Abstract 073: Blood Pressure Trajectories Among Young Veterans: Differences By Sex, Race, And Ethnicity

High blood pressure (BP) is a strong modifiable risk factor for cardiovascular disease (CVD). Longitudinal BP patterns themselves may reflect the burden of risk and vascular damage due to prolonged cumulative exposure to high BP levels. Current studies have begun to characterize BP patterns as a trajectory over an individual's lifetime. These BP trajectories take into account the absolute BP levels as well as the slope of BP changes throughout the lifetime thus incorporating longitudinal BP patterns into a single metric. Methodologic issues that need to be considered when examining BP trajectories include individual-level vs. population-level group-based modeling, use of distinct but complementary BP metrics (systolic, diastolic, mean arterial, mid, and pulse pressure), and potential for measurement errors related to varied settings, devices, and number of readings utilized. There appear to be very specific developmental periods during which divergent BP trajectories may emerge, specifically adolescence, the pregnancy period, and older adulthood. Lifetime BP trajectories are impacted by both individual-level and community-level factors and have been associated with incident hypertension, multimorbidity (CVD, renal disease, cognitive impairment), and overall life expectancy. Key unanswered questions remain around the additive predictive value of BP trajectories, intergenerational contributions to BP patterns (in utero BP exposure), and potential genetic drivers of BP patterns. The next phase in understanding BP trajectories needs to focus on how best to incorporate this knowledge into clinical care to reduce the burden of hypertensive-related outcomes and improve health equity.

A Chromosome 11q Quantitative-Trait Locus Influences Change of Blood-Pressure Measurements over Time in Mexican Americans of the San Antonio Family Heart Study

Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time?

How traditional cardiovascular disease (CVD) risk factors are related to long-term blood pressure change (BPC) or trajectories remain unclear. We aimed to examine the independent associations of these factors with 15-year BPC and trajectories in Chinese adults. We included 15 985 participants who had attended three surveys, including 2004-2008 baseline survey, and 2013-2014 and 2020-2021 resurveys, over 15 years in the China Kadoorie Biobank (CKB). We measured systolic and diastolic blood pressure (SBP and DBP), height, weight, and waist circumference (WC). We asked about the sociodemographic characteristics and lifestyle factors, including smoking, alcohol drinking, intake of fresh vegetables, fruits, and red meat, and physical activity, using a structured questionnaire. We calculated standard deviation (SD), cumulative blood pressure (cumBP), coefficient of variation (CV), and average real variability (ARV) as long-term BPC proxies. We identified blood pressure trajectories using the latent class growth model. Most baseline sociodemographic and lifestyle characteristics were associated with cumBP. After adjusting for other characteristics, the cumSBP (mmHg × year) increased by 116.9 [95% confidence interval (CI): 111.0, 122.7] for every 10 years of age. The differences of cumSBP in heavy drinkers of ≥60 g pure alcohol per day and former drinkers were 86.7 (60.7, 112.6) and 48.9 (23.1, 74.8) compared with less than weekly drinkers. The cumSBP in participants who ate red meat less than weekly was 29.4 (12.0, 46.8) higher than those who ate red meat daily. The corresponding differences of cumSBP were 127.8 (120.7, 134.9) and 70.2 (65.0, 75.3) for BMI per 5 kg/m 2 and WC per 10 cm. Most of the findings of other BPC measures by baseline characteristics were similar to the cumBP, but the differences between groups were somewhat weaker. Alcohol drinking was associated with several high-risk trajectories of SBP and DBP. Both BMI and WC were independently associated with all high-risk blood pressure trajectories. Several traditional CVD risk factors were associated with unfavorable long-term BPC or blood pressure trajectories in Chinese adults.

Blood Pressure Trajectories Through the Menopause Transition: Different Paths, Same Journey.

To examine whether blood pressure (BP) accelerates more rapidly during the menopause transition for women with a history of preterm or term small for gestational age (SGA) delivery compared to women with all term and appropriate for gestational age (AGA) births. A longitudinal analysis was conducted with 1,008 parous women who had BP data at ≥2 study visits. We used generalized linear modeling to examine BP before the final menstrual period, at the final mentrual period, and up to 10 years after the final menstrual period, according to pregnancy group. We assessed maternal changes in BP over time in relation to years near the final menstrual period using a piece-wise linear model, consistent with menopause-induced changes. Models were adjusted for socio-demographics, body mass index, smoking, physical activity, medications, parity, age at first birth, gestational diabetes, and gestational hypertension/preeclampsia. At baseline, women were on average 46 years old, 101 (10%) reported a prior preterm birth, and 102 (10.1%) reported a term SGA birth. Compared to women with all term AGA births, women with a term SGA birth had higher BP before the final menstrual period, at the final menstrual period, and up to 10 years after the final menstrual period; women with a preterm birth had higher BP in the postmenopausal years. Annual rate of change in BP during the menopause transition did not differ between pregnancy groups. Women with a history preterm and term SGA delivery have higher BP than women with all term AGA births during the menopause transition, but rate of change in BP does not differ in these groups relative to final menstrual period.

To describe circadian blood pressure (BP) patterns and linear interdialytic changes, a model was developed to describe simultaneously both the straight line change and oscillatory variation in BP and heart rate over an interdialytic interval in hemodialysis patients. Using this trended cosinor model, we simultaneously compared the impact of mean level of BP, linear changes over the interdialytic interval, and oscillatory changes in BP and its relationship with antihypertensive drug use. Neither a straight-line change model nor the cosinor model adequately described the BP variability in 12,750 BP measurements from 136 chronic stable hemodialysis patients. A combination of the 2 models that allowed for the oscillatory rhythmic pattern in BP variation to have an upward trend in the interdialytic period most accurately described the data. Time elapsed since the end of dialysis demonstrated a better model fit compared with the less meaningful clock time. More antihypertensive medication use was associated with increasing mean systolic, diastolic, and pulse pressure. Although the rate of change was blunted with increasing antihypertensive drug use, the impact on oscillatory change was U-shaped for systolic BP, direct for diastolic BP, and inverse for pulse pressure. A trended cosinor model better describes the change in BP in the interdialytic interval in hemodialysis patients, especially when time elapsed is measured from the end of dialysis. Antihypertensive drugs, though associated with higher average BP, are associated with blunted rate of change in BP over time.

Blood pressure (BP) and growth increase at an accelerated rate during puberty. The temporal relationship of the two events has not been well characterized. The purpose of this current investigation was to examine the rate of BP change in relation to pubertal growth with the intent to shed light on new mechanisms by which BP is regulated. We examined data from a cohort of 182 normotensive children who had measurements made semiannually for up to 12 yr. From the recorded heights, we identified the subject-specific pubertal growth spurt (PGS) using a growth curve model. With the estimated PGS as an anchoring point, we obtained the rates at which BP and weight changed as continuous functions of time for the duration of pubertal growth. Examining BP on a scale relative to PGS placed BP development in the context of pubertal growth. Average ages at PGS were 11.5 for girls and 13.3 for boys. Fitted spline models estimated that at the time of PGS, the mean systolic BP was 100 mm Hg for girls and 107 mm Hg for boys; the mean diastolic BP at the PGS was 59 mm Hg for girls and 61 mm Hg for boys. The most intriguing observation was that rate of change in systolic BP and weight peaked at precisely the estimated PGS. The time synchronization of rates of change in BP, weight, and height suggests common regulating mechanisms for somatic growth and BP or growth changes that secondarily affect BP.

BackgroundHypertension (HTN) is a major contributor to chronic kidney disease (CKD), a leading cause of global morbidity and mortality. In low-resource settings such as Ethiopia, where CKD risk factors remain understudied, identifying predictors and longitudinal blood pressure (BP) patterns associated with CKD incidence is crucial for early intervention. Therefore, this study aimed to determine the incidence and predictors of CKD, as well as its association with longitudinal BP changes, among hypertensive patients in Ethiopia.MethodsAn institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Referral Hospital. Using a Bayesian joint modeling approach, we integrated Cox proportional hazard and linear mixed effects models to evaluate the effects of time-dependent BP trajectories on CKD risk. The data were entered into the Kobo toolbox and analyzed with R software (version 4.3.1).ResultsA total of 408 hypertensive patients were followed for 2322.83 person-years. At the end of the follow-up, 58/408 (14.22%) developed CKD, with an incidence density of 2.5 cases per 100 person‐years (95% CI: 1.89–3.14). Both the current values and longitudinal the quarterly rate of change in BP were significantly associated with increased CKD risk. For systolic BP, the adjusted hazard ratio (AHR) was 6.25 (95% CrI: 2.85–9.85) for the current values and 3.75 (95% CrI: 3.16–7.95) for the quarterly rate of change. Similarly, the diastolic BP had an AHR of 4.32 (95% CrI: 2.35–8.27) for the current values and 5.64 (95% CrI: 4.24–10.82) for the quarterly rate of change. Additionally, age ≥ 65 years (AHR = 4.62; 95% CrI: 1.83–12.21), HDL-C < 40 mg/dL (AHR = 3.32; 95% CrI: 1.73–7.86), diabetes mellitus (AHR = 3.08; 95% CrI: 2.01–9.54), and proteinuria positivity (AHR = 2.85; 95% CrI: 1.48–5.55) were significant predictors of the incidence of CKD. These findings highlight the importance of close BP monitoring in Ethiopian hypertension clinics.ConclusionThe incidence of CKD in this study was relatively high compared with that reported in previous similar studies conducted in Ethiopia. Our findings confirm that time-dependent systolic BP and diastolic BP trajectories are strongly associated with an increased risk of CKD. Additionally, age, low HDL-C levels (<40 mg/dl), the presence of diabetes mellitus, and proteinuria were identified as significant predictors of CKD. Therefore, effective CKD prevention among hypertensive patients in Ethiopia hinges on regularly checking both their current blood pressure levels and how those levels change over time. We also need to keep a close eye on older patients (65 + years), low HDL‐C, diabetes, and proteinuria to catch those at highest risk early and step in with care.

Our population is aging; in the United States today there are 35 million people 65 years of age or older. That number will double by the year 2030 (Figure 1). Although epidemiological studies have discovered that lipid levels, diabetes, sedentary lifestyle, and genetic factors are risk factors for coronary disease, hypertension, congestive heart failure, and stroke, the quintessential cardiovascular diseases within our society, advancing age unequivocally confers the major risk. The incidence and prevalence of these diseases increase steeply with advancing age (Figure 2). Not only does clinically overt cardiovascular disease increase dramatically with aging, but so do subclinical or occult diseases, such as silent coronary atherosclerosis. Figure 3 (top) shows that a substantial percentage of older, community-dwelling, otherwise healthy volunteers have evidence of inducible ischemia during combined thallium/ECG treadmill stress testing, and their prognosis is poor compared with their counterparts without subclinical coronary disease (Figure 3, bottom). Figure 1. The demographic imperative. Numbers of persons 65 years of age or older (light bars) and 85 years of age or older in the United States from 1900 through 2030. Data taken from the US Census Bureau data with projections for 2030. Figure 2. A, Prevalence of hypertension, defined as systolic blood pressure ≥140, diastolic blood pressure ≥90, or current use of medication for purposes of treating high blood pressure. Data are based on National Health and Nutrition Examination Survey III (1988–1991) (Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension . 1995;25:305–313). B, Incidence of atherothrombotic stroke (per 1000 subjects per year) by age in men (light bars) and women (dark bars) from the Framingham Heart Study. Data from Wolf PA. Lewis A. Conner lecture: contributions of epidemiology to the …

Dietary protein, blood pressure and mortality : the value of repeated measurements

Introduction: Blood pressure (BP) is known to rise during developmental stages from childhood to adulthood, and that those with higher BP trajectories are more likely to develop hypertension and CVD. Yet, there is a paucity of studies that have evaluated trajectories of BP change or the genetic factors involved in the BP changes from childhood to adulthood. Epidemiological and genetic epidemiological studies of longitudinal BP changes through the life-course may enable a better understanding of the pathogenesis of hypertension and may lead to the identification of loci associated with BP trajectories and CVD risk during this critical period. Methods: We leverage multiple self-identified Hispanic/Latino populations with longitudinal BP and genomic data across the lifecourse, in particular between adolescence and young adulthood. We present herein preliminary results from the Santiago longitudinal study (SLS) that enrolled infants of Hispanic ancestry and measured BP at late adolescence (average age of 16 years) and early adulthood (average age of 22 years) to identify genetic variants associated with trajectories of BP traits (systolic BP, diastolic BP, mean arterial pressure and pulse pressure). We conducted a complete case analysis excluding participants taking antihypertensive medications and those whose BP measures were statistical outliers. Linear mixed models were used to assess the trajectories of individual BP traits between late adolescence and early adulthood (n = 1236), adjusting for age, sex and BMI. We assessed the relationship between residuals and genetic variants adjusting for two ancestral principal components using SUGEN software. Results: Males constituted 51% of the total SLS cohort. Interestingly, with each year increase in age, we observed downward trajectories of both mean systolic BP (-0.3 mmHg, 95% CI (-0.4, -0.2)) and mean diastolic BP (-0.1 mmHg, 95% CI (-0.2, -0.04)) adjusted for BMI and sex. We identified evidence for five known BP loci and two suggestive new signals. Our most significant finding is rs10894989 [beta (SE) = 6.57 (1.26), p =1.86x10 -7 , minor allele frequency (EAF = 0.94)] near the ARHGAP42 gene, an established locus for hypertension. However, this variant is not in linkage disequilibrium with the commonly reported SNP rs604723 (r 2 = 0.04). Ancestry-specific allele frequencies differed with rs604723 more common in East Asians and Europeans and rs10894989 commonest in Africans. Conclusion: Our longitudinal analyses of BP from late adolescence to early adulthood replicated BP loci and identified novel suggestive loci associated with BP trajectories supporting a need for further GWAS of longitudinal BP. We are currently conducting a meta-analysis of longitudinal BP trajectories in 3,000 young adults self-identified as Hispanic Latino in the Population Architecture using Genomics and Epidemiology (PAGE) study.

Racial disparities in survival for high-grade uterine cancer: a Surveillance, Epidemiology and End Results analysis

Analysis of Recent Papers in Hypertension

Association between blood pressure trajectories during pregnancy and childbirth-related post-traumatic stress disorder symptoms.