High-normal Systolic Blood Pressure Research Articles

High-normal systolic blood pressure in early midlife is a stronger risk factor for incident hypertension later in life for women than men

Abstract Background We have previously found that having high-normal blood pressure (BP) in early midlife is a stronger risk factor for incident hypertension later in life for women than for men. Whether this risk is related both to high-normal systolic and diastolic BP is not known. Purpose To explore whether there is a sex difference in risk of incident hypertension related to high-normal systolic and diastolic BP in early midlife. Methods In the community-based Hordaland Health Study, 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 26 years. Patients with hypertension at baseline were excluded. Attended BP was measured in triplets, and clinic BP taken as the average of the two last measurements. High-normal systolic BP was identified as systolic BP of 130-139 mmHg and high normal diastolic BP as diastolic BP 85-89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the follow-up visit. The associations of systolic and diastolic BP at baseline with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Multivariable analysis looking at high-normal diastolic BP was adjusted for baseline BMI, systolic BP, high-normal diastolic BP , heart rate, physical activity, daily smoker, cholesterol, triglycerides. Multivariable analysis looking at high-normal systolic BP was adjusted for baseline BMI, diastolic BP, high normal systolic BP , heart rate, physical activity, daily smoker, cholesterol, triglyceride. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values. Results At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p<0.001). A high-normal systolic BP was found in 16% of women and 35% of men (p< 0.001). A high-normal diastolic BP was found in 7% of women and 11% of men(p=0.008). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p<0.05). In multivariable logistic regression analyses, high-normal systolic and diastolic BP at baseline predicted incident hypertension at follow up in both sexes (Table 1). High-normal systolic BP was a significantly stronger predictor for incident hypertension in women (OR 2.32, CI 1.5-3.5) with p<0.01 for sex interaction (Table 1). In men, high-normal diastolic BP at baseline, was the strongest predictor of incident hypertension (OR 2.1, 95% CI 1.2-3.7), but no sex-interaction was found for high-normal diastolic BP, possibly due to low numbers. Conclusions Having a high-normal systolic BP in early midlife is a greater risk for developing hypertension later in life for women than men.Table 1

Hypertension and poor control of systolic blood pressure after a myocardial infarction with non-obstructive coronary arteries are associated with incident heart failure

Abstract Introduction Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in up to 10% of all acute myocardial infarctions. Although previously believed to be a benign condition, recent studies have observed an increased risk for long-term adverse cardiovascular events in this group. However, data on risk markers for specific outcomes following MINOCA are limited. Hypertension is an important risk factor for heart failure (HF), but it is yet unknown whether blood pressure control after MINOCA is associated with incident HF. Aims To investigate whether history of hypertension and control of systolic blood pressure at two-month follow-up visit after MINOCA were associated with hospitalization for HF during long-term follow-up. Material and Methods This was a nationwide cohort study using data from SWEDEHEART and the National Patient Registry. Patients with first-time MINOCA between 2005-2020 were included and divided into grades of hypertension based on systolic blood pressure (SBP) in mmHg at a two-month follow-up visit. The grades were low normal (<120), normal (120-129), high normal (130-139), grade 1 hypertension (140-159), grade 2 hypertension (160-179) and grade 3 hypertension (>180). MINOCA was defined as a discharge diagnosis of AMI combined with a coronary angiography showing less than 50% stenosis in all coronary arteries. Patients with a diagnosis of heart failure or cardiomyopathy one month or earlier before index hospitalization with MINOCA were excluded. After the two-month visit all patients were followed in the registries regarding hospitalization for HF, until December 2020. The association between SBP and time to first HF hospitalization was studied with univariate and multivariate Cox regression models, using high normal SBP as the reference group. Results Among the 5018 included patients (57.8% women, mean age 62.6 years), 197 (3.9%) were hospitalized for HF during a median follow-up of 6.5 years (IQR 3.2-9.9). A diagnosis of hypertension at index hospitalization for MINOCA was associated with hospitalization for HF, both in univariate analysis (HR 1.97 95% CI 1.49-2.62) and after age and sex adjustments (HR 1.45 95% CI 1.09-1.93). The highest hospitalization rate of 7.6% was seen among patients with grade 2-3 hypertension at the two-month follow-up visit. In univariate analysis a SBP >160 mmHg was associated with hospitalization for HF (HR 2.17 CI 1.36-3.45). After exclusion of patients with 30-49% stenosis, these findings remained after age and sex adjustments (HR 1.71 CI 1.04-2.83). Conclusions Both history of hypertension and a poor blood pressure control two-months after MINOCA were associated with hospitalization for HF during long-term follow-up. These findings highlight the importance of adequate blood pressure control following MINOCA. To better detect and treat high SBP should be seen as an opportunity to reduce HF hospitalizations in this group of patients.

Assessment of Vascular Indices by Abdominal Aortic Ultrasonography in Preterm Neonates with Bronchopulmonary Dysplasia.

Preterm infants with bronchopulmonary dysplasia (BPD) frequently encounter systemic hypertension, yet the underlying cause remains elusive. Given the absence of prior investigations concerning the correlation between systemic hypertension and aortic thickness, we undertook this study to assess and juxtapose diverse vascular indices amidst preterm neonates with BPD, preterm neonates lacking BPD, and healthy neonates, utilizing abdominal aorta ultrasonography. This cross-sectional study encompassed 20 preterm neonates, 20 preterm neonates with BPD, and 20 healthy neonates, meticulously matched for sex and postnatal age. Comprehensive demographic, anthropometric, and clinical evaluation data were documented. The neonates underwent abdominal aortic ultrasonography for comparative evaluation of aortic wall thickness and vasomotor function across the three groups. The study revealed that neonates with BPD exhibited a notably higher average systolic blood pressure than preterm and term neonates (P < 0.05). Conversely, echocardiographic parameters such as input impedance, and arterial wall stiffness index displayed no substantial variance among the three groups (P > 0.05). The mean (SD) aortic intima-media thickness (aIMT) for preterm neonates with BPD, preterm neonates, and term neonates were 814 (193.59) μm, 497.50 (172.19) μm, and 574.00 (113.20) μm, correspondingly (P < 0.05). Furthermore, the mean (SD) pulsatile diameter for preterm neonates with BPD, preterm neonates, and term neonates were 1.52 (0.81) mm, 0.91 (0.55) mm, and 1.34 (0.51) mm, respectively (P < 0.05). Following adjustment for birth weight, sex, and gestational age at birth, the study identified a noteworthy correlation between aIMT and BPD. The investigation concluded that the mean aortic intima-media thickness (aIMT) was significantly elevated in preterm neonates with BPD, signifying a potential early indicator of atherosclerosis and predisposition to future heightened blood pressure and cardiovascular ailments. Consequently, the study postulates that aIMT could be a consistent and well-tolerated marker for identifying BPD patients at risk of developing these health complications.

The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study

ObjectivesElevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated.Design and SettingWe examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men.ParticipantsThe Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42–61 years at baseline was employed for this prospective study analysis.MeasurementsResting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week, respectively).ResultsA total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23–1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03–1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39–2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06–2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77–1.61).ConclusionThere might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.

Left ventricular myocardial strain responding to chronic pressure overload in patients with resistant hypertension evaluated by feature-tracking CMR

ObjectivesThe study aimed to investigate the alterations of myocardial deformation responding to long-standing pressure overload and the effects of focal myocardial fibrosis using feature-tracking cardiac magnetic resonance (FT-CMR) in patients with resistant hypertension (RH).MethodsConsecutive RH patients were prospectively recruited and underwent CMR at a single institution. FT-CMR analyses based on cine images were applied to measure left ventricular (LV) peak systolic global longitudinal (GLS), radial (GRS), and circumferential strain (GCS). Functional and morphological CMR variables, and late gadolinium enhancement (LGE) imaging were also obtained.ResultsA total of 50 RH patients (63 ± 12 years, 32 men) and 18 normotensive controls (57 ± 8 years, 12 men) were studied. RH patients had a higher average systolic blood pressure than controls (166 ± 21 mmHg vs. 116 ± 8 mmHg, p < 0.001) with the intake of 5 ± 1 antihypertensive drugs. RH patients showed increased LV mass index (78 ± 15 g/m2 vs. 61 ± 9 g/m2, p < 0.001), decreased GLS (− 16 ± 3% vs. − 19 ± 2%, p = 0.001) and GRS (41 ± 12% vs. 48 ± 8%, p = 0.037), and GCS was reduced by trend (− 17 ± 4% vs. − 19 ± 4%, p = 0.078). Twenty-one (42%) RH patients demonstrated a LV focal myocardial fibrosis (LGE +). LGE + RH patients had higher LV mass index (85 ± 14 g/m2 vs. 73 ± 15 g/m2, p = 0.007) and attenuated GRS (37 ± 12% vs. 44 ± 12%, p = 0.048) compared to LGE − RH patients, whereas GLS (p = 0.146) and GCS (p = 0.961) were similar.ConclusionAttenuation of LV GLS and GRS, and GCS decline by tendency, might be adaptative changes responding to chronic pressure overload. There is a high incidence of focal myocardial fibrosis in RH patients, which is associated with reduced LV GRS.Clinical relevance statementFeature-tracking CMR-derived myocardial strain offers insights into the influence of long-standing pressure overload and of a myocardial fibrotic process on cardiac deformation in patients with resistant hypertension.Key Points• Variations of left ventricular strain are attributable to the degree of myocardial impairment in resistant hypertensive patients.• Focal myocardial fibrosis of the left ventricle is associated with attenuated global radial strain.• Feature-tracking CMR provides additional information on the attenuation of myocardial deformation responding to long-standing high blood pressure.

Dietary pattern associated with C-reactive protein and trajectories of blood pressure in Chinese adults: Evidence from the China Health and Nutrition Survey.

We aimed to investigate the relationship between a dietary pattern associated with C-reactive protein (CRP) levels and trajectories of blood pressure in Chinese adults. This prospective cohort study consisted of 7020 adults using three waves of the China Health and Nutrition Survey (2009, 2011 and 2015). Group-based trajectory modelling was used to identify trajectories of blood pressure. The dietary pattern associated with C-reactive protein (CRP) was measured using the reduced rank regression method. Logistic regression models were fit to explore the associations of the scores on inflammation-related dietary patterns and trajectories of blood pressure. We identified a dietary pattern associated with CRP at baseline, which was high in red meat, snacks and nuts, but low in grains, poultry and fish. The odds ratios (95% confidence intervals) pertaining to the highest dietary pattern score group for the high-normal systolic blood pressure (SBP) group and the high SBP group were 1.316 (1.155-1.498) and 1.295 (1.030-1.627), respectively. However, no significant association was observed between dietary patterns and trajectories of diastolic blood pressure (p > 0.05). Dietary pattern associated with CRP resulted in higher risk of high-normal and high levels of SBP.

Natural killer cells, gamma delta T cells and classical monocytes are associated with systolic blood pressure in the multi-ethnic study of atherosclerosis (MESA)

BackgroundHypertension is a major source of cardiovascular morbidity and mortality. Recent evidence from mouse models, genetic, and cross-sectional human studies suggest increased proportions of selected immune cell subsets may be associated with levels of systolic blood pressure (SBP).MethodsWe assayed immune cells from cryopreserved samples collected at the baseline examination (2000–2002) from 1195 participants from the multi-ethnic study of atherosclerosis (MESA). We used linear mixed models, with adjustment for age, sex, race/ethnicity, smoking, exercise, body mass index, education, diabetes, and cytomegalovirus titers, to estimate the associations between 30 immune cell subsets (4 of which were a priori hypotheses) and repeated measures of SBP (baseline and up to four follow-up measures) over 10 years. The analysis provides estimates of the association with blood pressure level.ResultsThe mean age of the MESA participants at baseline was 64 ± 10 years and 53% were male. A one standard deviation (1-SD) increment in the proportion of γδ T cells was associated with 2.40 mmHg [95% confidence interval (CI) 1.34–3.42] higher average systolic blood pressure; and for natural killer cells, a 1-SD increment was associated with 1.88 mmHg (95% CI 0.82–2.94) higher average level of systolic blood pressure. A 1-SD increment in classical monocytes (CD14++CD16−) was associated with 2.01 mmHG (95% CI 0.79–3.24) lower average systolic blood pressure. There were no associations of CD4+ T helper cell subsets with average systolic blood pressure.ConclusionThese findings suggest that the innate immune system plays a role in levels of SBP whereas there were no associations with adaptive immune cells.

Abstract TP205: Association Between Morphological Variations of Extracranial Internal Carotid Artery and Cerebral White Matter Hyperintensities

Background: Cerebral white matter hyperintensities (WMHs) often remain asymptomatic until they widely affect brain structure. The association between small and large vessel diseases is worth studying. We aimed to explore the relationship between morphological variations of extracranial internal carotid artery (EICA) and WMHs. The classic evaluation system of artery variations failed to describe the compound abnormities, and therefore some novel parameters were proposed in this study. Methods: Neck CT angiography scans and brain MRI data of 97 patients with acute ischemic stroke were retrospectively analyzed. The angle of EICA, tortuosity index (TI), deviation degree (DD) and angular number (AN) were measured as parameters of artery morphological variations (Figure). The severity of WMHs was assessed by Fazekas Scale. Differences of vascular morphological variations between mild and severe white matter lesion groups and factors independently associated with WMHs were analyzed. Results: Compared with the patients with mild WMHs, patients with severe WMHs were older ( P =0.001), had higher average systolic blood pressure ( P =0.026), larger median TI ( P &lt;0.001) and median DD ( P &lt;0.001). Also, more patients with severe WMHs had sharp blood vessel angles ( P =0.001) and history of stroke ( P =0.034). Sharp blood vessel angle (OR 4.056, 95%CI 1.578-10.467) and TI (OR 1.037, 95%CI 1.007-1.068) were independently associated with severe WMHs proved by multivariate logistic analysis. Several regression models suggested that age and history of stroke had close relationship with WMHs. Conclusions: Sharp angle of EICA and TI were independently associated with severe WMHs. Besides, age and history of stroke were firmly related to white matter lesions.

Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men

IntroductionTighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AimTo determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. MethodsWe performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. Main Outcome MeasuresIncidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. ResultsWe identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258–1.469]) and a shorter time to the development of ED (log rank, P < .0001). Clinical ImplicationsWe believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. Strength & LimitationsThe retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. ConclusionAmong adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED.Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410–417.

Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications.

Despite increasing popularity of prehospital tourniquet use in civilians, few studies have evaluated the efficacy and safety of tourniquet use. Furthermore, previous studies in civilian populations have focused on blunt trauma patients. The objective of this study was to determine if prehospital tourniquet use in patients with major penetrating trauma is associated with differences in outcomes compared to a matched control group. An 8-year retrospective analysis of adult patients with penetrating major extremity trauma amenable to tourniquet use (major vascular trauma, traumatic amputation and near-amputation) was performed at a Level I trauma center. Patients with prehospital tourniquet placement (TQ) were identified and compared to a matched group of patients without tourniquets (N-TQ). Univariate analysis was used to compare outcomes in the groups. A total of 204 patients were matched with 127 (62.3%) in the prehospital TQ group. No differences in patient demographics or injury severity existed between the two groups. Average time from tourniquet application to arrival in the emergency department (ED) was 22.5 ± 1.3 minutes. Patients in the TQ group had higher average systolic blood pressure on arrival in the ED (120 ± 2 vs. 112 ± 2, p = 0.003). The TQ group required less total PRBCs (2.0 ± 0.1 vs. 9.3 ± 0.6, p < 0.001) and FFP (1.4 ± 0.08 vs. 6.2 ± 0.4, p < 0.001). Tourniquets were not associated with nerve palsy (p = 0.330) or secondary infection (p = 0.43). Fasciotomy was significantly higher in the N-TQ group (12.6% vs. 31.4%, p < 0.0001) as was limb amputation (0.8% vs. 9.1%, p = 0.005). This study demonstrated that prehospital tourniquets could be safely used to control bleeding in major extremity penetrating trauma with no increased risk of major complications. Prehospital tourniquet use was also associated with increased systolic blood pressure on arrival to the ED, decreased blood product utilization and decreased incidence of limb related complications, which may lead to improved long-term outcomes and increased survival in trauma patients. Therapeutic, level IV.

Blood pressure and outcome post mechanical thrombectomy

Data on the blood pressure (BP) following mechanical thrombectomy (MT) is limited. In this study, we aimed to evaluate the correlation between BP and functional outcome following MT. We included patients who received MT between 6/12014 and 2/2017 at our institution. BP data included systolic, diastolic, and mean arterial BP readings recorded on an hourly interval for 24 h post-procedure. Functional outcome was assessed using 90-day modified Rankin Scale (mRS). Good outcome was defined as mRS ≤ 2, and poor outcome as mRS 3–6.A total of 298 patients were included. Mean age was 66.8 ± 15.2 years; 51% of patients were female, and mean NIHSS was 15.4 ± 7.7. Average systolic blood pressure (SBP) was 121 ± 11.5 mm Hg in the good outcome group and 125 ± 12.5 mm Hg in the poor outcome; P < 0.001. Maximum SBP was 147.9 ± 20.5 mm Hg and 152.5 ± 18.3 mm Hg in the good and poor outcome group respectively, P < 0.05. On multivariate analysis, higher average SBP was associated with a lower chance of good outcome (Odds ratio 0.97; 95% Confidence interval 0.94–0.998; P 0.026). Patients with average SBP of <120 mm Hg in 24-hour post MT had a better 90-day outcome and a lower mortality rate when compared to patients with ≥120 mm Hg (median mRS; 2 (IQR 3) vs 3 (IQR4); P < 0.001, mortality (12.1% vs 25.9%; P < 0.01)). In conclusion, higher SBP in the acute phase post-MT was associated with a worse functional outcome. Prospective studies are urgently needed to determine the optimal BP goal post MT.

Incidence and Risk Factors for Postpartum Severe Hypertension in Women with Underlying Chronic Hypertension.

To determine risk factors and time to diagnosis of postpartum severe hypertension (PHTN) in women with chronic hypertension (CHTN). Retrospective cohort of singleton pregnancies with CHTN at a tertiary care center. The primary outcome was PHTN, defined as hypertension ≥160/ ≥ 110 mm Hg during an emergency room (ER) or outpatient visit, or hospitalization within 8 weeks postpartum. Multivariable logistic regression was used to assess independent risk factors for PHTN. Two-hundred thirty-five women had CHTN: 30 (12.8%) were diagnosed with PHTN, and 17 (7.2%) were hospitalized or seen in the ER for PHTN. Women with PHTN had more severe superimposed pre-eclampsia (p < 0.05), higher average systolic blood pressures at discharge (141 vs. 135 mm Hg, p = 0.04), and required antihypertensives after delivery (p < 0.01). The number of antihypertensive medications (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI], 1.25-2.55) and a systolic blood pressure >135 mm Hg (aOR 4.55, 95% CI, 1.64-12.61) at discharge remained independently associated with PHTN. Median time to diagnosis of PHTN was 10 days (interquartile range [IQR] 6-32 days); time to diagnosis among women requiring readmission or ER evaluation was 8 days (IQR 5-11 days). PHTN occurred in 13% of women with CHTN, and was associated with blood pressure level and number of medications at discharge.

Prevalence of high blood pressure among school-aged children in St Petersburg based on the electronic database of the regular preventive medical examination

Objective. The aim of this study was to determine the age- and gender-stratified prevalence and structure of high blood pressure (BP) among school-age children (7–17 years) in St Petersburg based on the electronic protocols of the regular preventive medical examination in 2009–2013 years. Design and methods. We collected the data from the regular preventive medical examination electronic protocols of 4618 children aged from 7 to 17 years old for the period from 2009 to 2013. The mean age of males (52,2%) was 12,81 ± 0,05 years; Me = 13,2 years, the age of females (47,8%) was 12,95 ± 0,05; Me = 13,3 years. Data entry and assessment of height, BP percentiles were carried out using mathematical software. Gradations of systolic BP (SBP) and diastolic BP (DBP) were the following: high normal BP, stage 1 hypertension (HTN) and stage 2 HTN. Results. High normal BP was detected in 10,3% of school-age children, 8,7% had stage 1 HTN, 1% had stage 2 HTN. No significant differences in the HTN distribution were found between males and females. The proportion of males with higher BP increased significantly with increasing age of children. There was no significant relationship between age and BP gradation in females. The prevalence of elevated SBP was 12,7%. High normal SBP was found in 6,1% children, stage 1 HTN by SBP — in 5,9%, stage 2 HTN by SBP — in 0,7%. The rate of higher SBP was greater in the total sample, and in both boys and girls. The systolic hypertension was found only in older boys. The prevalence of increased DBP was 12,4% (high normal DBP was found in 7,5%, stage 1 HTN by DBP — in 4,5%, stage 2 HTN by DBP — in 0,4%). The DBP gradations did not correlate with the children’s age. Conclusions. The elevated BP was detected in 20% of school-age children (among males — in 19,4%, in females — 20,6%). The understanding of trends in the HTN prevalence in children will allow optimization of medical and organization approaches to treatment and prevention.

Subjective sleep quality, blood pressure, and hypertension: a meta-analysis.

Sleep quality is an important aspect of sleep, but no meta-analysis has elucidated its relationship with blood pressure (BP) and hypertension. A meta-analysis was conducted in October 2016 using multiple databases, including Embase and Medline. Studies that assessed subjective sleep quality and BP or hypertension were included. Upon full-text evaluation, 29 articles from 45041 patients were selected, of which 22 articles were included in the meta-analysis and seven were presented narratively. Poor sleep quality was significantly associated with a greater likelihood of hypertension (odds ratio,1.48; P value=.01). Poor sleepers had higher average systolic BP (mean difference=4.37, P value=.09) and diastolic BP (mean difference=1.25, P value=.32) than normal sleepers without statistical significance. Patients with hypertension had significantly worse sleep quality scores (mean difference=1.51, P value<.01), while BP dippers had significantly better scores (mean difference=-1.67, P value<.01). The findings highlight the relationship between sleep quality and hypertension.

Association of Systolic Blood Pressure with Progression of Symptomatic Intracranial Atherosclerotic Stenosis.

Background and Purpose Elevated blood pressure (BP) is associated with greater severity of intracranial atherosclerotic stenosis (ICAS) and increased risk of ischemic stroke. Because little is known about the relationship of maintained BP level with progression of symptomatic ICAS (sICAS), we evaluated the independent association of maintained systolic BP (SBP) with risk of sICAS progression.Methods We analyzed the Trial of cilOstazol in Symptomatic intracranial Stenosis 2, which evaluated 402 stroke patients with sICAS (mean age, 64.5±11.3 years; male, 52.2%). Study participants were categorized into four groups according to mean SBP level: low-normal (<120 mm Hg), normal to high-normal (120 to 139 mm Hg), high (140 to 159 mm Hg), and very-high (≥160 mm Hg). Progression of sICAS was defined as worsening in the degree of stenosis by ≥1 grade on the 7-month magnetic resonance angiography follow-up.Results sICAS progression was observed in 52 (12.9%) subjects. Percentages of sICAS progression by mean SBP category showed a J-shape pattern: low-normal (21.4%), normal to high-normal (10.7%), high (11.4%), and very-high (38.9%). In multivariable analysis, compared to the normal to high-normal SBP group, odds ratios (95% confidence intervals) were low-normal, 1.88 (0.62–5.67); high, 1.06 (0.47–2.37); and very-high, 8.75 (2.57–29.86). Rate of sICAS progression by 10-mm Hg strata showed a similar pattern to findings from mean SBP category (9.47; 2.58–34.73 for SBP ≥160 mm Hg).Conclusions Among individuals with a recent ICAS stroke, very-high SBP level during the short-term period after the index stroke was associated with significantly greater odds of sICAS progression.

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients: The Campania Salute Network.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02211365.

Depression in hypertension and blood pressure variability over shorter time periods.

Depression and hypertension are common diseases, and the combination of depression and hypertension is not rare. The association between depression and blood pressure (BP) level has been controversial. In the Three-City Study, depression diagnosed using the Center for Epidemiological Study Depression Scale (CES-D) was shown to be significantly associated with lower BP.1 The association remained significant after adjusting for the subjects’ use of antihypertensive and antidepressant medication. Licht et al.2 also reported that depression is associated with decreased BP. On the other hand, Shar et al. examined 2087 participants from the Baltimore Longitudinal Study of Aging,3 and an age-stratified analysis showed that a greater CES-D score was significantly associated with higher average systolic BP (SBP) and diastolic BP for older adults (58.8 years at first visit). In the same study’s younger age cohort, gender moderated the relationship of CES-D to SBP; higher CES-D scores in women, but lower CES-D scores in men, were associated with higher SBP.

Evaluation of Sonographic Features for Patients with Urinary Bladder Paraganglioma: A Comparison with Patients with Urothelial Carcinoma

The goals of the work described here were to analyze the ultrasonographic characteristics of urinary bladder paraganglioma and to evaluate the use of ultrasonography (US) in diagnosis. Ten patients with bladder paraganglioma (3 males, 7 females) and 51 patients with urothelial carcinoma (37 males, 14 females) were enrolled. Ultrasonographic characteristics as well as clinical features were analyzed. Patients with urothelial carcinoma were significantly older than those with paraganglioma (62.9 y vs. 48.1 y, p = 0.001). The patients with paraganglioma had higher average systolic blood pressure than those with urothelial carcinoma (146.7 mm Hg vs. 130.7 mm Hg, p = 0.012). All bladder paragangliomas were solitary, and 40% were located on the dome. There was a statistically significant difference in location of lesions between the bladder paraganglioma and urothelial carcinoma groups (p = 0.014). The longest diameters in 80% of the bladder paragangliomas were in the range 1.1–3.0 cm; 60% were hypoechoic, and 40% were located in the submucosa of the bladder. Color Doppler revealed that 40% of the bladder paragangliomas were highly vascular. One patient with paraganglioma and four patients with urothelial carcinoma underwent contrast-enhanced ultrasound, which revealed rapid contrast enhancement and slow wash-out, with a non-enhanced area. Contrast-enhanced ultrasound of urothelial carcinomas revealed rapid homogeneous enhancement and variable wash-out patterns. Pre-operative ultrasonography detected all neoplasms of the urinary bladder in the 10 patients with pathologically confirmed paraganglioma, but made the correct diagnosis in only 2 cases (20%). Although there is overlap in US findings among different diseases, solitary, submucosal masses arising on the dome may be the key US imaging characteristic for bladder paraganglioma.

Relation Between Self-Reported Physical Activity Level, Fitness, and Cardiometabolic Risk

Physical activity and cardiorespiratory fitness are associated with improved cardiovascular health and reduced all-cause mortality. The relation between self-reported physical activity, objective physical fitness, and the association of each with cardiometabolic risk has not been fully described. We studied 2,800 healthy Brazilian subjects referred for an employer-sponsored health screening. Physical activity level was determined as "low," "moderate," or "high" with the International Physical Activity Questionnaire: Short Form (IPAQ-SF). Fitness was measured as METs achieved on a maximal, symptom-limited, treadmill stress test. Using multivariate linear regression analysis, we calculated age, gender, and smoking-adjusted correlation coefficients among IPAQ-SF, fitness, and cardiometabolic risk factors. Mean age of study participants was 43 ± 9 years; 81% were men, and 43% were highly active. Mean METs achieved was 12 ± 2. IPAQ-SF category and fitness were moderately correlated (r = 0.377). Compared with IPAQ-SF category, fitness was better correlated with cardiometabolic risk factors including anthropomorphic measurements, blood pressure, fasting blood glucose, dyslipidemia, high-sensitivity C-reactive protein, and hepatic steatosis (all p <0.01). Among these, anthropomorphic measurements, blood pressure, high-sensitivity C-reactive protein, and hepatic steatosis had the largest discrepancies in correlation, whereas lipid factors had the least discrepant correlation. When IPAQ-SF and fitness were discordant, poor fitness drove associations with elevated cardiometabolic risk. In conclusion, self-reported physical activity level and directly measured fitness are moderately correlated, and the latter is more strongly associated with a protective cardiovascular risk profile.

Sex and Age Differences in the Relation of Depressive Symptoms With Blood Pressure

Longitudinal associations between depressive symptoms and blood pressure have been inconsistent. Most studies have examined incident hypertension as an outcome, and few have examined effect modification. This study examined moderating influences of sex and age on coincident trajectories of depressive symptoms and blood pressure among 2,087 participants from the Baltimore Longitudinal Study of Aging (aged 19-97 years; 53% men; 74% white). Participants underwent clinical blood pressure measurement and completed the Center for Epidemiological Studies-Depression (CES-D) scale on up to 14 occasions (mean = 3.8; SD = 2.6) over up to 29 years (mean = 7.8; SD = 6.4). CES-D was log-transformed (CES-D(log)) for analyses. Mixed-effects regression revealed that prospective relations of CES-D(log) to diastolic blood pressure differed by age in women (b = 0.095; P = 0.001) but not men; greater CES-D(log) attenuated the expected age-related decline in diastolic blood pressure. Across all testing sessions, greater CES-D(log) was associated significantly with higher average systolic blood pressure for women (b = 2.238; P = 0.006) but not men. Age-stratified analyses showed that greater CES-D(log) was associated significantly with higher average systolic (b = 3.348; P = 0.02) and diastolic (b = 1.730; P < 0.03) blood pressure for older adults (≥58.8 years at first visit). In the younger age cohort, sex moderated the relation of CES-D(log) to systolic blood pressure (b = -3.563; P = 0.007); greater CES-D(log) in women, but lesser CES-D(log) in men, was associated with higher systolic blood pressure. Results demonstrate sex and age differences in the relation between depressive symptoms and blood pressure. Findings suggest the potential importance of preventing, detecting, and lowering depressive symptoms to prevent hypertension among women and older adults.