Essential Hypertensive Population Research Articles

Residential greenspace and blood lipids in an essential hypertension population: Mediation through PM2.5 and chemical constituents

Fine particulate matter (PM2.5) adversely affects blood lipids, while residential greenspace exposure may improve blood lipids levels. However, the association between exposure to residential greenspace and blood lipids has not been adequately studied, especially in vulnerable populations (e.g. people with essential hypertension). This study aimed to assess the association between residential greenspace exposure and blood lipids, and to clarify whether PM2.5 and chemical constituents was mediator of it. We used a period (May 2010 to December 2011) from the Chinese national hypertension project. The residential greenspace was estimated using satellite-derived normalized difference vegetation index (NDVI). The generalized additive mixed model (GAMM) was used to assess the association between exposure to residential greenspace and blood lipids, and the mediation model was used to examine whether there was a mediating effect of PM2.5 and chemical constituents on that association. The exposure to residential greenspace was negatively associated with the decreased risk of dyslipidemia, especially short-term exposure. For example, the odd ratioshort-term for dyslipidemia was 0.915 (95% CI：0.880 to 0.950). This association was strengthened by physical activity and participants living in the North. PM2.5 and chemical constituents were important mediators in this association, with the proportion of mediators ranging from −5.02% to 26.33%. The association between exposure to residential greenspace and dyslipidemia in this essential hypertensive population, especially participants living in the North and doing daily physical activity, was mediated by PM2.5 and chemical constituents.

Associations of PM2.5 composition and green space with metabolic syndrome in a Chinese essential hypertensive population

BackgroundMetabolic syndrome (MetS) has emerged as a significant global public health concern. While environmental factors, including PM2.5, have been identified as important risk factors for MetS in the general population, limited studies have investigated their impact on individuals with essential hypertension. Therefore, our study aims to explore the relationship between PM2.5 composition, green space, and their combined effects on MetS among a Chinese essential hypertensive population. MethodA total of 20,131 participants diagnosed with essential hypertension from 10 provinces in China were included in this study. Individual level exposure to various environmental factors (including PM2.5, PM2.5 composition, green space and temperature) were evaluated using spatiotemporal models based on satellites data. Participants were defined as MetS according to the definition issued by the International Diabetes Federation. Generalized additive mixed models were used to analyze the individual air pollutants, green space and their interaction on MetS. ResultThe prevalence of MetS in this population was 44.33%. The adjusted odd ratio (OR) of MetS, with each one unit increase in SO42−, BC and NO3− were 1.077 (1.049, 1.106), 1.126 (1.077, 1.177) and 0.977 (0.958, 0.996) respectively. Additionally, each unit increase of the Normalized Difference Vegetation Index (NDVI) was associated with a decreased risk of MetS (OR: 0.988, 95% CI: 0.984–0.993). In particular, green space was found to mitigate the adverse impacts of PM2.5 on MetS (OR: 0.988, 95% CI: 0.984–0.993). ConclusionOur results suggested that there was a positive association between PM2.5 and its composition (SO42−, BC) with MetS in the essential hypertensive population, while green space might play a protective role. Moreover, green space could effectively weaken the positive relationship between air pollutants and MetS, especially in males and participants younger than 60 years old.

The effect of age, sex and BMI on the aldosterone-to-renin ratio in essential hypertensive individuals.

The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism, but its determinants in patients with essential hypertension are not fully known. The purpose of the present investigation is to identify the impact of age, sex and BMI on renin, aldosterone and the ARR when measured under strict, standardized conditions in hypertensive patients without primary aldosteronism. We analysed the data of 423 consecutive hypertensive patients with no concomitant cardiac or renal disorders from two different hospitals (Rotterdam and Maastricht) who had been referred for evaluation of their hypertension. Those who were diagnosed with secondary causes of hypertension, including primary aldosteronism, were excluded from analysis. Patients who used oral contraceptives or had hormonal replacement therapy were excluded as well. Plasma aldosterone concentration (PAC), active plasma renin concentration (APRC) and the ARR were measured under standardized conditions. All measurements were taken in the supine position at 10.00 h in the morning, with one subgroup of patients adhering to a sodium-restricted diet (55 mmol/day) for no less than 3 weeks, and the other subgroup maintaining an ad libitum diet. In those who were receiving antihypertensive treatment, all medications were discontinued at least 3 weeks before testing. In neither group did aldosterone correlate with age. Renin, however, was inversely related to age both during low-salt diet ( P < 0.001) and during ad lib salt intake ( P = 0.05). This resulted in a significant positive correlation between age and the ARR in both groups. Although on both dietary regimens, PAC and APRC were significantly higher in men when compared with women, the ARR was not significantly different between the two sexes. The age-relationships of renin and the ARR were comparable in men and women on both diets, albeit with greater variability in women. There was an upward trend between BMI and the ARR, which reached statistical significance only in men on low-salt diet. In multivariable regression analysis, age remained the only independent determinant of the ARR. In our essential hypertensive population, the ARR increased significantly with age but was not affected by sex or BMI.

Effects of long-term exposure to PM2.5 and chemical constituents on blood lipids in an essential hypertensive population: A multi-city study in China

Previous studies on the effects of fine particulate matter (PM2.5) and chemical constituents on lipid disorder among hypertension populations, particularly in China, are very limited. We aimed to examine the effects of long-term exposure to PM2.5 and chemical constituents on dyslipidemias in China. Finally, we included 34,841 participants with essential hypertension from 19 regions in China during 2010–2011. Data were modeled using the generalized additive mixed model. We found that PM2.5 and chemical constituents exposure were positively associated with the increased risk of dyslipidemias and increased levels of total cholesterol (TC) and triglyceride (TG). The odds ratio for hypercholesterolemia was 1.356 [95% confidence interval (CI): 1.246, 1.477] for PM2.5, and the strongest association with PM2.5 constituents was found for nitrate. Each 10 μg/m3 increase in PM2.5 showed a significant increase of TC by 2.60% (95% CI: 2.03, 3.17) and TG by 2.91% (95% CI: 1.60, 4.24), respectively. Meanwhile, an interquartile range increase in nitrate, ammonium and organic matter had stronger associations with TC and TG parameters than black carbon, sulfate, and mineral dust. Our findings may contribute to a better understanding of the chronic effects of PM2.5 and chemical constituents on lipid disorder in an essential hypertensive population.

Left atrial volume indexed for height2 is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients.

Left atrial enlargement (LAe) is a subclinical marker of hypertensive-mediated organ damage, which is important to identify in cardiovascular risk stratification. Recently, LA indexing for height was suggested as a more accurate marker of defining LAe. Our aim was to test the difference in LAe prevalence using body surface area (BSA) and height2 definitions in an essential hypertensive population. A total of 441 essential hypertensive patients underwent complete clinical and echocardiographic evaluation. Left atrial volume (LAV), left ventricular morphology, and systolic-diastolic function were evaluated. LAe was twice as prevalent when defined using height2 (LAeh2) indexation rather than BSA (LAeBSA) (51% vs. 23%, p < 0.001). LAeh2, but not LAeBSA, was more prevalent in females (p < 0.001). Males and females also differed in left ventricular hypertrophy (p = 0.046) and left ventricular diastolic dysfunction (LVDD) indexes (septal Em/Etdi: p = 0.009; lateral Em/Etdi: p = 0.003; mean Em/Etdi: p < 0.002). All patients presenting LAeBSA also met the criteria for LAeh2. According to the presence/absence of LAe, we created three groups (Norm = BSA-/h2-; DilH = BSA-/h2+; DilHB = BSA+/h2+). The female sex prevalence in the DilH group was higher than that in the other two groups (Norm: p < 0.001; DilHB: p = 0.036). LVH and mean and septal Em/Etdi increased from the Norm to the DilH group and from the DilH to the DilHB group (p < 0.05 for all comparisons). These results show that LAeh2 identified twice as many patients as comparing LAe to LAeBSA, but that both LAeh2 and LAeBSA definitions were associated with LVH and LVDD. In female patients, the LAeh2 definition and its sex-specific threshold seem to be more sensitive than LAeBSA in identifying chamber enlargement.

IL-18 predicts cardiac organ damage in a population of hypertensive patients

Objectives: Hypertensive patients (HTs) develop arterial and cardiac damage (TOD) which is a marker of cardiovascular-CV-morbidity. Inflammatory activation is also an important determinant of cardiovascular status. Interleukin-18 (IL-18), a strong predictor of CV disease and death, has been related to plaque progression and vulnerability. We investigated whether IL-18 plays a role in TOD development in the arteries and heart in an essential hypertensive population.

E0584 A study of Exforge on the treatment effects and CVE prevention in patients with mild to moderate essential hypertension

ObjectiveTo compare the difference of the treatment effects and the incidence of CVE in further 10 years in the mild to moderate essential hypertensive population who used Exforge—a new fixed...

Total antioxidant status and oxidative DNA damage in a South Indian population of essential hypertensives

To investigate the total antioxidant status (TAS) and the extent of oxidative DNA damage in total lymphocytes and their relation with essential hypertension. A total of 130 South Indian subjects aged 30-65 were recruited for the study. Of these hypertensive subjects investigated, 30 were newly diagnosed and were not on any antihypertensive drugs, but had systolic blood pressure (BP) ranging between 140 and 160 mm Hg and diastolic BP between 95 and 100 mm Hg; 50 hypertensive patients who were already on drug therapy for 1 year and 50 were normotensive controls with BP < or =120/80 mm Hg. DNA damage was significantly increased in hypertensive patients (both newly diagnosed and who were already on drug therapy) compared with control group. The major increase in DNA damage was observed in newly diagnosed hypertensive patients compared with hypertensive patients who were already on drug therapy. There was a significant decrease in plasma TAS value in essential hypertensive groups as compared to normotensive controls. Lymphocyte DNA damage was independently correlated with only TAS. Lymphocyte DNA damage was increased in hypertensive patients. The major increase in lymphocyte DNA damage was observed in newly diagnosed hypertensive patients compared with hypertensive patients who already on drug therapy. Decreased TAS levels, which reflect to increased oxidative stress, may be the reason of increased total lymphocyte DNA damage in South Indian hypertensive patients.

The G501C polymorphism of oxidized LDL receptor gene [OLR-1] is associated with susceptibility and serum C-reactive protein concentration in Chinese essential hypertensives

Background Oxidized LDL receptor gene 1 (OLR-1) polymorphism is reportedly associated with several cardiovascular conditions. However, its relationship with essential hypertension remains unknown. The aim of this study is to explore the association of OLR-1 polymorphism at position 501 in the open reading frame (G501C), with the susceptibility of essential hypertension. Methods 2-hundred eighty Chinese essential hypertensive and 284 control subjects were enrolled and genetic study was performed. The clinical data, i.e., sex, age, blood pressure, body mass index, smoking history, lipid profile and serum C-reactive protein concentration in both hypertensives and controls were obtained. Results A significant difference in OLR-1 genotype distributions was noted between the hypertensives and the controls (GG: 67.9% vs. 70.8%; GC: 20.0% vs. 23.6%; CC: 12.1% vs. 5.6%, P = 0.021). For G and C allele frequencies, the difference between these 2 groups was significant as well (G: 67.5% vs. 23.5%, C: 82.6% vs. 17.4%, P = 0.011). Logistic regression analysis revealed that the CC genotype is an independent risk factor for hypertension (OR = 3.036, 95% CI: 1.572–6.174, P = 0.016). Furthermore, when the serum C-reactive protein concentration in the hypertensive group was studied according to OLR-1 genotypes, the serum CRP concentration in CC homozygous carriers were found significantly higher than that in GC and GG carriers (1.53 ± 0.32, 1.31 ± 0.32 and 2.94 ± 1.29 respectively, P = 0.002). Conclusions The CC genotype of OLR-1 G501C polymorphism is associated with susceptibility and serum C-reactive protein concentration in Chinese essential hypertensive population.

Podagra, Uric Acid, and Cardiovascular Disease

Hippocrates would not be surprised to read that persons with gout had higher mortality, and particularly cardiovascular-related mortality, than persons without gout.1 On the other hand, he might well have been bemused, nearly 2500 years after he described the syndrome, that this made news. Article p 894 He should not have been. All too often, rigorous examination debunks conventional wisdom. Reassuringly, in this case, Drs Choi and Curhan found evidence to support long-standing belief. These dedicated and productive students of the pathogenesis and natural history of gout have here reported empiric data from the 51 000 male nonphysician health professionals who participated in the Health Professions Follow-up Study. From initial examination in 1986 through nearly 600 000 person-years of follow-up, 5825 deaths occurred, of which 2132 were cardiovascular and 1576 were ascribed to coronary heart disease, rates that attest to the generally good health of the group. The ≈6% prevalence of gout, at baseline, in men in their mid-50s, who mirror the general US population in body mass index, reported history of hypertension, hypercholesterolemia, and diabetes mellitus, was higher than expected. Interim biennial questionnaires identified incident cases of gout. Participants with gout were both more likely to report coronary heart disease (CHD) at baseline and, regardless of CHD status, more likely than gout-free persons to have cardiovascular disease (CVD) risk factors. Results were presented after stratification by CHD status at baseline. As expected, the incidence of all-cause and CHD mortality was much greater in those with than in those without prevalent CHD. The adjusted increased relative risk of those with gout (compared with those without) for all-cause, CVD, and CHD mortality was ≈25%. The single exception was a near doubling of increased relative risk of CHD mortality among those free of CHD at baseline. Neither the inclusion of incident …

Lack of Association Between Serum Uric Acid and Organ Damage in a Never-Treated Essential Hypertensive Population at Low Prevalence of Hyperuricemia

It is still undefined whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and cardiovascular events in human hypertension. We sought to investigate the association of SUA with subclinical cardiac, vascular, and renal alterations in never-treated uncomplicated essential hypertensives. A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by sex and tertiles of SUA levels, were considered for this analysis. All subjects underwent extensive clinical, laboratory, and ultrasonographic investigations searching for cardiac and extracardiac TOD. Hyperuricemia (SUA >7.0 mg/dL in men and >6 mg/dL in women) was present in 8.3% of the patients. The overall prevalence of left-ventricular hypertrophy (LVH), carotid alterations, and microalbuminuria was 28%, 27%, and 8%, respectively. No differences in the prevalence rates of these TOD markers were present across all SUA tertiles in the entire population, as well as in both sexes. The SUA levels were similar in patients with and without LVH, carotid alterations, or microalbuminuria. When patients were classified according to the number of organs involved, those with multiple TOD (2 or 3 organs) had significantly higher SUA levels (5.1 +/- 1.3 or 5.2 +/- 1.4 mg/dL), as compared with those with a single or no organ involvement (4.9 +/- 1.3 or 4.9 +/- 1.4 mg/dL, P < .05). The association, however, between SUA levels and multiple TOD was not confirmed in a logistic regression analysis. Our findings do not support the role of SUA as an independent risk factor for subclinical TOD in a selected population of recently diagnosed uncomplicated hypertensives at low prevalence of hyperuricemia.

Lack of Association between Serum Uric Acid and Organ Damage in a Never Treated Essential Hypertensive Population at Low Prevalence of Hyperuricaemia

Lack of Association between Serum Uric Acid and Organ Damage in a Never Treated Essential Hypertensive Population at Low Prevalence of Hyperuricaemia

Proinflammatory effect of abnormal nocturnal blood pressure fall in essential hypertension

Recent evidence suggests an association between inflammation and increased atherosclerotic burden. The prognostic significance of abnormal nocturnal blood pressure (BP) fall in essential hypertensive patients (pts) is increasingly recognized. The aim of the present study was to investigate the effect of nocturnal BP fall patterns on inflammatory status, in hypertensive pts. We studied 780 consecutive untreated pts (412 men, 368 women, age 56.8±12.9 years old) with mild to moderate chronic uncomplicated essential hypertension. According to their nocturnal systolic BP fall, pts were classified in extreme dippers (130 pts with >20% nocturnal systolic BP fall), dippers (433 pts with >10% but <20% fall), nondippers (161 pts with >0% but <10% fall) and reverse dippers (56 pts with nocturnal increase of systolic BP). Apart from full biochemical evaluation, inflammatory status was assessed in all pts, by measuring the plasma homocystine (Hcy), serum high-sensitivity C-reactive protein (hsCRP) and serum amyloid-A (SAA) levels. SAA increased from 4.07 mg/l in extreme dippers, to 4.72 in dippers, 5.67 in nondippers and 7.2 mg/l in reverse dippers (p<0.00001). Homocystine and hsCRP levels exhibited as well a significant (p<0.00001) stepwise increase across the groups of nocturnal BP fall patterns (11.22 vs 11.75 vs 13.1 vs 14.7 μmol/l for Hcy and 1.88 vs 1.96 vs 2.64 vs 3.69 mg/l for hsCRP respectively). Extreme dippers did not differ (p=NS) from dippers in regard to any inflammatory marker. In contrast, reverse dippers had significantly increased levels of SAA (p=0.004) and hsCRP (p=0.03) compared to nondippers. Abnormal nocturnal BP fall is associated with increased levels of inflammatory markers in an essential hypertensive population. Reverse dipping status seems to confer an even greater proinflammatory effect than nondipping pattern.

Mild renal impairment is associated with increased cardiovascular risk in hypertensive patients

P-149 Key Words: Renal Impairment, Microalbuminuria, Target Organ Lesion

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well?

Plasma renin activity and metabolic risk factors in essential hypertension

Elevated plasma renin activity (PRA) has been shown to be associated with enhanced cardiovascular morbidity. In small series of patients (pts), high PRA levels have been observed in subjects with clustering of classical risk factors. Aim of the present study was to investigate the relationshipS between PRA and plasma lipids, glucose (G), insulin (I) and uric acid (UA) in a population of essential hypertensives (EH). Records of 487 EH, either untreated or whose treatment with diuretics, betablockers or ACE-inhibitors had been withdrawn at least 4 weeks before, were reviewed for baseline PRA, total, LDL- and HDL-cholesterol, triglycerides, serum G and UA and plasma I. All pts were on controlled Na intake; they were grouped according to quartiles of PRA (ngAI/ml/h)(I quart., median 0.15, range 0.05-0.25; II quart., median 0.40, range 0.30-0.60; III quart., median 0.90, range 0.65-1.30; IV quart., median 2.1, range 1.35-6.75). Sex distribution, body mass index (BMI), systolic and diastolic blood pressure values and 24-hour urinary Na were similar across quartiles of PRA. The pts in the highest quartile were slightly but significantly younger than those in the lowest quartile (46±11 vs 53±11, P<0.01). There were no significant differences in plasma lipids and serum G, whereas plasma I was highest in the highest quartile (Table). HOMA-IR, an index of insulin resistance, was also significantly higher in the IV compared with the I quartile (2.50±2.12 vs 2.05±1.35, P=0.016), even after correction for age and BMI. Serum UA was also significantly higher in the highest compared with the lowest PRA quartile. We conclude that in middle-aged, nondiabetic EH moderately elevated PRA levels are not associated with an unfavourable plasma lipid pattern; however, insulin resistance and UA levels appear to increase with increasing PRA values.

Angiotensin II AT1 receptor gene polymorphism and microalbuminuria in essential hypertension

The objective of this study was to analyze the relationship of polymorphisms of the angiotensin II AT1 receptor gene with microalbuminuria in a group of young adults with essential hypertension. Essential hypertensives, less than 50 years old, never previously treated with antihypertensive drugs, and in absence of diabetes mellitus were included. Office blood pressure (BP), 24-h ambulatory BP monitoring, urinary albumin excretion (UAE) measurements, and DNA analysis were performed. Polymorphisms of the angiotensin II AT1-receptor gene (A1166C and C573T) were studied by polymerase chain reaction and single-strand conformation polymorphism techniques. One hundred eighty-three patients, 49 (27%) microalbuminurics, were included. Office and ambulatory BP values were significantly higher in the microalbuminuria group. No differences in the presence of microalbuminuria were observed among the genotypes of either A1166C or C573T polymorphisms of the angiotensin II receptor AT1 gene, or in the allele frequency of the A1166C or the C573T polymorphism. LogUAE was significantly different among genotypes of the C573T polymorphism [CC 1.30(1.15–1.45), CT 1.14(1.00–1.28), and TT 0.94(0.68–1.20), P < .05]. Both office and ambulatory blood pressure and the TT/C573T genotype were independently related to logUAE, and, at the same BP values, UAE was lower in subjects with this genotype. We have found that the C573T polymorphism is on linkage disequilibrium with A1166C, as the 573T allele is closely linked to the presence of the 1166A allele, but not vice versa. Haplotype analysis among subjects with the AA genotype for the A1166C polymorphism confirms the influence of the TT genotype of the C573T polymorphism on the UAE in hypertensives. The C573T polymorphism of the angiotensin II receptor AT1 gene seems to be a genetic protective factor for UAE in a population of essential hypertensives.

Effects of gender and genotype on the phenotypic expression of nonmodulating essential hypertension

Nonmodulation describes a subset of the normal/high renin essential hypertensive population. It is an inherited trait. This report reviews the genetic and gender data recently available that discuss the modification of the expression of the nonmodulating phenotype. Both the adrenal and the renal blood flow markers for nonmodulation are associated with a single nucleotide polymorphism (SNP) in the coding region of the angiotensinogen gene at codon 235. Even though the nonmodulating phenotype is associated with a somatic gene, gender modifies its expression. In women, the expression of the nonmodulating phenotype is approximately half of that in men. Additional analysis suggests that this gender difference is almost entirely explained by a difference in the frequency of nonmodulation in younger premenopausal women. In older, likely postmenopausal women, there is no gender difference. This suggests that the expression of the nonmodulating phenotype, presumably secondary to changes in the expression of the angiotensinogen gene, is modulated by female sex hormones.