Future Development Of Hypertension Research Articles

Hypertensive Response to Exercise as an Early Marker of Disease Development.

Arterial hypertension is one of the world's leading risk factors for death and disability. With the number of people living with this disease doubling between 1990 and 2019 from 650 million to 1.3 billion, it is a global burden that increases mortality from cardiovascular and kidney diseases. It is extremely important to use all possible diagnostic methods, indicating the possibility of early detection that subsequently leads to effective prevention of disease development. The phenomenon called hypertensive response to exercise (HRE) is one such method. The HRE is defined as a pathological, excessive increase in blood pressure as a result of exposure to the stressor, which is physical exercise. There is no consensus about precise cutoffs in the definition of this condition, which is most commonly diagnosed based on systolic blood pressure (SBP) ≥ 210 mm Hg in men and ≥190 mm Hg in women at peak exercise intensity. The fact that exercise hypotension is a pathologic sign is universally accepted. Accumulating data deliver the information that HRE is also connected to higher overall cardiovascular risk. It was demonstrated that HRE is associated with functional and structural impairment of the left ventricle and the future development of hypertension. HRE should act as a warning signal of increased cardiovascular risk, leading to the need for profound clinical care.

Fibrosis-4 index is closely associated with future development of hypertension in the Japanese general population.

The fibrosis-4 index, a noninvasive method for evaluating liver fibrosis, is closely associated with cardiovascular events. In this study, we tested the hypothesis that the fibrosis-4 index is associated with new-onset hypertension in the general population. A total of 15,502 individuals (51.0 ± 13.2 years) who participated in our health checkup program were screened. Participants with hypertension were excluded, and the remaining 8719 normotensive participants (48.4 ± 12.6 years) were followed up (median 1739 days) with the endpoint of the new onset of hypertension. During follow-up, 1750 participants (39.0 per 1000 person-years) developed hypertension. In Kaplan-Meier analysis, where participants were divided into three groups according to the fibrosis-4 index at baseline (low, <1.30; intermediate, 1.30-2.67; high, ≥2.67), the risk of hypertension increased with increasing fibrosis-4 index (low, 33.8; intermediate, 55.2; high, 69.4 per 1000 person-years). Multivariate Cox hazard regression analysis revealed that the log-transformed fibrosis-4 index was independently associated with the development of new hypertension (hazard ratio 4.279, 95% confidence interval 3.318-5.518). These results suggest that the fibrosis-4 index is a useful tool to evaluate a risk of developing hypertension in the general population. Hypertension and liver fibrosis may share a common basis.

Relationship between fibrosis-4 index and new onset hypertension in the general population

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) is a risk for cardiovascular events and malignant tumors as well as liver cirrhosis, and the risk increases with increasing fibrosis of the liver. Thus, the fibrosis-4 (FIB-4) index, developed as a noninvasive test to stage liver fibrosis, may predict the development of hypertension. Purpose The present study investigated the relationship of FIB-4 index with the prevalence and future development of hypertension in the general population. Methods A total of 16125 participants who visited our hospital for a physical check-up at least twice from 2008 to 2018 (male=9700, 52.0±12.3 year-old) were subjected for cross-sectional analysis. Among them, 3995 participants were hypertensive. The remaining 12111 normotensive participants (male=6984, 49.5±11.9 year-old) were followed up for the median of 1643 days with the endpoint being the development of hypertension, defined as systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg or the use of antihypertensive medication. FIB-4 index was calculated as follows; (age×AST)/(platelet number×√ALT). Results Cross-sectional analysis revealed that FIB-4 index was higher in hypertensive than normotensive participants (1.40±0.74 vs. 1.09±0.54, p&amp;lt;0.001). During the follow-up, 2819 participants (45.7 per 1000 person-year) developed hypertension. The incidence was more frequent in male (55.6 per 1000 person-year) than female participants (32.7 per 1000 person-year, p&amp;lt;0.001). High level of FIB-4 index (≥2.67, n=194) showed a significant impact on the incident hypertension (80.5 per 1000 person-year) as compare with middle (≥1.30, &amp;lt;2.67, n=3082) or low level (&amp;lt;1.30, n=8835) of FIB-4 index (65.4 and 38.8 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of FIB-4 index for the new onset of hypertension was 1.483 (1.416-1.553). In multivariate Cox hazard analysis adjusted for sex, body mass index, systolic blood pressure, pulse rate, serum creatinine, uric acid, HbA1c, LDL-cholesterol, triglyceride, hemoglobin, current smoking, frequent alcohol consumption and family history of hypertension, FIB-4 index was an independent predictor of the development of hypertension (HR 1.321, 95%CI [1.213-1.438]). Similar results were obtained in analyses of male (HR 1.382, 95%CI [1.300-1.470]) and female subgroups (HR 1.369, 95%CI [1.230-1.524]). History of viral hepatitis or frequent alcohol consumption did not affect the results (data not shown). Conclusions FIB-4 index is a useful predictor of the development of hypertension in the general population. Increased risk of cardiovascular events in patients with NAFLD may partially be attributable to the development of or coexistence with hypertension.

Acute partial sleep deprivation attenuates blood pressure responses to cycling exercise.

Exaggerated blood pressure (BP) responses during exercise are independently associated with future development of hypertension. Partial sleep deprivation (PSD) can increase 24-h ambulatory BP, but the effects on exercise BP are unclear. We hypothesized that acute PSD would augment the BP response to constant load cycling exercise and a 20-min time trial. Twenty-two healthy adults (22 ± 3 yr old; 13 males; V̇o2peak, 43.6 ± 8.2 mL·kg-1·min-1) completed a randomized crossover trial in which they either slept normally (normal sleep-wake schedule for each participant) or sleep was partially deprived (early awakening, 40% of normal sleep duration). Each participant completed a 12-min warm-up consisting of two 6-min steps (step 1, 62 ± 25 W; step 2, 137 ± 60 W) followed by a 20-min time trial on a cycle ergometer. PSD did not alter power output during the 20-min time trial [(control vs. PSD) 170 ± 68 vs. 168 ± 68 W, P = 0.65]. Systolic BP did not differ during step 1 of the warm-up (141 ± 15 vs. 137 ± 12 mmHg, P = 0.39) but was lower following PSD during step 2 (165 ± 21 vs. 159 ± 22 mmHg, P = 0.004) and the 20-min time trial (171 ± 20 vs. 164 ± 23 mmHg, P < 0.001). These results were maintained when peak oxygen uptake (V̇o2peak) was included as a covariate. Systolic BP responses were modulated by sex (time × visit × sex interaction P = 0.03), with attenuated systolic BP during the warm-up and the 20-min time trial in males but not in females. In contrast to our hypothesis, acute PSD attenuates systolic BP responses during constant load and 20-min time trial cycling exercise; however, these observations appear to be primarily driven by changes in males.NEW & NOTEWORTHY A single night of partial sleep deprivation (PSD) can increase ambulatory blood pressure (BP) the following day. Despite this phenomenon, the present study found that acute PSD attenuates systolic BP responses to both constant load cycling and a 20-min cycling time trial in young healthy adults. Interestingly, the attenuated systolic BP responses following PSD appeared to be modulated by sex such that attenuations were observed in males but not in females.

Association between weight gain following smoking cessation and development of hypertension in the future.

Although quitting smoking lowers the risk of developing chronic conditions, it usually leads to weight gain. Literature on the association between weight gain after quitting smoking and the future development of hypertension is scarce. Among 234 596 individuals who visited our health center, 856 who had quit smoking for whom data were available at least 6 years after smoking cessation were included. We evaluated changes in blood pressure and antihypertensive drug prescription rate at 1 and 6 years after smoking cessation. We also compared weight and blood pressure between the smoking cessation and continued smoking groups after 6 years. Multiple regression analyses were performed to identify predictors of changes in systolic and diastolic blood pressures using covariates affecting blood pressure. Since a median weight gain of 1.8 kg was observed at 1 year after smoking cessation, we divided the participants into high and low-weight gain groups. No significant intergroup difference in the antihypertensive drug prescription rate was observed after 6 years. The high weight gain group showed significant increases in systolic and diastolic blood pressures after 6 years. Multiple regression analyses revealed that systolic blood pressure was affected by age and high weight gain, while diastolic blood pressure was affected by high weight gain. Our findings suggest that weight gain following smoking cessation leads to blood pressure elevation: the smoking cessation group gained more weight and had higher blood pressure than the continued smoking group. Therefore, weight loss guidance may be useful for individuals who want to quit smoking. Participants in the high weight gain group showed significant increases in systolic and diastolic blood pressures at 6 years after smoking cessation that were significantly different from those observed in participants in the low weight gain group and the continued smoking group.

Fasting Plasma Glucose and Glycated Hemoglobin Levels as Risk Factors for the Development of Hypertension: A Retrospective Cohort Study.

Hypertension (HTN) is a significant risk factor for cardiovascular disease. Identifying new risk factors for hypertension is crucial. This study aims to determine the predictive value of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) in the development of hypertension. In this study, we examined 16,026 individuals without diabetes and other cardiovascular risk factors who were underwent annual screening at the People's Hospital of Yuxi, Yunnan, China from 2013 to 2016. The participants were divided into two groups: normoglycemic and prediabetic. Normoglycemia was defined as having an HbA1c level of less than 5.7% and an FPG level of less than 5.6 mmol/ L. Prediabetes was defined according to the ADA criteria, which includes having an HbA1c level between 5.7% and 6.5%, or an impaired fasting glucose level between 5.6 mmol/L and 7.0 mmol/L. The participants were further divided into four subgroups based on their FPG and HbA1c levels: normoglycemia, impaired HbA1c only, FPG only, and both parameters impaired. The cohort study was conducted on 16,026 participants from Yunnan, China, consisting of 60.6% males and 39.4% females, with a mean age of 44.6 ± 12.5 years. The study revealed that prediabetes was independently associated with an increased risk for HTN (OR 1.53, 95% CI 1.41~1.67, P < 0.001). The analysis of different subgroups of HbA1c and FPG showed that FPG was a better predictor of HTN than HbA1c, regardless of the group. FPG and HbA1c were significantly associated with the future development of HTN in individuals with prediabetes.

PS-BPC11-1: ASSOCIATION BETWEEN INCREASED ABDOMINAL CIRCUMFERENCE AND FUTURE DEVELOPMENT OF HYPERTENSION IN MILDLY OBESE MIDDLE-AGED INDIVIDUALS

Objective: While increased abdominal circumference is reportedly associated with an increased risk of hypertension, few studies have examined sex-specific differences in this relationship. Here, we investigated sex-specific differences in the association between increased abdominal circumference and future development of hypertension. Design and method: Among 53,281 middle-aged (40 to 59 years old) individuals who underwent a health examination at least once between 2007 and 2014, we examined 890 of 1,744 individuals with mild abdominal obesity (above the median waist circumference) because examination data at 3- and 8-year follow-ups for these individuals were available. Propensity score (PS) matching, based on the first examination data, was used to match participants with an increased waist circumference (IWC; ≧ 3 cm at the 3-year time point, IW group) with those not meeting this criterion (non-IW group). Variables, such as age, body mass index, smoking status, alcohol consumption, estimated glomerular filtration rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (defined as SBP ≧ 140 mmHg and/or DBP ≧ 90 mmHg), were used for PS matching. Blood pressure and hypertension incidence were compared between two groups at the 8-year time point. Results: PS matching resulted in 91 men and 85 women in each group. In men, SBP and hypertension incidence at the 8-year time point were significantly higher in the IW than in the non-IW group (SBP: 126.2 ± 12.8 vs. 121.7 ± 14.8 mmHg, P &lt; 0.05; hypertension incidence: 44.0% vs. 27.5%, P &lt; 0.05). In women, there were no significant differences in these two parameters between the two groups (SBP: 123.3 ± 15.8 vs. 120.2 ± 16.8 mmHg, P = 0.22; hypertension incidence: 24.7% vs. 29.4%, P = 0.49). Conclusions: A sex-specific association between increased abdominal circumference and future development of hypertension was observed in mildly obese middle-aged men, but not women.

PS-BPP02-2: BLOOD PRESSURE VARIABILITY PREDICTS THE DEVELOPMENT OF HYPERTENSION IN NORMOTENSIVE INDIVIDUALS

Objective: Hypertension is one of the important risk factors for atherosclerosis leading to cardiovascular diseases. Although several factors have been reported as predictors of new onset of hypertension, the association of blood pressure (BP) variability in normotensive subjects with future development of hypertension is not intensively discussed. We tested the hypothesis that the yearly variability of BP in normotensive subjects predicts new onset of hypertension. Design and Methods: Subjects who participated in our annual physical check-up program for 5 years in a row during 2008 and 2013 were screened (screening period) and those under antihypertensive medication or with the average BP for the 5 visits ≧ 140/90 mmHg were excluded. The rest of 2006 participants (male = 1287) were eligible in the present study. Standard deviation (SD) and coefficient of variation (CV) of their systolic BP (SBP) during the 5 consecutive visits were calculated (screening period) and, then, they were followed up for the next 5 years (follow-up period). The onset of hypertension was defined as average BP during the follow-up period ≧ 140/90 mmHg or the use of antihypertensive medications. Results: The average, SD, and CV of SBP were 118.7 ± 10.0 mmHg, 7.44 ± 2.98 mmHg, and 6.30 ± 2.54%, respectively. During the follow-up, hypertension developed in 259 subjects, with the incidence being more frequent in male (n = 180, 14.0%) than female subjects (n = 79, 11.0%). In retrospective analysis, the average (128.7 ± 7.7 vs. 117.2 ± 9.5 mmHg, p &lt; 0.001) and SD (8.05 ± 3.48 vs. 7.34 ± 2.89 mmHg, p &lt; 0.001) were higher in subjects with than without future hypertension, whereas CV was not different in the both groups (6.28 ± 2.73 vs. 6.30 ± 2.51%). Non-adjusted odds ratio (OR) (95% confidence interval [CI]) of average, SD and CV for the incident hypertension were 1.169 (1.146–1.193), 1.078 (1.034–1.124) and 0.997 (0.947–1.050), respectively. Multivariate logistic regression analysis adjusted for age, gender, family history of hypertension, frequent alcohol consumption (six or seven times per week), current smoking, body mass index, heart rate, serum creatinine, fasting plasma glucose, LDL-cholesterol, and triglyceride at baseline demonstrated that average (OR [95%CI] = 1.193 [1.138–1.187]) and SD (1.058 [1.014–1.105]), but not CV (0.992 [0.941–1.046]), were associated with new onset hypertension. Similar results were obtained using diastolic BP (data not shown). Conclusions: In normotensive subjects, an increase in year-to-year variability as well as average of SBP may be a predictor of the new onset of hypertension. Careful interpretation of year-to-year BP variability is necessary for evaluation of future cardiovascular risk in normotensive individuals.

Study of Role of Autonomic Component Imbalance in young adults with parental hypertension and in those without it.

Autonomic functions , both sympathetic and vagal/ parasympathetic, are found to be deranged in hypertensive subjects. Autonomic dysfunction has been demonstrated before hypertension is established, as well as in its early stages. This was a case -control study involving a cross sectional examination of students/subjects / participants aged 17 – 19 years , both males and females. From a selection of those fulfilling the criteria of case group , having at least one hypertensive parent and control group whose no parent has hypertension. 30 subjects was selected by simple random sampling for each group. In our study it was found that Parasympathetic variable (.E : I ratio) when compared between 2 groups was not significant but Sympathetic variable(HGT) when compared between 2 groups was found to be significant. This indicates that offspring of hypertensive parents are susceptible to future development of Hypertension. Therefore they should maintain their sympathovagalbalance to reduce the incidence of estabilished hypertension and its associated complication. .

White blood cell count and incidence of hypertension in the general Japanese population: ISSA-CKD study.

This study aimed to clarify the relationship between the white blood cell (WBC) count and hypertension in the general Japanese population. We conducted a population-based retrospective cohort study using annual health check-up data of residents of Iki City, Nagasaki Prefecture, Japan. A total of 2935 participants without hypertension at baseline were included in the present analysis. WBC counts were classified as tertile 1 (<4700/μL), tertile 2 (4700-5999/μL), and tertile 3 (≥6000/μL). The outcome was incident hypertension (blood pressure ≥140 mmHg). Multivariable-adjusted hazard ratios and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazards model. During an average follow-up of 4.5 years, 908 participants developed hypertension. The incidence (per 100 person-years) of hypertension increased with an elevation in the WBC count (6.3 in tertile 1, 7.0 in tertile 2, and 7.4 in tertile 3). This association was significant, even after adjustment for other risk factors, including age, sex, current smoking habits, current alcohol intake, exercise habits, obesity, elevated blood pressure, diabetes mellitus, and dyslipidemia. The hazard ratios were 1.07 for tertile 2 (95% CI 0.90-1.26) and 1.27 for tertile 3 (95% CI 1.06-1.51) compared with the reference group of tertile 1 (p = 0.009). The WBC count was associated with future development of hypertension in the general Japanese population.

The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension

BackgroundPrediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear.AimIn this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects.Design and methodsWe investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired.ResultsDuring a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired.ConclusionOur study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels.

LDL cholesterol is associated with systemic vascular resistance and wave reflection in subjects naive to cardiovascular drugs

Background and aim: Low density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerosis, but it is also associated with elevated blood pressure (BP) and future development of hypertension. We examined the relationship between LDL-C and haemodynamic variables in normotensive and never-treated hypertensive subjects.Methods: We recruited 615 volunteers (19–72 years) without lipid-lowering and BP-lowering medication. Supine haemodynamics were recorded using continuous radial pulse wave analysis, whole-body impedance cardiography, and single channel electrocardiogram. The haemodynamic relations of LDL-C were examined using linear regression analyses with age, sex, body mass index (BMI) (or height and weight as appropriate), smoking status, alcohol use, and plasma C-reactive protein, sodium, uric acid, high density lipoprotein cholesterol (HDL-C), triglycerides, estimated glomerular filtration rate, and quantitative insulin sensitivity check index as the other included variables.Results: The mean (SD) characteristics of the subjects were: age 45 (12) years, BMI 27 (4) kg/m2, office BP 141/89 (21/13) mmHg, creatinine 74 (14) µmol/l, total cholesterol 5.2 (1.0), LDL-C 3.1 (0.6), triglycerides 1.2 (0.8), and HDL-C 1.6 (0.4) mmol/l. LDL-C was an independent explanatory factor for aortic systolic and diastolic BP, augmentation index, pulse wave velocity (PWV), and systemic vascular resistance index (p < 0.05 for all). When central BP was included in the model for PWV, LDL-C was no longer an explanatory factor for PWV.Conclusions: LDL-C is independently associated with BP via systemic vascular resistance and wave reflection. These results suggest that LDL-C may play a role in the pathogenesis of primary hypertension.

Metabolic and Hypertensive Complications of Pregnancy in Women with Nephrolithiasis.

Kidney stones are associated with future development of hypertension, diabetes, and the metabolic syndrome. Our objective was to assess whether stone formation before pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with higher risk for maternal complications in pregnancy. We conducted a retrospective cohort study of women who delivered infants at the Massachusetts General Hospital from 2006 to 2015. Women with abdominal imaging (computed tomography or ultrasound) before pregnancy were included in the analysis. Pregnancy outcomes in women with documented kidney stones on imaging (stone formers, n=166) were compared with those of women without stones on imaging (controls, n=1264). Women with preexisting CKD, hypertension, and diabetes were excluded. Gestational diabetes and preeclampsia were more common in stone formers than nonstone formers (18% versus 6%, respectively; P<0.001 and 16% versus 8%, respectively; P=0.002). After multivariable adjustment, previous nephrolithiasis was associated with higher risks of gestational diabetes (adjusted odds ratio, 3.1; 95% confidence interval, 1.8 to 5.3) and preeclampsia (adjusted odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6). Infants of stone formers were born earlier (38.7±2.0 versus 39.2±1.7 weeks, respectively; P=0.01); however, rates of small for gestational age offspring and neonatal intensive care admission were similar between groups (8% versus 7%, respectively; P=0.33 and 10% versus 6%, respectively; P=0.08). First trimester body mass index significantly influenced the association between stone disease and hypertensive complications of pregnancy: in a multivariable linear regression model, stone formation acted as an effect modifier of the relationship between maximum systolic BP in the third trimester and body mass index (P interaction <0.001). In women without preexisting diabetes, hypertension, and CKD, a history of nephrolithiasis was associated with gestational diabetes and hypertensive disorders of pregnancy, especially in women with high first trimester body mass index.

OP.2A.01] IMPACT OF A 29 SNPS-BASED GENETIC RISK SCORE FOR HYPERTENSION ON AORTIC DISEASE

Objective: A genetic risk score (GRS) based on 29 SNPs associated with high blood pressure (BP) was shown to be associated with future development of hypertension, stroke and cardiovascular events. Aim of the present study is to evaluate the impact of this polygenetic BP component on the incidence of aortic disease, namely aortic dissection (AD), thoracic aorta aneurysm (TAA), abdominal aorta aneurysm (AAA), including possible events (either rupture or need of surgical correction). Design and method: More than 27,000 people in the Swedish Malmo Diet and Cancer Study had at least 24 valid SNPs and were followed up for a median of more than 18 years. The number of BP elevating alleles of each SNPs, weighted by their effect size in the discovery studies, was summed into a BP-GRS. Results: In Cox regression models, adjusted for traditional cardiovascular risk factors (TRF) including hypertension, we found a significant associations of the BP-GRS, prospectively, with incident TAA (hazard ratio 1.32; 95% confidence interval (CI) 1.06–1.24 comparing the third vs. first tertile; P.0.015) but not with either AAA or aortic dissection. Calibration, discrimination and reclassification analyses did not show any improvement in prediction using the BP-GRS in addition to the model which used only the TRF. Conclusions: A GRS for hypertension associates with TAA suggesting a link between genetics determinat of BP and aortic disease. The effect size is small but the addition of more SNPs to the GRS could improve its discriminatory capability.

OP 48 Metabolic and hypertensive complications of pregnancy in women with nephrolithiasis

Introduction Kidney stones are associated with future development of hypertension, diabetes and the metabolic syndrome. The relationship between nephrolithiasis and pregnancy complications, including gestational dysglycemia and hypertension, has not previously been evaluated. Objectives We sought to assess whether kidney stone formation prior to pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with maternal complications in pregnancy. Patients and methods We conducted a retrospective cohort study of women who received prenatal care and delivered infants at Massachusetts General Hospital from 2011 to 2016. Women with abdominal imaging (CT or ultrasound) prior to pregnancy were included in the analysis.Women with chronic kidney disease, hypertension and diabetes were excluded. Pregnancy outcomes of women with documented kidney stones on imaging (stone formers, n = 79) were compared to women without stones on imaging (controls, n = 642). We performed a stratified analysis of pregnancy outcomes in women with high (>25 kg/m2) vs. normal (⩽25 kg/m2) BMI in the first trimester. Results Mean glucose levels after a 50-gram glucose challenge were higher in stone formers (127 ± 29 mg/dl vs. 118 ± 27 mg/dl, p = 0.02) despite similar baseline body mass index (27.3 ± 5.5 kg/m2 vs. 27.6 ± 6.4 kg/m2, p = 0.62). Rates of hypertensive disorders of pregnancy were higher in stone formers (16% vs 6%, p Conclusion In women without preexisting diabetes and hypertension, a history of nephrolithiasis was associated with gestational dysglycemia and hypertensive disorders of pregnancy, especially in women with high first trimester BMI. Nephrolithiasis may be a marker of increased metabolic risk in women without traditional risk factors for pregnancy complications.

Preventive effect of pravastatin on the development of hypertension in patients with hypercholesterolemia: A post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study

It remains unclear whether treatment of dyslipidemia with 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) reduces the risk of developing hypertension. In this post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, a large-scale primary prevention trial with pravastatin, we examined the preventive effect of pravastatin on the future development of hypertension in patients with hypercholesterolemia. Of the overall (MEGA) Study population, 3397 nonhypertensive patients at baseline were enrolled in this study. The patients were randomly assigned to either the dietalone group (n=1722) or the diet plus pravastatin group (n=1675) and then were followed-up for a median of 36months to determine new-onset hypertension. During the follow-up period, 1595 patients developed hypertension (49.1% in the dietalone group and 44.7% in the diet plus pravastatin group). After adjusting for multiple covariates, the diet plus pravastatin group showed a 10% reduction in the risk of developing hypertension (hazard ratio 0.90, 95% confidence interval 0.81-0.998), compared with the dietalone group. Subgroup analyses revealed that the preventive effect of pravastatin on the development of hypertension was pronounced in patients aged ≥60years, men, those with chronic kidney disease or diabetes mellitus and those without obesity. Pravastatin reduced the risk of developing hypertension in Japanese patients with hypercholesterolemia. The risk reduction of cardiovascular disease with statins could be partly explained by their preventive effect on the development of hypertension.

The incidence of hypertension and its risk factors in the German adult population: results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008-2011.

To analyze incident hypertension and its risk factors based on 11.9 years follow-up of a recent National Examination Survey cohort in Germany. Out of 7124 participants of the German National Health Interview and Examination Survey 1998 (GNHIES98), 640 had died at follow-up 2008-2011 and 3045 were reexamined as part of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Baseline and follow-up included standardized blood pressure (BP) measurements. Hypertension was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in participants with known hypertension. Out of 2231 GNHIES98-DEGS1 participants aged 18-79 years without hypertension in 1998, 26.2% developed hypertension within a mean of 11.9 (range 10.0-14.1) years (men 29.0%, women 23.4%). In univariate analysis, hypertension incidence was positively associated with age, BMI, initial BP levels, pulse pressure, and alcohol consumption. Comorbidities such as diabetes and hyperlipidemia increased the chance to develop hypertension. In the multivariate model, initial SBP and DBP levels had the strongest influence on the development of future hypertension (7% increase in men and 5% in women per mmHg SBP). The percentage of aware, treated, and controlled hypertensive patients were 75.8, 62.1, and 50.3% in men and 83.8, 73.3, and 59.0% in women. The high 11.9-year incidence in all age groups points to the lifelong potential for prevention of hypertension.

Abstract P251: Association of Microvascular Measures with Brachial and Central Pressures in Young Non-hypertensive Adults

Microvascular rarefaction (reduced capillary density) is associated with hypertension. Little is known about capillary rarefaction in young individuals, in whom brachial and central blood pressure (BP) may be quite divergent. Thus, we compared capillary density in young subjects with their office and central BP profiles. We measured central BP using the SphygmoCor XCEL device, and office BP in 102 healthy young participants ( Table 1 ). Capillary density was measured progressively in the nailbed at baseline rest, following ischemic stimulus, and using passive venous congestion. All capillary densities were significantly associated with central DBP and MAP ( Table 2 ). Only post-ischemic capillary density was significantly associated with office brachial SBP and MAP (rest and venous densities were marginally associated). In conclusion, capillary density is consistently and significantly associated with central MAP in young, non-hypertensive individuals. Since MAP is a key determinant of systemic vascular resistance, capillary rarefaction may lead to the future development of hypertension.

The Effect of Early Excessive Weight Gain on the Development of Hypertension in Pregnancy.

Background Previous studies have shown an association between total excessive gestational weight gain and hypertension in pregnancy. However, this may be a reflection of excessive water retention associated with the pathophysiology of hypertensive disorders of pregnancy. Early excessive weight gain, prior to the third trimester, results in greater maternal fat deposition and inflammation, which has also been associated with the development of hypertension. By focusing on early excessive weight gain, the association between maternal weight gain and the future development of hypertension can be examined. Objective To evaluate the association between early excessive maternal weight gain and the development of hypertension during pregnancy. Study Design This was a secondary analysis of a longitudinal cohort study of 1,441 women without chronic hypertension who were enrolled in a prospective study evaluating maternal angiogenic factors and the prediction of preeclampsia. Initial body mass index (BMI) was calculated by weight and height at the first study visit. Early excessive maternal weight gain was defined as weight gain by 28 weeks that exceeded the Institute of Medicine (IOM) guidelines and was calculated utilizing the maximum amount of weight gain per week recommended by the IOM based on the patient's starting BMI (normal: 0.45 kg; overweight: 0.32 kg; obese: 0.27 kg). Hypertension was defined as a sustained systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg. Logistic regression was used to determine the association between early excessive weight gain, initial BMI, and the development of hypertension, including gestational hypertension and preeclampsia, during pregnancy. Results Of 1,441 women, 767 (53.2%) had weight gain that exceeded the IOM guidelines in the first 28 weeks and 154 (10.8%) developed hypertension during pregnancy. Women whose weight gain exceeded the IOM guidelines were more likely to develop hypertension even after adjusting for relevant confounders (12.5 vs. 8.6%; p = 0.02; adjusted odds ratio [OR] = 1.70; 95% confidence interval [CI]: 1.18-2.44; p < 0.01). Obese women had a 2.4-fold increased risk of developing hypertension, even after controlling for excessive weight gain (adjusted OR = 2.44; 95% CI: 1.66-3.59; p < 0.01) Conclusions Early excessive maternal weight gain and initial BMI are independently associated with the diagnosis of a hypertensive disorder of pregnancy. Women should be counseled regarding the benefits of achieving a normal BMI prior to pregnancy and appropriate weight gain during pregnancy, as well as the potential harms of excessive weight gain related to perinatal outcomes.

Hypertensive response to exercise: mechanisms and clinical implication.

A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates that a HRE is associated with functional and structural abnormalities of left ventricle, especially when accompanied by increased central blood pressure. A HRE harbors prognostic significance in future development of hypertension and increased cardiovascular events, particularly if a HRE is documented in moderate intensity of exercise. As supported by previous studies, a HRE is not a benign phenomenon, however, currently, whether to treat a HRE is controversial with uncertain treatment strategy. Considering underlying mechanisms, angiotensin receptor blockers and beta blockers can be suggested in individuals with HRE, however, evidences for efficacy and outcomes of treatment of HRE in individuals without hypertension is scarce and therefore warrants further studies.