Association of childhood maltreatment with hypertension outcomes in adulthood: A systematic review and meta-analysis.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Chlorthalidone or Hydrochlorothiazide for Treatment of Hypertension

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Self-reported depressive symptoms in adolescence increase the risk for obesity and high BP in adulthood

Background and aims Birthweight and weight gain have been associated with high adult blood pressure (BP). Less well known is the association between height gain across the life cycle and hypertension (HT). The objective of the present study is to assess the independent association of body mass index (BMI) and length at birth and BMI and height gains from birth to childhood, and from childhood to adulthood with adult blood pressure and HT. Methods A prospective cohort of all living born in Ribeirao Preto, Brazil, was assessed at birth (1978/79), school-age (1987/89) and adulthood (2002/04). Data on neonatal variables, socioeconomic position and anthropometry of all three moments as well as adult risk factors for HT were present for 1141 subjects. Conditional weight analysis was performed to assess the independent association of BMI and height repeated-in-time measurements on adult HT. Results After adjustments BMI at birth (inversely: RR = 0.58; 95% CI 0.35–0.96), BMI gain in adolescence (RR = 3.39; 95% CI 1.87–6.16) and height gain in childhood (RR = 1.95; 95% CI 1.12–3.38) were associated with adult HT. Adult systolic BP was associated with BMI at birth, BMI and height gains in childhood and adolescence. Diastolic BP was associated with BMI at birth, BMI gain in childhood and adolescence, and with height gain in childhood. Conclusion Lower BMI at birth, higher height gain between birth and school age and higher BMI gain during the second decade of life were associated with adult HT. BMI and height also predict both systolic and diastolic blood pressure. Supported CNPq, FAPESP, FAEPA.

ImportanceChildhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.ObjectiveTo update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, International Pharmaceutical s, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study SelectionFair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and SynthesisTwo reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and MeasuresSensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.ResultsForty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were −4.38 mm Hg (95% CI, −7.27 to −2.16) for angiotensin-converting enzyme inhibitors and −3.07 mm Hg (95% CI, −4.99 to −1.44) for angiotensin receptor blockers. Candesartan reduced SBP by −6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (−4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (−2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (−7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and RelevanceObservational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.

Response variation as a result of tai chi on resting blood pressure in hypertensive adults: An aggregate data meta-analysis

Clinical Value of Ambulatory Blood Pressure Monitoring in CKD

Une nouvelle voie d’immunomodulation, l’induction de l’arginase par les trypanosomes chez leurs hôtes, a été identifiée et caractérisée. Pour éviter la réponse cytotoxique de l’activation « classique » M1 des macrophages et bénéficier de leur activation « alternative » M2, les parasites induisent l’arginase, qui produit la L-ornithine, indispensable à leur développement. Cette voie d’immunomodulation mise en évidence chez la souris infestée par son parasite naturel, Trypanosoma musculi, est également présente dans d’autres trypanosomoses, en particulier la trypanosomose humaine africaine (THA). Une augmentation de l’arginase, retrouvée dans le sérum de patients trypanosomés, se normalise après un traitement efficace. T. brucei gambiense, parasite de l’homme, induit l’arginase au niveau des macrophages murins et des leucocytes humains. T. lewisi, parasite du rat, induit également l’arginase. Au cours de leur longue coévolution avec leurs hôtes, les trypanosomes extracellulaires ont sélectionné un procédé favorisant leur croissance, l’induction de l’arginase, par des facteurs d’excrétion/sécrétion. Nous avons produit un anticorps monoclonal dirigé contre ce facteur inducteur. Il bloque l’induction de l’arginase par T. musculi in vitro et in vivo. Chez la souris infectée, son injection diminue considérablement la parasitémie. Il a permis l’identification du facteur inducteur, une kinésine orpheline. Cet anticorps, inhibant l’induction de l’arginase par différents trypanosomes, reconnaîtrait une région conservée de la kinésine induisant l’arginase. Cette kinésine se lie à des récepteurs de la membrane des macrophages. In vitro, l’addition de mannose à des co-cultures macrophages-parasites bloque l’induction de l’arginase et la multiplication des parasites. Chez la souris infestée par T. musculi, l’injection de mannose diminue la parasitémie, qui est également réduite chez les souris Mrc1-/-, KO pour le récepteur mannose. L’utilisation de molécules ciblant la voie inductrice de l’arginase et/ou ce récepteur peut représenter une nouvelle approche thérapeutique dans les trypanosomoses.

Lowering Blood Pressure to Lower the Risk of Cardiovascular Events in CKD

High blood pressure in adults with disabilities: Influence of gender, body weight and health behaviors

The authors hypothesized that individuals born in the early 20th century who experienced the hottest and driest summers during infancy would be more likely to have suffered severe infant diarrhea and dehydration, and consequently have had higher blood pressure in adulthood, than those who experienced cooler and wetter summers. In this context, these climate data act as an instrumental variable for the association of early-life dehydration with later blood pressure. For 3,964 randomly selected British women born between 1919 and 1940 and whose blood pressure was measured at age 60-79 years, a one standard deviation (1.3 degrees C) higher mean summer temperature in the first year of life was associated with a 1.12-mmHg (95% confidence interval: 0.33, 1.91) higher adult systolic blood pressure, and a one standard deviation higher mean summer rainfall (33.9 mm) was associated with lower systolic blood pressure (-1.65 mmHg, 95% confidence interval: -2.44, -0.85). Equivalent results for diastolic blood pressure were 0.11 (95% confidence interval: -0.65, 0.86) and -0.32 (95% confidence interval: -0.71, 0.05). The climate variables were not associated with potential confounding factors such as socioeconomic position or lifestyle risk factors. These findings provide some evidence in favor of the hypothesis that dehydration in infancy is associated with higher adult blood pressure.

Hospital birth records were sought for 104 men from a pool of male army conscripts with "normal" or "high" blood pressure when measured at 28 years of age. Of 77 men whose birth weight and date of the mother's last menstrual period before the pregnancy could be found, 25 had a resting diastolic blood pressure of greater than or equal to 90 mm Hg. In 11 of these compared with nine of the 52 men with normal diastolic pressures their birth weights in relation to gestational age had been below the mean and 1 SD of a comparable Swedish population. The risk of increased diastolic blood pressure in early adult life was significantly higher among men who had been growth retarded at birth than among those whose birth weight had been appropriate for gestational age (odds ratio 3.63; 95% confidence interval 1.14 to 12.57). Being born small for gestational age may be a predictor of raised blood pressure in early adult life.

he recognition of the risks of high blood pressure (BP) in the last century was highlighted by observing the acute association between very high BP and medical catastrophes in emergency settings, including stroke, acute left ventricular failure, and myocardial infarction.Edward Freis was among the first authors to propose the concept of "hypertensive crisis," which he characterized as a life-threatening disorder caused by acute or severe elevation of BP and clinical manifestations secondary to hypertension. 1 According to Freis, the clinical manifestations included encephalopathy, neuroretinitis, evidence of rapidly advancing renal impairment, and acute heart failure.Hypertension guidelines incorporated the diagnosis of hypertensive crisis, and the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure report proposed the classification of hypertensive emergencies and urgencies. 2Hypertensive emergencies were characterized by hypertensive encephalopathy, intracranial hemorrhage, acute left ventricular failure, dissecting aortic aneurysm, severe hypertension, toxemia, head trauma, extensive burns, unstable angina pectoris, and acute myocardial infarction, in which BP should be lowered within 1 hour.Urgencies were defined as situations in which BP should be controlled within 24 hours, including accelerated or malignant hypertension, perioperative hypertension, and patients requiring emergency surgeries.With slight variations in the criteria for the definition of urgencies and emergencies, these recommendations have been repeatedly copied and pasted into the Joint National Committee guidelines and the guidelines from Europe and other countries.The 2017 American Heart Association/American College of Cardiology hypertension guidelines 3 defined hypertensive emergencies as severe BP elevations (>180/120 mm Hg) associated with evidence of hypertensive encephalopathy, intracerebral hemorrhage, acute ischemic stroke, acute myocardial infarction, acute left ventricular failure, unstable angina pectoris, dissecting aortic aneurysm, acute renal failure, and eclampsia.The guideline defined hypertensive urgencies as situations associated with severe BP elevation in patients without an acute or impending change in target organ damage or dysfunction.The 2018 European Society of Cardiology/European Society of Hypertension guidelines of hypertension 4 included the diagnosis of malignant hypertension (characterized by funduscopic changes or disseminated intravascular coagulation), excluded any presentation of stroke from the criteria to characterize hypertensive emergencies, and proposed a similar definition for hypertensive urgencies.Patients with high BP in emergency departments have worse long-term cardiovascular outcomes than those with lower BP. 5 This consequence is expected because these patients already have high BP levels and a longer duration of hypertension.The diagnoses of urgency and emergency would be justified if short-term outcomes were influenced by prompt therapy in emergency departments.Nevertheless, there is no clinical trial in patients diagnosed as having

Child maltreatment and blood pressure in young adulthood