Greater Risk Of Hypertension Research Articles

Prevalence of hypertension and prehypertension in children and adolescents with intellectual disability in southeastern Poland.

There is insufficient information on the prevalence of hypertension (HPT) among children and adolescents with ID. The aim of this study was to determine the prevalence of HPT in children and adolescents with ID in comparison with the control group, which accounted for children and adolescents without ID. The study included 568 students with ID, aged from 7 to 18, attending special education institutions in southeastern Poland. The control group consisted of 568 students (matched to the study group for age and gender) without ID, attending randomly selected elementary and secondary schools located in the same area. Blood pressure was measured in compliance with the European Society of Hypertension recommendations. The overall prevalence of HPT and pre-HPT in children and adolescents with ID were 18.5 and 20.6% respectively. Prevalence of HPT and pre-HPT in children and adolescents without ID were 5.8 and 18.5% respectively. Children and adolescents with a higher level of ID were found to be at a greater risk of HPT. An excessive body mass and older age were predisposing factors to a significantly higher prevalence of HPT in children and adolescents with ID. The prevalence of HPT among students with ID was more than three times higher than in the general population. The level of ID, age, sex and body mass significantly correlated with HPT in the study group.

Vitamin D and hypertension: Prospective study and meta-analysis.

ObjectivesThe study sought to determine the link between vitamin D concentrations and incident hypertension in prospective study and meta-analysis.MethodsThe study was embedded in the Kailuan Study, a population-based cohort of adults that contains underground miners. In 2012, we studied 2,456 men and women free of prevalent hypertension, age 21 to 67 at baseline. Serum 25-hydroxyvitamin D was measured from previously frozen baseline samples using ELISA (Enzyme-Linked ImmunoadSorbent Assay). We use the logistic regression analysis to estimate the odd radio (ORs) 95% confidence intervals (CIs) for 25-hydroxyvitamin D [25(OH)D] concentrations with incident hypertension. To help place our new data in context, we conducted a systemic review and meta-analysis of previous prospective reports of vitamin D and hypertension.ResultsDuring a median follow-up of 2 years, 42.6% of the cohort (n = 1047) developed hypertension. Compared with the 25-hydroxyvitamin D >30ng/ml, 25-hydroxyvitamin D <20 ng/ml was associated with a greater hypertension risk (OR: 1.225 [95% CI: 1.010 to 1.485] p = 0.04), although the association was attenuated and not statistically significant after adjusting for potential confounders (OR: 1.092 [95% CI: 0.866 to 1.377] p = 0.456). This meta-analysis included seven prospective studies for 53,375 participants using adjusted HR founded a significant association between vitamin D deficiencies and incident hypertension (HRs = 1.235 (95% CI: 1.083 to 1.409, p = 0.002)).ConclusionLower serum 25-hydroxyvitamin D concentrations were not associated with a greater risk of incident hypertension. More research is needed to further determine the role of 25-hydroxyvitamin D in hypertension prevention and therapy.

Steeper change in body mass across four decades predicts poorer cardiometabolic outcomes at midlife.

ObjectiveWe examined patterns of change in adiposity across four decades starting in young adulthood and their relationships with midlife cardiometabolic outcomes.MethodsBMI was assessed at average age 20, 40, 56 and 62 years in 977 male veterans from the Vietnam Era Twin Study of Aging. Age 62 (range 56–66) cardiometabolic outcomes included hypertension, diabetes, dyslipidemia, inflammation, and ischemic heart disease. Analyses included latent growth modeling (LGM), latent class growth modeling (LCGM), and logistic regression models.ResultsLinear BMI slope was associated with all outcomes. Accelerated (quadratic) BMI slope was significantly associated with greater risk for hypertension, diabetes, dyslipidemia, and inflammation; odds ratios ranged from 1.93 (diabetes) to 3.15 (dyslipidemia). Initial BMI did not predict later outcomes. Linear slope contributed significant unique variance for diabetes and dyslipidemia even controlling for age 62 BMI. LCGM revealed three trajectories. Men with the relatively stable, lower BMI trajectory had significantly better outcomes than those with trajectories with accelerated increases, especially those including obesity.ConclusionsHow individuals reach late midlife BMI is important. Steepness of BMI change across 40 years from young adulthood to late midlife, in addition to late midlife BMI itself, was robustly associated with greater risk for poor cardiometabolic outcomes.

Community Policy Brief

Community Policy Brief S. Megan Berthold, PhD, LCSW, Sengly Kong, PhD, Theanvy Kuoch, MA, LPC, Elizabeth A. Schilling, PhD, Rasy An, MA, Mary Blatz, MA, Rorng Sorn, MS, Sivheng Ung, BA, Yorn Yan, MBA, Mary Scully, APRN, Seiya Fukuda, MSW, MA, and Lorin Mordecai, MSW, LSW COMMUNITY POLICY BRIEF What Is the Purpose of this Study? • This study engaged Cambodian-led nonprofit organizations in six regions of the United States in a community–university partnership that used a community-based participatory research (CBPR) approach to: 1 further develop the Cambodian American community's capacity to design and conduct health research meaningful to their community via a CBPR approach; 2 train and deploy bilingual community health workers to gather health-related data from their communities using mobile technology; and 3 measure the feasibility and effectiveness of our efforts. What Is the Problem? • Cambodians who came to the United States as refugees have experienced high rates of trauma during the Khmer Rouge genocide and in refugee camps on the Thai–Cambodian border. • Those Cambodians who were adolescents in the United States have faced significant community violence and racial discrimination, and these experiences are associated with posttraumatic stress disorder and depression. • Cambodian Americans have higher rates of persistent health and mental health problems compared to the general U.S. population; are more likely to experience posttraumatic stress disorders, major depressive disorder, and co-occurring post-traumatic stress disorder and depression; and are also at greater risk for hypertension, diabetes, and cardiovascular disease. • Limited systematic study of community health and a relatively modest community capacity for collecting data contribute to these disparities. What Are the Findings? • Community health workers, leaders, and community members reported largely positive experiences with the iPads and spoken Khmer format of the community health survey, despite inconsistent Internet connectivity. • The institutional capacity of Cambodian American community-based organizations to collect health-related data in their own communities was strengthened. • Our efforts proved to be both feasible and effective. [End Page 107] Who Should Care Most? • Community-based organizations providing services to Cambodian communities or other vulnerable populations. • Cambodian community members living in the United States as well as other trauma survivors or refugees. • Health and mental health service providers. • Researchers studying the feasibility of using mobile technology in CBPR health studies. Recommendations for Action • CBPR approaches that use technology should continue to be used to research health disparities in Cambodian American and other communities. • Community engagement in this research is essential. • Trained and experienced community health workers and community leaders are an asset to their communities and uniquely placed to protect the rights and well-being of their community members. [End Page 108] S. Megan Berthold University of Connecticut School of Social Work Sengly Kong Khmer Health Advocates Theanvy Kuoch Khmer Health Advocates Elizabeth A. Schilling Center for Public Health and Health Policy, InCHIP, UConn Health Rasy An Cambodian Mutual Assistance Association of Greater Lowell Mary Blatz Mount Carmel Cambodian Center Rorng Sorn Cambodian Association of Greater Philadelphia Sivheng Ung Cambodian-American Community of Oregon Yorn Yan United Cambodian Association of Minnesota Mary Scully Khmer Health Advocates Seiya Fukuda Health Services Research Division, Bedford Veterans Affairs Medical Center Lorin Mordecai University of Connecticut School of Social Work Copyright © 2017 Johns Hopkins University Press

Pulse rate reactivity in childhood as a risk factor for adult hypertension: the 1970 British cohort study.

Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in childhood and risk of hypertension in adulthood. A total of 6507 participants (51.6% women) underwent clinical examination at 10 years of age that involved measurement of blood pressure, BMI, and pulse rate pre and postexamination. Hypertension was ascertained by self-reported doctor diagnosis 32 years later at age 42. On average, there was a reduction in pulse rate after the medical examination (-1.2 ± 8.2 bpm), although nearly a third of the sample recorded an increase in pulse rate of at least 3 bpm. A total of 488 (7.5%) study members developed hypertension at follow-up. After adjustment for a range of covariates, including resting blood pressure and BMI in childhood, a heightened pulse rate response to the examination (≥3 bpm) was associated with greater risk of hypertension in adulthood (odds ratio = 1.30, 95% confidence interval, 1.02, 1.67). The association persisted whether we modelled pulse rate as an absolute measure (postexamination) or a change score. These observational data suggest that elevated childhood cardiovascular reactivity could increase risk for hypertension in adulthood.

Association between sleep disorders and hypertension in Taiwan: a nationwide population-based retrospective cohort study.

There is insufficient evidence to assess the risk for hypertension in patients with sleep disorders (SDs) in a large population-based cohort study. The aim of this study was to examine the risk of hypertension in groups both with and without SDs. Taiwan's National Health Insurance Research Database (NHIRD) data from 2005 to 2010 were used in a retrospective cohort study. A Cox proportional hazard regression analysis was used to evaluate the effects of SDs on hypertension risk. The overall incidence of hypertension was 120.7 per 1000 person-years for patients with SDs, which was significantly higher than that of the non-SD comparison cohort (76.4 per 1000 person-years). Overall, patients with SDs had a higher risk of hypertension compared with comparison cohort (adjusted hazard ratio (HR)=1.58, 95% confidence interval (CI)=1.26-1.79). Among patients aged <40 years, patients with SDs had a higher risk for hypertension than the comparison cohort (adjusted HR, 2.90 (95% CI, 2.46-3.14)). Compared with the cohort without insomnia, patients with insomnia had a 21% higher risk for hypertension (adjusted HR, 1.21 (95% CI, 1.01-1.76)). Compared with non-SD comparison cohort, patients with SDs had a higher risk for developing hypertension, particularly pronounced among those who were younger adults (age ⩽40 years) and who had insomnia. We suggest that possible persisting exposure to sleep problems was correlated with a greater risk of hypertension.

Infertility, fertility treatment, and risk of hypertension

To evaluate the association between infertility and fertility treatments on subsequent risk of hypertension. Cohort study. Not applicable. A total of 116,430 female nurses, followed from 1993 to June 2011, as part of the Nurses' Health Study II cohort. None. Self-reported, physician-diagnosed hypertension. Compared with women who have never reported infertility, infertile women were at no greater risk of hypertension (multivariable adjusted relative risk (RR) = 1.01, with 95% confidence interval [CI] [0.94-1.07]). Infertility due to tubal disease was associated with a higher risk of hypertension (RR = 1.15 [1.01-1.31]), but no other diagnoses were associated with hypertension risk, compared with women who did not report infertility (ovulatory disorder: RR = 1.03 [0.94-1.13]; cervical: RR = 0.88 [0.70-1.10]; male factor: RR = 1.05 [0.95-1.15]; other reason: RR = 1.02 [0.94-1.11]; reason not found: RR = 1.02 [0.95-1.10]). Infertile women collectively had 5,070 cases of hypertension. No clear pattern between use of fertility treatment and hypertension was found among infertile women (clomiphene citrate: RR = 0.97 [0.90-1.04]; gonadotropin alone: RR = 0.97 [0.87-1.08]; intrauterine insemination: RR = 0.86 [0.71-1.03]; in vitro fertilization: RR = 0.86 [0.73-1.01]). Among this relatively young cohort of women, no apparent increase occurred in hypertension risk among infertile women, or among women who had undergone fertility treatment previously.

145 Evidence of Hypertension but not Metabolic Disorders in Young Adults Born to Hypertensive Pregnancies

Objective Children born to hypertensive pregnancies are known to have higher levels of cardiovascular risk factors. We studied whether by age 20 years they have developed hypertension or metabolic disorders that may warrant intervention. Methods We quantified cardiovascular risk in young adults born to hypertensive pregnancies using data fromthe 2868 offspring of women enrolled during pregnancy into Western Australia Pregnancy Cohort (Raine) Study, taking into account whether risk varies with severity of the hypertensive pregnancy syndrome and degree of prematurity. Results Young adults born to hypertensive pregnancies accounted for 30% of those with hypertensive blood pressures at age 20 years. Detailed pregnancy medical records demonstrated that a more complicated history, characterised as preeclampsia or preterm birth due to maternal hypertension, associated with a 3-fold (95% CI 1.3 to 7.0, p = 0×01) greater risk of hypertension, whereas, pregnancy-induced hypertension at term associated with a smaller blood pressure rise. Although incidence of overweight and obesity was 2-fold (95% CI 1.5 to 2.8, p = 0×001) higher in the pregnancy-induced hypertension group, body size did not account for blood pressure variation in either group and metabolic risk markers did not vary. Associations were consistent throughout life and independent of other birth-related factors. Conclusions Adults born following a complicated hypertensive pregnancy are significantly more likely to be hypertensive by age 20 years and exhibit a specific hypertensive phenotype without metabolic changes. Consideration of maternal pregnancy history may be of value to provide insight into why some young adults present with hypertension.

Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study.

In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10–18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent’s sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES.Conclusion: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments. What is known: • Socioeconomic gradient exists in adolescent blood pressure levels. • Adolescents from lower SES families are at greater risk of hypertension. What is new: • Urbanization levels of residence area affect adolescent blood pressure by parental socioeconomic status. • Socioeconomic inequalities in adolescent hypertension may be modulated through effects of body weight.

Overweight and obese adolescents from Mthatha – South Africa may have a greater risk of hypertension and pre-hypertension

Overweight and obese adolescents from Mthatha – South Africa may have a greater risk of hypertension and pre-hypertension

Study of autonomic functions in young adults of hypertensive and normotensive parents

Background: Hypertension is a major public health problem worldwide, including India. Nowadays, prehypertension is common in young adults. It has genetic basis and runs in families. Parental history of hypertension increases the risk of developing hypertension, especially if both parents are hypertensive. Cause & effect relation of hypertension & autonomic dysfunction is not clear. Therefore, this study was planned to see autonomic function alterations in young adults of hypertensive parents, if any.Methodology: In this study autonomic activity was assessed in students with both parents hypertensive (n= 30), one parent hypertensive (n= 30) and both parents normotensive (n= 30).Resting heart rate and BP was measured for parasympathetic function assessment and rise in diastolic BP with hand grip dynamometer was used for sympathetic function assessment.Results: The study showed no significant difference in resting pulse rate of all the groups. BP was slightly higher in groups with hypertensive parents as compared to a group of normotensive parents, but the difference was statistically insignificant. Statistically significant rise in diastolic BP with handgrip dynamometer was observed in subjects with hypertensive parents.Conclusion: This rise in diastolic BP indicates increased sympathetic activity. Our results showed higher sympathetic activity in those with hypertensive parents. It also confirmed the genetic basis of sympathetic (vasomotor) tone. Young adults having hypertensive parents are at a greater risk of hypertension at an early age. Regular assessment of blood pressure and autonomic function with lifestyle modifications should be recommended to delay onset of hypertension in them.

Hypertension risk in Dutch women with symptomatic uterine fibroids.

Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions. Blood pressure was measured in women scheduled for fibroid surgery compared to women scheduled for nonfibroid gynecological surgery and women randomly sampled from the general population. We used multivariable binary logistic regression to assess whether hypertension was more common with surgically treated fibroids, independent of age, body mass index, and African ancestry. We included 1,342 women (542 of African ancestry), of which 272 scheduled for fibroid surgery, 385 controls scheduled for nonfibroid gynecological surgery, and 685 random population controls, with a mean age (SD) of, respectively, 43.4 (6.6), 41.3 (10.2), and 45.1 (6.6) years; and a mean body mass index (SD) of, respectively, 27.4 (5.3), 25.7 (5.7), and 28.2 (5.6) kg/m(2). Hypertension was found more frequently with surgically treated fibroids, with an occurrence of 41.9% in women with fibroids vs. 27.5% in surgical controls, and 28.3% in population controls (P < 0.001 for fibroids vs. controls). The association with hypertension was independent of age, body mass index, and African ancestry (odds ratio, 2.4; 95% confidence interval, 1.7-3.4). Hypertension risk is higher in Dutch women with surgically treated fibroids than in surgery or population controls, independent of age, body mass index, and African ancestry. Our data add to the body of evidence indicating that women with uterine fibroids are eligible for hypertension screening.

Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study.

BackgroundThe epidemics of HIV and hypertension are converging in sub-Saharan Africa. Due to antiretroviral therapy (ART), more HIV-infected adults are living longer and gaining weight, putting them at greater risk for hypertension and kidney disease. The relationship between hypertension, kidney disease and long-term ART among African adults, though, remains poorly defined. Therefore, we determined the prevalences of hypertension and kidney disease in HIV-infected adults (ART-naive and on ART >2 years) compared to HIV-negative adults. We hypothesized that there would be a higher hypertension prevalence among HIV-infected adults on ART, even after adjusting for age and adiposity.MethodsIn this cross-sectional study conducted between October 2012 and April 2013, consecutive adults (>18 years old) attending an HIV clinic in Tanzania were enrolled in three groups: 1) HIV-negative controls, 2) HIV-infected, ART-naive, and 3) HIV-infected on ART for >2 years. The main study outcomes were hypertension and kidney disease (both defined by international guidelines). We compared hypertension prevalence between each HIV group versus the control group by Fisher’s exact test. Logistic regression was used to determine if differences in hypertension prevalence were fully explained by confounding.ResultsAmong HIV-negative adults, 25/153 (16.3%) had hypertension (similar to recent community survey data). HIV-infected adults on ART had a higher prevalence of hypertension (43/150 (28.7%), P = 0.01) and a higher odds of hypertension even after adjustment (odds ratio (OR) = 2.19 (1.18 to 4.05), P = 0.01 in the best model). HIV-infected, ART-naive adults had a lower prevalence of hypertension (8/151 (5.3%), P = 0.003) and a lower odds of hypertension after adjustment (OR = 0.35 (0.15 to 0.84), P = 0.02 in the best model). Awareness of hypertension was ≤25% among hypertensive adults in all three groups. Kidney disease was common in all three groups (25.6% to 41.3%) and strongly associated with hypertension (P <0.001 for trend); among hypertensive participants, 50/76 (65.8%) had microalbuminuria and 20/76 (26.3%) had an estimated glomerular filtration rate (eGFR) <60 versus 33/184 (17.9%) and 16/184 (8.7%) participants with normal blood pressure.ConclusionsHIV-infected adults on ART >2 years had two-fold greater odds of hypertension than HIV-negative controls. HIV-infected adults with hypertension were rarely aware of their diagnosis but often have evidence of kidney disease. Intensive hypertension screening and education are needed in HIV-clinics in sub-Saharan Africa. Further studies should determine if chronic, dysregulated inflammation may accelerate hypertension in this population.

Preeclampsia: effect on newborn blood pressure in the 3 days following preterm birth: a cohort study.

Maternal hypertension and preeclampsia are associated with greater risk of hypertension in childhood, and cardiovascular events in adulthood. However, whether preeclampsia affects blood pressure (BP) in the newborn period is unclear. Previous neonatal studies were based on small sample sizes, very low birth weight or gestational age or limited duration (h). To delineate hemodynamic repercussions of maternal preeclampsia on preterm infants (gestational ages ⩾29 weeks) with/without intrauterine growth restriction (IUGR) in the first 3 postnatal days, we conducted a single-centre retrospective cohort study of singleton births at 29-35 weeks of gestation in Montreal, Canada, from 2008 to 2011. Data were obtained from medical charts. Exclusion criteria included congenital anomalies, infections, pre-pregnancy maternal hypertension and gestational diabetes. IUGR was defined as birth weight <10th percentile. Of the 338 eligible neonates, 230 were included: 75 preeclampsia-IUGR, 72 preeclampsia-only and 83 controls. The preeclampsia-IUGR group had longer gestations than the preeclampsia-only or control groups (32.4±1.8 vs. 31.3±1.6 vs. 31.7±1.6 weeks, respectively; P<0.001). Mean BPs increased over the first 3 days for all newborns (P<0.001). Infants with preeclampsia-associated IUGR had the highest systolic and diastolic BPs, even after adjustment for birth weight, and preeclampsia-only the next highest. Systolic BP progression showed significant differences between groups (P<0.05). We conclude that impact of preeclampsia on children blood pressure was manifest within days of birth, over and above coexisting IUGR. Long-term cardiovascular follow-up and targeted preventive strategies are advised for this underrecognized high-risk population.

Avaliação das propriedades dinâmicas da pressão arterial em mulheres com antecedentes de pré‐eclâmpsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross‐sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE 38±6 vs. NP 38±5 years, NS) and body mass index: (PE 25±4 vs. NP 26±4 kg/m2, NS) studied, respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24‐h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central‐peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow‐up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Assessment of central hemodynamic properties of the arterial wall in women with previous preeclampsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross-sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE: 38±6 vs. NP: 38±5 years, NS) and body mass index: PE: 25±4 vs. NP: 26±4 g/m2, NS) studied respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24-h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central-peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow-up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Abstract P387: Race and Sex Differences Exist in the Volumes of Visceral Adipose Tissue Associated With Prevalent Hypertension in Middle Age Adults

Background: Higher visceral adipose tissue (VAT) volume is associated with greater risk for hypertension (HTN). Although VAT volume and prevalence of HTN vary by sex and race, the differences in VAT volumes associated with identification of individuals with prevalent HTN across these groups is unclear. Objective: To determine VAT volume cut points that maximize true positive, true negative and optimal identification of prevalent HTN and to compare the cut points across sex and race groups. Methods: Data were examined from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-center longitudinal study of the development of cardiovascular risk in black and white men and women ages 18-30 years at baseline. In 2010-11, the Year 25 exam was performed (43-55 years) and VAT volume (cm3) was quantified by computed tomography based on two 5 mm contiguous slices at the level of the 4th-5th lumbar vertebra (n=3,153). HTN was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg and/or anti-hypertension medication use. Receiver operating characteristic (ROC) curve analysis was used to identify VAT volume cut points associated with true positive, true negative and optimal identification of prevalent HTN. Results: Year 25 prevalence of HTN ranged from 18.2% (white women) to 49.4% (black women); mean VAT volume ranged from 113.5 cm3 (white women) to 172.1 cm3 (white men). White males exhibited the highest VAT volumes (22-36% higher) and black women exhibited the lowest VAT volumes (3-50% lower) associated with true positive, true negative and optimal identification of HTN compared to other race/sex groups (Table 1). VAT volumes associated with HTN among black participants were generally lower than those exhibited for whites. Conclusions: Although the utility of VAT alone to identify HTN cases is modest - likely a result of unaccounted HTN confounders - these findings display the distinct race- and sex-specific differences in VAT volumes associated with prevalent HTN in middle age adults.

Sarcopenia as a determinant of blood pressure in older Koreans: findings from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2008-2010.

BackgroundBlood pressure (BP) is directly and causally associated with body size in the general population. Whether muscle mass is an important factor that determines BP remains unclear.ObjectiveTo investigate whether sarcopenia is associated with hypertension in older Koreans.ParticipantsWe surveyed 2,099 males and 2,747 females aged 60 years or older.MeasurementsSarcopenia was defined as an appendicular skeletal muscle mass divided by body weight (ASM/Wt) that was <1 SD below the gender-specific mean for young adults. Obesity was defined as a body mass index (BMI) ≥25 kg/m2. Subjects were divided into four groups based on presence or absence of obesity or sarcopenia. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg, a diastolic BP (DBP) ≥90 mmHg, or a self-reported current use of antihypertensive medications.ResultsThe overall prevalence of hypertension in the four groups was as follows 49.7% for non-obese non-sarcopenia, 60.9% for non-obese sarcopenia, 66.2% for obese non-sarcopenia and 74.7% for obese sarcopenia. After adjustment for age, gender, regular activity, current smoking and alcohol use, the odds ratio (OR) for having hypertension was 1.5 (95% confidence interval (CI) = 1.23–1.84) in subjects in the non-obese sarcopenia group, 2.08 (95% CI = 1.68–2.57) in the obese non-sarcopenia group and 3.0 (95% CI = 2.48–3.63) in the obese sarcopenia group, compared with the non-obese non-sarcopenia group (p for trend <0.001). Controlling further for body weight and waist circumference did not change the association between hypertension and sarcopenia. The association between sarcopenia and hypertension was more robust in the subjects with diabetes mellitus.ConclusionBody composition beyond BMI has a considerable impact on hypertension in elderly Koreans. Subjects with sarcopenic obesity appear to have a greater risk of hypertension than simply obese or sarcopenia subjects.

Association of 25-Hydroxyvitamin D and Parathyroid Hormone With Incident Hypertension: MESA (Multi-Ethnic Study of Atherosclerosis)

This study investigated whether lower 25-hydroxyvitamin D and higher parathyroid hormone concentrations are associated with incident hypertension. Disturbances in vitamin D metabolism are plausibly related to hypertension. MESA (Multi-Ethnic Study of Atherosclerosis) is a community-based, prospective cohort with baseline measurements obtained between 2000 and 2002. We studied 3,002 men and women free of prevalent cardiovascular disease and hypertension, age 45 to 84 years at baseline. Serum 25-hydroxyvitamin D and intact parathyroid hormone were measured from previously frozen baseline samples using liquid chromatography-mass spectroscopy and a 2-site immunoassay, respectively. We used a complementary log-log model with interval censoring to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for 25-hydroxyvitamin D and parathyroid hormone concentrations with incident hypertension through 2010. During a median follow-up of 9.0 years, 41% of the cohort (n = 1,229) developed hypertension. Mean serum 25-hydroxyvitamin D was 26.3 ± 11.2 ng/ml and mean parathyroid hormone was 41.2 ± 17.3 pg/ml. Compared with 25-hydroxyvitamin D ≥30 ng/ml, 25-hydroxyvitamin D <20 ng/ml was associated with a greater hypertension risk (HR: 1.28 [95% CI: 1.09 to 1.50]), although the association was attenuated and not statistically significant after adjusting for potential confounders (HR: 1.13 [95% CI: 0.96 to 1.33]). Compared with parathyroid hormone <33 pg/ml, parathyroid hormone ≥65 pg/ml was associated with a significantly greater risk of hypertension (HR: 1.27 [95% CI: 1.01 to 1.59]) after adjusting for potential confounders. Lower 25-hydroxyvitamin D concentrations were not associated with a greater risk of incident hypertension. Higher serum parathyroid hormone concentrations showed a significant, but statistically marginal, relationship to the development of hypertension. These findings will require further confirmation. (Multi-Ethnic Study of Atherosclerosis; NCT00005487).

Influence of Conventional Cardiovascular Risk Factors and Lifestyle Characteristics on Cardiovascular Disease After Hematopoietic Cell Transplantation

To determine the influence of modifiable lifestyle factors on the risk of cardiovascular disease after hematopoietic cell transplantation (HCT). HCT survivors of ≥ 1 year treated from 1970 to 2010 (n = 3,833) were surveyed from 2010 to 2011 on current cardiovascular health and related lifestyle factors (smoking, diet, recreational physical activity). Responses (n = 2,362) were compared with those from a matched general population sample (National Health and Nutrition Examination Survey [NHANES]; n = 1,192). Compared with NHANES participants, HCT survivors (median age, 55.9 years; median 10.8 years since HCT; 71.3% allogeneic) had higher rates of cardiomyopathy (4.0% v 2.6%), stroke (4.8% v 3.3%), dyslipidemia (33.9% v 22.3%), and diabetes (14.3% v 11.7%; P < .05 for all comparisons). Prevalence of hypertension was similar (27.9% v 30.0%), and survivors were less likely to have ischemic heart disease (6.1% v 8.9%; P < .01). Among HCT survivors, hypertension, dyslipidemia, and diabetes were independent risk factors for ischemic heart disease and cardiomyopathy, and smoking was associated with ischemic heart disease and diabetes (odds ratios [ORs], 1.8 to 2.1; P = .02). Obesity was a risk factor for post-transplantation hypertension, dyslipidemia, and diabetes (ORs ≥ 2.0; P < .001). In contrast, lower fruit/vegetable intake was associated with greater risk of dyslipidemia and diabetes (ORs, 1.4 to 1.8; P ≤ .01), and lower physical activity level was associated with greater risk of hypertension and diabetes (ORs, 1.4 to 1.5; P < .05). Healthier lifestyle characteristics among HCT survivors attenuated risk of all cardiovascular conditions assessed. Attention of clinicians to conventional cardiovascular risk factors and modifiable lifestyle characteristics offers hope of reducing serious cardiovascular morbidity after HCT.