Current Use Of Antihypertensive Medication Research Articles

Low-level exposure to lead, blood pressure, and hypertension in a population-based cohort

BackgroundEnvironmental lead exposure is a possible causative factor for increased blood pressure and hypertension, but large studies at low-level exposure are scarce, and results inconsistent. ObjectiveWe aimed to examine the effects of environmental exposure to lead in a large population-based sample. MethodsWe assessed associations between blood lead and systolic/diastolic blood pressure and hypertension in 4452 individuals (46–67 years) living in Malmö, Sweden, in 1991–1994. Blood pressure was measured using a mercury sphygmomanometer after 10min supine rest. Hypertension was defined as high systolic (≥140mmHg) or diastolic (≥90mmHg) blood pressure and/or current use of antihypertensive medication. Blood lead was calculated from lead in erythrocytes and haematocrit. Multivariable associations between blood lead and blood pressure or hypertension were assessed by linear and logistic regression. Two-thirds of the cohort was re-examined 16 years later. ResultsAt baseline, mean blood pressure was 141/87mmHg, 16% used antihypertensive medication, 63% had hypertension, and mean blood lead was 28µg/L. Blood lead in the fourth quartile was associated with significantly higher systolic and diastolic blood pressure (point estimates: 1–2mmHg) and increased prevalence of hypertension (odds ratio: 1.3, 95% confidence interval: 1.1–1.5) versus the other quartiles after adjustment for sex, age, smoking, alcohol, waist circumference, and education. Associations were also significant with blood lead as a continuous variable. Blood lead at baseline, having a half-life of about one month, was not associated with antihypertensive treatment at the 16-year follow-up. ConclusionsLow-level lead exposure increases blood pressure and may increase the risk of hypertension.

Abstract 113: Adherence to Antihypertensive Medication in the Jackson Heart Study (JHS)

Objectives: Adherence to antihypertensive medications is associated with increased blood pressure (BP) control and reduced cardiovascular disease and mortality. The Jackson Heart Study (JHS) is a longitudinal study of 5,301 adults recruited from the general population of the Jackson, Mississippi area designed to evaluate cardiovascular disease in African Americans. The goal of the current analysis was to develop a measure of adherence to antihypertensive medication from available JHS data to facilitate future research in this sample. Methods: JHS participants were asked to bring in all medications taken in the prior two weeks to the baseline interview and were asked if they had taken each medication in the past 24 hours. Non-adherence was defined as not taking all antihypertensive medications in the past 24 hours. The mean of two clinic BP measurements taken one minute apart with a Hawksley random zero sphygmomanometer was used for this analysis. The associations between non-adherence and systolic/diastolic BP and uncontrolled BP (systolic/diastolic BP ≥ 140/90 mm Hg) were examined using linear and Poisson regression. Analyses were adjusted for age, sex, smoking, years of education, income, cohabitation, diabetes, depressive symptoms, and weekly stress symptoms. Results: Of the 5,301 JHS participants, 2,415 who reported current use of antihypertensive medication and had valid clinic BP and 24-hour adherence data were included. The mean age was 54.9 (SD 12.9) years and 68.7% (n=1,660) were female. Overall, 25.3% of participants (n=612) were non-adherent to their antihypertensive medication. For adherent and non-adherent participants, the mean systolic BP was 130.0 (SD 17.2) and 135.2 (SD 19.8) mm Hg, respectively ( P <0.001), and the mean diastolic BP was 78.7 (SD 10.6) and 79.4 (SD 10.9) mm Hg, respectively ( P =0.15). After multivariable adjustment and compared to their adherent counterparts, non-adherent participants had 4.6 (SD 0.8) mm Hg higher systolic BP ( P <.001) and 1.1 (SD 0.4) mm Hg higher diastolic BP ( P =.01). The prevalence of uncontrolled BP was 31.3% among adherent participants and 41.7% among non-adherent participants. After multivariable adjustment, non-adherent participants were 1.28 times more likely to have uncontrolled BP (95% CI:1.14-1.43; P <.001). Conclusions: These findings suggest that 24-hour adherence to antihypertensive medications is a viable measure of medication adherence in the JHS. Implications: Evaluatingmedication adherence in patients with hypertension is important butchallenging. Valid and reliable self-report measures are needed when objectivemeasures are unavailable. If validated in future research, 24-hour adherence to antihypertensive medications may provide a parsimonious way of assessing medication adherence in epidemiological studies.

Abstract P186: Gender Dependent Association Between Asthma and Hypertension in Nationally Representative Young Korean Adults

Background: It has been reported that those with asthma have increased risk of hypertension due to spastic nature of their smooth muscle as well as high cardiac burden of delivering the oxygenated air to the whole body. The prevalence of hypertension tended to increase concurrently with the prevalence of asthma. However, little is known about the relationship between asthma and hypertension in young adults. Method: Among subjects who participated in the Korea National Health and Nutrition Examination Survey conducted in 2008-2013, a total of 10,138 young adults (4,226 men and 5,912 women), aged 19[[Unable to Display Character: –]]39 years were analyzed. Asthma was defined by self-report of ever receiving a diagnosis. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mm Hg, a diastolic blood pressure (DBP) ≥90 mm Hg, or a self-reported current use of antihypertensive medications. Results: The prevalence of asthma was 10.7%(451/4226) in males and 7.8%(459/5912) in females. The prevalence of hypertension was 7.7%(325/4226) in males and 16.6%(981/5912) in females. Mean SBP and DBP were lower in males with asthma than males without asthma (114.4±0.6 vs. 115.5±0.2 (P=0.087), 76.6±0.5 vs. 77.6±0.2 (P=0.033) mmHg, respectively), whereas mean SBP and DBP were higher in females with asthma than females without asthma (106.2±0.7 vs. 104.9±0.2 (P=0.080), 70.9±0.6 vs. 69.6±0.2 (P=0.041) mmHg, respectively). In multiple logistic regression analyses, females with asthma were more likely to have hypertension compared to females without asthma [odds ratio (OR): 2.46, 95 % confidence interval (CI): 1.40-4.35], on the other hands, males with asthma were less likely to have hypertension [OR: 0.54, CI: 0.35-0.81] compared to males without asthma, after adjusting for age, smoking, drinking alcohol, exercise, income status, vitamin D concentration, metabolic risk factors, and co-existing allergic conditions, respectively. Conclusion: Asthma was positively associated with hypertension in female; inversely associated with hypertension in male. This result implies that asthma pathophysiology might be differentially associated with hypertension by gender in young adults. Furthermore, gender specific management of hypertension may be required in young asthmatic patients. Our findings need to be confirmed in prospective cohort and experimental studies to provide further explanation. Key words: Asthma ;hypertension; Prevalence;Blood pressure; KNHANES

CO-13: Temporal evolution of cognitive changes in hypertension and potential effect modification by antihypertensive treatment status. VISAT cohort study

Background Identifying modifiable risk factors for cognitive decline and dementia is crucial to effective preventive strategies. The aim of our study was to compare the cognitive trajectories of individuals with and without hypertension and to study potential effect modification by antihypertensive treatment status. Methods 337 subjects from the VISAT study, a 10-year prospective multi-center cohort, were included. Data were collected at three cross-sectional time point in 1996, 2001 and 2006. Cognitive function, both memory and speed, was assessed. Hypertension was defined as either high blood pressure (greater or equal to 140/90) or current use of antihypertensive medication. Participants with hypertension were further divided into controlled hypertension, uncontrolled hypertension and untreated hypertension. Subjects with no medication use and normal blood pressure represented the control group. Linear mixed models for repeated data were used in our analyses. Results 1105 participants (34%) were classified with baseline hypertension. They were on average older, more often men, had less education, a higher body mass index and more cardiovascular comorbidities. Hypertensive subjects had poorer cognitive performance at baseline, at 5 years of follow-up and finally at 10 years with more pronounced difference (–5.1, 95% CI [−6.37,−3.82], p Conclusions In our study, hypertension went with cognitive decline during follow-up, especially in the second time period which supports the idea of a slowly progressive effect of hypertension on brain functioning. For prevention, such a trajectory seems favorable, providing a window of opportunity for early treatment. Our results also suggest some benefit of antihypertensive treatment on brain health and stress the importance of tight and adequate blood pressure control.

Prevalence of hypertension subtypes in 2011 and the trends from 1991 to 2011 among Chinese adults

BackgroundThis study aims to estimate the current prevalence and trends of hypertension subtypes among Chinese adults from 1991 to 2011.MethodsWe analysed the measurements of systolic and diastolic blood pressure among...

Association between fried food consumption and hypertension in Korean adults.

The present study explored the relationships between fried food consumption and metabolic risk factors and hypertension in Korean adults. The study was based on the fifth Korean National Health and Nutrition Examination Survey between 2010 and 2011. A total of 9221 Korean adults aged ≥19 years were studied. Fried food consumption was assessed using a validated FFQ. Metabolic risk factors such as waist circumference, fasting plasma glucose (FPG), TAG, HDL-cholesterol and systolic and diastolic blood pressure (SBP and DBP) were measured. Hypertension was defined as SBP≥140 mmHg, DBP≥90 mmHg or current use of antihypertensive medication. Adjusted OR for elevated blood pressure significantly increased in men (OR 1·62; 95% CI 1·11, 2·37; P(trend)=0·0447) and women (OR 2·20; 95% CI 1·21, 4·00; P(trend)=0·0403) with a greater than twice a week consumption of fried food compared with those who rarely consumed fried food. However, fried food consumption was not associated with other metabolic risk factors (abdominal obesity, high FPG, hypertriacylglycerolaemia, low HDL-cholesterol and the metabolic syndrome). The adjusted OR for hypertension increased by 2·4-fold in women (OR 2·37; 95% CI 1·19, 4·72; P(trend)=0·0272) with a greater than twice a week fried food consumption compared with those who rarely consumed it. No significant association was found between fried food consumption and hypertension in men. This study suggests that frequent fried food consumption is associated with hypertension in Korean women. Further studies are needed to investigate the effect of different types of fried foods on hypertension.

Age and sex differences in the relationship between serum 25-hydroxyvitamin D and hypertension in the general Korean population.

Previous studies have suggested that serum 25-hydroxyvitamin D (25(OH)D) is associated with hypertension. However, the effects of age and sex on the relation between serum 25(OH)D and hypertension has not been examined. The present study examined the relationship between serum 25(OH)D and hypertension by age and sex in the general Korean population, considering potential confounders for hypertension. We conducted a population-based, cross-sectional study. Twenty thousand four hundred and forty adults aged 19 years or older, who participated in the 2009-2012 Korean National Health and Nutrition Examination Surveys, were selected for the present study. Hypertension was defined as a systolic blood pressure ⩾ 140 mm Hg, diastolic blood pressure ⩾ 90 mm Hg or current use of antihypertensive medication. We found that serum 25(OH)D levels are inversely associated with hypertension in young and middle-aged adults, but not in the elderly population. In young and middle-aged adults, the adjusted odds ratios (ORs) for hypertension tended to decrease according to the quartiles of serum 25(OH)D after adjustment for potential confounders, although it was only significant in women (OR=0.73, 95% confidence interval (CI)=0.58-0.91, P for trend=0.0349). There was no association between serum 25(OH)D concentration and hypertension in elderly subjects of either sex. A higher serum 25(OH)D level was strongly associated with a lower prevalence of hypertension in young and middle-aged Korean women, but not in elderly adults.

Association of Serum 25-Hydroxyvitamin D and Parathyroid Hormone With Hypertension in Middle-Aged and Older Korean Adults.

Previous studies have suggested that serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels are associated with hypertension. However, the associations have yet to be studied in Koreans. This study explored the relationship among serum 25(OH)D, PTH concentrations, and the presence of hypertension in middle-aged and older Korean adults using the most recent nationally representative survey data. A population-based, cross-sectional study was conducted with data collected from 5,260 Korean adults (aged ≥50 years) who participated in the 2010 and 2011 Korean National Health and Nutrition Examination Surveys. Hypertension was defined as a systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or current use of antihypertensive medication. The prevalence of hypertension significantly increased according to the quartiles of serum PTH levels (P < 0.0001), but not of serum 25(OH)D levels. In multivariable logistic analysis, the adjusted odds ratios (ORs) for hypertension were significantly higher among participants in the highest quartile than among those in the lowest quartile of serum PTH level, after adjusting for potential confounders (OR = 1.26, 95% confidence interval: 1.02-1.56, P = 0.03). The adjusted ORs for hypertension tended to decrease across the quartiles of serum 25(OH)D level, but the associations were not significant. Serum 25(OH)D was not associated with the presence of hypertension, whereas serum PTH was positively associated, suggesting that serum PTH may be an independent risk factor for hypertension in middle-aged and older Korean adults.

Age and Sex Analysis on the Relationship between Serum 25‐Hydroxyvitamin D and Hypertension in General Korean Population

BackgroundPrevious studies have suggested that serum 25‐hydroxyvitamin D [25(OH)D] is associated with hypertension. However, it has not been examined the age difference on the relation between serum 25(OH)D and the risk of hypertension.ObjectiveThe present study examined the relationship between serum 25(OH)D and the risk of hypertension by age in general South Korean populations with considering potential risk factors for hypertension.MethodsWe conducted a population‐based, cross‐sectional study.20,440 adults aged 19 years or over that participated in 2009 to 2012 Korean National Health and Nutrition ExaminationSurveys were selected for the present study. Hypertension was defined as SBP 蠅140 mmHg, or DBP蠅90 mmHg, or current use of anti‐hypertensive medication.ResultsWe found that serum 25(OH)D levels are inversely associated with the risk of hypertension in young and middle‐aged adults, but not in elderly. In young and middle‐aged adults, the adjusted ORs for hypertension tended to decrease according to the quartiles of serum 25(OH)D after adjustment for potential confounders significantly only in women (OR=0.73, 95% CI=0.58‐0.91, P for trend =0.0345). ). Although the adjusted ORs for hypertension showed the tendency to decrease with increasing serum 25(OH)Dconcentration, the association was not significant. There was no association between serum 25(OH)D concentration and the risk of hypertension in elderly subjects.ConclusionHigher serum 25(OH)D level was strongly associated with a lower risk of hypertension in young and middle‐aged Korean women, not in elderly.

Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension.

1. Relationship Between Hypertension and CAD e437 2. Prevention of Cardiovascular Events in Patients With Hypertension and CAD e443 3. BP Goals e445 4. Management of Hypertension in Patients With CAD and Stable Angina e449 5. Management of Hypertension in Patients With ACS e451

Dynamics of arterial hypertension and its impact on mortality in the Russian population

Aim. To assess impact of hypertension status in Muscovites cohort aged 35-64 examined twice for 20-years period on all cause mortality. Material and methods. Population based cohorts consists of 2029 Muscovites (1046 men and 983 women) observed twice during 21,8 years period. The same protocol was used with response rate - 65%. Participants defined as hypertensives if their SBP was ≥140 mm Hg, and/or their DBP was ≥90 mm Hg, and/or they reported current use of antihypertensive medications. Effective treatment - the proportion of those with SBP

Creatine kinase as predictor of blood pressure and hypertension. Is it all about body mass index? A follow-up study of 250 patients.

The correlation between creatine kinase (CK) and blood pressure (BP) was examined prospectively in 120 patients with persistent high CK and 130 individuals with normal CK. Hypertension was defined as systolic BP (SBP) ≥ 140 mm Hg or diastolic BP (DBP) ≥ 90 mm Hg or current use of antihypertensive medication. Baseline CK was weakly correlated with SBP (r = 0.11, P = .07) and DBP (r = 0.16, P = .01) at follow-up. Persons with persistent high CK had higher SBP (140.8 mm Hg vs 138.2 mm Hg) and DBP (83.2 mm Hg vs 81.0 mm Hg, P = .06) values and were more likely to have hypertension (66.7% vs 55.5%, P = .05) than individuals with normal CK. In age- and sex-adjusted analysis, a 1-unit change in logCK was associated with a 4.9-mm Hg higher SBP, a 3.3-mm Hg higher DBP, and a 2.2-higher odds for having hypertension at follow-up (P = .1, .07, and .06, respectively). When including body mass index (BMI) to the model, BMI was a strong and independent predictor for SBP, DBP, and hypertension at follow-up and the CK effect on blood pressure was substantially attenuated. This study showed that the CK effect on blood pressure is clearly modified by BMI.

Abstract P046: Association of Stromal Derived Factor 1 (SDF1) and Transforming Growth Factor ß1 (TGFß1) with Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis (MESA)

Incident hypertension varies across races/ethnicities. Mechanisms implicated in the pathogenesis are endothelial dysfunction with reduction of nitric oxide and alterations of the Renin-Angiotensin-Aldosterone System (RAAS). Stromal Derived Factor 1 (SDF1) and Transforming Growth Factor β1 (TGFβ1) are essential in these processes. SDF1 is a chemotactic protein that regulates migration of endothelial progenitor cells from the bone marrow to the arterial wall to repair endothelial damage; TGFβ1 promotes extra-cellular matrix deposition within arterial vessels, inhibits nitric oxide production and stimulates renin release. In order to investigate the association of circulating levels of these proteins with incident hypertension across different ethnicities, an ethnic stratified random sample of 2,880 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Of those, 988 participants had available plasma samples and were without hypertension, defined as blood pressure ≥ 140/90 mmHg, or current use of antihypertensive medications, at baseline. During a median follow up of 8.5 years, 388 new cases of hypertension (101 in non-Hispanic whites, 94 in Chinese, 101 in African Americans and 92 in Hispanics) were observed. Time to hypertension incidence was estimated using Cox proportional hazards regression. Hazard Ratios were adjusted for age, sex, diabetes, LDL, HDL, triglycerides, BMI, smoking status and current alcohol use. The race/ethnicity by protein interaction p-values were 0.055 and 0.066 for TGFβ1 and SDF1 respectively, suggesting heterogeneity across races/ethnicities. In Chinese, a difference of one standard deviation of plasma TGFβ1 was associated with a 22% increase in incident hypertension (HR (95% CI) 1.22 (1.02, 1.47), p-value=0.03); and a difference of one standard deviation of plasma SDF1 was associated with a 31% decrease in incident hypertension (HR (95% CI) 0.69 (0.52, 0.91), p-value 0.008). No significant association was found between these proteins and incident hypertension among non-Hispanic whites, African or Hispanic Americans. In conclusion, soluble markers of endothelial integrity and of RAAS activation were associated with the incidence of hypertension among Chinese Americans. These results suggest heterogeneity in the pathophysiology of hypertension according to race/ethnicity.

Ethnic Differences in the Incidence of Hypertension among Rural Chinese Adults: Results from Liaoning Province

BackgroundThis study was conducted to examine the differences in the incidence of hypertension and associated risk factors between Mongolian and Han populations in northeast China.MethodsA population-based sample of 4753 Mongolian subjects and 20,247 Han subjects aged ≥35 years and free from hypertension at baseline were followed from 2004–2006 to 2010. Incident hypertension was defined as systolic blood pressure≥140 mmHg, diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication.ResultsDuring mean 4.3 years follow-up, a total of 8779 individuals developed hypertension. The age-adjusted incidence of hypertension for Mongolian subjects was 12.64 per 100 person-years, for Han subjects was 9.77 per 100 person-years (P<0.05). The incidence of hypertension was positively correlated with age, physical activity, drinking, body mass index (BMI), family of hypertension and prehypertension in the Han population. In the Mongolian population, hypertension was positively correlated with age, physical activity, education level, drinking, BMI, prehypertension and family history of hypertension. The rates of awareness, treatment and control of hypertension for newly developed cases among both Han and Mongolian populations were low. (36.5% vs. 42.3%, 13.1% vs. 18.2%, 0.7% vs. 1.3%, P<0.05, respectively).ConclusionsThe incidence rate of hypertension is higher in the Mongolian populations than that in the Han populations, and hypertension in both ethnic populations was associated with similar risk factors. Our results suggest that most newly-diagnosed cases of hypertension are not adequately treated. Improvements in hypertension prevention and control programs in rural China are urgently needed.

Динамика артериальной гипертонии и ее влияние на смертность в российской популяции

Aim. To assess impact of hypertension status in Muscovites cohort aged 35-64 examined twice for 20-years period on all cause mortality. Material and methods. Population based cohorts consists of 2029 Muscovites (1046 men and 983 women) observed twice during 21,8 years period. The same protocol was used with response rate - 65%. Participants defined as hypertensives if their SBP was ≥140 mm Hg, and/or their DBP was ≥90 mm Hg, and/or they reported current use of antihypertensive medications. Effective treatment - the proportion of those with SBP<140 mm Hg and DBP<90 mm Hg among those treated.The first survey participants were divided into the four groups by blood pressure levels and arterial hypertension treatment: First - normal blood pressure, second - treated and controlled hypertensives, third - hypertensives never treated, and fourth - treated but not achieved target BP level. Mortality follow up after second screening was 3,7 years, 154 deaths were observed.Proportional hazard (Cox) regression was applied for linking all cause mortality with groups of hypertension status controlling on sex, age and survey. First - used as a reference group.Results. During the observation period mean SBP has increased among males by 17,6 mm Hg (p<0,0001) and among females by 8 mm Hg (p<0,0001). Mean DBP has decreased significantly among both sexes, (p<0,0001). The dramatically increase in the prevalence of hypertension (from 42,0 to 76,2% in males; from 41,8 to 72,9% in females; р<0,0001) was found.The frequency of adherence to antihypertensive medications without achieving target value has increased (from 3 to 33,2% in males and from 7,4 to 33,1% in females; p<0,0001). The frequency of effective treatment has increase (males: from 0,9 to 14,8%, females: from 3,1 to 23,7%; p<0,0001). After adjustment for sex, age at the first screening, and second hypertension status the effective treated subjects presented a similar all cause mortality risk (risk ratio - RR 0,618 with 95% confidence interval - CI 0,084-4,527) as those with normal blood pressure. Hypertensives who didn’t take medication presented RR 1,564 (1,107-2,208). Those without control of hypertension had RR 1,728 (0,79-3,78).Conclusion. The natural history of hypertension in our country demonstrates its dramatic increase with age. Keeping in mind the progression of the aging process, we expect the increase number of persons suffering from hypertension. To reduce the risk of death in hypertensives it is necessary to steadily improve adherence to treatment and thus increase the number of effective treatment of patients.

Elevated depressive symptoms in metabolic syndrome in a general population of Japanese men: a cross-sectional study

BackgroundUncertainty still surrounds the association between metabolic syndrome (MetS) and depression. We aimed to evaluate the association between MetS and elevated depressive symptoms in a general Japanese population.MethodsThis is a cross-sectional survey of 3,113 community-dwelling individuals aged 40 years or over. MetS was defined according to the joint interim statement. MetS was diagnosed when a subject had three or more of the following components: 1) central obesity (waist circumference ≥90 cm for men, ≥80 cm in for women); 2) elevated blood pressure (≥130/85 mmHg or current use of antihypertensive medication); 3) hypertriglyceridemia (≥1.7 mmol/L); 4) low HDL cholesterol (< 1.0 mmol/L for men, < 1.3 mmol/L for women); and 5) elevated fasting plasma glucose (≥5.55 mmol/L or current use of antidiabetic medication). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The age- and multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated using a logistic regression model.ResultsElevated depressive symptoms were observed in 4.3% of male and 6.3% of female participants. In men, the age-adjusted prevalence of elevated depressive symptoms was significantly higher in subjects with MetS than in those without (7.1% versus 3.6%, p = 0.04). The prevalence of elevated depressive symptoms rose progressively as the number of MetS components increased (3.5%, 3.6%, 5.8%, and 9.2% in male subjects with 0–1, 2, 3, and ≥4 components, respectively; p = 0.02 for trend). This association remained significant even after adjustment for age, marital status, history of cardiovascular disease, smoking habit, alcohol intake, and regular exercise. In women, on the other hand, there was no clear association between MetS and depressive symptoms.ConclusionsMetS was associated with elevated depressive symptoms in a general population of Japanese men.

Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults

BackgroundChronic kidney disease (CKD) is an emerging public health problem worldwide. Previous studies have shown an association between blood pressure (BP) and CKD. However, it is not clear if there are ethnic differences in this association. We examined the association between BP and CKD in a multi-ethnic Asian population in Singapore.MethodsWe analysed data from three large population-based studies conducted between 2004–2011, (n=3,167 Chinese, 3,082 Malays and 3,228 Indians) aged 40–80 years. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73m2 from serum creatinine. Hypertension was defined as a self-reported current use of antihypertensive medication or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. We also analysed the association of CKD with individual BP components.ResultsThe prevalence of both hypertension and CKD was higher among Malays (68.6, 21%) compared to Chinese (57.9, 5.9%) and Indians (56.0, 7.4%), but treatment for hypertension was lower among Malays (53.4%) compared to Chinese (89.8%) and Indians (83.1%). Hypertension was associated with CKD in all three ethnic groups (OR [95% CI] = 2.71 [1.59-4.63], 2.08 [1.62-2.68], 2.43 [1.66-3.57] in Chinese, Malays and Indians). Among the BP components, both systolic and diastolic BP were associated with CKD in Malays whereas, systolic BP was not significantly associated with CKD, and diastolic BP showed an inverse association which was explained by anti-hypertensive medication use in Chinese and Indians.ConclusionsHypertension was associated with CKD in Chinese, Malays and Indians. However, the BP components were associated with CKD only in Malays.

Preconception Care: The Perfect Opportunity for Health Care Providers to Advise Lifestyle Changes for Hypertensive Women

To provide estimates for prevalence of health care provider advice offered to reproductive-aged women and to assess their association with behavior change. Cross-sectional study using the 2009 Behavioral Risk Factor Surveillance System. Setting. Nineteen states/areas. Women aged 18 to 44 years with a self-reported history of hypertension or current antihypertensive medication use (n = 2063). Self-reported hypertension; sociodemographic and health care access indicators; and provider advice and corresponding self-reported behavior change to improve diet, limit salt intake, exercise, and reduce alcohol use. We estimated prevalence and prevalence ratios for receipt of provider advice and action to change habits. We calculated 95% confidence interval (CI) and used χ(2) tests to assess associations. Overall, 9.8% of reproductive-aged women had self-reported hypertension; most reported receiving advice to change eating habits (72.9%), reduce salt intake (74.6%), and exercise (82.1%), and most reported making these changes. Only 44.7% reported receiving advice to reduce alcohol intake. Women who received provider advice were more likely to report corresponding behavior change compared to those who did not (prevalence ratios ranged from 1.3 [95% CI, 1.2-1.5, p < .05] for exercise to 1.6 [95% CI, 1.4-1.8, p < .05] for reducing alcohol use. Health care providers should routinely advise hypertensive reproductive-aged women about lifestyle changes to reduce blood pressure and improve pregnancy outcomes.

Abstract 18578: Replication of a Risk Prediction Model for Ambulatory Incident Atrial Fibrillation Using Electronic Medical Record

Introduction: Atrial fibrillation (AF) contributes to substantial increases in morbidity, mortality and increasing healthcare expenditures. Using data from community-based cohorts, CHARGE-AF investigators developed an AF risk prediction model. We aimed to replicate the CHARGE AF risk model using the Vanderbilt electronic medical records (EMR) repository. Methods: We identified a large ambulatory cohort of Caucasians and African Americans of age ≥ 40 years without a prior history of AF, followed by assessment of incident AF over a 5-year period (December 2005 to December 2010) using prospective chart review and validated AF algorithm. Baseline clinical variables (age, ethnicity, sex, height, weight, systolic and diastolic BP, PR interval, current use of antihypertensive medications, DM, MI, CHF, current smoking, and LVH on ECG) were extracted on or within 6 months prior to December 2005. We used multiple imputation for missing values and multivariable Cox proportional hazards analysis to construct our risk prediction model. Results: Our study cohort consisted of 63,772 subjects (age 58±11 years, 47% male, 90% Caucasians) with no prior history of AF. Over a mean follow up time of 3.9±0.95 years, 3,383 (5.3%) subjects developed AF in 2.6±1.3 years. In the multivariable model, older age, Caucasian ethnicity, male sex, taller height, greater weight, history of heart failure, LVH on ECG and prolonged PR interval were all significant risk predictors of AF (similar to CHARGE-AF risk model), whereas current use of antihypertensive medication was protective of developing AF (Table). The C-index from our model, 0.768, indicated relatively good discrimination. Conclusions: From clinical factors readily accessible in a large de-identified EMR database, we replicated the CHARGE AF risk prediction model to identify individuals at risk for developing AF in an ambulatory setting. This risk model may be used to target high risk-individuals for preventive measures.

Trends in prevalence, awareness, treatment, and control of hypertension, and the risk of mortality among middle-aged Lithuanian urban population in 1983–2009

BackgroundArterial hypertension (AH) is a main risk factor for the risk from cardiovascular (CVD) and stroke mortality. Only few data was published on prevalence, awareness and management of AH in Lithuania. Development of objective approaches to the treatment and control of AH reduces the risk of mortality. The aim of this study was to evaluate time trends, the prevalence, awareness, treatment and control of AH and risk of mortality among Lithuanian urban population aged 45–64 years during the period of 1983–2009.MethodsTime trends of AH and risk of mortality were examined in three MONICA health surveys in 1983, 1986, 1992, and in one health survey according to MONICA protocol in 2002 included randomly recruited of 2,218 men and 2,491 women. AH was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP of ≥90 mmHg or current use of antihypertensive medication. The main outcome measures were all-cause mortality, mortality from CVD, coronary heart disease (CHD) and stroke. The mean duration of follow-up was 11.8 ± 9.2 years. All survey periods were age standardized to the year 2006 of Kaunas population. The estimates of hazard ratio and 95% confidence interval were based on the multivariate Cox proportional hazards regression.ResultsIn men during 1983–2002 period hypertension prevalence was 52.1–58.7% and did not significantly change whereas in women decreased from 61.0 to 51.0%. There was a significant increase in hypertension awareness among hypertensive men and women (45.0 to 64.4% and 47.7 to 72.3%, respectively) and in treated hypertensives (55.4 to 68.3% in men and 65.6 to 86.2% in women). Adjusted Cox proportional hazard regression analyses revealed a strong dose–response association between blood-pressure level and all-cause, CVD, CHD and stroke-mortality risk in both men and women groups.ConclusionIn Lithuanian urban population the prevalence of hypertension remains high. Despite positive changes in hypertension awareness and treatment, hypertension control remains poor. A strong dose–response association between the level of BP and all-cause, CVD, CHD and stroke mortality risk was indicated.