High-normal Blood Pressure Research Articles

Prevalence and determinants of normal, high-normal and high blood pressure and association with cardiovascular risk in Egypt.

High-normal blood pressure (HNBP) has become associated with a 2-3-fold increase in the risk of developing hypertension. Cardiovascular diseases (CVDs) are independently linked to HNBP. To estimate the prevalence of HNBP, its predictors, and association with CVD risk among a country-representative sample of Egyptian adults. This study draws on data from the most recent Egyptian Health Issues Survey, and includes 13 983 adults aged 18-59 years. Sociodemographic data and anthropometric and blood pressure (BP) measurements were obtained, and the 10-year cardiovascular risk score was calculated using World Health Organization CVD risk charts for participants aged ≥ 40 years. Overall, 15.31% and 21.0% of the study population had HNBP and hypertension, respectively. Compared to people aged 18-30 years, the odds of HNBP were 1.36, 1.67 and 2.39 among those aged 31-40, 41-50 and 51-59 years, respectively. The odds of HNBP were higher among male, overweight and obese adults, and patients with diabetes. The odds of HNBP and hypertension were higher among participants with high WHO CVD risk than those with low WHO CVD risk. HNBP is an alarming risk factor among Egyptian adults because it is strongly associated with CVD risk. Policy-makers should devise long-term, effective strategies for its prevention and control.

PARAMETERS INDICATING DEVELOPMENT OF HYPERTENSION IN THREE-YEAR FOLLOW-UP STUDY OF SUBJECTS WITH HIGH NORMAL BLOOD PRESSURE

Objective: Assess the relation of hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) while sympathetic overactivity assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffening are linked with development of hypertension (HTN). Design and method: 100 consecutive subjects with high normal BP [systolic BP = 130–139mmHg and/or diastolic BP = 85–89mmHg], underwent a negative for ischemia treadmill exercise test (Bruce protocol). Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA. Follow-up was scheduled every 6 months for 3 consecutive years, where BP measurements were assessed in office and with ambulatory BP monitoring (ABPM). All participants offered lifestyle advice. Endpoint was development of HTN either with OffBP or ABPM. We divided into Group I those who developed HTN and Group II without HTN. Results: From 100 subjects (54 ± 8 years, 42 males, baseline OffBP: 132/82 mmHg, 24-hour BP: 122/76 mmHg) 40 developed HTN (Group I) and 50 developed HRE (BP> or = 210mmHg in men and > or = 190mmHg in women). Group I vs II had higher HRE (75%vs13%, p = 0.026) with intermediate stage intervals of 3 min (160vs147mmHg, p = 0.068) and 6 min (181vs164mmHg, p = 0.035). The SBP/MET-slope [(peakSBP—restingSBP)/(peakMET-1)] in Group I was increased in all stages till peak exercise (stage1: 6.25vs4.25, stage2: 7.6vs5.3, peak: 7.22vs5.1, p = 0.035). Their exercise capacity was reduced (10vs11.5METs) as their maximum exercise heart rate (154vs164, p = 0.001). They demonstrated higher levels of PWV (8.35vs7.5m/sec, p = 0.043) and MSNA levels (37vs31 bursts, p = 0.04), while did not differ regarding their metabolic profile at the follow-up. Echocardiographicly LVMI did not differ, but LVEDD (47vs45 mm, p = 0.02), E/A ratio of mitral valve inflow (0.92vs1.05, p = 0.034) and left atrium diameter (3.8vs3.6 mm p < 0.1) were statistically significant. At their initial ECG had shorter P-wave duration (101.3vs93.2, p = 0.013) and QRS duration (93.4vs85.7, p = 0.006). In ABPM they demonstrated higher night systolic BP (116vs112mmHg, p < 0.04). Conclusions: In subjects with high normal BP, MSNA identifies a state of increased sympathetic overdrive, PWV demonstrates arterial stiffening and exercise testing proves its prognostic value as a hypertension predictor screening tool acknowledging a state of increased systemic vascular resistance.

EFFECTS OF HOME-BASED ISOMETRIC HANDGRIP OR AEROBIC EXERCISE TRAINING IN OLDER ADULTS WITH PRE-HYPERTENSION AND HYPERTENSION

Objective: Isometric handgrip exercise training (IHT) is a promising non-pharmacological treatment to hypertension. In HoldAge (NCT04275037) we compared the effects of a home-based IHT intervention to home-based aerobic exercise training (AET) intervention or usual care on blood pressure (BP) in older adults with high normal BP and hypertension. Design and method: 53 participants with high normal BP to stage I hypertension were (24 men, age 71.7 ± 4.2 years, systolic BP 138.2 ± 16.2 and diastolic BP 80.4 ± 8.7 mmHg) were randomized into IHT (n = 19), AET (n = 19) or an attention control group (AC, n = 15). Participants performed IHT or AET, 3 times/week, for 8 weeks. IHT consisted of 4x45 sec bilateral contractions, at an intensity of 50% of the maximum voluntary contraction, with a 1-min rest between sets. AET was walking at an intensity of 50–70% of the estimated peak maximal oxygen consumption. The AC group received standardized optimal medical care, including lifestyle advice. Results: Of the 53 participants, 49 finished the intervention (92.5%) with one dropout in AET and 3 in AC. Three participants were excluded due to changes in the antihypertensive medication (AET:1 and AC:2). The self-reported exercise adherence was 96.6% for IHT and 83.8% for AET. There were no significant differences at baseline for SBP (p = 0.343), DBP (p = 0.107) and pulse pressure (PP, p = 0.386). Both exercise interventions elicited similar reductions in SBP from baseline to postintervention (IHT: 138.8 ± 14.9 vs 129.2 ± 10.4 mmHg; p = 0.003; AET: 139.8 ± 19.6 vs 132.6 ± 9.5 mmHg; p = 0.049). There were no changes in BP in the AC group (130.6 ± 12.7 vs 127.9 ± 18.3 mmHg; p = 0.392). DBP decreased after IHT (78.6 ± 7.9 vs 74.7 ± 8.1 mmHg; p = 0.025) but not AET (83.1 ± 9.2 vs 80.8 ± 9.5 mmHg; p = 0.360) or AC (76.5 ± 5 vs 76.5 ± 10.1 mmHg; p = 0.942). Both exercise interventions also elicited similar reductions in PP (IHT: 60.2 ± 10.5 vs 54.4 ± 8.9 mmHg; p = 0.014; AET: 56.7 ± 13.2 vs 51.7 ± 13.5 mmHg; p = 0.016) with no differences for the AC (54.1 ± 10.3 vs 51.2 ± 13.3 mmHg; p = 0.285). Conclusions: The preliminary results from HoldAge indicate home-based IHT and AET elicit significant reductions in office SBP among older adults with high-normal BP to Stage 1 hypertension.

EXERCISE AND AMBULATORY BLOOD PRESSURE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS WITH META-ANALYSIS

Objective: Hypertension remains the biggest single contributor to the global burden of disease and to the global mortality rate. Lifestyle changes, including exercise therapy, are recommended in the prevention and treatment of high blood pressure (BP). To date, most randomized controlled trials (RCT’s) have evaluated the effect of exercise therapy on resting office blood pressure (BP). Data on the efficacy of exercise on ambulatory BP (AMBP), nowadays considered the gold standard measurement, remain scant. The current systematic review and meta-analysis aimed to summarize the effect of different exercise modalities on AMBP in individuals with a normal, high normal BP or hypertension. Design and method: This systematic review was conducted and reported according to the PRISMA-guidelines. A systematic literature search was conducted in three databases including only RTC’s involving exercise of at least 4 weeks in adults with a normal, high-normal BP or hypertension without concomitant diseases and published as a full-text in a peer-reviewed journal up to October 2021. Random effects models were used for analyses, with data reported as weighted means and 95% CI. We included 30 trials, including 36 study groups (n = 31 aerobic endurance exercise interventions, n = 4 resistance exercise interventions; n = 1 combined exercise intervention) randomizing a total of 1919 participants. Results: Analyses were performed with Comprehensive Meta-Analysis software (CMA 2.0). Aerobic endurance exercise significantly decreased 24 h AMBP (-2.8/-1.7 mmHg; p < 0.05); daytime AMBP (-3.6/-2.8mmHg; p < 0.001), nighttime ABMP (-1.6/-1.1; p < 0.05). Following resistance training, only a decrease in daytime systolic BP (-5.3 mmHg; p> 0.05) was observed without a statistically significant effect on daytime diastolic BP or nighttime BP (p > 0.05 for both). Conclusions: This meta-analysis confirms the BP lowering potential of exercise therapy in the management of BP. Daytime, nighttime and 24 h AMBP were significantly lower following an aerobic exercise intervention. The limited data available on resistance exercise warrants more research to confirm the resistance exercise as a sole exercise therapy to lower AMBP.

THE EFFECT OF DIETERY CHANGES ON WEIGHT AND BLOOD PRESSURE IN MIDDLE AGE PATIENTS WITH OVERWEIGHT/OBESITY AND HIGH NORMAL BLOOD PRESSURE

Objective: To evaluate the effects of dietary weight loss intervention in middle age with high normal blood pressure and overweight/obesity. Design and method: Men and women aged 25–54 was from working population were observed within the prospective epidemiological study: in subjects with BMI more than 25 kg/m2and BP 130–139/85–89 mm Hg. Was found a strong correlation of systolic BP and BMI was revealed: p = 0.0001 in women and p = 0.0045 in men. The same was true for diastolic BP: p = 0.0001 in women and p = 0.0001 in men. Two groups were formed and followed for 3 years: Intervention and Control groups consisted of 455 subjects (203 and 252 respectively). Dietician’s consultations were used in intervention group. Results: An increase of BMI by 1 kg/m2was associated with increase of systolic BP in women and men (by 1.3 and 0.7 mmHg respectively), (p < 0.05). For diastolic BP increase of BMI by 1 kg/m2was associated with increase in men and women (by 0.7 and 0.9 mm Hg respectively). In stepwise regression analysis body mass explains 27% of systolic BP variability and 11% of diastolic BP variability in men. In women it was 19% and 17% respectively. Last follow up visit attended more than 76% of the participants. After 3 years of intervention a weight loss was noted in the intervention group on an average at 1.17 kg in women (p < 0.05) and 0.63 kg (p < 0.05) in men. In controls body weight increased in women and in men (at 3.08 and 2.89 kg respectively) (all p < 0.05). BP decreased in the intervention group - 3.27 for systolic BP and – 2.09 mm Hg for diastolic BP in women; - 1.92 and – 1.91 mm Hg in men respectively. In control group BP increased: 2.97 mm Hg systolic BP and 1.29 mm Hg for diastolic Bp in women and 2.56 mm Hg and 2.39 mm Hg in men respectively (all p < 0.05). Conclusions: Dietary approach to weight loss is effective tool in middle age men and women with high normal BP and overweight/obesity for prevention of hypertension.

A PROSPECTIVE STUDY ON THE ASSOCIATION BETWEEN ATRIAL FIBRILLATION AND BLOOD PRESSURE IN AN ELDERLY CHINESE POPULATION

Objective: In the present prospective study, we investigated the association between atrial fibrillation (AF) and blood pressure (BP) in an elderly Chinese population. Design and method: Elderly (aged 65 years and over) residents were recruited from 6 communities in Shanghai from 2006 to 2020. 9019 participants who did not have AF at baseline had at least one ECG recording during follow-up. BP status at baseline was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2 or 3 hypertension. Results: During a median of 3.5 years follow-up, the overall incidence rate of AF was 5.6 per 1000 person-years (n = 178, men vs. women: 7.0 vs. 4.5 per 1000 person-years, P = 0.008). The AF incidence increased with both higher systolic and diastolic BP. Statistical significance was achieved for age- and sex-adjusted hazard ratio (HR) relative to optimal BP in stage 2 or 3 systolic hypertension (1.78, 95% confidence interval [CI] 1.04–3.05, P = 0.03) and in stage 1 (1.67, 95% CI 1.01–2.77, P = 0.04) and stage 2 or 3 systolic and diastolic hypertension (1.93, 95% CI 1.11–3.33, P = 0.02) and for fully adjusted HR relative to optimal BP in stage 2 or 3 systolic and diastolic hypertension (1.76, 95% CI 1.00–3.08, P = 0.05). The association between AF incidence and BP status tended to be stronger in participants with no than those with a history of cardiovascular disease at baseline (P for interaction = 0.06). Indeed, in participants with no history of cardiovascular disease at baseline, multivariate-adjusted HRs of AF relative to their counterparts with optimal BP were statistically significant in stage 1 (1.76, 95% CI 1.00–3.11 P = 0.05) and stage 2 or 3 systolic hypertension (2.08, 95% CI 1.12–3.85, P = 0.02) and stage 1 (1.93, 95% CI 1.06–3.50, P = 0.03) and stage 2 or 3 systolic and diastolic hypertension (2.34, 95% CI 1.24–4.44, P = 0.01). Conclusions: In the Chinese people aged 65 years and over, AF incidence is higher with high BP, especially systolic hypertension and in the absence of cardiovascular disease.

EFFECTS OF ISOMETRIC EXERCISE ON THE SPECTROMETRIC PROFILE OF OLDER ADULTS WITH HIGH BLOOD PRESSURE

Objective: A decline in protein homeostasis is associated with the development and progression of several cardiovascular diseases, including hypertension. Physical exercise is a promising intervention to counter defects in protein quality control. Isometric resistance training (IRT) promotes clinically relevant reductions in blood pressure (BP), however, its effects on protein homeostasis are not clearly defined. We determined the general proteomic profile in human plasma of older adults with high normal BP to hypertension and how it changes in response to IRT. Design and method: Older adults (n = 11, age: 73 ± 3 years) with high normal BP to hypertension participated in 8-weeks of IRT. IRT consisted of 4x45 sec contractions, alternatively with both hands, at an intensity of 50% of the maximum voluntary contraction, with a 1-min interval between sets, performed 3 times per week. Fourier-transform infrared (FTIR) spectroscopy assessed changes in the plasma after versus before IRT in the region of the spectra attributed to the secondary structure of proteins (1700–1600 cm-1). Results: Samples showed an excellent discrepancy before versus after IRT in the 1700–1600 cm-1 region. IRT induced a shift in the peak in the in the spectra region of 1622 cm-1; this region is attributed to intermolecular beta-sheets, which are common structures found in mature fibrils. Mature fibrils are prone to form toxic protein aggregates, especially amyloid aggregates. After IRT, participants appeared to have lower levels of intermolecular beta-sheets and samples were enriched with antiparallel beta-sheets (1696 cm-1) and beta-turns (1665 cm-1). Conclusions: The decrease in intermolecular beta-sheets may represent an improvement in the protein turnover and a better protein quality control in hypertension as a result of IRT. The differences in the antiparallel beta-sheets and beta-turns after IRT indicate IRT is modifying the protein profile. Further studies are needed to confirm these results and to address how exercise is influencing protein homeostasis.

ADHERENCE TO PHYSICAL ACTIVITY IN OLDER ADULTS WITH HYPERTENSION: LESSONS FROM THE HOLDAGE RANDOMIZED CONTROLLED TRIAL

Objective: Isometric exercise training (IHT) may be a practical, inexpensive and time efficient modality to reduce blood pressure (BP). We report preliminary exercise adherence data from HoldAge (NCT04275037) among older adults with high-normal BP to stage I hypertension. Design and method: Participants performed a total of 24 sessions of IHT or aerobic exercise training (AET), 3 times/week, for 8 wks. IHT was 4x45 min contractions, alternatively with both hands, at an intensity of 50% of the maximum voluntary contraction, with 1 min rest between sets. AET was walking 20–30 min at an intensity of 50–70% of the estimated peak maximal oxygen consumption (VO2peak) assessed with a submaximal step test. The attention control (AC) group received standardized optimal medical care including lifestyle advice. The adherence to IHT was a mean quality score recorded in the digital dynamometer, representing the % time participants performed the exercise sessions at the prescribed intensity. The adherence to AET was the time spent exercising at the prescribed intensity, recorded with a heart rate monitor. Results: 95 eligible people were contacted to participate and 72 agreed to participate (76%). Of these, 49 participants have finished the study (IHT:19; AET:18; AC:12) with 4 dropouts (AET:1; AC:3). Three participants changed their antihypertensive medication and were excluded (AET:1; AC:2). IHT had a self-reported exercise adherence of 96.7 ± 9.3%, while data downloaded from the exercise devices showed an adherence of 88.6 ± 13.9% of the sessions, with 2.3 ± 3.3% incomplete sessions. IHT registered a mean quality score of 91.8 ± 11.2% for the right hand (mean strength: 22.6 ± 7.7 kg), 91.7 ± 13.5% for the left-hand (mean strength: 20.9 ± 8.6 kg), and 91.6 ± 12.2% for both hands. AET had a self-reported exercise adherence of 83.8 ± 33.6%, consistent with the data downloaded from the heart rate monitors. AET participants spent a total of 578.1 ± 263.6 min exercising, of which 153.3 ± 152.4 min (22.6 ± 23.2%) was spent walking at the prescribed intensity, 286.3 ± 210.5 min (45.4 ± 35.2%) was below and 137.8 ± 154.7 minutes (19.4 ± 21.7%) was above. Conclusions: Exercise adherence in HoldAge is high in both IHT and AET, but the time spent at the prescribed intensity appears to be higher in IHT than AET.

Hypertension in obese children is associated with vitamin D deficiency and serotonin dysregulation

BackgroundObesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children.MethodsOne hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children.ResultsHypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS.ConclusionsDysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.

Parameters indicating development of hypertension in three-year follow-up study of subjects with high normal blood pressure

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension (HTN). Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP who developed hypertension in a 3 year follow up. Methods 100 subjects with high normal office BP [systolic BP=130-139 mmHg and diastolic BP=85-89 mmHg] underwent a treadmill exercise stress test. Arterial stiffness was evaluated based on carotid to femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA levels. Follow up was every 6 months for 3 years, where BP was measured at both office (OffBP) and ambulatory blood pressure monitoring (ABPM). All participants offered lifestyle advises. Endpoint was development of HTN diagnosed either from OffBP or from ABPM. Then they were divided into Group I: those developed HTN and Group II: those remained normotensive. Results Mean age 54±8 years, 42 males, baseline offBP: 132/82 mmHg, ABPM: 122/76 mmHg). Out of them, 50 subjects developed HRE (BP ³210mmHg in men and ³190 mmHg in women) and 40 HTN. Group I developed higher HRE (75% vs. 13%, p=0.026), higher levels of PWV (8.35 vs 7.5 m/sec, p=0.043) and MSNA levels (37 vs. 31 bursts, p=0.04), while did not differ at their metabolic profile. Echocardiographically left ventricular mass index did not differ statistically as E/A ratio of mitral valve inflow (0.92 vs 1.05, p=0.034). Those who developed HTN was related to night systolic BP from ABPM (116 vs 112 mmHg, p<0.04), as also to intermediate stage intervals of 3 min (160 vs 147 mmHg, p=0.068) and 6 min (181 vs 164, p=0.035) of Bruce protocol. A novel metric, the SBP/MET-slope [(peak SBP—resting SBP)/(peak MET-1)] found to add crucial information. Regarding those who developed HTN, SBP/MET-slope was higher in all stages till peak exercise (stage 1: 6.25 vs 4.25, stage 2: 7.6 vs 5.3, peak: 7.22 vs 5.1, p=0.035). It was noticed that they performed a higher exercise capacity (10 vs 11.5 METs) and additionally differ significantly in their maximal heart rate (HR) at peak exercise (154 vs 164, p=0.001). Conclusion In subjects with high normal BP, a HRE, the intermediate BP intervals along with the SBP/MET-slope, identifies a state of systemic vascular resistance, arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. Additionally, exercise capacity demonstrates cardiovascular functional tolerance. These findings suggest that exercise testing provides determining clinical information regarding the overall cardiovascular status, proving its superior prognostic value as a hypertension screening tool, that alarms the physician to warn the patient to take action.

Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study.

Background:High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality.Objective:We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran.Methods:We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed.Results:The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions.Conclusion:Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men.

Postexercise hypotension in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials

Abstract Funding Acknowledgements Type of funding sources: None. Background Worldwide, raised blood pressure (BP) or hypertension (HT) is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African-origin populations. Post-exercise hypotension (PEH) defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management which can last up to 24 hours. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. Objectives To systematically summarize the acute effects of a single bout of aerobic exercise on blood pressure in a population of African or Asian origin. Methods We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or HT published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random effect models fitted to estimate effect sizes. Results We identified 10 aerobic exercise trials of individuals of Asian origin (n= 156; mean age: 27.05 years: 72% male; baseline SBP/DBP: 114.93 [99,142] / 67.34 [61,74] mmHg) and 11 aerobic exercise trials involving individuals of African origin (n=112; mean age: 41.37 years; 62% male; baseline SBP/DBP: 125.77 [106.6,140.2] / 79.72 [69.9, 84.3] mmHg). Non-significant moderate reductions in office SBP and DBP at 30 minutes postexercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28 / -1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 minutes postexercise (-2.80 [-7.90, 2.28], p = 0.27 / -1.95, [-5.66, 1.75], p = 0.3) were observed compared to control group. No statistically significant differences were found between ethnic groups (p &amp;gt; 0.05). Ambulatory BP was reported only in the African groups. No effect was found on 24h-SBP post-exercise, but 24h-DBP was statistically signficantly reduced (-1.89 [-3.47, -0.31] mmHg, p &amp;lt; 0.01) after a bout of aerobic exercise. Conclusions A single bout of aerobic exercise did not significantly reduce BP immediately in the African and Asian group. In the African group a small though statistically significant lower 24h-DBP was observed. Unfortunately, no data was found on the 24h-BP response in Asians. The low number of studies in both ethnic groups and lack of data on isometric and resistance exercise in African and Asian populations warrant more research to improve quality of evidence.

Prognostic significance of gender and sexual risk factors in the development of arterial hypertension in an organized population

Relevance. Persistent high levels of morbidity and mortality of the working-age population from cardiovascular diseases (CVD) in Russia require the search for new targets for screening programs and subsequent development of evidence-based prevention models in organized populations showing their clinical and economic effectiveness in long-term prospective follow-up.Objective. To carry out a comprehensive assessment of the prognostic factors of arterial hypertension (AH) according to the data of 8-year prospective study of an organized sample taking into account gender and sex characteristics.Design and methods. We conducted a two-stage study: a one-stage integral study of an organized population (400 people) followed by a prospective 8-year follow-up of a group of relatively healthy subjects without clinical manifestations of CVD (193 people aged 21 to 64 years, mean age 49,0 [42,0; 58,0], of whom men 48,2%). Stage I indicators under study: sociodemographic characteristics; clinical and physical findings; behavioral factors; family history of early CVD; occupational interview and degree of work stress; psychological characteristics; biochemical indices of stress response; cardiovascular remodeling indices. Stage II indicators under study: newly diagnosed cases of AH.Results. The pattern of prognostic factors for AH depended on gender. Among women, prognostic factors for 8-year incidence of AH were: marital status (widow) (Hazard ratio (HR) 10,1), diastolic blood pressure level (HR1,1), and physical activity outside work (HR0,3). In men, in addition to behavioral (smoking history, HR1,1) and clinical (high normal blood pressure, HR4,1) factors, there was also an independent contribution of a psychological factor (personality anxiety, HR6,5).Conclusions. Our findings substantiate the need for a poly-professional approach (physician-internistpsychiatrist-medical psychologist) to the prevention of CVD in the studied organized population, taking into account gender-specific features.

The Effect of a Family History of Hypertension on Left Ventricular Mass When Controlling for Physical Activity Frequency

A positive family history of hypertension (+FHH) is associated with non‐exercise induced increases in left ventricular mass (LVM) and high‐normal blood pressure (BP). Regular physical activity (PA) can lead to non‐pathological increases in LVM, but evidence shows adults with elevated BP can decrease LVM with PA.PURPOSETo determine if a +FHH is associated with a greater LVM indexed to body surface area (BSA) compared to a negative family history of hypertension (‐FHH) group within a sample of young, mostly active healthy adults.METHODSHealthy young (18‐32yrs) participants self‐reported family history of hypertension (FHH) status and habitual moderate and vigorous PA frequency as days per week with at least 10 minutes of recreational activity. Participants then underwent an echocardiogram. Participants were excluded from this retrospective analysis if there was a prior diagnosis of cardiovascular‐related disease or hypertension. Within‐group normality of each variable was tested using the Shapiro‐Wilk test. Simple bivariate comparisons between groups were made using unpaired t‐tests for normally distributed variables and Mann‐Whitney tests when normality was violated. LVM/BSA was logarithmically transformed prior to ANCOVA testing due to non‐normality.RESULTSOf the 61 participants, 32 (M=11, W=21; non‐active=8) reported ‐FHH and the remaining 29 (M=13, W=16; non‐active=2) reported a +FHH. While still in the normal range, the +FHH group displayed greater systolic BP (‐FHH 112±12, +FHH 117±12 mmHg, p=0.043), but similar values for all other demographic information when compared to the ‐FHH group (age ‐FHH 23±3, +FHH 23±2 yrs, p=0.116; BSA ‐FHH 1.74±0.20, +FHH 1.74±0.21 m2, p=0.903; diastolic BP ‐FHH 68±6, +FHH 69±8 mmHg, p=0.287; resting heart rate ‐FHH 66±13, +FHH 64±9 bpm, p=0.578; moderate exercise frequency ‐FHH 1.8±1.8, +FHH 2.6±2.1 days/week, p=0.117; vigorous exercise frequency ‐FHH 2.5±2.2, +FHH 3.4±2.0 days/week, p=0.105). The +FHH group had greater LVM (‐FHH 129.5±41.8, +FHH 155.2±42.6 g, p=0.015) and LVM/BSA (‐FHH 73.5±17.4, +FHH 88.4±17.3 g/m2, p=0.004). Separate ANCOVA models accounting for moderate and vigorous PA found that FHH status independently predicted LVM/BSA and PA frequencies were a significant modifier (ANCOVA controlling moderate PA: FHH status p=0.004, partial η2=0.133; moderate PA p=0.020, partial η2=0.089), (ANCOVA controlling vigorous PA: FHH status p=0.004, partial η2=0.132; vigorous PA p=0.007, partial η2=0.117).CONCLUSIONThis preliminary analysis suggests that young adults with a family history of hypertension have elevated left ventricular mass compared to their counterparts without a family history of hypertension. This finding is independent of their habitual moderate and vigorous physical activity patterns.

32 BLOOD PRESSURE DIARY AS A COMMUNITY-BASED INTERVENTION TO INCREASE HYPERTENSIVE PATIENTS' PERCEPTION OF TREATMENT: A PRELIMINARY STUDY

Background: Hypertension is one of global health issues that become a leading modifiable risk factor of various illnesses. As one of twelve indicators of The Healthy Indonesia Program-a family approach (PIS-PK), comprehensive hypertension treatment is a parameter of a healthy community. Objective: This preliminary study aim was to determine demographic profile of hypertension patients and improve patients' perceptions of hypertension treatment. Method: In this cross-sectional descriptive study, we used patients with hypertension who reside in Panjeng village, Ponorogo, Indonesia in November 2020 as population sample. Definition of hypertension was based on the 2020 International Society of Hypertension practice guidelines. The intervention of this study was distribution of a blood pressure diary, which consists blood pressure evaluation page for each visitation as well as educational page about risk factors and management of hypertension. Healthy Family Index, a PIS-PK outcome, was used to assess the intervention's effectiveness. Result: This study has 21 participants, with an average age of 63,3 ± 10,5 years, and 76,2% were female. Among those subjects, 61,9% of participants had grade 2 hypertension, 33,3 % had grade 1 hypertension, and 4,8% had normal-high blood pressure. Only 23,8% of patients were committed to taking their medicine regularly. Based on the results of the Healthy Family Index, there was a 6% rise in the indicator of adherence to treatment in patients with hypertension in the year following the intervention (36.4 % (2020) vs. 42.2 % (2021)). One of the factor that affect this result was Covid-19 pandemy, that patients may feel hesitate to visits to healthcare facility. Conclusion: Blood pressure diary can be considered as potential community-based intervention to improve patient perception of treatment, as well as to monitor and evaluate hypertension therapy. Further and bigger-scale research is needed to determine the direct effect of this intervention to medication adherence.

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.

IDF21-0652 Blood pressure-lowering for prevention of major cardiovascular diseases in persons with and without type 2 diabetes

Background: There is insufficient randomised evidence as to whether the effect of blood pressure (BP)-lowering treatment differs in people with type 2 diabetes versus those without this metabolic condition, particularly at a normal or high-normal BP level. Aim: To investigate the effects of BP-lowering treatment on the risk of major cardiovascular events in people with and without type 2 diabetes, and by baseline levels of systolic and diastolic BP. Method: We used the resource provided by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) to conduct a one-stage individual participant data meta-analysis of major randomised trials. The primary outcome was total major cardiovascular events, defined as the first occurrence of fatal or non-fatal stroke or cerebrovascular disease, fatal or non-fatal myocardial infarction, and heart failure causing death or requiring hospitalisation. The analysis was stratified for type 2 diabetes status at baseline, and baseline categories of systolic BP (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg) and diastolic BP from <70 mm Hg to ≥110 mm Hg diastolic). Cox proportional hazard model stratified by the trial was used to estimate hazard ratio (HR). A Poisson regression model with an identity link was used to calculate the absolute risk reduction (ARR). Results: Data for 358,533 participants (58.4% men) from 51 randomised clinical trials were included in the analysis, in which 28.8% (n=103,325) of the participants had diagnosis of type 2 diabetes at baseline. Baseline mean systolic/diastolic BPs were 149/84 mm Hg in participants with type 2 diabetes (n=103,325) and 153/88 mm Hg in participants without type 2 diabetes (n=255,208). The incidence risks of primary events during the study follow-up time in participants with and without type 2 diabetes were 16.5% and 10.2%, respectively. Over 4.2 years of median follow-up, a fixed value of 5-mm Hg reduction in systolic BP was associated with a lower risk of major cardiovascular events both in participants with type 2 diabetes (HR 0.94 [95% CI 0.91 to 0.98]; ARR -0.015 [95% CI -0.020 to -0.010]) and in those without history of type 2 diabetes (HR 0.89 [95% CI 0.87 to 0.92]; ARR =-0.016 [95% CI -0.018 to -0.013]). In stratified analyses, we did not find reliable evidence for heterogeneity of treatment effects by baseline systolic or diastolic BP level in participants with or without type 2 diabetes (all P for interaction > 0.78). Discussion: The effect of BP reduction for primary and secondary prevention of major cardiovascular events was broadly comparable among people with and without type 2 diabetes, with no clinically important evidence that the level of systolic or diastolic BP at baseline is a determinant of treatment effect. Recommendations by guidelines on different BP reduction treatment in people with and without diabetes, or initiation of BP reduction therapy at a specific BP threshold, are not substantiated by these findings. This work will be presented on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration. Working group: Milad Nazarzadeh, Zeinab Bidel, Dexter Canoy, Emma Copland, Abbas Dehghan, Derrick A Bennett, George Davey Smith, Rury R. Holman, Mark Woodward, Ajay Gupta, Amanda Adler, Naveed Sattar, Richard J McManus, Koon Teo, Barry R Davis, John Chalmers, Carl J. Pepine, Kazem Rahimi.

Adherence to the Chinese Food Pagoda in the High-Risk Population of Non-communicable Diseases Aged 35–59 in Central China

ObjectivesA healthy dietary habit is essential for preventing non-communicable diseases (NCDs). We aimed to assess the adherence to the Chinese Food Pagoda (CFP) proposed in the Chinese Dietary Guidelines 2016 in the high-risk population of NCDs in central China.MethodsA cross-sectional study was conducted in two large enterprises (totally 3,016 employees) from October to December 2019 in Hubei Province (central China). The high-risk population of NCDs was identified by physical examination, laboratory test and face-to-face questionnaire survey according to the National Norms for Prevention and Control of Non-communicable Diseases issued by the Chinese government. We assessed the deviation of real diet from the CFP recommended diet in the high-risk population of NCDs.ResultsA total of 821 participants aged 35–59 years old with at least one high-risk factor of NCDs were enrolled in our study. Of them, 53.8% were daily smokers, 49.6% had elevated blood cholesterol, 31.4% were centrally obese, 23.3% had high normal blood pressure, and 3.5% had impaired fasting glucose. Significant disparity was detected in the high-risk population of NCDs between real food consumption and the CFP's recommendation (P < 0.05), such as the deficient intake of nuts and milk and dairy products, and the over-consumption of cereals, meat and poultry, oil, and salt. Participants with impaired fasting glucose had the highest intake of cereals and vegetables on average. Participants with central obesity were more likely to consume meat and poultry (P < 0.05). The lowest average intake of eggs and the highest average intake of milk and dairy products were found in participants with high blood cholesterol (P < 0.05). The daily smokers were more likely to consume beans and nuts (P < 0.05). The lowest average intake of fruits and the highest average intake of tubers were found in participants with high normal blood pressure (P < 0.05).ConclusionAdherence to CFP in the high-risk population of NCDs appeared to be challenging. It is necessary to adopt dietary education campaign focusing on the high-risk population of NCDs to prevent or delay the occurrence of NCDs.

Prevalence and Risks Factors of Prehypertension in Africa: A Systematic Review.

Background:Hypertension is one of the major factors for high mortality of adults in Africa. However, complications occur at lower values than those previously classified as hypertension. Thus, prehypertension is considered as a new category of hypertension and a major risk factor for developing clinical hypertension relative to those with normotension, it has been linked with increased future risk of hypertension as well as cardiovascular diseases.Objectives:The objective of this review was to determine prevalence of prehypertension and describe the associated factors of prehypertension in Africa during the past 10 years.Methods:We did a systematic review using the databases PubMed/Medline, and search engine google scholar. We selected sources of publications and conducted an analysis of articles. Keywords in English were: prehypertension, high normal blood pressure, high blood pressure, elevated blood pressure, Africa. Keywords in french were: préhypertension artérielle, préhypertension, pression artérielle normale haute, pression artérielle normale, Afrique.Mesh terms were:Prehypertension, Africa.Results:Twenty-seven articles were selected. Prevalence of prehypertension ranged from 2.5% to 34% in children and adolescents. In adults, prevalence varied from 32.9% to 56.8%. Several factors were associated with prehypertension in Africa. These factors included: age; sex; lifestyle such as smoking, alcohol consumption, low physical activity, overweight and obesity. There were also cardiometabolic factors and few others factors which were associated with prehypertension.Conclusion:This review allowed us to observe that the prevalence of prehypertension was variable according to age of the population and prehypertension is associated with several factors.

High normal blood pressure value, is the patient at increased CV risk?

High normal blood pressure value, is the patient at increased CV risk?