High-normal Blood Pressure Group Research Articles

CENTRAL BLOOD PRESSURE AND VASCULAR RESPONSES TO DIFFERENT PHYSICAL EXERCISE INTENSITIES IN NORMAL AND HIGH-NORMAL BLOOD PRESSURE AS A TOOL TO IDENTIFY EARLY VASCULAR DAMAGE

Objective: To evaluate acute changes in arterial distensibility and central pressure by high-intensity interval physical exercise (HIIPE) compared to moderate intensity continuous physical exercise (MICPE) sessions in subjects with normal and high-normal blood pressure (BP). Design and method: A randomized two-period crossover trial with 29 subjects (48±7years, 76%female, BMI=28.3±4.3kg/m2) divided into two groups according to Normal BP (120-129 and/or 80-84 mmHg) or HighNormal BP (130-139 and 85-89 mmHg) levels. They underwent either MICPE-HIIPE or HIIPE-MICPE sequences. Exercise intensity was defined according to the cardiopulmonary exercise test. The measures included aortic pulse wave velocity (PWV) and applanation tonometry (Sphygmocor®) changes at baseline, immediately, and 24 hours after each physical exercise session. Results: In HighNormal BP group, PWV was significantly lower 24h after MICPE compared to baseline (7.49 ±0.95 vs 8.20± 0.64 m/s; p=0.022). Aortic SBP was significantly lower immediately after HIIPE than baseline and 24h after MICPE (113 ± 8; 124±9 and 121±9; p < 0.05). Comparison between groups, aortic SBP was higher in HighNormal BP at baseline and immediately after MICPE compared to Normal BP (124 ±9 and 122 ±17 vs 114± 9 and 110 ±8; respectively p=0.012). Conclusions: In subjects with normal and high-normal BP, vascular distensibility response to exercise is more dependent on basal levels of stiffness and more sensitive to the stimulus of MICPE; however, changes in aortic BP are more dependent on basal BP levels and more sensitive to high-intensity stimuli.

Association of high normal blood pressure defined by different criteria with all-cause and cardiovascular mortality

Abstract By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice. By grouping population according to SBP, we found that the grouping could better distinguish the all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death. The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification. Conclusion and clinical significance In this study, our analysis showed that the blood pressure classification based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.abstract figure

Arterial stiffness, blood pressure progression and penile vascular disease in males with erectile dysfunction: a closer look at microcirculatory damage

Abstract Background Elevated aortic stiffness may be associated with microvascular remodelling and damage, which may be an important causal contributor to incident cardiovascular disease. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events. Purpose Aim of the study is to examine in men with erectile dysfunction the association of increased aortic stiffness with penile vascular damage by taking into account BP level. Methods We measured carotid-femoral pulse wave velocity (PWV) and assessed microvascular (penile vascular damage) changes in four age-matched groups without a history of diabetes and cardiovascular disease; Normal BP (n=137), high-normal BP (n=94), stage I hypertension (n=82) and stage II and III hypertension (n=76). Microvascular damage was examined by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostaglandin E1. Lower PSV values indicate severe penile vascular disease. Results Carotid-femoral PWV increased and PSV decreased across BP groups (all P<0.001). In regression analysis increased systolic BP (b= -0.185, P<0.01) and PWV (b= -0.170, P<0.05) are significant determinants of low penile PSV after controlling for age, body mass index, cholesterol and smoking. We dichotomized carotid-femoral PWV taking into account the mean value in the whole study population. Figure shows the differences in PSV across the BP groups considering the cut-off PWV value of 8.5m/s (high vs low PWV). Individuals with higher PWV had lower penile PSV in normal BP (P<0.01) and in high normal BP group (P=0.02) after adjusting for age and systolic BP. On the contrary, hypertensive patients already have significant structural damage in the penile arteries and high PWV does not further reduce penile blood flow. Interestingly, figure shows the comparable PSV measurements between individuals with high-normal BP level who had high PWV and patients in stage 1 hypertension group denoting significantly impaired microvascular damage in males with high-normal BP and increased aortic stiffness. The high normal BP group has significantly lower PSV compared to normal BP group independently of PWV value. Conclusion Increased aortic stiffness may promote penile microvascular remodelling and damage in men without increased BP level. Additionally, in men with high-normal BP higher arterial stiffness is associated with comparable penile microvascular damage of men with arterial hypertension. Because aortic stiffening may be preventable, further clinical research on earlier preventive measures that focus on aortic stiffness and microvascular remodelling within individuals with erectile dysfunction who have normal BP is warranted.Aortic stiffness, BP level and PSV

ASSOCIATION OF HIGH NORMAL BLOOD PRESSURE DEFINED BY DIFFERENT CRITERIA WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY

Objective: To evaluate the association of the all-cause and cardiovascular mortality with the guideline-based classification criteria and systolic blood pressure (SBP)-based classification for high normal blood pressure. Design and method: We collected data from the NHANES Database,which is a large, serial, cross-sectional survey designed to be nationally representative of the civilian adult population in the United States Inclusion Criteria: SBP > 90mmHg; Without any antihypertensive treatment; Having complete record for a history of major cardiovascular-related disease including hypertension, coronary heart disease, myocardial infarction, heart failure, stroke, diabetes and hyperlipemia. All the participants were divided into 3 groups according to the latest guidelines or systolic blood pressure. Group1: Normotensivel; Group2: High normal blood pressure; Group3: Hypertension Results: By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice. By grouping population according to SBP, we found that the grouping better distinguished all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death. The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification. Conclusions: In this study, our analysis showed that the blood pressure based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.

The Correlation Between Obesity Phenotypes and High Normal Blood Pressure in Fuzhou Community Residents

Abstract Background To explore the correlation between obesity phenotypes and high normal blood pressure (BP) among residents residing in Fuzhou communities. Methods A cross-sectional study was conducted and on-site questionnaire survey, physical examinations and laboratory tests were carried out on the residents aged over 18 years in communities of Fuzhou city from 2018 to 2019, in which 900 people with normal BP and 1,006 people with high normal BP were included for analysis. Univariate analysis and multivariate logistic regression model were utilized to analyze the relationship between obesity phenotypes and high normal BP. Receiver operating characteristic (ROC) curve was used to analyze the predictive power of various obesity phenotypes for high normal BP in different genders. Results The rates of overweight and obesity, abdominal obesity (28.4% vs. 16.0%, P < 0.001), and abnormal waist-to-height ratio (61.6% vs. 41.1%, P < 0.001) were higher in the high normal BP group than those in normal BP group. Multivariate logistic regression analysis showed that high normal BP was positively correlated with body mass index, waist circumference, and waist-to-height ratio. Furthermore, overweight (OR, 95% CI: 1.896, 1.390–2.587), obesity (2.489, 1.427–4.342), abdominal obesity (1.598, 1.152–2.215), and abnormal waist-to-height ratio (2.110, 1.579–2.821) were risk factors of high normal BP among females while abdominal obesity (1.649, 1.021–2.661) and abnormal waist-to-height ratio (1.504, 1.044–2.165) were risk factors of high normal BP among males. The ROC area under the curve was over 0.6 for all obesity types. Conclusions Overweight, obesity, abdominal obesity, and abnormal waist-to-height ratio are risk factors of high normal BP.

The Relationship Between Blood Electrolytes and Hypertension in College Students

Abstract Background To analyze the correlation between plasma sodium, potassium, calcium, and blood pressure (BP) levels in college students. Methods Students from 3 universities in Zhengzhou were randomly selected and cluster-sampled for BP survey. According to the “Chinese guidelines for prevention and treatment of hypertension (revised in 2018),” the students were divided into 3 groups: normal BP, high normal BP, and hypertension group. Eighty-three, 101, and 102 cases were selected respectively by stratified sampling using R language from each group. After fasting for 12 hours, fasting venous blood was collected. The plasma electrolytes and biochemical parameters were determined. Results The blood calcium levels were higher in the hypertension group compared with normal BP and high normal BP groups (2.48 ± 0.11 vs. 2.36 ± 0.12 and 2.41 ± 0.26 mmol/l, P < 0.001). Correlation analysis showed that systolic and diastolic BP were both positively correlated with blood sodium (rs = 0.139, P = 0.019, rs = 0.140, P = 0.018) and blood calcium (rs = 0.377, P < 0.001, rs = 0.301, P < 0.001) while negatively correlated with blood sodium to calcium ratio (r = −0.354, −0.264, both P < 0.001). Multiple stepwise linear regression analysis showed that both systolic and diastolic BP were positively correlated with body mass index (β = 0.304, P = 0.028 and β = 0.130, P = 0.032), blood sodium (β = 0.121, P = 0.013 and β = 0.124, P = 0.021), and blood calcium levels (β = 0.336, 0.273, P < 0.001). Conclusions College students with hypertension have higher blood calcium levels than nonhypertension students. Blood calcium levels are positively correlated with systolic and diastolic BP.

High normal blood pressure and left ventricular structural and functional disorders in young adults

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

The relationship between high-normal blood pressure in the first half of pregnancy and the risk of hypertensive disease of pregnancy.

Early warning of hypertensive disorder in pregnancy (HDP) can improve maternal and infant outcomes. However, few studies had evaluated the warning value of high–normal blood pressure (BP) before the onset of HDP. This was a prospective cohort study to investigate the relationship between high‐normal BP in the first half of pregnancy and the risk of HDP. According to the maximum BP measured before 20+6 weeks of gestation, the cohort was divided into three groups: optimal BP (SBP < 120 mmHg and DBP < 80 mmHg), normal BP (120 mmHg ≤ SBP < 130 mmHg or 80 mmHg ≤ DBP < 85 mmHg), and high–normal BP (130 mmHg ≤ SBP < 140 mmHg or 85 mmHg ≤ DBP < 90 mmHg). The relationship between different BP levels in the first half of pregnancy and HDP risk was assessed by general linear models. Ten thousand one hundred and ninety‐three normotensive pregnant women with complete information were finally included for data analysis. Among them, 532 pregnant women were diagnosed with HDP, with a total HDP incidence of 5.2%. The incidences in the optimal, normal, and high–normal BP groups were 2.4%, 6.0%, and 21.8%, respectively. Compared to women with optimal BP in the first half of pregnancy, women with high‐normal BP had a 445% increased risk of HDP (aRR: 5.45, 95% CI: 4.24–7.00), and even women with normal BP had a 107% increased risk of HDP (aRR: 2.07, 95% CI: 1.68–2.56). This study demonstrated that among low‐risk healthy women, women with high–normal BP in the first half of pregnancy had a significantly higher risk of HDP.

Interaction of Hypertension and Insulin Resistance Exacerbates the Occurrence of Diabetes Mellitus in Healthy Individuals.

Objective Hypertension and type 2 diabetes are common complications. Patients with hypertension often show insulin resistance. The purpose of this study was to investigate the correlations between different blood pressure levels and different degrees of insulin resistance, as well as their interactions, with newly diagnosed diabetes mellitus. Methods We conducted a retrospective study on 1251 adult medical examiners who were examined in the Physical Examination Center of Zhongshan Hospital, Fudan University (Shanghai, China) during 2015. All human subjects had no history of diabetes. General clinical data, including blood pressure, fasting glucose and 2-h post-load glucose levels, and lipid profiles, were collected. HOMA-IR was separately calculated. Statistical analyses were carried out by using SPSS software (version 13.0). Results In 1251 physical examination subjects, a total of 166 cases of newly diagnosed diabetes were detected, with a total detection rate of 13.3%. The rates of newly diagnosed diabetes in the normal blood pressure group, high-normal blood pressure group, and hypertension group were 4.9%, 10.6%, and 19.0%, respectively. Compared with the normal blood pressure group, the proportion of newly diagnosed diabetes in the hypertension group was significantly increased [OR: 2.956, 95% CI 1.736-5.032, P < 0.001]. According to the stratification of HOMA-IR level, with the first quartile group (HOMA-IR<1.21) as a reference, the risk of newly diagnosed diabetes in the fourth quartile group (HOMA-IR ≥2.68) was significantly increased. After adjusting for gender and age, for every unit increase in HOMA-IR, the risk of developing newly diagnosed diabetes increased 9.67 times [OR: 9.670, 95% CI 5.086-18.384, P < 0.001]. When hypertension was combined with insulin resistance (HOMA-IR ≥2.68), the risk of newly diagnosed diabetes was 38.32 times compared with the control group [OR: 38.315, 95% CI 9.227-159.108, P < 0.001]. Conclusions Elevated blood pressure levels and insulin resistance levels were associated with the risk of newly diagnosed diabetes. Hypertension was an independent risk factor for newly diagnosed diabetes, and the combination of hypertension with insulin resistance further increased the risk of newly diagnosed diabetes.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Prevalence of target organ damage in subjects with high-normal blood pressure without known cardiovascular and kidney disease

Abstract Background Heterogeneous results have been obtained regarding the presence of Target Organe Damage (TOD) in subjects with high-normal Blood Pressure (BP) value (sistoly 130–139, diastolic 85–89 mmHg). Purpose Aim of our study was to assess the prevalence of TOD in healthy subjects with high-normal BP comparing them with subjects with BP values that are considered normal (&amp;lt;130/85 mmHg) or indicative of hypertension (≥140/90 mmHg). Methods 755 otherwise healthy subjects participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT) and plaque. Results When subjects were classified according to BP levels we found that high-normal BP group showed intermediate values of PWV and LMVI with higher value of IMT. This corresponds to intermediate prevalence of arterial stiffness (PWV&amp;gt;10 m/s: 3.4% vs 2.3% for normal and 9.6% for high BP groups, p=0.0014), Left Ventricular Hypertrophy – LVH (32.4% vs 25.7% for normal and 46.6% for high BP groups, p=0.0001) while there were no differences for IMT&amp;gt;0.9 or carotid plaque. At multivariable analysis the odds of having a PWV&amp;gt;10 m/s (OR=1.75, 95% C.I. 0.59–5.16), an IMT&amp;gt;0.9 mm (OR=1.81, 95% C.I. 0.60–5.00) or a LVH (OR=1.1, 95% C.I. 0.72–1.67) in the high-normal group resulted not different to the normal group. Conclusions In our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac TOD. Funding Acknowledgement Type of funding sources: None.

Prevalence of hypertension mediated organ damage in subjects with high-normal blood pressure without known hypertension as well as cardiovascular and kidney disease.

Purpose of our study was to assess the prevalence of hypertension mediated organ damage (HMOD) in healthy subjects with high-normal Blood Pressure (BP) comparing them with subjects with BP values that are considered normal (<130/85 mmHg) or indicative of hypertension (≥140/90 mmHg). Seven hundred fifty-five otherwise healthy subjects were included. HMOD was evaluated as pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima-media thickness (IMT) and plaque. When subjects were classified according to BP levels we found that the high-normal BP group showed intermediate values of PWV and higher values of IMT. This corresponds to intermediate prevalence of arterial stiffness, while there were no differences for increased IMT or carotid plaque. No subjects showed left ventricular hypertrophy. At multivariable analysis, the odds of having arterial stiffness or carotid HMOD in the high-normal group resulted not different to the normal group. In conclusion, in our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac HMOD.

The Incidence of Metabolic Syndrome and the Valid Blood Pressure Cutoff Value for Predicting Metabolic Syndrome Within the Normal Blood Pressure Range in the Population Over 40 Years Old in Guiyang, China.

PurposeThe study was conducted to investigate metabolic syndrome (MS) incidence within the normal blood pressure (BP) range in a population over 40 years old in an urban area of Guiyang, Guizhou Province, China, and to identify a valid BP cutoff value for predicting MS.Materials and MethodsData from this study are based on the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. In total, 2935 subjects in the normal BP range and without MS (795 males, 2140 females) aged 40–80 years were included in this study. Follow-up subjects were classified by baseline BP and grouped by age. After the 3-year follow-up, the MS incidence and valid BP cutoff value for predicting MS were calculated for subjects within the normal BP range.ResultsAfter the 3-year follow-up study, the crude and standardized MS incidences in the cohort were 19.83% and 16.89% for follow-up subjects, respectively, with incidences of 10.94% and 10.50% for males and 23.13% and 20.66% for females. The incidence of MS in normotensive subjects (15.53%) was lower than that in subjects with high-normal BP (29.08%). After adjusting for age, sex, BMI, smoking, and drinking, the risk of having MS in the high-normal BP group was 1.823-fold [HR 1.823 95% CI (1.538–2.162)] higher than that in the normotensive group. The ROC curve showed that the BP cutoff values were more than 117/74 mmHg in males and 112/74 mmHg in females.ConclusionWhen BP was within the normal range, the incidence of MS in participants was very high. The MS incidence was higher among high-normal BP subjects than among normotensive subjects, as was the risk of having MS. The valid BP cutoff value for predicting MS in the population was 117/74 mmHg in males and 112/74 mmHg in females. Currently, epidemiological investigations are needed to determine whether a lower BP cutoff value is needed in diagnosing MS.

Uric acid and salt intake as predictors of incident hypertension in a primary care setting

BackgroundHypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. ObjectivesTo estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. MethodsRetrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120mm Hg and diastolic BP ≤ 80mm Hg) and high-normal BP group (systolic BP 121-139mm Hg and/or diastolic BP 81-89mm Hg). ResultsIn multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. ConclusionIn a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension.

Sympathetic nerve traffic and baroreflex function in optimal, normal, and high-normal blood pressure states.

Adrenergic activation and baroreflex dysfunction are common in established essential hypertension, elderly hypertension, masked and white-coat hypertension, resistant hypertension, and obesity-related hypertension. Whether this autonomic behavior is peculiar to established hypertension or is also detectable in the earlier clinical phases of the disease, that is, the high-normal blood pressure (BP) state, is still largely undefined, however. In 24 individuals with optimal BP (age: 37.1 ± 2.1 years, mean ± SEM) and in 27 with normal BP and 38 with high-normal BP, age matched with optimal BP, we measured clinic, 24-h and beat-to-beat BP, heart rate (HR), and muscle sympathetic nerve activity (MSNA) at rest and during baroreceptor stimulation and deactivation. Measurements also included anthropometric as well as echocardiographic and homeostasis model assessment (HOMA) index. For similar anthropometric values, clinic, 24-h ambulatory, and beat-to-beat BPs were significantly greater in normal BP than in optimal BP. This was the case when the high-normal BP group was compared to the normal and optimal BP groups. MSNA (but not HR) was also significantly greater in high-normal BP than in normal BP and optimal BP (51.3 ± 2.0 vs. 40.3 ± 2.3 and 41.1 ± 2.6 bursts per 100 heartbeats, respectively, P < 0.01). The sympathetic activation seen in high-normal BP was coupled with an impairment of baroreflex HR control (but not MSNA) and with a significant increase in HOMA Index, which showed a significant direct relationship with MSNA. Thus, independently of which BP the diagnosis is based, high-normal BP is a condition characterized by a sympathetic activation. This neurogenic alteration, which is likely to be triggered by metabolic rather than reflex alterations, might be involved, together with other factors, in the progression of the condition to established hypertension.

High-normal blood pressure, functional capacity and left heart mechanics: Is there any connection?

Objective. To evaluate the relationship between functional capacity and left ventricular (LV) and left atrial (LA) myocardial deformation, assessed by two- and three-dimensional (2DE and 3DE) strain analysis, in subjects with high-normal blood pressure (BP). Methods. This cross-sectional study included 64 subjects with optimal BP and 75 subjects with high-normal BP of similar gender and age. All the subjects underwent a complete 2DE and 3DE examination and cardiopulmonary exercise testing. Results. 3DE global longitudinal strain was significantly lower in the group with high-normal BP than in the optimal BP group (− 20.1 ± 2.4 vs − 18.5 ± 2.3%, p < 0.001). Similar results were obtained for 3DE global circumferential strain (− 21.8 ± 2.6 vs − 19.3 ± 2.4%, p < 0.001), as well as for 3DE global radial strain (45.1 ± 8.8 vs 42.3 ± 7.2%, p = 0.042), and 3DE global area strain (− 30.1 ± 4.2 vs − 28.1 ± 3.8%, p < 0.001). LV twist was similar between the observed groups, whereas untwisting rate was significantly decreased in the subjects with high-normal BP (− 123 ± 30 vs − 112 ± 26°/s, p = 0.023). Peak VO2 was significantly lower in the high-normal BP group (30.8 ± 4 vs 28.3 ± 3.7 ml/kg/min, p < 0.001). 2DE LV ejection fraction (β = 0.38, p = 0.014), 2DE global longitudinal strain (β = 0.35, p = 0.019) and 3DE global longitudinal strain (β = 0.27, p = 0.042) were independently associated with peak VO2. Conclusion. LV and LA mechanics, as well as functional capacity are significantly impaired in the subjects with high-normal BP. LV and LA myocardial deformations are associated with peak oxygen uptake.

High–normal blood pressure is associated with new-onset electrocardiographic left ventricular hypertrophy

Whether high-normal blood pressure (BP) is a predictor of new-onset electrocardiographic (ECG)-left ventricular hypertrophy (LVH) is not known. A total of 4112 subjects who underwent physical examinations were enrolled in this study. BP was measured on entry. Standard 12-lead ECG was recorded at initial evaluation and 3 years later. BP categories were defined on the basis of the 2013 European Society of Hypertension/European Society of Cardiology guidelines. Of the 4112 subjects, 133 developed ECG-LVH 3 years later. Crude cumulative prevalence rates of new-onset ECG-LVH were 2.0% for the optimal BP group, 3.2% for the normal BP group, 5.1% for the high-normal BP group and 5.0% for the hypertension group. After adjustment for age, gender, body mass index, smoking, low-density lipoprotein cholesterol, log-transformed high-density lipoprotein cholesterol, log-transformed triglycerides, estimated glomerular filtration rate, haemoglobin A1c, haemoglobin, uric acid and antihypertensive medication use, compared with the optimal BP group, the odds ratios of new-onset ECG-LVH for the normal BP, high-normal BP and hypertension groups were 1.52 (95% confidence interval (CI): 0.93-2.49, P=0.094), 2.38 (95% CI: 1.40-4.03, P=0.001) and 2.44 (95% CI: 1.43-4.18, P=0.001), respectively. Even high-normal BP was significantly associated with the presence of new-onset ECG-LVH.

The impact of high-normal blood pressure on left ventricular mechanics: a three-dimensional and speckle tracking echocardiography study

To assess the presence of subclinical left ventricular myocardial dysfunction in subjects with high-normal blood pressure (BP) and untreated arterial hypertension, using three-dimensional (3D) echocardiography strain analysis. This cross-sectional study included 49 subjects with optimal BP, 50 subjects with high-normal BP, and 50 newly diagnosed untreated hypertensive patients matched by gender and age. All the subjects underwent 24 h blood pressure monitoring and complete two-dimensional and 3D echocardiography examination. The enrolled subjects were grouped according to 24 h systolic BP values, dividing the subjects with optimal BP from those with high-normal BP and the hypertensive patients (cut-off values were 120 and 130 mmHg, respectively). 3D global longitudinal strain was significantly lower in the high-normal BP group and the hypertensive patients, in comparison with the optimal BP group (-20.5 ± 3.3 vs. -18.7 ± 2.8 vs. -17.6 ± 2.7%, p < 0.001). Similar results were obtained for 3D global circumferential strain (-18.6 ± 3 vs. -17.1 ± 2.9 vs. -16 ± 2.5 %, p < 0.001), as well for 3D global radial strain (49.4 ± 9.5 vs. 44.7 ± 8.1 vs. 43.5 ± 7.8%, p = 0.002), and global area strain (-31.2 ± 4.8 vs. -28.7 ± 4.2 vs. -27.1 ± 4.5%, p < 0.001). LV twist was increased in the hypertensive patients in comparison with the high-normal and the optimal BP groups (10.1° ± 2.4° vs. 10.8° ± 2.6° vs. 13.8° ± 3.1°, p < 0.01), whereas untwisting rate significantly and gradually decreased from the optimal BP group, across the high-normal BP group, to the hypertensive patients (-135 ± 35 vs. -118 ± 31 vs. -102 ± 27°/s, p < 0.001). 3D echocardiography revealed that the subjects with high-normal BP suffered subclinical impairment of LV mechanics similar as the hypertensive patients.

Association of blood pressure with development of metabolic syndrome components: a five-year Retrospective Cohort study in Beijing

BackgroundRaised blood pressure (BP) is associated with the incidence of metabolic syndrome (MetS). It is unknown if subjects with different BP levels may develop certain components of MetS over time. We investigated the incidence of MetS relative to different levels of BP over a 5-year period in a Chinese population in Tongren Hospital, Beijing.MethodsDuring the period of 2006–2011, we recruited 2,781 participants with no MetS, or self-reported type 2 diabetes, dyslipidemia, hypertension, or cardiovascular disease at baseline. Association rule was used to identify the transitions of MetS components over time.ResultsThe incidence of MetS at follow-up was 9.74% for men and 3.21% for women in the group with optimal BP; 10.29% and 7.22%, respectively, in the group with normal BP; 10.49% and 10.84%, respectively, in the group with high-normal BP; and 14.48% and 23.21%, respectively in the group with high BP. The most common transition was from healthy to healthy in the groups with optimal or normal BP (17.9–49.3%), whereas in the high-normal BP group, 16.9-22.1% of subjects with raised BP returned to healthy status or stayed unchanged, while 13.8-21.4% of people with high BP tended to develop raised fasting glucose levels.ConclusionsThe incidence of MetS increased in parallel with the increase in BP. People with optimal and normal BP levels were less susceptible to developing MetS over time, whereas abnormal BP seemed to be a pre-existing phase of MetS. High-normal BP was a crucial status for MetS prevention.