Association Of Blood Pressure Levels Research Articles

Associations of blood pressure with cardiovascular and mortality outcomes in over 2 million older persons with or without diabetes mellitus: A systematic review and meta-analysis of 45 cohort studies

BackgroundThe impact of blood pressure on cardiovascular disease (CVD) and mortality outcomes in older people with diabetes mellitus (DM) is not well quantified. Using a systematic review and meta-analysis of observational cohort studies, we aimed to compare the associations of blood pressure levels with cardiovascular and mortality outcomes in older people aged ≥ 65 years with or without DM. MethodsStudies were identified from MEDLINE, Embase, Web of Science, and search of bibliographies to July 2022. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. ResultsForty-five unique observational cohort studies (n = 2305,189 participants) assessing the associations of systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) levels with adverse cardiovascular outcomes were included. In the general population, the pooled RRs (95% CIs) of SBP ≥ 140 vs < 140 mmHg and per 10 mmHg increase for composite CVD/MACE were 1.26 (0.96–1.64) and 1.15 (1.08–1.23), respectively. The respective estimates were 1.56 (1.04–2.34) and 1.10 (1.04–1.18) for patients with DM. SBP ≥ 130 vs < 130 mmHg was not associated with an increased risk of adverse cardiovascular outcomes in both populations. SBP < 120 vs ≥ 120 mmHg was associated with an increased risk of all cause-mortality in the general population (n = 10 studies). DBP ≥ 90 mmHg was associated with an increased risk of some adverse cardiovascular outcomes in both populations. Interaction analyses suggested similar risk of outcomes in both populations. ConclusionsObservational evidence suggests SBP and DBP confer similar cardiovascular and mortality risk in older adults in the general population and those with DM. A blood pressure target range of > 130/80 to < 140/90 mmHg may be optimal for patients ≥ 65 years with DM, but specific targets may need to be individualised based on patients’ unique circumstances. Furthermore, findings do not support stringent blood pressure control in this population group. Definitive RCTs are needed to support these observational findings.

Associations between blood pressure levels and diabetic retinopathy in patients with diabetes mellitus: A population-based study

PurposeTo evaluate the associations of blood pressure levels with diabetic retinopathy (DR), proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) in patients with diabetes mellitus. DesignA cross-sectional, population-based study. SubjectsA total of 152,844 patients with diabetes from 90 major cities in 19 provincial regions of mainland China during 2018–2021 were finally recruited. MethodsBlood pressure was graded into 5 levels: normal (without hypertension and <120/80 mmHg), normal high (without hypertension and ≥120/80 mmHg), HT-intensive (hypertension and <120/80 mmHg), HT-moderate (hypertension and blood pressure between 120/80 mmHg and 140/90 mmHg) and HT-high (hypertension and ≥140/90 mmHg). Logistic regression was employed to verify the associations of hypertension and blood pressure levels with DR, PDR and DME. The impacts of blood pressure levels on the outcomes were qualified with nomogram models. Main outcome measuresThe main outcome was DR. ResultsThere were 16,685 (10.92%) participants having DR, 2841 (1.86%) having PDR, and 1566 (1.02%) having DME. There were 8126 (5.32%) patients without hypertension and 1350 (0.88%) patients with hypertension having blood pressure <120/80 mmHg. When compared to the normal group with covariates adjusted, an increased prevalence of DR was observed in normal high (adjusted odds ratio [OR] = 1.114, 95% confidence interval [CI] = 1.033–1.202), HT-moderate (adjusted OR = 1.163, 95% CI = 1.065–1.271), and HT-high (adjusted OR = 1.203, 95% CI = 1.114–1.300). ConclusionsThere were associations between hypertension and DR, PDR, and DME in the diabetic population. Increased prevalence of DR was found with blood pressure >120/80 mmHg in both patients with and without hypertension. A nomogram was developed for DR prediction based on blood pressure levels.

Abstract MP06: Women but Not Men With a Systolic Blood Pressure Greater the 110mmhg Was Associated With Higher Risk of All-Cause Dementia

Introduction: Whether the association of blood pressure levels and risk of dementia differed by sex remains unclear. Hypothesis: We hypothesized that there might be a sex difference in the association between blood pressure levels and dementia. Methods: We used cohort data from UK Biobank, a large population-based prospective cohort study that recruited 502 649 individuals ages 40-69, between 2006 and 2010. Cox proportional hazards models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI) for the association between blood pressure levels and incident dementia (including all-cause dementia, Alzheimer's Disease (AD), vascular dementia). We conducted subgroup analyses to divide people into two categories of baseline age &lt; 60 years and ≥60 years. Restricted cubic spline models were used to estimate the association between blood pressure levels and all-cause dementia. Results: Overall, 425504 (53.9% women) people with no prevalent dementia were included. After 11.4 (median) years follow-up, 5114 participants (46.2% women) developed dementia. The crude incidence rates were 10.3 for women and 14.0 for men, per 10,000 person-years. The relationship between diastolic blood pressure (DBP) and dementia was U-shaped in both men and women. Women with higher SBP levels were associated with higher risk of all-cause dementia, with an SBP threshold of 110mmhg. Also, women with SBP levels greater than a threshold of 120mmhg and 150mmhg was linked to higher risk of AD and VD, respectively. No relationship between SBP and dementia was observed in men. After the analyses were stratified by age when the SBP was measured (&lt;60 years or ≥60 years), we found that in women younger than 60 years, a nonlinear relationship was observed, i.e., high SBP level greater than 120mmhg was linked to higher risk of all-cause dementia. Conclusions: Women with a threshold of SBP level greater the 110mmhg was associated with higher risk of all-cause dementia, while no such relationship was observed in men.

The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry. Rationale, design and objectives.

Hypertension is a major risk factor for the development of heart failure with preserved ejection fraction (HFPEF) and blood pressure (BP) in itself is an important marker of prognosis. The association of BP levels, and hemodynamic parameters, measured by ambulatory blood pressure monitoring (ABPM), with outcomes, in patients with HFPEF is largely unknown. Patients with HFPEF have a substantial burden of co-morbidities and frailty. In addition there are marked geographic differences in HFPEF around the world. How these difference influence the association between BP and outcomes in HFPEF are unknown. The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry aims to assess the relevance of BP parameters, measured by ABPM, on the outcome of HFPEF patients worldwide. Additionally, the influence of other relevant factors such as frailty and co-morbidities will be assessed. Stable HFPEF patients with a previous hospitalization, will be included. Patients should be clinically and hemodynamically stable for at least 4 weeks before study inclusion. Specific data related to HF, biochemical markers, ECG and echocardiography will be collected. An ABPM and geriatric and frailty evaluation will be performed and the association with morbidity and mortality assessed. Follow up will be at least one year.

Abstract 15706: Association of Blood Pressure Level With Left Atrial Size and Function in Adolescents (SHIP AHOY)

Introduction: Left atrial (LA) enlargement and dysfunction are risk factors for stroke, atrial fibrillation and death in adults, and are associated with hypertension (HTN). In children, left ventricular hypertrophy is the most common manifestation of cardiac-specific organ damage in those with HTN, but gaps in knowledge remain regarding the association of HTN with LA size and function. Hypothesis: Increasing blood pressure (BP) is associated with increased LA volume and abnormal LA strain in children. Methods: Echocardiographic images of youth, aged 11 to 18 yrs from 5 clinical sites were obtained. LA strain and strain rate were analyzed using 2-D speckle tracking imaging with R-R gating in the apical 4 and 2-chamber views and averages of both views were used. Subjects were grouped by SBP as low-risk (L; &lt;80th %ile), mid-risk (M; 80-&lt;90th %ile), or high-risk, (H;≥90th %ile). Linear regression models were used to determine the association between BP z-score and LA size and function adjusting for age, sex, race and ethnicity. Results: N=347 youth (median age 15.7 yrs) 60% (n=208) male and 40% (n=139) non-white were included. BP groups differed by age (L&amp;H&lt;M) and BMI (L&lt;M&amp;H). BP groups did not differ by LA size and strain but differed by left ventricular mass index (H&gt;L), stroke volume (M&amp;H&lt;L), peak global longitudinal strain (L&gt;H), mitral E/e’ (H&gt;L) and pulse wave velocity (H&gt;L), each indicating worse CVD risk in the H vs. L group (Table). Multivariable analyses revealed DBP z-score to be independently associated with LA conduit strain (beta 0.73, 95% CI 0.01, 1.45, p&lt;0.05). No other LA size or function variables were associated with BP. Conclusions: Greater BP is associated with increased CVD risk among youth as assessed by non-invasive measurements of CV structure and function. DBP is independently associated with LA conduit strain, a finding associated with CV events in adults. Future studies to determine the long-term association of abnormal DBP with LA strain are needed.

Associations of blood pressure levels with clinical events in older patients receiving home medical care.

Some studies reported that excessive blood pressure (BP) control was not appropriate for older people, especially from the viewpoint of quality of life and maintaining sufficient blood flow for tissue perfusion. However, the lower limit of the target BP is still unclear, and there has not yet been a sufficient consensus. Therefore, we investigated the associations of BP levels with clinical events in older patients ~85 years old receiving home medical care. A total of 144 patients were included, who were followed for longer than 3 months in the Osaka Home Care Registry study, a prospective cohort study targeting older patients receiving home medical care in Japan. BP levels were divided into lower and higher groups based on the average systolic blood pressure (SBP). The main outcomes were clinical events, including hospitalizations, falls, and deaths during follow-up. As a result, the hospitalization rate in the SBP below 124 mmHg group was significantly higher than that in the SBP over 124 mmHg group. When comparing the clinical events between the two groups only in participants with hypertension, the same results were obtained. Furthermore, in Cox proportional hazards regression models adjusted by age, sex, and current diseases, the SBP below 124 mmHg group showed a significantly higher rate of required hospitalization (hazard ratio: 7.25, 95% confidence interval: 1.79-29.45). Thus, in older and very frail patients requiring home medical care, an SBP level below 124 mmHg could be a predictive marker of clinical events leading to hospitalization.

Abstract TMP110: Design of the BP-COG Study of Blood Pressure Over the Life Course and Later-Life Cognition in Blacks, Hispanics, and Whites: A Pooled Cohort Analysis of ARIC, CARDIA, CHS, FOS, MESA, and NOMAS

Background: High blood pressure (BP), particularly in mid-life, increases the risk for late-life cognitive impairment and dementia (CID). The extent to which Blacks’ and Hispanics’ worse BP control starting in young adulthood contributes to their greater risk of CID compared to Whites is uncertain. Objective: To describe a pooled, multi-ethnic cohort created to determine the associations between BP levels over the life course and CID risk in Blacks, Hispanics, and Whites. Methods: We pooled individual-level data from 35,473 adults (22.6% Blacks, 8.1% Hispanics, 67.3% Whites, 2% Other) with baseline age ≥18 and cognitive assessments across 6 longitudinal cohorts in the United States from 1971 to 2016: Atherosclerosis Risk in Communities Study (ARIC), Coronary Artery Risk Development in Young Adults Study (CARDIA), Cardiovascular Health Study (CHS), Framingham Offspring Study (FOS), Multi-Ethnic Study of Atherosclerosis (MESA), and Northern Manhattan Study (NOMAS). We harmonized cognitive tests across studies into 3 factors representing global cognitive performance, executive function, and memory using statistically appropriate confirmatory factor analysis. Mean (SD) follow up was 17.1 (10.9) years. Results: The mean (SD) baseline age was 54.3 (16.4) years and 19554 (55.1%) participants were female (Table). There were 3193 (9.0%) first incident strokes (2651 ischemic, 348 hemorrhagic, and 117 other or undetermined type) and 15147 (42.7%) deaths. The Table presents mean BPs at the first and last visits by cohort and the pooled sample. From the initial to the last assessment, mean global cognition decreased over time (p&lt;0.001), as did mean executive function (p&lt;0.001) and mean memory scores (p&lt;0.001) in the pooled sample. Conclusion: This will be the first comprehensive, large investigation of the association of BP levels from young adulthood to late-life and CID risk in Blacks, Hispanics, and Whites.

A3579 The Association of Blood Pressure Level with Clinical Events in Old Patients with Home Medical Care

A3579 The Association of Blood Pressure Level with Clinical Events in Old Patients with Home Medical Care

HIGH BLOOD PRESSURE AN OBESITY PREVALENCE IN ADOLESCENTS

Objective: Obesity is a growing problem worldwide and is likely a major cause of the increased prevalence of high blood pressure in children. The aim of the screening program was to investigate the association of blood pressure levels and obesity, hypercholesterinaemia and increased body fluid in adolescents. Design and method: 2202 children participated in the screening program between April 2010 to May 2011. Blood pressure, heart rate, body composition, cholesterol and blood glucose level, bodyweight, height and BMI were assessed. Results: The participants range of age was between 14–18 years. The average systolic blood pressure (SBP) was 126.34+12,55 mmHg. Boys had higher SBP than girls (131.87+13.59 mmHg versus 117.49+5.69 mmHg, p < 0,001). The average diastolic blood pressure (DBP) was 71.86+8.74 mmHg. DBP was also higher in boys than girls (72.61+9.17 mmHg versus 66.69+5.04 mmHg, p < 0,001). High SBP (>percentile 95%) was detected in 307/1326 cases (23.15%) in girls, and in 403/876 cases (46%) in boys. High DBP occurred in 85 girls and in 90 boys. Overweight and obese were 18.994% of the girls and 15.26 % of the boys. The percentage of high blood pressure was more frequent among boys and girls who were in the overweight and obese group 93/145 (64.14%), 94/239 (39.33%). The pathologically high level of body fat percentage appeared to be 12.98% among girls and 5.9% among boys. In elevated BMI groups the frequency of high body fat was 66% among girls and 81% among boys. The mean cholesterol level was significantly higher in the overweight and obese group 3.78+1.26 and 4.17+0.91 mmol/L (p < 0.001). Conclusions: Prevalence rates of hypertension and overweight and obesity are high in school children in Budapest, and increased bodyweight is a significant risk factor for hypertension. The results of the study will help to design preventive programmes.

Association of blood pressure level with nonalcoholic fatty liver disease in nonhypertensive population: Normal is not the new normal.

The functional crosstalk between nonalcoholic fatty liver disease (NAFLD) and hypertension has been reported by some literatures; however, in nonhypertensive individuals, there is no article describes the characteristic of NAFLD. In this study, we aimed to determine the strength of the association between NAFLD with normal blood pressure (BP) in nonhypertensive individuals. This cross-sectional study was conducted in the sixth Affiliated Hospital of Wenzhou Medical University, from October 2007 to December 2011. In brief, 24,200 subjects were enrolled to participate in the survey. Among those subjects, there were 5305 enrolled subjects, those with filling the diagnostic criteria for NAFLD (21.9%; 4803 males and 502 females). Nonhypertension was identified in 17,403 (71.9%; 8179 males and 9224 females). The PR% of NAFLD for the systolic blood pressure (SBP) in quartiles 1 to 4 was 10.83, 12.55, 20.38, and 19.97. SBP, diastolic blood pressure (DBP), sex, age, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, fasting plasma glucose, uric acid, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol are closely associated with the risk for NAFLD. SBP (odds ratio [OR]: 1.092, 95% confidence interval [CI]: 1.030–1.158; P < 0.05) and DBP (OR: 1.157, 95%CI: 1.094–1.223; P < 0.05) were found to be independent risk factors for NAFLD. Our analysis indicates that BP is significantly associated with NAFLD in nonhypertensive individuals; SBP and DBP are found to be independent risk factors for NAFLD.

Prognostic value of 24-h ABPM in acute ischemic stroke for short-, medium-, and long-term outcome: a systematic review and meta-analysis.

The association of blood pressure levels during the acute phase of ischemic stroke with outcome remains controversial. The objective of this systematic review is to assess the predictive value for stroke outcome assessed by the modified Rankin scale score of systolic and diastolic blood pressure, measured by ambulatory blood pressure monitoring methods during the acute phase of ischemic stroke, compared with the values of casually derived blood pressure measurement on admission. We searched for studies with patients admitted within 24 h of stroke onset, and who had ambulatory blood pressure monitoring during the first 24 h of admission. We identified studies that reported blood pressure in those with good outcome and in those with poor outcome at end of follow-up, and performed a meta-analysis of the effect of mean blood pressure on outcome. High systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor short-, medium-, and long-term outcome, but the same was not found for casual blood pressure measurements. An increase in systolic blood pressure of 9·1 mmHg (95% confidence interval: 6·6-11·6, P < 0·001; I(2) = 9%) and an increase in diastolic blood pressure of 2·3 mmHg (95% confidence interval: 0·8-3·7, P = 0·002; I(2) = 0%) were associated with poor outcome. Higher systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor outcome. The same was not found for higher casual blood pressure measurements on admission, and it is possible that ambulatory blood pressure monitoring conveys better prognostic information.

Variability of Measurement of Retinal Vessel Diameters

Purpose: To examine the effects of various cardiovascular, ocular, and lifestyle factors on retinal vessel diameters over short periods of time.Methods: Subjects were invited to have photographs of their retina taken at each of three study visits. The same eye was photographed each time. The photographs were digitized and retinal vessel diameters were measured. Measurements from the retinal photographs taken consecutively (at visit 2 and visit 3), and 1, 3, and 4 weeks apart (between visits 1 and 2, 2 and 3, and 1 and 3, respectively) were compared.Results: There were 63 persons who participated in all study visits and had gradable vessel measurements from all five images used in the analysis. Correlations for pairs of study visits were high, and decreased slightly with increasing length of the time interval. For consecutive photographs taken, and 1 week, 3 weeks, and 4 weeks apart, correlations were 0.95, 0.90, 0.91, and 0.86, respectively, for central retinal arteriolar equivalent (CRAE) and 0.95, 0.90, 0.91, and 0.87, respectively, for central retinal venular equivalent (CRVE). We examined the associations of blood pressure levels, smoking habits, time since last eating, exercising, consuming caffeine, and taking anti-hypertensive medication, and image focus with CRAE and CRVE. We found no consistent pattern of association of any of these characteristics with short-term changes in CRAE and CRVE.Conclusion: Retinal vessel diameters are stable over short intervals of time and none of the factors studied were consistently associated with change in the diameters of either vessel type.

Level of blood pressure above goal and clinical inertia in a Medicaid population

Failure to adjust hypertension therapy despite elevated blood pressure (BP) levels is an important contributor to lack of BP control. One possible explanation is that small elevations above goal BP are not concerning to clinicians. BP levels farther above goal, however, should be more likely to prompt clinical action. We reviewed 1 year’s worth of primary care records of 3742 North Carolina Medicaid recipients 21 years and older with hypertension (a total of 15,516 office visits) to examine variations in hypertension management stratified by level of BP above goal and the association of BP level above goal with documented antihypertensive medication change. Among the 53% of patients not at goal BP, 42% were within 10/5 mm Hg of goal; 11% had a BP 40/20 mm Hg or higher above goal. Higher level of BP above goal was independently associated with antihypertensive medication change. Compared with visits at which BP was less than 10/5 mm Hg above goal, the adjusted odds of medication change were 7.9 (95% Confidence Interval 6.2–10.2) times greater at visits when patients’ BP was 40/20 mm Hg or higher above goal. However, even when BP was above goal at this level, treatment change occurred only 46% (95% Confidence Interval 40.2–51.8) of the time.

Brain Microbleeds Relate to Higher Ambulatory Blood Pressure Levels in First-Ever Lacunar Stroke Patients

Hypertension is an important risk factor for brain microbleeds (BMBs) in lacunar stroke patients. However, beyond the qualitative label "hypertension," little is known about the association with ambulatory blood pressure (BP) levels. In 123 first-ever lacunar stroke patients we performed 24-hour ambulatory BP monitoring after the acute stroke-phase. We counted BMBs on T2*-weighted gradient-echo MR images. Because a different etiology for BMBs according to location has been suggested, we distinguished between BMBs in deep and lobar location. BMBs were seen in 36 (29.3%) patients. After adjusting for age, sex, number of antihypertensive drugs, asymptomatic lacunar infarcts, and white matter lesions, we found 24-hour, day, and night systolic and diastolic BP levels to be significantly associated with the presence and number of BMBs (odds ratios 1.6 to 2.3 per standard deviation increase in BP). Distinguishing between different locations, various BP characteristics were significantly associated with the presence of deep (or combined deep and lobar) BMBs, but not with purely lobar BMBs. Our results underline the role of a high 24-hour BP load as an important risk factor for BMBs. The association of BP levels with deep but not purely lobar BMBs is in line with the idea that different vasculopathies might be involved. Deep BMBs may be a particular marker of BP-related small vessel disease, but longitudinal and larger studies are now warranted to substantiate these findings.

Association of blood pressure levels with the effects of alcohol intake on the vasculature in Japanese men

The association of blood pressure levels with the effects of alcohol intake on the vasculature has not been clarified. We evaluated the differential effects of alcohol intake on the vasculature of subjects with optimal or normal blood pressure (ONbp) and those with high normal blood pressure or higher (HNHbp) in a 6-year follow-up study. The pulse wave velocity (PWV) was measured on three occasions at an interval of 3 years in 1185 middle-aged Japanese men (age 41+/-8 years). In subjects with ONbp (n=677), a U-shaped relationship between alcohol intake (non-drinker, and light-to-moderate and heavy alcohol intake groups) and the increase in the adjusted value of PWV was observed at the end of 6 years' observation. On the other hand, in subjects with HNHbp (n=508), a U-shaped relationship was not observed. At the end of 6 years' observation, the increase in PWV was significantly more in the heavy intake group than in the light-to-moderate intake group or the non-drinker group, even after adjustment for changes in blood pressure and prescribed medication (P<0.01). In conclusion, blood pressure levels may modulate the effects of alcohol intake on the vasculature in middle-aged Japanese subjects. In subjects with ONbp, light-to-moderate alcohol intake appeared to have a possible vasculoprotective effect; on the other hand, in subjects with NHNbp, heavy alcohol intake seemed to exert a detrimental effect on the vasculature.

Association of Blood Pressure Levels with Carotid Intima-Media Thickness and Plaques

The aim of this study was to investigate the association of blood pressure levels with the common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. Data were obtained from 2,635 subjects, aged 50 years and over, who participated in the Community Health Survey (a population-based, cross-sectional study) in Dong-gu, Gwangju city between 2007 and 2008. Participants were categorized into three groups according to blood pressure levels; normotensives (<120/80 mmHg), prehypertensives (120-139/80-89 mmHg), and hypertensives (> or =140/90 mmHg). Prehypertensives were further categorized as low prehypertensives (120-129/80-84 mmHg) and high prehypertensives (130-139/85-89 mmHg). Carotid intima-media thickness and plaques were evaluated with a high-resolution B-mode ultrasound. Statistical analyses were performed using chi-square test, ANOVA, and multiple logistic regression. Prehypertensives had significantly greater maximal CCA-IMT values than normotensives, with a multivariate adjusted odds ratio of 1.78 (95% CI=1.36-2.32) for abnormal CCA-IMT (maximal CCA-IMT > or =1.0 mm), and 1.45 (95% CI=1.19-1.77) for carotid plaques. The multivariate adjusted odds ratio of low prehypertensives was 1.64 (95% CI=1.21-2.21) for abnormal CCA-IMT, and 1.30 (95% CI=1.04-1.63) for carotid plaques compared with normotensives. Subject with hypertension had higher frequency of abnormal CCA-IMT (odds ratio, 2.18; 95% CI=1.49-3.18), and carotid plaques (odds ratio, 1.98; 95% CI=1.46-2.67) compared with normotensives after adjustment for other cardiovascular risk factors. Our results indicate that there is a significant increase in the prevalence of carotid atherosclerosis in subjects with prehypertension (even in low prehypertensives) compared with normotensive subjects. Further studies are required to confirm the benefits and role of carotid ultrasonography in persons with prehypertension.

Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease

Kidney disease is associated with an increased risk of cardiovascular disease (CVD); however, there have been few well-designed prospective studies of this issue in Asian populations. Recent epidemiological studies have suggested that a lower blood pressure level may be associated with an increased risk of CVD in individuals with kidney dysfunction. Using data from 10 community-based cohort studies in Japan, we conducted follow-up on a total of 30 657 individuals 40 to 89 years of age without preexisting CVD or kidney failure and examined the relationship between reduced glomerular filtration rate (GFR) and the risk of CVD. During an average 7.4-year follow-up, 727 individuals experienced CVD. The age- and sex-adjusted incidence of CVD increased significantly in subjects with GFR of 60 to 89 mL . min(-1) . 1.73 m(-2) (4.3 per 1000 person-years, P=0.002) and in those with a GFR <60 mL . min(-1) . 1.73 m(-2) (6.5, P<0.001) compared with those with a GFR >/=90 mL . min(-1) . 1.73 m(-2) (2.9). Even after adjustment for potential confounding factors, subjects with a GFR <60 mL . min(-1) . 1.73 m(-2) had a 57% (95% CI 14% to 115%) greater risk of CVD than those with a GFR >/=90 mL . min(-1) . 1.73 m(-2). The multivariate-adjusted hazard ratios of CVD increased in a log-linear manner with elevations in blood pressure levels, regardless of GFR levels (all P for trend <0.01). Our findings suggest that a reduced GFR is a significant risk factor for CVD in the general Japanese population. Additionally, a log-linear association of blood pressure level with CVD risk was observed, without evidence of a J-curve association, regardless of GFR levels.

Risk for Incident Renal Dialysis in a Managed Care Population

The influence of poorly controlled blood pressure (BP) on progression to end-stage renal disease typically has been studied in qualified populations. Few observational studies examined the influence of change in BP. We conducted a retrospective observational study of a cohort of adults 18 years or older with glomerular filtration rates of 15 to 89 mL/min/1.73 m(2) (0.25 to 1.48 mL/s) in 2001 (N = 16,299) in a managed care organization. The cohort generally was representative of many urban areas in the United States. The principal outcome was incident renal dialysis in 2002 (N = 73). BP was measured in 1999 and 2001. Risk for incident dialysis therapy was estimated in the entire cohort by using Cox proportional hazards regression and in a subset of 4 randomly selected controls (n = 292) matched (for 2001 glomerular filtration rate, age, and sex) with incident dialysis cases by using conditional logistic regression. Within this cohort, dialysis incidence was 4.5 cases/1,000 adults. For incident dialysis cases, mean time to dialysis therapy in 2002 (from December 31, 2001) was 167 days. Greater levels of systolic or diastolic BP in 1999 were associated significantly with greater risk for incident dialysis treatment in 2002 (controlling for age, sex, coronary artery disease, diabetes, and tobacco use). Decreased systolic or diastolic BP from 1999 to 2001 was associated with significantly reduced risk for incident dialysis treatment in 2002. Improving BP control in adults with early or advanced kidney disease and moderately to severely elevated BP should continue to be a focus of care management programs seeking to decrease the risk for incident dialysis treatment.

Midlife blood pressure and neuritic plaques, neurofibrillary tangles, and brain weight at death: the HAAS ☆

Midlife hypertension is associated with later development of cognitive impairment, vascular dementia (VsD), and possibly Alzheimer’s disease (AD). Neuropathic cerebrovascular lesions and brain atrophy have been associated with elevated blood pressure (BP), however, to our knowledge there have been no prospective investigations of an association of blood pressure levels measured in midlife with the microscopic lesions of AD. We investigated the relationship of BP level in midlife to development of neurofibrillary tangles (NFT), neuritic plaques (NP), and low brain weight at autopsy among Japanese-American men who were members of the Honolulu Heart Program/Honolulu-Asia aging Study (HHP/HAAS) cohort. The HHP/HAAS is a population-based, longitudinal study of cognitive function and dementia with 36 years of follow-up. Neocortical and hippocampal NFT and NP were counted per mm 2, and fixed brain weight was measured for 243 decedents. Elevated systolic BP, (≥160 mm Hg) in midlife was associated with low brain weight and greater numbers of NP in both neocortex and hippocampus. Diastolic BP elevation, (≥95 mm Hg) was associated with greater numbers of NFT in hippocampus. Results indicate that in addition to the accepted association of high BP with neuropathic cerebrovascular lesions, there is a direct relationship with brain atrophy, NP and NFT.

The association of blood pressure levels and change in renal function in hypertensive and nonhypertensive subjects

• We compared the changes in serum creatinine levels over time after a mean follow-up of 9.8 years in essential hypertensive (EH, n=56) and control (n=59) male veteran subjects. All subjects had normal serum creatinine levels (62 to 124 μmol/L) and "normal" urinalysis results on entry into the study. Subjects with comorbid renal diagnoses and diabetes mellitus were eliminated from the analysis. Although not statistically significant, the rate of change in the serum creatinine concentration over time was greater in the EH cohort compared with the control cohort (1.08±4.8 vs 0.027±3.5 μmol/L per year). The difference was especially marked in black EH subjects vs black control subjects (1.60 ± 6.2 μmol/L per year vs -0.21 ± 3.3 μmol/L per year). When age, race, body mass index, and a diagnosis of EH were entered into a logistic regression analysis, EH subjects had a statistically significantly greater rate of decline in renal function than did control subjects (1.5 ±8.3 μmol/L per year). When mean time-averaged systolic blood pressure for each subject was also included in the logistic regression analysis, only systolic time-averaged blood pressure was statistically significant (0.063 ± 0.029 μmol/L per year). We conclude that in the absence of clinically detected parenchymal renal disease, EH subjects have a greater rate of decline in renal function than do nonhypertensive subjects. Time-averaged blood pressure is predictive of the change in serum creatinine concentration not only in EH subjects but also in nonhypertensive subjects. Thus, preservation of renal function may require a blood pressure lower than the currently accepted normotensive range. (<i>Arch Intern Med.</i>1990;150:2073-2076)