Determinants Of Elevated Blood Pressure Research Articles

Hemodynamic Determinants of Elevated Blood Pressure and Hypertension in the Middle to Older-Age UK Population: A UK Biobank Imaging Study.

Increased systemic vascular resistance and, in older people, reduced aortic distensibility, are thought to be the hemodynamic determinants of primary hypertension but cardiac output could also be important. We examined the hemodynamics of elevated blood pressure and hypertension in the middle to older-aged UK population participating in the UK Biobank imaging studies. Cardiac output, systemic vascular resistance, and aortic distensibility were measured from cardiac magnetic resonance imaging in 31 112 (distensibility in 21 178) participants (46.3% male, mean age±SD 63±7 years). Body composition including visceral adipose tissue volume and abdominal subcutaneous adipose tissue volume were measured in 19 645 participants. Participants with higher blood pressure had higher cardiac output (higher by 17.9±26.6% in hypertensive compared with those with optimal blood pressure) and higher systemic vascular resistance (higher by 11.4±27.9% in hypertensive compared with those with optimal blood pressure). These differences were little changed after adjustment for body size and adiposity. The contribution of cardiac output relative to systemic vascular resistance was more marked in younger compared with older subjects. Aortic distensibility decreased with age and was lower in participants with higher compared with lower blood pressure but with a greater difference in younger compared with older subjects. In the middle to older-aged UK population, cardiac output plays an important role in contributing to elevated mean arterial blood pressure, particularly in younger compared with older subjects. Reduced aortic distensibility contributes to a rise in pulse pressure and systolic blood pressure at all ages.

Prevalence and Determinants of Elevated Blood Pressure among Children in Rural Kayonza District, Rwanda

Childhood elevated blood pressure (BP) has emerged as a concern for global public health. In Sub-Saharan African countries, where Rwanda is located, there is a scarcity of BP data for both children and adolescents. Elevated blood pressure (EBP) is a neglected issue in children, it can develop in young age and can last into adulthood. This community-based cross-sectional study in rural Kayonza, Rwanda investigated the prevalence and determinants of elevated blood pressure (EBP) in children aged 36 months. Measurements of blood pressure and height were converted to percentiles using World Health Organization standards. Data collection involved face-to-face interviews with a digital questionnaire. OMRON HBP-1320 blood pressure monitor and SECA 213 stadiometer were used. The mean systolic blood pressure was 90.60 mmHg and 58.75 mmHg and standard deviation of 7.60mHg for diastolic blood pressure. Most child's mothers (76%) were farmers, more than half (62.7%) of child mothers attended primary school, and 36.60% were between the ages of 31 and 35. (Mean age: 30.4 years, Stand. Dev.: 4.4, Minimum age: 21 years and Maximum age: 39 years), (53%) of children were males, 38 % were 36 months old (Mean age: 36.9 months, Stand. Dev.: 1.0, Minimum age: 35 months, and Maximum age: 39 months). Elevated BP for children is defined as being prehypertensive and hypertensive; all children with systolic or diastolic blood pressure percentiles of ≥90th to <95th were prehypertensive, while those with systolic or diastolic blood pressure percentiles of ≥95th to 99th and above were hypertensive. The prevalence of elevated BP was 40.4% with 18.6% being prehypertension and 21.8% being hypertension among 3-year-old children in the rural Kayonza district. Of them 72 (97%) children who had elevated blood pressure, their family were using biomass fuel and 71(36.60%) of study children were below the 5th percentile of height which an indicator of short stature, 27(40.91%) among them had elevated blood pressure. Factors like difficulty getting food on daily basis (food insecurity) (AOR=3.75; 95% CI: [1.70-8.27]; p=0.001) and medium monthly family income (AOR= 2.38; 95% CI: [1.07-5.31]; p=0.033) were associated with increased prevalence of elevated BP. No statistically significant was found between elevated blood pressure and prenatal factors. Mobilization and increase community’s awareness on the procedure for measuring children’s BP during routine health visits from 3 years old should be done to prevent this increasingly common health condition which is ignored and in asymptomatic nature. Keywords: Elevated Blood Pressure, Prehypertension, Hypertension, Prenatal Factors, Environmental Factors, Behavioural Factors, Kayonza District, Rwanda.

Associations of obesity and serum leptin level with elevated blood pressure among urban secondary school students of a northeastern city of India: A baseline observation.

Background:Elevated blood pressure has been found to be associated with body mass index (BMI) and serum leptin levels among adults. But there is a paucity of reports regarding such associations among adolescents.Objectives:To estimate the prevalence of prehypertension and hypertension and its associations with BMI and serum leptin levels among the secondary school going students of the Agartala Municipal Corporation area.Materials and Methods:This school-based cross-sectional study was conducted from 1st April 2018 to 31st December 2018, among 1,000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multistage sampling ensuring proportionate representation in the sample.Result:Prevalence of prehypertension and hypertension were found to be 42.40% and 15.70%, respectively, 55.20% had normal, 22.80% had low, and 22.00% had high BMI. Serum leptin levels were found to be normal among 54.70% of the students, whereas, 36.70% had high and 8.60% had low levels, respectively. Logistic regression analysis has identified male sex (OR = 0.231, 95% CI = 0.172–0.310, P = 0.000) and high BMI (OR = 4.289, 95% CI = 2.857–6.440, P = 0.000) as the significant determinants of elevated blood pressure, but the effect of serum leptin level and family history of hypertension did not attain the level of statistical significance.Conclusion:Prevalence of prehypertension and hypertension among urban school-going adolescents were found to be 42.40% and 15.70%, respectively and were significantly associated with their sex and BMI and serum leptin level, but regression analysis failed to detect any significant effect of serum leptin level in determining the blood pressure of the study subjects.

Abstract P406: Sleep Health as an Important Determinant of Elevated Blood Pressure: A Population Based Study

Introduction: One mechanism elucidating the association between lack of sleep and elevated blood pressure includes over-activity of the sympathetic neurotransmitters which in turn raises the levels of adrenaline in the blood. Persistently raised adrenaline levels directly elevate heart rate, systolic blood pressure (SBP) and the diastolic blood pressure (DBP). We aimed at evaluating the association of sleep duration with blood pressure among the adult population in the United States after adjusting for the confounding effects of age, gender, BMI, income poverty ratio (IPR), and race. Methods: Our study was based on a population-based cross-sectional study design, comprising of a nationally representative sample of US adults derived from the National Health and Nutrition Examination Survey (NHANES) data cycle 2013-2014 (N=6266). Study population comprised of adults aged 16 years or above who had participated in both interview and medical examination components of the NHANES survey. Measurements on SBP, DBP, and BMI were obtained at the designated clinic by trained personnel, while age, gender, IPR, and race were recorded during the interview by self-report. Results: Of 6266 participants, aged between 16 to 80 years with a mean age of 45( + 9.2) years, a total of 2302 (34%) reported short sleep duration (<6 hours per day) (Table 1). The outcome variables, SBP and DBP, were significantly different across short and normal sleep duration (p-value <0.05) (Table 1). SBP and DBP were also significantly different among males and females (p-value <0.0001) (Table 2). Both unadjusted and adjusted analyses showed a statistically significant association between sleep duration and DBP [b adjusted = -0.42, sd=0.16, 95%CI= -0.74, 0.08, p-value= 0.02]. When stratified by gender, the association was only significant for males [b adjusted = -0.50, sd=0.20, 95%CI= -0.90, -0.09, p-value = 0.02] (Table 3). Conclusion: Sleep health is a significant determinant of elevated blood pressure in our data even when BMI was held constant. Prospective studies are needed to augment the understanding of this association to seek early public health and behavioral interventions for the prevention of premature cardiovascular morbidity.

OP.6A.03] PREVALENCE AND DETERMINANTS OF HYPERTENSION IN A COHORT OF 15.049 PORTUGUESE CHILDREN AND ADOLESCENTS. THE AVELEIRA REGISTRY

Objective: To ascertain the prevalence and fundamental determinants of arterial hypertension (Ht) in children and adolescents. Objective: Table: Determinants of elevated blood pressure through logistic regression. Design and method: Cross-sectional assessment of blood pressure (BP) in 15.049 portuguese children and adolescents, mean age 13.02 ± 2.05 years (5–17 years), body mass index (BMI) 19.22 ± 3.60 Kg/m2, mostly male (73%). BP and heart rate were measured three times after a 10-minute resting period, with a validated automatic blood pressure monitor (OMRON 705IT) and an appropriately sized cuff over the brachial artery. About 26% of the youngsters were amateur registered athletes and 20% had family history of cardiovascular diseases (mainly Ht). All participants were clinically evaluated by the same clinician, warranting an uncommon high degree of reproducibility of the clinical evaluations. Results: Mean BP was 112.82 ± 9.27 mmHg and 70.42 ± 6.49 mmHg, for systolic and diastolic BP. Mean heart rate (HR) was 70.32 ± 18.01 bpm. BP distribution was 15.7% Ht (12.5% stage 1, 3.2% stage 2), 15.3% high-normal, and 69% normal. The distribution of Ht and high-normal BP was slightly higher in males (16.2% and 16.1%, respectively) than females (14.1% and 13.1%, respectively; p = 0.001). Overweight and at-risk weight classification accounted respectively for 6.3% and 13.6% of the cohort. The determinants of elevated BP were assessed through logistic regression (cf. table). Male sex, increased BMI, no regular physical activity and family history of Ht were the main determinants of elevated BP. Considering the BMI, a 7.6% increase in the risk of Ht and a 7.5% increase in the risk of high-normal BP per 1 kg/m2 of BMI were also documented. Conclusions: The proportion of children with BP above the 90th percentile was high, with an overall prevalence of Ht of 15.7%, related to overweight, physical inactivity, male gender and family history of Ht.

How much salt do adults consume in climate vulnerable coastal Bangladesh?

BackgroundEvidence from numerous studies suggests that salt intake is an important determinant of elevated blood pressure. Robust data about salt consumption among adults in Bangladesh is sparse. However, much evidence suggests saline intrusion due to sea level rise as a result of climate change exposes more than 20 million people to adverse effects of salinity through the food and water supply. The objective of our study was to assess salt consumption among adults in a coastal region of Bangladesh.MethodsOur study was cross sectional and conducted during October-November 2011. A single 24 hour urine was collected from 400 randomly selected individuals over 18 years of age from Chakaria, a rural, coastal area in Southeastern Bangladesh. Logistic regression was conducted to identify the determinants of high salt consumption.ResultsThe mean urinary sodium excretion was 115 mmol/d (6.8 g salt). Based on logistic regression using two different cutoff points (IOM and WHO), housewives and those living in the coastal area had a significantly higher probability of high salt intake compared with people who were engaged in labour-intensive occupations and who lived in hilly areas.ConclusionIt is important to create awareness about the implication of excessive salt intake on health and to develop strategies for reducing salt intake that can be implemented at the community-level. A sustainable policy for salt reduction in the Bangladeshi diet should be formulated with special emphasis on coastal areas.

Blood pressure level profiles among children and adolescents with various types of obesity: study in a large population in Shandong, China

It is well known that obesity is a key determinant of elevated blood pressure (BP) in children and adolescents. The present study compared the BP levels among children and adolescents with various types of obesity in a large population in China. A total of 38,822 students (19,456 boys and 19,366 girls) aged 7-17 years participated in this study. Height, weight, waist circumference (WC), and BP of all subjects were measured, and body mass index (BMI) was calculated. General obesity was assessed by BMI and central obesity by WC. All obese subjects were classified into three types: general obesity only, central obesity only and combined obesity. Relatively high BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender. The overall prevalences of general obesity only, central obesity only and combined obesity were 10.38, 9.61 and 10.77 % for boys and 5.46, 11.41 and 5.44 % for girls, respectively. In both boys and girls, significant differences in BP level and the prevalence of relatively high BP were observed among the three types of obesity (P < 0.05); combined obesity group had the highest BP levels and prevalence of relatively high BP. Children and adolescents with both general and central obesity might have an increased risk of elevated BP than those with isolated types of obesity. Our results suggest that the combined measurement of BMI and WC as a screening tool for high BP among children and adolescents.

Abstract 602: Determinants of Elevated Blood pressure with Water Immersion

Introduction ; Although exercise in water is appreciated in rehabilitation for patients with renal disease and obesity individuals with knee joint pain, elevated blood pressure (BP) is also induced by water immersion via water pressure. This elevation of BP in water may lead to incidence of acute heart diseases in rehabilitation exercise. It is important for prevention of such acute event to understand determinants of elevated BP with water immersion. Hypothesis ; We assessed the hypothesis that elevated BP with water immersion is affected by venous volume or baroreflex sensitivity (BRS) as well as age or arterial stiffening, because blood pressure is associated with venous return (contributing cardiac output) or vascular functions. Methods ; Thirty-eight young (21.2 ± 1.7 yrs) and 20 older (65.1 ± 3.2 yrs) men participated in this study. In all subjects, mean BP (oscillometric method), pulse wave velocity adjusted by BP (cardio-ankle vascular index: CAVI), venous volume (by using MRI and plethysmography), and BRS by using valsalva maneuver were measured at resting supine position on land. Furthermore, BP and heart rate at standing position on land and following in water (located surface of water at epigastrium) were determined. Results ; On land, mean BP and CAVI were greater, and BRS was smaller in older men compared with young men. There was no different venous volume between 2 age groups. Change in increased systolic BP with water immersion was greater in older men (127 ± 12 mmHg → 145 ± 18 mmHg; P&lt;0.05) than in young men (118 ± 129 mmHg → 129 ± 10 mmHg; P&lt;0.05) (Interaction; P&lt;0.05). Multiple-regression analysis revealed that the change in increased systolic BP with water immersion were independently associated with CAVI (beta = 0.406), when entering BRS, heart rate, venous volume, and CAVI. Conclusion ; In conclusion, these results of the present study suggests that arterial stiffening may contribute to elevated BP with water immersion, but not BRS or venous volume.

Population-Wide Sodium Reduction: The Bumpy Road from Evidence to Policy

Elevated blood pressure is a highly prevalent condition that is etiologically related to coronary heart disease and stroke, two of the leading causes of morbidity and mortality throughout the world. Excess salt (sodium chloride) intake is a major determinant of elevated blood pressure. In this article, we discuss the scientific rationale for population-wide salt reduction, the types and strength of available evidence, policy-making on dietary salt intake in the United States and other countries, and the role and impact of key stakeholders. We highlight a number of lessons learned, many of which are germane to policy development in other domains.

Determinants for the development of hypertension in adolescents. A 6-year follow-up.

This study was aimed to evaluate the determinants of elevated blood pressure (BP) in adolescents. We retrospectively evaluated the BP and anthropometric data in 419 Japanese students (268 males and 151 females) during high school and university. Their annual health records were analysed for BP, heart rate, height and body weight between the ages of 15 and 21 years. The number of hypertensive students did not vary significantly during the 6 years. Concerning changes in BP categories according to the modified JNCVI classification between the ages of 15 to 21 years, 150 males kept a normal BP (keeping normal BP group); 39 males developed high BP (developing high BP group); 37 males kept high BP (keeping high BP group); and 42 males became normal BP (becoming normal BP group). The majority of females (n = 144, 95.4%) were included in the keeping normal BP group. In male students, both the keeping and becoming normal BP groups, especially the latter, showed a significant decrease in heart rate over the 6 years, while the other two groups showed no change. The height and body weight of each of the four groups showed a significant increase, but the body mass index (BMI) of the males in the becoming normal BP group did not increase over the 6 years. Body weight and BMI at the age of 15 years in the male keeping normal BP group were significantly below that of the other three groups; this difference persisted at the age of 21 years. Furthermore, male university students who showed a BP above 'high-normal' at the age of 21 years exhibited a significantly higher BP, heart rate, body weight and BMI than did the normotensives, when they were high school students. Stepwise regression analysis of the data showed that the best predictors of BP at the age of 21 years were the initial high school BP and BMI levels and changes in BMI and heart rate during the 6-year period for male students. Results indicate that the BP and BMI during high school and the changes in BMI and heart rate from high school to university influenced the BP at the age of 21 years in male students. Data indicate that information on the prevention and management of hypertension including weight control should begin early, especially in male adolescents.

Determinants of elevated blood pressure in women around menopause: results from a cross-sectional study in Italy

Objective: To analyse the determinants of high blood pressure in women around menopause. Methods: Eligible women were consecutively identified among patients who asked for a visit of their general practitioner during the period March–November 1997. A total of 22 919 women aged 44–66 years (median age 55 years), were identified. Women whose mean of the second and third of the three measures of diastolic blood pressure values performed during interview was >90 mm of mercury and/or reporting any type of current pharmacological treatment for elevated blood pressure were considered hypertensive. Results: In comparison with women aged 40–50 years, the multivariate odds ratio (OR) of elevated blood pressure were 1.4 in women aged 51–55, 2.0 in those aged 56–60 and 2.7 in those aged ≥61. In comparison with women with a body mass index (kg m −2) <25, the OR of elevated blood pressure was 1.7 and 2.7, respectively, for women with a BMI of 25–28 and ≥29. In comparison with women reporting a low level of physical activity, the OR of elevated blood pressure were 0.9 (95%, confidence interval, CI 0.7–1.0) and 0.7 (95% CI 0.4–0.9), respectively, for those reporting an intermediate or high level of activity. In comparison with premenopausal women, the OR of elevated blood pressure was, after taking into account the confounding effect of age, 1.6 (95% CI 1.0–1.4) in post menopausal ones. The OR of elevated blood pressure was 0.8 (95% CI 0.7–0.9), for current users of hormone replacement therapy (HRT), but no clear association emerged with duration of HRT pressure. Conclusions: This study suggests that, after taking into account the effect of age, post-menopausal women are at higher risk of the condition, and current HRT use decreases the risk. Other main determinants of risk of elevated blood pressure were overweight and low physical activity.

Emotional and familial determinants of elevated blood pressure in black and white adolescent females

The relationship between various measures of the expression and experience of anger (and anxiety), traditional risk factors and blood pressure were examined in a sample of black and white female adolescents who were enrolled in health science courses in Tampa, Florida. Whereas a number of the personality and traditional risk factors were significantly correlated with blood pressure, body mass ( w/h 2) was the most consistent predictor of blood pressure (SBP and DBP) for both black and white females. The findings examining the relationship between suppressed anger (AX/Anger-In) and blood pressure show that SBP and DBP was significantly higher for both black and white females who frequently harbored grudges and held in their angry feelings. In addition, the relationship of AX/Anger-In scores and blood pressure appears to have a ‘threshold’.

Emotional and familial determinants of elevated blood pressure in black and white adolescent males

The relationships between blood pressure and several personality and traditional risk factors were examined in a sample of black and white adolescent males who were enrolled in a health science course in Tampa, Florida. Although a number of personality and traditional risk factors significantly predicted elevated blood pressure for both groups of adolescent males, suppressed anger and weight were the major independent predictors. Among black and white males, those who generally harbored grudges and suppressed their anger had higher systolic blood pressure; diastolic blood pressure was higher only for the white males who frequently held in their angry feelings. Weight and excessive salt usage significantly predicted both elevated systolic and diastolic pressures for white males, while these variables significantly predicted systolic pressures for black males. Familial factors were found to be independent predictors of systolic and diastolic blood pressure only for the white adolescent males. A further examination of the relationship between the frequency that anger is suppressed shows that the shape of the curves relating anger-in scores to blood pressure appers to have a ‘threshold’. These findings indicate that adolescent males who are at increased risk for elevated systolic and diastolic blood pressure can be identified by how often angry feelings are held-in and suppressed.