High Blood Pressure Status Research Articles

Machine Learning Interpretability in Diabetes RiskAssessment: A SHAP Analysis

Diabetes continues to be a complicated and prevalent metabolic illness, providing a serious burden to public health. While machine learning approaches like extreme gradient boosting (XGBoost) provide intriguing options for diabetes prediction, their 'black-box' nature typically limits clinical interpretability. To overcome this gap, our work applied SHapley Additive exPlanations (SHAP) to give insights into the XGBoost model's predictions. The dataset utilized in this research comprised of 253,680 patients and contained 21 parameters, such as General Health Status, High Blood Pressure Status, Age, and Body Mass Index. After feature selection using Recursive Feature Elimination (RFE), 15 important characteristics were discovered. In the test set, the XGBoost model obtained an accuracy of 86.6%, precision of 54.1%, recall of 17.0%, and an F1-score of 25.9% for the Original dataset. For the RFE dataset, the model displayed an accuracy of 86.6\%, precision of 54.9%, recall of 16.5%, and an F1-score of 25.3%. SHAP analysis found that General Health Status, High Blood Pressure Status, Age, and Body Mass Index were the most important characteristics in both the Original and RFE datasets. This work provides as a platform for transparent and clinically applicable predictive modeling, assisting in early diabetes identification and preventive healthcare.

Minimal Contribution of the Social Determinants of Health to the Prevalence of Hypertension among Egyptian Public Servants.

Previous research suggests the role of social determinants of health (SDH) in the prevalence of hypertension. The study aimed to estimate the contribution of SDH to the prevalence of hypertension. We recruited 3072 Egyptian public servants who answered a self-administered questionnaire, including hypertension history. We measured the participants' blood pressure with standardized procedures. The logistic regression models were used to assess the associations between SDH and hypertension. The prevalence of hypertension was 28.2% (34.2% in males and 22.5% in females). The prevalence of undiagnosed hypertension was 16.3% (23.9% and 9.2%, respectively); thus, 57.8% of the hypertensive subjects were unaware of their high blood pressure status. SDH were associated with the odds of having hypertension in the unadjusted analyses. Higher education, being single, and having minor family members were associated with low odds of hypertension. On the other hand, non-professional occupations, job hours, household income, total family members, and work-family conflicts were associated with higher odds of hypertension. However, in the multivariable analyses, which included all SDH and adjusted for age, gender, smoking, physical activity, body mass index, medical history of chronic diseases, and family history of hypertension, only job hours were associated with the odds of having hypertension and undiagnosed hypertension: odds ratio (95% CI) = 1.07 (1.01-1.14) and 1.11 (1.02-1.20), respectively. SDH contributed minimally to the odds of having hypertension among public officials in Minia, Egypt. Civil servants with long working hours should be tracked with regular blood pressure monitoring as a high-risk group for hypertension.

Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"?

To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS". From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors. Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control. Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.

Long-term Kidney Function Evolution in Living Kidney Donors: A Single Center Experience

Living donor kidney transplant is the best treatment for end-stage kidney disease, posing minimal perioperative morbimortality for the donor, although long-term consequences are subject of debate if donor acceptance widens. We present a retrospective observational study analyzing clinical, demographic, and analytical variables throughout the follow-up period of 60 kidney donors whose procedures were performed between 1985 and 2021 at our hospital. Donors were divided according to their previous high blood pressure status, analyzing kidney function and other clinical parameters throughout follow-up. There were no statistically significant differences, although there was a trend toward a higher uric acid levels and lower high-density lipoprotein cholesterol in predonation patients with hypertension, not yielding an excess of end-stage kidney disease between groups at the end of the follow-up. We also analyzed the evolution of estimated glomerular filtration rate (eGFR), dividing patients into tertiles, which resulted in none of the parameters associating a higher rate of progression. All donors had an eGFR >71 mL/min/1.73 m2 at the time of donation. Over time, a decline in eGFR <60 mL/min/m/1.73 m2 was observed in 26 patients (53.6%), measured by Chronic Kidney Disease Epidemiology Collaboration estimation and in 55.4% of the total (31 patients) by Modification of Diet in Renal Disease. At our center, kidney donors with adequate predonation eGFR, although presenting a reduction in postnephrectomy eGFR, remain stable afterward, with none of them reaching an eGFR <30 mL/min/1.73 m2. We found no differences in the impact of high blood pressure on long-term eGFR, nor predictive factors influencing the rate of eGFR decline. Studies with larger number of patients are needed to confirm these results.

Abstract P031: Does The Place Of Residence Influence Your Risk Of Being Hypertensive? A Case Study From Nepal

Introduction: Area level factors could be an independent risk factor for disease and negative health outcomes. Despite the multiple studies on risk factors for hypertension, area-level influence is poorly investigated especially in low- and middle-income countries. Hypothesis: This study aims to test the hypothesis that area-level deprivation (AD) is significantly associated with the risk of hypertension independent of individual risk factors in the context of Nepal. Methods: The study is based on the latest Nepal Demographic Health Survey conducted in 2016. The area-level deprivation index was constructed and validated based on the material (household assets, household structure), social and geospatial features. The index ranged from 52 to 146 with higher scores representing higher levels of deprivation. Individuals aged 15 and above were identified as hypertensive if they met any of the following criteria: i) systolic blood pressure ≥140 mmHg; ii) diastolic blood pressure ≥90 mmHg; iii) taking antihypertensive medication irrespective of their blood pressure readings during the survey; iv) history of earlier diagnosis of hypertension by any health care provider. Associations between the quartiles of AD and hypertension were investigated using two-level logistic regression. Further, potential cross-level interaction and mediated pathways between AD and hypertension were explored. Results: The overall prevalence of hypertension was approximately 23% of which nearly 50% were unaware of their high blood pressure status at the time of the survey. Individuals from the least deprived areas seemed to have higher odds of hypertension compared to highly deprived areas (Odds Ratio=1.54 (95% CI 1.26, 1.89); p-trend=&lt;0.001). Literate individuals from deprived areas were likely to have a higher risk of hypertension compared to those without formal education. However, the association was not significant in the least deprived areas (p-interaction &lt;0.001). Overweight/obesity seems to explain a significant magnitude of the indirect pathway (67%) between AD and hypertension in the context of Nepal. Conclusion: Residing in the least deprived or more affluent areas might increase an individual’s risk of being hypertensive. Association between individual risk factors and hypertension is likely to vary across the areas with varying levels of deprivation. These results seem paradoxical and are inconsistent with epidemiological data from high-income countries. Over-nutrition and changing lifestyle, driven by affluence and higher disposable income, could explain this counterintuitive association in the context of a country like Nepal which is undergoing a rapid socio-demographic and epidemiological transition.

Potential impact of systematic and random errors in blood pressure measurement on the prevalence of high office blood pressure in the United States.

The authors examined the proportion of US adults that would have their high blood pressure (BP) status changed if systolic BP (SBP) and diastolic BP (DBP) were measured with systematic bias and/or random error versus following a standardized protocol. Data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES; n = 5176) were analyzed. BP was measured up to three times using a mercury sphygmomanometer by a trained physician following a standardized protocol and averaged. High BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg. Among US adults not taking antihypertensive medication, 32.0% (95%CI: 29.6%,34.4%) had high BP. If SBP and DBP were measured with systematic bias, 5 mm Hg for SBP and 3.5 mm Hg for DBP higher and lower than in NHANES, the proportion with high BP was estimated to be 44.4% (95%CI: 42.6%,46.2%) and 21.9% (95%CI 19.5%,24.4%). Among US adults taking antihypertensive medication, 60.6% (95%CI: 57.2%,63.9%) had high BP. If SBP and DBP were measured 5 and 3.5 mm Hg higher and lower than in NHANES, the proportion with high BP was estimated to be 71.8% (95%CI: 68.3%,75.0%) and 48.4% (95%CI: 44.6%,52.2%), respectively. If BP was measured with random error, with standard deviations of 15 mm Hg for SBP and 7 mm Hg for DBP, 21.4% (95%CI: 19.8%,23.0%) of US adults not taking antihypertensive medication and 20.5% (95%CI: 17.7%,23.3%) taking antihypertensive medication had their high BP status re‐categorized. In conclusions, measuring BP with systematic or random errors may result in the misclassification of high BP for a substantial proportion of US adults.

Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER).

Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3–17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non‐Hispanic, 32% Hispanic, 39% White non‐Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15–17 years), and being male. Nearly half of treatment‐seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.

Bias correction in self-reported high blood pressure prevalence based on objectively measured data

Abstract Background Reliable and precise estimates of high blood pressure (HBP) prevalence are essential to inform decision-making and policies evaluation. Self-reported HBP may be underestimated by surveys due to misclassification of health status by participants. Misclassification may lead to inaccurate inference. We aimed to assess a feasibility of correcting misclassification bias in self-reported HBP in the Portuguese component of the European Health Interview Survey (INS2014) using data on objective blood pressure measurements from a smaller health examination survey (INSEF). Methods We assumed that “true” measured HBP status was missing at random for INS2014 participants (n = 13937). Using a multiple imputation method of logistic regression for monotone missing data patterns, HBP was imputed for INS2014 sample. Auxiliary data on measured HBP from INSEF (n = 4910) was used. Crude and corrected HBP prevalence rates stratified by sex and age group were calculated. Results HBP prevalence based on INS2014 increased significantly after multiple imputation correction, from 22.0% [CI95%:20.6-23.5%] to 38.8% [35.4-41.9%] for men and from 26.8% [25.3-28.3%] to 33.0% [30.5-35.4%] for women. Corrected estimates were similar to the objectively measured from INSEF, 39.6% for men and 32.7% for women. Corrected HBP prevalence in INS2014 increased from 4.1% [2.9-5.9%] to 7.9% [4.0-11.8%] in 25-34 years old (yo); from 9.3% [7.8-11.0%] to 17.6% [14.0-21.3%] in 35-44 yo; from 22.5% [20.3-24.8%] to 38.7% [34.2-43.2%] in 45-54 yo; from 39.8% [37.2-42.4%] to 53.8% [49.1-58.5%] in 55-64 yo and from 54.3% [51.5-57.1%] to 67.7% [63.1-72.3%] in 65-74 yo. Corrected rates were similar to the obtained by INSEF (5.7%, 17.0%, 35.8%, 54.8% and 71.3%, respectively). Conclusions Our results highlight the importance of bias analysis when using self-reported data on HBP. Multiple imputation is a feasible approach to adjust misclassification bias in health outcomes collected by population surveys. Key messages The magnitude and direction of misclassification bias in self-reported health outcomes should be investigated. Multiple imputation is a feasible approach to misclassification bias correction in self-reported survey data.

0384 Do Nurses with High Blood Pressure Have More Sleep Disturbances Than Their Peers?

Abstract Introduction Nurses work in stressful environments and often have rotating work schedules, which may put them at risk for disturbed sleep and health. Poor quality and short sleep duration are strong risk factors for high blood pressure (HBP). Yet few studies have examined these associations in nurses, who may be a particularly at-risk sample. To address this gap, we examined group differences in self-reported and actigraphy-assessed sleep among nurses with and without self-reported HBP. Methods Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a parent study. Participants completed baseline questionnaires including the Pittsburgh Sleep Quality Index (PSQI), followed by 14 days of actigraphy and sleep diaries to prospectively assess 14-day mean total sleep time (TST) and sleep efficiency (SE). An independent samples t-tests was used to assess group differences in sleep variables by HBP status. Linear regression was used to further examine the association between HBP status on sleep variables when controlling for age, race, gender, ethnicity, and body mass index (BMI). Results Twenty-nine (7%) nurses endorsed having clinically-diagnosed HBP. Nurses with HBP had higher global PSQI scores (indicating worse sleep quality; t=2.71, p=0.007), compared to nurses who did not report HBP, with a mean difference of 1.24. When adjusting for covariates, the association between HBP and the PSQI became marginally significant (p=0.054). There were no group differences in sleep diary or actigraphy TST or SE by HBP status, nor did HBP predict these sleep variables when controlling for covariates. Conclusion We found that nurses who reported having clinically diagnosed HBP had poorer global sleep quality. Although limited by self-reported history of HBP diagnosis, and low endorsement of HBP in our sample, our results corroborate other findings which suggest there is a strong association between high blood pressure and disturbed sleep. Future studies should examine these associations in larger samples, assess blood pressure directly, and experimentally examine the effects of HBP treatment on sleep quality. Support NIH/NIAID R01AI128359-01

Relationship between low-level lead, cadmium and mercury exposures and blood pressure in children and adolescents aged 8–17 years: An exposure-response analysis of NHANES 2007–2016

This study investigated whether low-level blood and urinary lead, cadmium and mercury exposures were associated with blood pressure (BP) in children and adolescents. Data from National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016 for children and adolescents aged 8–17 years (n = 7076) were analyzed. Outcome variables were systolic BP, diastolic BP and high BP status. High BP was defined as: self-reported antihypertensive medication usage or a diagnosis of hypertension; classified as having elevated BP/hypertension according to 2017 AAP guidelines. Multivariable linear and logistic regressions models were performed and stratified by race/ethnicity and gender. Blood lead was negatively associated with diastolic BP among blacks, and positively associated with diastolic BP among whites. For a two-fold increase of blood lead concentration, the change in diastolic BP was −1.59 mm Hg (95% CI: −3.04 to −0.16 mm Hg) among blacks and 1.38 mm Hg (95% CI: 0.40 to 2.36 mm Hg) among whites. No significant associations between either systolic BP or diastolic BP with urinary lead were observed. The inverse associations between blood lead and high BP were found in females, Mexican Americans and other Hispanics. No associations between blood cadmium and BP were observed, except in other Hispanics. Urinary cadmium levels were inversely correlated with systolic BP, diastolic BP and high BP in all participants and in men. When compared to the lowest quartile of urinary cadmium levels, participants with a urinary cadmium level ≥ 0.12 μg/L had 0.48 (95% CI: 0.29–0.78) times and 0.53 (95% CI: 0.30–0.94) times reduced odds of having high BP in all participants and in men, respectively. No associations between either blood mercury or urinary mercury with systolic BP were observed. Significant inverse associations were found between blood total mercury and methyl mercury with diastolic BP in all participants and in men. Future prospective studies are warranted to confirm these findings.

Abstract P196: Mississippi Delta Health Collaborative Community and Faith Based Programs to Screen Hypertension

Introduction: The Mississippi Delta Health Collaborative (MDHC) provides leadership in the Delta region to implement heart disease and stroke prevention interventions. Barbers Reaching Out To Educate on Routine Screenings (BROTHERS) is an innovative community based program whereby MDHC partners with existing barbershops to provide routine blood pressure screenings and referrals. The faith-based Delta Alliance for Congregational Health (DACH) supports the mission of its member churches to minister to their communities with regular cardiovascular health screenings and include community outreach events. The MDHC program started in 2008 and has devoted the last 2 years to screen residents’ blood pressure and help them to control it as a risk factor for cardiovascular disease. The aim of this study is to track the community base initiatives outcomes. Methods: From October 2016 to March 2018, from all 18 counties of the Mississippi Delta region, 33 barbers participated in the BROTHERS program and completed a total of 4,926 blood pressure screening encounters of 4,301 individuals (97.6% (n= 3943) black; 71.14% (n=3060) male; mean age= 35.67, SD=13.92). Also 26 churches participated in the DACH program and completed a total of 2,658 blood pressure screening encounters of 1,987 individuals (94.5% (n=1877) black; 65.2% (n=1295) female; mean age= 52.62, SD=16.43). Results: Barbers screenings showed that 51.84% (n=1688) of men were pre-hypertensive while only 10.81% (n=352) had normal blood pressure. Among all, 16.2% (n=738) participants reported never having their blood pressure checked. Among men, 1,216 (37.34%) had hypertension while 26.8% (n=326) were currently taking blood pressure medications, 37.9% (n=459) were current smokers, 31% (n=375) had no insurance coverage and 46.7% (n=566) had no personal doctor. DACH screenings showed that 42.3% (n=842) of participants were pre-hypertensive and 40.46% (n=804) had hypertension. Among hypertensive participants, 63.8% (n=513) were aware of the high blood pressure status and 58.3% (n=469) were currently taking medications for high blood pressure. Conclusion: Health is determined in part by access to social and economic opportunities as well as the resources and support in communities. Because of the innovative health initiatives underway in the Mississippi Delta region, a new story is unfolding. Community based screenings help people to become familiar with their health status, educate them on various methods of prevention and intervention and help them to change their life style to have a healthier life. Each healthy step taken is one towards improved health and prosperity not only for our state, but for the entire country.

Risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression: A study on 703 individuals

ABSTRACTBackground: Since few studies have investigated the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression, the aim of this study was to examine this risk in a large sample of individuals with major depression. Methods: Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. High blood pressure status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg during at least two medical examinations. Logistic regression analyses were conducted to examine the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression. Results: After adjustment for major confounding factors associated with high blood pressure, multivariate logistic regression analysis revealed that severe objective insomnia, low complaints of repeated nighttime awakenings or early morning awakening, and intermediate or low self-reported insomnia complaints were significant risk factors of high blood pressure in major depression. Conclusion: In major depression, severe objective insomnia and lower self-reported insomnia complaints are associated with higher risk of high blood pressure, which justifies a better management of objective insomnia and a better assessment of insomnia complaints in this particular subpopulation to avoid the negative consequences related to the co-occurrence of high blood pressure and major depression.Abbreviations: AHI, Apnea-Hypopnea Index; BDI, Beck Depression Inventory; BMI, Body Mass Index; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition - Text Revision; ESS, Epworth Sleepiness scale; ISI, Insomnia Severity Index; HBP, High Blood Pressure; OSA, Obstructive Sleep Apnea Syndrome; REM, rapid eye movement sleep.

Objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are risk factors for high blood pressure in individuals with insomnia: a study in 1272 individuals referred for sleep examinations

IntroductionGiven conflicting data in the literature, the aim of this study was to examine the risk of high blood pressure (HBP) associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of individuals with insomnia. MethodsDemographic and polysomnographic data from 1272 individuals with insomnia recruited from the research database of the sleep laboratory of Erasme Hospital were analyzed. HBP status was defined by the presence of one of the following: self-report at interview of either a physician's diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of HBP associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in individuals with insomnia. ResultsThe prevalence of HBP in individuals with insomnia is 30.03%. After adjustment for major confounding factors associated with HBP, multivariate logistic regression analysis revealed that short sleep duration (<5 h), severely reduced sleep efficiency (<65%), high sleep fragmentation (sleep fragmentation index ≥18/h), and long-term use of short or intermediate half-life benzodiazepine receptor agonists were significant risk factors for HBP in individuals with insomnia. ConclusionIn individuals with insomnia, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of HBP. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and HBP.

Prevalence of severe obesity and its association with elevated blood pressure among children and adolescents in Shandong, China.

Childhood obesity has increased markedly during the past decades; however, data on the prevalence of severe obesity in children and adolescents are limited. The present study examined the prevalence of severe obesity and its association with elevated blood pressure (BP) among children and adolescents in Shandong, China. A total of 44 630 (22 404 boys and 22 226 girls) students aged 7-18 years participated in the study. BMI cut-off points recommended by the International Obesity Task Force were used to define class I-III obesity. Relatively high BP status was defined as systolic BP and/or diastolic BP of at least 95th percentile for age and sex. The prevalence rates of class I, class II, and class III obesity were 6.67, 1.47, and 0.42% for boys and 2.88, 0.64, and 0.18% for girls, respectively; boys had a higher prevalence than girls (P<0.01). Substantial urban-rural disparities exist in childhood obesity; urban boys and girls had a higher prevalence of class I and class II obesity than their rural peers (P<0.05). Severe obesity is associated with elevated BP; the prevalence of relatively high BP increased from 39.93% (boys) and 39.53% (girls) in the class I obese group to 50.54% (boys) and 53.66% (girls) in the class III obese group (P<0.05). Although the current prevalence of severe obesity was at a relatively low level, but we should not relax our vigilance to the obesity epidemic. Our findings also emphasize the importance of the prevention of severe obesity to prevent future-related problems such as hypertension in children and adolescents.

Profiles of blood pressure among children and adolescents categorized by BMI and waist circumference.

BMI and waist circumference (WC) are two commonly used measurements for defining general and central obesity. The present study examined the profiles of blood pressure (BP) among children and adolescents categorized by BMI and WC in Shandong, China. A total of 38 810 students (19 453 boys and 19 357 girls) aged 7-17 years participated in this study. Height, weight, WC, and BP of all participants were measured, and BMI was calculated. Relatively high BP status was defined as systolic BP and/or diastolic BP ≥95th percentile for age and sex. All individuals were classified into four groups (Q1-Q4) according to the age-specific and sex-specific quartiles of BMI and WC; the BP level and the prevalence of relatively high BP among the four groups were compared. In both boys and girls, significant differences in BP level and the prevalence of relatively high BP were observed among the four groups categorized by BMI and WC separately (P<0.01). Children and adolescents in the high BMI group (Q4) had higher systolic BP and diastolic BP than their counterparts in the low BMI group (Q1) in all age groups (P<0.01), the range of differences being 5.7-10.3, 3.6-5.6 mmHg for boys and 3.9-8.7, 2.2-5.3 mmHg for girls, respectively. Similar differences were also observed among different groups categorized by WC. High BMI and WC are associated with elevated BP. Our findings emphasize the importance of the prevention of general and central obesity to prevent future-related problems such as hypertension in children and adolescents.

Percentiles of waist-to-sitting-height ratio and its relationship with obesity and elevated blood pressure among children and adolescents in Shandong, China.

Waist circumference (WC) and related anthropometric indices have been recognized as useful measures of abdominal obesity. However, little is known about the association of waist-to-sitting-height ratio (WSHtR) with obesity and elevated blood pressure (BP). Data for this study were obtained from a large cross-sectional survey of school children. A total of 6889 students (3438 boys and 3451 girls) aged 7-17 years participated in this study. Height, sitting height, weight, WC, triceps and subscapular skinfold thickness, systolic blood pressure (SBP), and diastolic blood pressure (DBP) of all participants were measured. WSHtR was calculated as WC divided by sitting height. The BMI cutoff points recommended by the Working Group on Obesity in China (WGOC) were used to define overweight and obesity. Relatively high BP status was defined as SBP and/or DBP greater than or equal to the 95th percentile for age and sex. WSHtR was positively correlated with BMI, skinfold thickness, SBP, and DBP in both boys and girls in all age groups (7-17 years). Children and adolescents with high WSHtR (≥75th) had a higher prevalence of overweight and obesity and a relatively high BP compared with their peers with low WSHtR (<25th). The prevalence of overweight plus obesity was 0.57 versus 90.91% for boys and 0.81 versus 61.03% for girls, and the prevalence of relatively high BP was 6.78 versus 31.35% for boys and 6.04 versus 22.18% for girls. Large WSHtR is associated with obesity and elevated BP. Our results suggest that WSHtR may be a new useful index for screening obesity and related health risks.

Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension.

To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in "at-risk" groups, and to sample patients' opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension. Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) -in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire. A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these, (62 subjects) 66.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor. Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was poorly controlled, twenty-two of whom were on medication. The patients who participated in this study were positively disposed toward the routine measurement of BP by optometrists.

Psychological distress may affect nutrition indicators in Australian adults

Objective: The purpose of this research was to explore which demographic and health status variables moderated the relationship between psychological distress and three nutrition indicators: the consumption of fruits, vegetables and takeaway. Method: We analysed data from the 2009 Self-Reported Health Status Survey Report collected in the state of Queensland, Australia. Adults (N = 6881) reported several demographic and health status variables. Moderated logistic regression models were estimated separately for the three nutrition indicators, testing as moderators demographic (age, gender, educational attainment, household income, remoteness, and area-level socioeconomic status) and health status indicators (body mass index, high cholesterol, high blood pressure, and diabetes status). Results: Several significant interactions emerged between psychological distress, demographic (age, area-level socio-economic status, and income level), and health status variables (body mass index, diabetes status) in predicting the nutrition indicators. Relationships between distress and the nutrition indicators were not significantly different by gender, remoteness, educational attainment, high cholesterol status, and high blood pressure status. Conclusions: The associations between psychological distress and several nutrition indicators differ amongst population subgroups. These findings suggest that in distressed adults, age, area-level socio-economic status, income level, body mass index, and diabetes status may serve as protective or risk factors through increasing or decreasing the likelihood of meeting nutritional guidelines. Public health interventions for improving dietary behaviours and nutrition may be more effective if they take into account the moderators identified in this study rather than using global interventions.

High homocysteine and blood pressure related to poor outcome of acute ischemia stroke in Chinese population.

ObjectivesTo assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population.MethodsBetween June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models.ResultsCompared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19–1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85–1.53), 1.37 (1.03–1.84) and 1.70 (1.29–2.34), respectively.ConclusionThe present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility to poor outcome among acute ischemic stroke patients in a northern Chinese population.

Roc curves of obesity indicators have a predictive value for children hypertension aged 7-17 years.

The aim of the study is to examine the distribution of integrated covariate and its association with blood pressure (BP) among children in Anhui province, China, and assess the predictive value of integrated covariate to children hypertension. A total of 2,828 subjects (1,588 male and 1,240 female) aged 7-17 years participated in this study. Height, weight, waistline, hipline and BP of all subjects were measured, obesity and overweight were defined by an international standard, specifying the measurement, the reference population, and the age and sex specific cut off points. High BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95th percentile for age and gender. Our results revealed that the prevalence of children hypertension was 11.03%, the SBP and DBP of obesity group were significantly higher than that of normal group. Anthropometric obesity indices such as body mass index (BMI) were positively correlated with SBP and DBP. Integrated covariate had a better performance than the single covariate in the receiver-operating characteristic (ROC) curve, the cut-off value; the sensitivity and the specificity of the integrated covariate were 0.112, 0.577, 0.683, respectively. Integrated covariate is a simple and effective anthropometric index to identify childhood hypertension.