining the anti-hypertensive regimens of individuals with different comorbidities may offer insights into how we can improve hypertension management.
METHODS
The Medical Expenditure Panel Survey (2013-2015) was used to describe the most common single-, two-, three-, and four-drug hypertension regimens among hypertensive adults in four different comorbidity groups: 1. Hypertension only; 2. Hypertension and diabetes; 3. Hypertension and cardiovascular disease (coronary heart disease or stroke history); and 4. Hypertension, diabetes, and cardiovascular disease.
RESULTS
15,901 adults with hypertension taking anti-hypertensive medications were included in the study. 58.6% (95% CI: 57.3-59.8) took multiple anti-hypertensive medications, but the proportion of adults taking multiple anti-hypertensives varied by comorbidity group. Regimens including an ACE-inhibitor/ARB were the most prevalent regimens among individuals taking ≥2 anti-hypertensive medications. The most common two-drug regimen for both the hypertension-only and hypertension-diabetes groups was an ACE-inhibitor/ARB with thiazide. The most prevalent regimen for the two cardiovascular disease groups was an ACE-inhibitor/ARB with beta-blocker.
CONCLUSIONS
Most individuals with hypertension use between 2-5 medications and the medications comprising these regimens vary by comorbidity. The ACCOMPLISH trial suggested that certain combinations may lead to superior cardiovascular outcomes. Research comparing the efficacy of different hypertension medication combinations among individuals with different comorbidities could lead to better patient hypertensionrelated outcomes.
Topics: Adult; Antihypertensive Agents; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Drug Therapy, Combination; Female; Humans; Hypertension; Male; United States
PubMed: 31907256
DOI: 10.3122/jabfm.2020.01.190134 -
American Journal of Hypertension Apr 2024Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk.
BACKGROUND
Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk.
METHODS
All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension.
RESULTS
Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled.
CONCLUSIONS
Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
Topics: Humans; Antihypertensive Agents; Hypertension; Blood Pressure; Medication Adherence; Vasoconstrictor Agents
PubMed: 38124494
DOI: 10.1093/ajh/hpad118 -
Medicine Nov 2020To audit the young patients referred to the Hypertension Clinic at Groote Schuur Hospital that predominately serves the underprivileged communities of Cape Town.Folders...
To audit the young patients referred to the Hypertension Clinic at Groote Schuur Hospital that predominately serves the underprivileged communities of Cape Town.Folders of patients between the ages of 15 and 30 years over a 2 year period were reviewed. The data collected included demographic, clinical and laboratory data, investigations, causes of hypertension, and presence of hypertensive organ damage.Of the 110 patients reviewed, 61 (55.5%) were females, 22 (20%) Black African, and 88 (80%) of Mixed Ancestry. Eight (7.3%) were found to be normotensive, 16 (14.5%) had a secondary cause and 86 (78.2%) had essential hypertension. Thirty five (31.8%) were current or previous smokers, and 11 (10%) admitted to current or prior use of metamphetamines. A family history of hypertension in a first degree relative was present in 80 (72.7%) patients. Comorbidities present were diabetes in 7 (6.4%) patients, metabolic syndrome in 13 (11.8%), and obesity in 26 (23.6%), but 42.6% had a body mass index (BMI) <25 kg/m. Chronic kidney disease (CKD) was present in 29 (26.4%) patients and ECG left ventricular hypertrophy in 56 (50.9%). Overall organ damage was present in 72 (65.5%) patients.In this cohort of young hypertensives most patients had essential hypertension with a strong family history. Significant organ damage was identified. High risk behavior, including smoking and illicit drug use, and obesity were identified as contributing factors. Secondary causes were identified in 14.2%. These results suggest a targeted approach to the investigation of young hypertensives for secondary causes, and significant opportunities for lifestyle intervention.
Topics: Adolescent; Adult; Ambulatory Care Facilities; Commission on Professional and Hospital Activities; Comorbidity; Diabetes Mellitus; Essential Hypertension; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Metabolic Syndrome; Obesity; Prevalence; Renal Insufficiency, Chronic; Risk Reduction Behavior; South Africa; Young Adult
PubMed: 33235075
DOI: 10.1097/MD.0000000000023137 -
Cardiovascular Ultrasound Aug 2011Various diagnostic methods have been used to evaluate hypertensive patients under physical and pharmacological stress. Several studies have shown that exercise... (Review)
Review
Various diagnostic methods have been used to evaluate hypertensive patients under physical and pharmacological stress. Several studies have shown that exercise hypertension has an independent, adverse impact on outcome; however, other prognostic studies have shown that exercise hypertension is a favorable prognostic indicator and associated with good outcome. Exercise hypertension may be encountered as a warning signal of hypertension at rest and future hypertensive left ventricular hypertrophy. The results of diagnostic stress tests support that hypertensive response to exercise is frequently associated with high rate-pressure product in hypertensives. In addition to the observations on high rate-pressure product and enhanced ventricular contractility in patients with hypertension, evaluation of myocardial contractility by Doppler tissue imaging has shown hyperdynamic myocardial function under pharmacological stress. These recent quantitative data in hypertensives suggest that hyperdynamic myocardial function and high rate-pressure product response to stress may be related to exaggerated hypertension, which may have more importance than that it has been already given in clinical practice.
Topics: Cardiotonic Agents; Dobutamine; Echocardiography; Exercise; Exercise Test; Humans; Hypertension; Stress, Physiological
PubMed: 21846346
DOI: 10.1186/1476-7120-9-22 -
Brain and Behavior May 2022Hypertension is a well-established risk factor for cognitive impairment, brain atrophy, and dementia. However, the relationship of other types of hypertensions, such as...
BACKGROUND
Hypertension is a well-established risk factor for cognitive impairment, brain atrophy, and dementia. However, the relationship of other types of hypertensions, such as isolated hypertension on brain health and its comparison to systolic-diastolic hypertension (where systolic and diastolic measures are high), is still relatively unknown. Due to its increased prevalence, it is important to investigate the impact of isolated hypertension to help understand its potential impact on cognitive decline and future dementia risk. In this study, we compared a variety of global brain measures between participants with isolated hypertension to those with normal blood pressure (BP) or systolic-diastolic hypertension using the largest cohort of healthy individuals.
METHODS
Using the UK Biobank cohort, we carried out a cross-sectional study using 29,775 participants (mean age 63 years, 53% female) with BP measurements and brain magnetic resonance imaging (MRI) data. We used linear regression models adjusted for multiple confounders to compare a variety of global, subcortical, and white matter brain measures. We compared participants with either isolated systolic or diastolic hypertension with normotensives and then with participants with systolic-diastolic hypertension.
RESULTS
The results showed that participants with isolated systolic or diastolic hypertension taking BP medications had smaller gray matter but larger white matter microstructures and macrostructures compared to normotensives. Isolated systolic hypertensives had larger total gray matter and smaller white matter traits when comparing these regions with participants with systolic-diastolic hypertension.
CONCLUSIONS
These results provide support to investigate possible preventative strategies that target isolated hypertension as well as systolic-diastolic hypertension to maintain brain health and/or reduce dementia risk earlier in life particularly in white matter regions.
Topics: Biological Specimen Banks; Blood Pressure; Brain; Cross-Sectional Studies; Dementia; Female; Humans; Hypertension; Magnetic Resonance Imaging; Male; Middle Aged; United Kingdom
PubMed: 35362209
DOI: 10.1002/brb3.2525