Different Levels Of Blood Pressure Research Articles

A non-linear relationship between blood pressure and mild cognitive impairment in elderly individuals: A cohort study based on the Chinese longitudinal healthy longevity survey (CLHLS).

Hypertension is an established risk factor for mild cognitive impairment (MCI) in elderly individuals. Nevertheless, the impact of different levels of blood pressure on the progression of MCI remains uncertain. This study aims to investigate the non-linear relationship between blood pressure and MCI in the elderly and detect the critical blood pressure threshold, thus, improving blood pressure management for individuals at high risk of MCI. Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort. We chose normal cognitive elderly individuals who entered the cohort in 2014 for a 5-year follow-up to observe the progression of MCI. Subsequently, we utilized the Cox regression model to identify risk factors for MCI and conducted a Cox-based restricted cubic spline regression (RCS) model to examine the non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with MCI, determining the critical blood pressure threshold for MCI progression. In the elderly population, female (HR = 1.489, 95% CI: 1.017-2.180), lacking of exercise in the past (HR = 1.714, 95% CI: 1.108-2.653), preferring animal fats (HR = 2.340, 95% CI: 1.348-4.061), increased age (HR = 1.061, 95% CI: 1.038-1.084), increased SBP (HR = 1.036, 95% CI: 1.024-1.048), and increased DBP (HR = 1.056, 95% CI: 1.031-1.081) were associated with MCI progression. After adjusting factors such as gender, exercise, preferred types of fats, and age, both SBP (P non-linear < 0.001) and DBP (P non-linear < 0.001) in elderly individuals exhibited a non-linear association with MCI. The risk of MCI rose when SBP exceeded 135mmHg and DBP was in the range of 80-88mmHg. However, when DBP exceeded 88mmHg, there was a declining trend in MCI progression, although the HR remained above 1. The identified critical blood pressure management threshold for MCI was 135/80mmHg. In this study, we discovered that risk factors affecting the progression of MCI in elderly individuals comprise gender (female), preferring to use animal fat, lack of exercise in the past, increased age, increased SBP, and increased DBP. Additionally, a non-linear relationship between blood pressure levels and MCI progression was confirmed, with the critical blood pressure management threshold for MCI onset falling within the prehypertensive range.

Hormonal-metabolic trajectory of menopausal transition in a normoglycemic cohort of women with different blood pressure levels

Introduction. The gradual clustering of cardio-metabolic factors in women depending on age and decline of ovarian function justifies attention to the phenotype of the formation of the metabolic syndrome during the menopausal transition depending on the presence of hypertension without dysglycemia. Aim: to evaluate the association of indicators of the functional state of the pituitary-ovarian axis with markers of metabolic syndrome (MetS) and parameters of insulin resistance (IR) in a cohort of normoglycemic women aged 35-59 years with different levels of blood pressure (BP). Patients and methods. In a cohort of women 35–59 years old without dysglycemia (n = 88), 58 women had hypertension, 30 were normotensive. It was determined: body mass index (BMI), waist circumference (WC), levels of BP, triglycerides (TG), HDL-C, insulin, follicle-stimulating hormone (FSH) and estradiol, fasting glucose (FG); TyG and HOMA2-IR indices. Using SPSS (version 17) assessed the median (25; 75%); intergroup differences using the Mann-Whitney test; correlation analyzes: Spearman (R) and partial correlation (R рс ) to level out the influence of age. Results. In the general cohort of women, the influence of postmenopausal duration (PMD), FSH and E2 levels on MetS and TyG parameters depended on age, except for the correlation of PMD with FG (R pc = 0.313; p = 0.004). The range of associations of MetS markers with each other and TyG in the group of patients with hypertension is similar to those in the general cohort of women. In both cohorts, the interrelations between FG, OT, insulin and TyG remained relevant with partial correlation. The TyG index, associated with HOMA2-IR (R=0.600; p&lt;0.001; R pc =0.426; p&lt;0.001), had a greater range of connections with MetS components, as well as with FSH (R=0.312; p=0.017; R pc =0.286; p=0.030) and E2 (R= -0.393; p=0.002; R pc = -0.376; p=0.004) in the presence of hypertension. Conclusion. The influence of indicators of the functional state of the pituitary-ovarian axis on MetS and TyG markers was revealed, along with a spectrum of associations of parameters and factors in the formation of menopausal MetS with IR indices, especially TyG. Correlation relations between FG with PMD and MetS components, as well as estradiol in case of hypertension, reflect a high risk of progression to dysglycemia.

Cardio-respiratory endurance of individuals with different blood pressure levels

Evaluation of cardio-respiratory endurance in individuals with different levels of blood pressure is one of the key factors in preventing the development of diseases of the cardiovascular system. The purpose of the study was to conduct a comparative assessment of cardio-respiratory endurance, the level of maximum oxygen consumption, and the results of the Ruffier test in individuals with different blood pressure levels. 320 people were examined, of which 4 groups were formed according to the initial level of blood pressure. After measuring baseline blood pressure and heart rate, all subjects underwent a Ruffier test (30 sit-ups for 45 seconds), followed by repeated heart rate measurements at 15 seconds, 1 minute, and blood pressure measurements at 3 minutes. Determination of the level of maximum oxygen consumption was performed according to the formula. Representatives of the group with normal-low and normal blood pressure have a significantly higher level of maximum oxygen consumption. Individuals with normal-high blood pressure and first-degree hypertension had higher levels of systolic and diastolic blood pressure during daily blood pressure monitoring, both during the day and at night, compared to individuals with normal and normal-low blood pressure. It was established that people with normal-low blood pressure have a higher cardio-respiratory endurance than people with normal-high blood pressure and first-degree hypertension. The findings of the study can be used by cardiologists and general practitioners for early detection and prevention of diseases of the cardiovascular system, and physiologists in further investigation of the features of the functioning of the cardiovascular system

CHRONIC CEREBRAL VENOUS DYSFUNCTION SYNDROME AND DEGENERATIVE-DYSTROPHIC CHANGES OF THE CERVICAL SPINE: ANATOMO-PHYSIOLOGICAL UNDERSTANDING OF COMORBIDITY

Aim: to investigate the features of CS DDC in patients with CCVDS in comparison with patients without clinical signs of chronic venous cerebral dysgemia, to substantiate comorbidity.&#x0D; Material and methods. In compliance with ethical norms, 2 groups of patients were examined: 125 patients have CCVDS and different levels of blood pressure (98 women, 27 men, average age 53.60±10.27ys), 28 similar patients, but without CCVDS (17 women and 11 men, 52.54±10.03 years old). General clinical and clinicalneurological examination, clinical assessment of the hypoglossal veins condition, MRI of the cervical spine, X-ray functional tests, MedStat programs.&#x0D; Results. The main group patients had a mixed headache, stiffness, limitation of movements and pain in the CS, irradiation in the upper limb aggravated by movements and forced positions; paresthesias and arm pain, which were significantly different from the control group except for tension headache. A significant difference in cerebral complaints – dizziness, transient visual and hearing impairments (&lt;0.001). Limitation of mobility in the CS up to 30-45 degrees, tension, compaction and tenderness of the paravertebral muscles during palpation, usually asymmetric, expansion and fullness of the sublingual veins of patients in the main group were significantly different from the indicators of the control group (&lt;0.001). According to the MRI and X-ray spondylography, the patients of the main group had structural changes in the spinal cord significantly worse than the control group (&lt;0.001).&#x0D; Conclusions. Patients with CCVDS had significantly worse clinical, structural and dynamic changes in the cervical spine, which were significantly different from the indicators of patients without chronic brain venous dyshemia (&lt;0.001). DDC of the cervical spine should be considered a significant comorbid factor of chronic cerebral venous blood flow disorders, which can be explained by anatomical and physiological dependences.

К ВОПРОСУ О ПРОФИЛАКТИКЕ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ В СТУДЕНЧЕСКОЙ СРЕДЕ

The most common non-communicable disease is arterial hypertension, which determines the medical and social significance of its prevention. The aim of the work was to identify the prevalence of high blood pressure among students of higher education in the northern region. The proportions of students with different levels of blood pressure have been established. It has been determined that negative trends in the state of the cardiovascular system are more common among young men and are more often associated with the mechanisms for ensuring systolic blood pressure. A route sheet has been compiled for students with elevated blood pressure to receive primary health care.

Associations between different levels of blood pressure and risk of prediabetes

Objective: To explore sex and rural-urban differences in the associations of different blood pressure levels with the risk of prediabetes. Methods: We used a multi-stage stratified cluster random sampling method to investigate 21 637 residents aged ≥18 years from 10 survey areas in Hubei province in 2020. The data on questionnaire, physical measurements, and laboratory indicators of the participants were collected. The associations of different blood pressure levels with risk of prediabetes by sex and regions were analyzed using multivariate logistic regressions after complex weighting. Results: A total of 16 111 subjects were included. The prevalence (95%CI) of prediabetes, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and IFG complicated with IGT were 25.1% (14.4%-35.9%), 12.7% (3.2%-22.1%), 8.1% (6.3%-9.8%), and 4.4% (2.3%-6.5%), respectively. After multivariate adjustment, the risk of prediabetes, IFG, IGT, and IFG complicated with IGT increased with the increment of blood pressure (both P for trend <0.05). The positive dose-response relationships between blood pressure levels and risk of prediabetes were also significant among male, urban, and rural residents (both P for trend <0.05), and the interactions between sex and blood pressure showed significant associations for risk of prediabetes and IGT (both P for interaction <0.05). Conclusions: Higher blood pressure levels were associated with an increased risk of prediabetes. The association with prediabetes was stronger in males, but no significant difference was found between urban and rural residents. More distinctive and effective prevention and control strategies should be developed for different populations.

Blood pressure age ranges for community patient care.

British Journal of Community NursingVol. 27, No. 9 TreatmentsBlood pressure age ranges for community patient careAysha MendesAysha MendesE-mail Address: [email protected]Freelance Journalist, specialising in Healthcare and PsychologySearch for more papers by this authorAysha MendesPublished Online:7 Sep 2022https://doi.org/10.12968/bjcn.2022.27.9.422AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References National Institute for Health and Care Research. People of all ages benefit from drugs to lower blood pressure. 2022. https://evidence.nihr.ac.uk/alert/people-of-all-ages-benefit-from-drugs-to-lower-blood-pressure/ (Accessed 15 August 2022) Google ScholarThe Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet. 2021a;397(10285):1625-1636. https://doi.org/10.1016/S0140-6736(21)00590-0 Google ScholarThe Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021b;398:1053-1064. https://doi.org/10.1016/S0140-6736(21)01921-8 Google Scholar FiguresReferencesRelatedDetails 2 September 2022Volume 27Issue 9ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 7 September 2022 Published in print 2 September 2022 Information© MA Healthcare LimitedPDF download

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Smoking causes the disorder of glucose metabolism under different levels of blood pressure in male occupational population.

Smoking is an important modifiable factor in the risk of type 2 diabetes. Type 2 diabetes and hypertension overlap in the population. The present study investigated effects of smoking on glucose metabolism under different blood pressure (BP) levels in occupational population. A smoking survey among occupational groups was conducted in 2018. The general linear model was used to analyze the differences of glucose metabolism indexes and BP indexes influenced by different smoking intensity (never 0, mild <10, moderate <20, heavy ≥20 pack‐years). Odds ratios of developing diabetes and β‐cell deficiency were analyzed by using logistic regression model. BP was further taken into account in the relationship between smoking and glucose metabolism. As a result, 1730 male workers aged 21 to 60 years were included in the analysis finally. Compared to never smokers, heavy smokers had significantly increased fasting plasma glucose. Moderate and above smokers had significantly increased glycosylated hemoglobin, decreased fasting plasma insulin and β‐cell function, after adjustment for covariates. Further, smoking intensity was found to have a dose‐dependent relationship with impaired β‐cell function and diabetes. In conclusion, smoking has a positive dose‐dependent relationship with β‐cell deficiency and diabetes. Male smoking workers, especially the moderate or higher smoking, with high‐normal and high BP levels are at high risk of abnormal glucose metabolism.

Blood pressure states transitions among bus drivers: the application of multi-state Markov model.

To explore the transition patterns among different levels of blood pressure for bus drivers. A follow-up study was conducted to investigate the transition probabilities of three blood pressure states, the sojourn time in each state, the survival probabilities, and the risk factors affecting hypertension progression. Based on 5618 blood pressure measurements of 1883 Chinese bus drivers from 2017 to 2021, a multi-state Markov model was established. The mean age of participants was 41.43 ± 6.71years, and 82.37% were male. The probabilities from normal state to hypertension within 1-year follow-up were 4.60% (male) and 2.13% (female); however, the corresponding changes over a 3-year follow-up had a significant increase to 20.27% (male) and 7.98% (female). The sojourn time of normal state and elevated state was 1.82 ± 0.09years and 1.98 ± 0.08years, respectively. The male participants, the increasing age, BMI, CHOL and TG were risk factors for progression from normal state to elevated state, and/or from elevated state to hypertensive state (HR: 1.04-2.53). Early preventive measures on the progression of hypertension should be taken for Chinese bus drivers, and at least one physical examination per year is strongly recommended. The government and bus companies should pay more attention to these kinds of bus drivers with high probabilities of hypertension: male, older than 40years, with the higher values of BMI and blood lipid. The derived findings of sojourn time, transition probabilities and survival probabilities can provide reference for health professionals to make targeted intervention to reduce bus drivers' hypertension occurrence.

Cardiovascular System Response to Cold Stress in Individuals with Different Levels of Blood Pressure

The study determines the peculiarities of the response of the central and peripheral links of to a cold stimulus in people with different levels of blood pressure (BP). The dynamics of blood pressure, heart rate, rheographic index and cardiorhythmography before and after the cold pressor test were evaluated. A significantly higher increase in systolic and diastolic BP in response to the cold pressor test was found in the persons with a normal high level of initial blood pressure (130/85–139/89 mm Hg) (p &lt; 0.05). During the examination, a higher percentage of those with a hyperreactive blood pressure response was found (25%). In the experiment participants with initial blood pressure &gt; 130/85 mm Hg a significant influence of the sympathetic nervous system on the cardiovascular system central and peripheral links in response to cold stress was observed. The individuals with normal (120/80– 129/84 mm Hg) and normal low (110/70-120/80 mm Hg) blood pressure showed a satisfactory response of the cardiovascular system to cold stress, so they should expect less health risks when working at low ambient temperatures.

Features of functional adaptation of the cardiovascular system in athletes with different levels of blood pressure

Objective. To assess cardiovascular functional adaptation in athletes with different levels of blood pressure (BP) in the Republic of Sakha (Yakutia).Design and methods. We examined 147 professional athletes of high sportsmanship (average age 22 (18; 26) years), cyclic and speed-weightlifting sports. All athletes underwent anthropometry, measurement of office BP and daily BP monitoring, exercise test (PWC170), with determination of maximum oxygen consumption, assessment of the reserve capacity of the cardiovascular system, echocardiography.Results. Masked hypertension (MH) was detected in 40,8% of athletes, normal BP in 59,2%. All athletes showed a high tolerance to physical activity; athletes with MH showed high indices of left ventricular (LV) wall thickness and myocardial mass index compared with athletes with normal BP. The athletes with MH achieve a high level of physical performance due to a less efficient hemodynamic mechanism and energy-intense regimen. A positive correlation was found between LV wall thickness and indicators of cardiovascular functional reserves.Conclusions. MH was detected in 40,8% athletes. In athletes with different BP levels, quantitative and qualitative differences in ensuring physical performance are expressed by the ratio between the “initial” (rest) and “maximum” (test with physical load) indicators of the functional state. Thus, in athletes with MH, inefficient hemodynamic and energy-intensive processes can lead to overstrain of the cardiovascular system. Indicators of functional reserves of the cardiovascular system positively correlate with indicators of LV myocardial wall thickness and myocardial mass index, which may indirectly indicate the relation between cardiovascular overstrain in athletes with MH and target organ damage (LV hypertrophy).

The relationship between impaired uteroplacental blood flow and blood pressure level in pregnant women with chronic and gestational hypertension

Aim. To assess the relationship between impaired uteroplacental blood flow and different levels of blood pressure in pregnant women with chronic and gestational hypertension at different stages of pregnancy with the determination of the optimal systolic blood pressure.&#x0D; Methods. We conducted a prospective cohort study between 2018 and 2019. The study enrolled pregnant women aged 18 to 45 years: 55 women with chronic and gestational hypertension each, as well as 80 healthy pregnant women as control. The groups were formed by the continuous method, in which all pregnant women with arterial hypertension were included in the study until the required number of subjects was obtained. Follow-up was conducted at different gestation periods (1416, 2022, 2830, 3436 weeks) until delivery. Independent groups were compared by using the Student's t-test, the Pearsons 2 test, the MannWhitney U test, the KruskalWallis H test.&#x0D; Results. Comparison of the groups revealed differences in blood pressure levels at different gestation periods. In chronic hypertension compared with gestational hypertension, there was an increase in the impairment of the uteroplacental blood flow in pregnant women, indicating an unfavorable prognosis. The study of impaired uteroplacental blood flow among pregnant women with various forms of arterial hypertension revealed an increase in pregnant women with chronic arterial hypertension compared with gestational (p=0.04), indicating an unfavorable prognosis. In chronic arterial hypertension, the impairment of uteroplacental blood flow was the least for systolic pressures up to 120 mm Hg (up to 0.9%) at 1416 and 2022 weeks of gestation, and for 130139 mm Hg (from 1.8 to 2.7%) in later pregnancy. In gestational hypertension, the least or no impairment rate of uteroplacental blood flow was determined for blood pressures up to 129 mm Hg at all stages of pregnancy compared with chronic hypertension.&#x0D; Conclusion. The optimal systolic blood pressure in chronic hypertension reducing the risk of impaired uteroplacental blood flow in pregnant women is 129 mm Hg before 20th week of pregnancy and 130139 mm Hg in later (2030 weeks); in gestational hypertension, blood pressure reduction to 129 mm Hg is recommended at all stage of gestation.

Хроническая церебральная венозная дисфункция: взгляд на проблему

В статье представлен аналитический обзор результатов отечественных и зарубежных исследований по проблеме хронических нарушений мозгового венозного кровообращения, которым уделяют меньше внимания в сравнении с патологией артериальной системы из-за нечеткости проявлений, особенно ранних, анатомической изменчивости венозного русла даже у здоровых, сложности верификации диагноза и т.д. Когда баланс артериального притока и венозного оттока нарушается и это нарушение прогрессирует, развиваются необратимые изменения в других структурах полости черепа — в первую очередь страдает головной мозг (что согласуется с концепцией Монро — Келли). Хронические нарушения церебрального венозного кровообращения могут иметь разные причины и разную степень выраженности. Синдром хронической церебральной венозной дисфункции, терминологически принятый у нас, в некоторых странах рассматривается как хроническая венозная цереброспинальная недостаточность, что подчеркивает патогенетическую связь нарушений церебрального венозного кровотока с внечерепными венами, что, на наш взгляд, является логичным и обоснованным. Признание хронической цереброспинальной венозной недостаточности вызвало значительный интерес к изучению роли внечерепной венозной патологии и вариантов ее развития. Несмотря на то, что диагноз изначально был основан на допплерографической сонографии, пока не установлено диагностических способов визуализации, неинвазивных или инвазивных, которые могут служить золотым стандартом для выявления венозных отклонений, свидетельствующих о хронической цереброспинальной венозной недостаточности. Обсуждаются результаты ряда исследований, в частности, гипотезы о роли хронической цереброспинальной венозной недостаточности в патогенезе рассеянного склероза и многих сопутствующих клинических проявлений. Анализируется общность по патогенезу идиопатической внутричерепной гипертензии, болезни Меньера, синдрома спондилогенной вертебрально-базилярной недостаточности. Акцентируется внимание и на другом мнении ученых, которые повышение венозного кровенаполнения головного мозга и других образований полости головы при определенных условиях рассматривают как компенсаторную реакцию. Рассматриваются анатомо-физиологические особенности венозной системы черепной полости, обосновывающие клинические проявления венозной дисфункции, способы диагностики и лечения патологии. Обобщая вышесказанное отметим, что хроническое нарушение циркуляции венозной крови в полости черепа в значительной степени связано с проблемами внечерепного венозного кровотока и не только само по себе является достаточно характерным синдромокомплексом, который негативно влияет не только на неврологические функции за счет гипоксии мозга и метаболических изменений, ухудшает качество жизни, но и на течение или имеет патогенетическую связь с другими заболеваниями, в частности, может сопровождаться различным уровнем артериального давления.

The longitudinal association between the use of antihypertensive medications and 24-hour sleep in nursing homes: results from the randomized controlled COSMOS trial

BackgroundAntihypertensive medication use and sleep problems are highly prevalent in nursing home patients. While it is hypothesized that blood pressure and antihypertensive medication use can affect sleep, this has not been investigated in depth in this population. Alongside a multicomponent intervention including a systematic medication review, we aimed to investigate the longitudinal association between antihypertensive medication use, blood pressure and day- and night-time sleep over 4 months.MethodsThis study was based on secondary analyses from the multicomponent cluster randomized controlled COSMOS trial, in which the acronym denotes the intervention: COmmuncation, Systematic pain assessment and treatment, Medication review, Organization of activities and Safety. We included baseline and 4-month follow-up data from a subgroup of nursing home patients who wore actigraphs (n = 107). The subgroup had different levels of blood pressure, from low (< 120) to high (≥ 141). Assessments included blood pressure, antihypertensive medication use, and sleep parameters as assessed by actigraphy.ResultsWe found a significant reduction in total sleep time at month four in the intervention group compared to the control group. When analysing the control group alone, we found a significant association between antihypertensive medication use and increased daytime sleep. We also found negative associations between blood pressure, antihypertensive medication use and sleep onset latency in the control group.ConclusionsOur results suggest a correlation between excessive daytime sleep and antihypertensive medication use. These findings should be followed up with further research, and with clinical caution, as antihypertensive medications are frequently used in nursing homes, and sleep problems may be especially detrimental for this population.Trial registrationThe trial is registered at clinicaltrials.gov (NCT02238652).

Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis

SummaryBackgroundThe effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure.MethodsWe did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat.FindingsData for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1–Q3 2·97–4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3–32·5) in the comparator group and 25·9 (25·4–26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0–40·5) and 36·0 (95% CI 35·3–36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89–0·94 for partipants without previous cardiovascular disease and 0·89, 0·86–0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories.InterpretationIn this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high–normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself.FundingBritish Heart Foundation, UK National Institute for Health Research, and Oxford Martin School.

Decisions about antihypertensive treatment should focus on reducing cardiovascular risk

Epidemiological studies 1 Lewington S Clarke R Qizilbash N Peto R Collins R Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360: 1903-1913 Summary Full Text Full Text PDF PubMed Scopus (7223) Google Scholar , 2 Rapsomaniki E Timmis A George J et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet. 2014; 383: 1899-1911 Summary Full Text Full Text PDF PubMed Scopus (819) Google Scholar provide strong evidence for an association between high blood pressure and fatal cardiovascular complications, and interventional studies have shown that antihypertensive treatments reduce cardiovascular events and all-cause mortality. 3 Thomopoulos C Parati G Zanchetti A Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertens. 2014; 32: 2285-2295 Crossref PubMed Scopus (167) Google Scholar , 4 Ettehad D Emdin CA Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387: 957-967 Summary Full Text Full Text PDF PubMed Scopus (1541) Google Scholar Although the target blood pressure for patients with hypertension receiving treatment in the current US guidelines 5 Whelton PK Carey RM Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018; 71: e127-e248 Crossref PubMed Scopus (2007) Google Scholar is less than 130/80 mm Hg and European recommendations indicate achieving 120–129/70–79 mm Hg for people younger than 65 years (and 130–139/70–79 mm Hg for those ≥65 years), 6 Williams B Mancia G Dessormais E et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). J Hypertens. 2018; 36: 1953-2041 Crossref PubMed Scopus (1073) Google Scholar other guidelines such as those from the UK 7 National Institute for Health and Care ExcellenceHypertension in adults: diagnosis and management. NICE Guideline 136. National Institute for Health and Care Excellence, London2019https://www.nice.org.uk/guidance/ng136Date accessed: April 4, 2021 Google Scholar recommend higher target values for treatment. Thus, threshold blood pressure levels for initiating therapy and target blood pressure levels with treatment remain controversial. Furthermore, the effect of initial blood pressure on outcome, and the benefit for patients treated in primary versus secondary prevention settings have not been settled. 4 Ettehad D Emdin CA Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387: 957-967 Summary Full Text Full Text PDF PubMed Scopus (1541) Google Scholar , 8 Brunström M Carlberg B Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med. 2018; 178: 28-36 Crossref PubMed Scopus (177) Google Scholar Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysisIn this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high–normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Full-Text PDF Open Access

PREMATURE AND FAVORABLE VASCULAR AGING IN YOUNG PEOPLE TAKING INTO ACCOUNT BLOOD PRESSURE

Abstract Objective: Features of vascular aging in young people have been studied very poorly to date. Meanwhile, increased vascular stiffness is regarded by experts as a realized risk factor. Purpose was to assess the representation of different variants of elastic vascular potential in young people depending on the level of blood pressure and taking into account sex. Design and method: 243 freshmen students including 81 boys and 162 girls were examined on the basis of the Health Center of StSMU within the framework of the National Preventive Project University is Territory of Health. All the examined patients were divided into quartile groups according to such an indicator of vascular stiffness as cardiovascular vascular index or CAVI, which was determined using the diagnostic complex VaSera-1500, Fucuda Denshia, Japan. According to some experts, the fourth quartile of this distribution corresponds to early vascular aging or EVA syndrome. The first quartile corresponds to favorable vascular aging. Then the representation of carriers of prehypertension (PH) and arterial hypertension (AH) in each of the four quartile groups was analyzed. The same analysis was carried out among carriers of normotension and hypotension. Data processing was carried out using the software package Statistica 10.0, StatSoft Inc, USA. Results: The representation of both boys and girls with normal and reduced blood pressure is slightly higher in the first quartile CAVI-group. The representation of young men with increased blood pressure is also somewhat greater in the first quartile CAVI-group. The bulk of girls with high blood pressure is represented in the first and second quartile CAVI-groups. Conclusions: Among freshmen with different levels of blood pressure there are carriers of different variants of elastic vascular potential. At the same time, regardless of the BP level, carriers of favorable vascular aging dominate among young people. Cases of premature vascular aging also occur among individuals with any level of blood pressure. This suggests the need for an optimized approach to the formation of youth groups of cardiovascular risk, taking into account not only traditional risk factors such as hypertension, but also the characteristics of vascular elastic status.

Retinal Microvascular Changes in Hypertensive Patients with Different Levels of Blood Pressure Control and without Hypertensive Retinopathy

ABSTRACT Purpose To determine possible correlations between different levels of blood pressure (BP) control and retinal microvascular changes in the macula and optic nerve head, using coherence tomography angiography (OCTA) in hypertensive patients without hypertensive retinopathy. Methods This was an observational, cross-sectional study. Seventy-three patients and 40 healthy volunteers were included in this study. The patients and volunteers were divided into four groups and from each participant one eye was selected randomly: Group A comprised 32 hypertensive patients with intensive BP control; Group B comprised 26 hypertensive patients with standard BP control; Group C comprised 15 hypertensive patients with poor BP control; Group D comprised 40 control subjects. 6 × 6 mm macula scan and 4.5 × 4.5 mm optic nerve head scan were obtained using OCTA. Results In macula scans, most measured regions of retinal VD showed significant reduction in group C, compared to groups A, B, and D (all P < .05). Partial measured regions of retinal VD were significantly lower in group B than groups A and D (all P < .05). In ONH scans, RNFL thickness and inside disc capillary density were significantly thinner and lower in groups B and C than in group D (all P < .05). SBP was significantly correlated with RNFL thickness (R = 0.430, 95% CI −0.583 to −0.201, P ≤ 0.001). Conclusions We demonstrated that the frequency of OCTA follow-up may improve detection of reduced retinal VD, thus avoiding further retinal damage in hypertensive patients; however, the clinical implications of this finding deserve further study. Moreover, further exploration is needed regarding the implication that reduced SBP may be beneficial for lowering the risk of glaucoma.

The association between maternal anthropometry and blood pressure in pregnancy – results from the Croatian islands’ birth cohort study (CRIBS)

Elevated blood pressure (BP) in pregnancy, especially gestational hypertension and preeclampsia, can lead to serious pregnancy complications and adverse birth outcomes. A large body of literature already reported the effect of baseline body mass index (BMI) on changes in blood pressure during pregnancy. The aim of this study was therefore to define trajectory of systolic (SBP) and diastolic (DBP) blood pressure in 308 pregnant participants from the CRIBS study (146 from the mainland and 162 from the islands of Brač and Hvar) and to analyze the association of blood pressure with maternal BMI prior to pregnancy and maternal anthropometry during pregnancy. Pregnant women included in the CRIBS study had no history of chronic diseases. The BP of CRIBS participants was measured at least once in each trimester, and maternal pre-pregnancy weight was self-reported. All analyses were performed using SPSS 10.0. Results showed that pre-pregnancy BMI was the strongest predictor of pregnancy blood pressure. This association was evident for pre-pregnancy BMI independently (p&amp;lt;0.001), and it also persisted after adjusting for maternal age, education, income, parity, smoking and physical activity (p&amp;lt;0.05). The association between maternal anthropometry during pregnancy and blood pressure was not as strong and was therefore less informative. The study reinforces the role of BMI on SBP and DBP and highlights its importance during prenatal care monitoring. Significant association also emerged between blood pressure in pregnancy and place of residence (mainland vs. island). Women on Dalmatian islands have lower educational level, higher pre-pregnancy BMI and different levels of blood pressure than women from the mainland (namely, higher SBP and lower DBP). Such comparisons between mainland and island populations are valuable, because they can, in the long term, lead to better maternal health care on the islands.