Higher SBP Research Articles

Does higher SBP at discharge explain better outcomes in non-heart failure with reduced ejection fraction patients? Insights from Fuwai Hospital.

We hypothesized that discharge SBP had different associations with outcomes in non-HFrEF (left ventricular ejection fraction ≥40%) patients with or without high blood pressure (HBP) at admission. Non-HFrEF patients hospitalized for decompensated heart failure were consecutively recruited and were categorized into HBP (admission SBP ≥130 mmHg) group and non-HBP group. The primary outcome was a composite of cardiovascular death and heart transplantation. Multivariate Cox and penalized spline analyses were used to assess the relationships between discharge SBP and outcomes. Nine hundred and sixty-four non-HFrEF patients were enrolled with a median follow-up of 71.8 months. Three hundred and sixty-five (37.9%) patients had HBP. In multivariate Cox analyses, non-HBP patients with higher discharge SBP were associated with a better outcome (per 10 mmHg increased, hazard ratio = 0.788, P = 0.001). However, an opposite relationship between discharge SBP and the primary outcome was observed in HBP group (per 10 mmHg increased, hazard ratio = 1.312, P = 0.002). Results of penalized spline regression models showed that there was a U-shaped association between discharge SBP and outcomes in the total cohort. Compared with 120 mmHg, the risk of the primary outcome increased when discharge SBP was below 99 mmHg in non-HBP group; in HBP group, a worse outcome was observed when discharged SBP was above 145 mmHg. Non-HFrEF had a U-shaped association between discharge SBP and adverse events. Such an association was modified by admission HBP. Higher discharge SBP correlated with a worse outcome in non-HFrEF patients with admission HBP, as opposed to patients admitted without HBP.

Abstract P128: Age-related Patterns In Systolic And Diastolic Blood Pressure In Adults From The United States And India

The purpose of this cross-sectional, exploratory analysis was to describe age-related patterns of blood pressure (BP) among participants in India (using the 2014 Annual Health Survey) and the United States (using National Health & Nutrition Examination Surveys 2011-2016). We included 10,759 U.S. and 790,641 Indian participants aged ≥20 years with ≥2 BP readings. We plotted mean systolic (SBP) and diastolic BP (DBP) across 5-year age groups and estimated best fit models. SBP increased linearly with age in both sexes and study populations (R 2 : 0.88-0.99; Fig. 1-2). Those with overweight/obese BMI had higher SBP and modestly higher rates of increase in SBP. DBP followed a quadratic curve (R 2 : 0.68-0.99), peaking in the 5-6th decade (45-49 years in U.S. and 50-59 in India) with higher and earlier peaks in those with elevated BMI. The models’ strong fit and similarity between study populations supports the notion that physical processes underly BP’s age-related changes.

Abstract P039: The Endogenous Ouabain And Changes In Blood Pressure And Sodium Excretion Following An Acute Saline Load In Essential Hypertension

Among ~25% of patients with essential hypertension (EH), circulating endogenous ouabain (EO) and aldosterone (Aldo) are typically coelevated and their BP is especially salt-sensitive (SS). We probed for exaggerated natriuresis in a large cohort (712) of hypertensive patients that underwent an acute 2hr (T 120 ) load with saline (0.9%/2 L). Results: Using a quartiles analysis of sodium excretion, the 4th quartile subgroups showed higher SBP and DBP at T 120 , and at 2 hrs recovery (T 240 ). Fractional sodium excretion (FE Na) was significantly higher during loading and recovery in the 4 th quartile subgroup. Plasma Aldo was suppressed after saline in all subgroups as expected. SS patients showed an increased EO. In the 4 th quartiles EO was elevated at baseline and after saline (see figure), p Manova > 0.001 and the urinary Na/K ratio output was higher. Further, increases in plasma Na + were greater in the 4 th quartile group (1.91 ± 0.15 vs 0.83 ± 0.13 mM, p<0.001). These data suggest circulating EO is a potential mediator of the exaggerated natriuresis in SS EH, and that this phenomenon is reminiscent of an “aldosterone escape”.

Abstract P037: Association Between Early Post-kidney Transplant Visit-to-Visit Systolic Blood Pressure Variability And Late Post-Transplant Systolic Blood Pressure

Background: Visit-to-visit blood pressure variability (VVBPV) results from regional or systemic circulatory factors such as stiffness or neuro-hormonal factors. Association between VVBPV and long-term post-kidney transplant (KT) blood pressure (BP) is unknown. Method: VVBPV was measured by average successive variability (ASV), which is the average absolute difference between successive BP measured at 4, 12, and 24 weeks post-KT. Association between the VVBPV and BP at 48 weeks post-KT was examined by multiple linear regression. Results: Of all 105 KT recipients, mean age±SD was 54±12 years and 64 patients (61%) was female. Mean ASV of SBP and DBP were 16±12 mmHg (range 1-58) and 11±6.3 mmHg (range 1-29.5), respectively. Mean SBP at 24 and 48 weeks post-KT were 135±19 and 133±16 mmHg, respectively. Similar to SBP, mean DBP at 24 weeks post-KT was higher than DBP at 48 weeks (DBP 24 vs 48 weeks 80±12 vs 77±11 mmHg). Every 10-mmHg increase in ASV of SBP predicts 3.4 mmHg increase in SBP at 48 weeks post-KT (p 0.01; 95%CI 0.83, 6.14; Figure 1A). However, an increase in 10 mmHg of ASV of DBP predicts a decrease in DBP of 0.12 mmHg (p 0.12, 95%CI -0.28, 0.04; Figure 1B). After adjusted for age, gender, donor type (deceased vs living), induction immunosuppressive medications, pre-KT weight-spline interaction term at 70 kg, every 10 mmHg increase in ASV of SBP was significantly associated with 2.7 mmHg increase in SBP at 48 weeks post-KT (p 0.04, 95%CI 0.15, 5.29); whereas, 10 mmHg increase in ASV of DBP predicts a decrease in DBP of 2.13 mmHg with no statistical significance (p 0.16, 95% -5.14, 0.88) Conclusion: Higher VVSBPV during early post-KT predicts a higher SBP, but not DBP, at late post-KT period.

Dietary inflammation and cardiometabolic health in adolescents.

The Children's Dietary Inflammatory Index (C-DII) has been validated to characterize the inflammatory potential of an individual child's diet. To determine the association between C-DII and markers of cardiometabolic risk (adiposity, blood pressure [BP], lipids, albuminuria, glomerular hyperfiltration) in adolescents. Participants aged 12-18 enrolled in NHANES from 2005 to 2014 who completed a 24-hour dietary recall were included in this cross-sectional study. Regression models adjusted for age, sex, race and height examined associations of C-DII quartiles stratified by weight status. Among adolescents (mean age 15 years), the average C-DII score was 0.86 (SE 0.04). When comparing C-DII quartile 4 (most pro-inflammatory) to quartile 1 (most anti-inflammatory), there was a positive association with albuminuria (OR 1.44, 95% CI 1.02, 2.03). After stratifying by weight status, C-DII quartile was found to be significantly associated with albuminuria (OR 4.27, 95% CI 1.83, 9.92) and dyslipidemia (OR 1.87, 95% CI 1.15, 3.03) in adolescents who were overweight. Among adolescents with obesity, C-DII quartile was associated with higher SBP (β = 5.07, 95% CI 2.55-7.59) and lower DBP (β = -4.14, 95% CI -6.74, -1.54). Consuming a pro-inflammatory diet in adolescence was associated with alterations in albuminuria, lipid and BP measures.

Associations of Blood Pressure and Carotid Flow Velocity with Brain Volume and Cerebral Small Vessel Disease in a Community-Based Population.

Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI). We previously demonstrated that high blood pressure (BP) and low carotid flow velocity were associated with cerebrovascular disease. However, their associations with brain volume and CSVD remain to be determined. A total of 721 adults (≥ 50years) from the community-based I-Lan Longitudinal Aging Study were included. Flow velocities at the common (CCA) and internal carotid artery (ICA), including peak systolic velocity (PSV) and end-diastolic velocity (EDV), were measured with Doppler ultrasound. We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between carotid flow velocity, BP, brain volume, and CSVD. The mean of white matter, gray matter, and WMH volume were 422.2cm3, 546.9cm3, and 2.61cm3, respectively. The proportion of lacune and microbleed were 11.1% and 14.2%, respectively. The CSVD score were negatively associated with gray (r = - 0.121, p < .01) and white matter volume (r = 0.058, p = 0.12), but positively associated with systolic BP (beta = 1.02, p = 0.0017). EDV at common carotid artery associated positively with white matter volume (beta = 1.013, p = 0.0064) and negatively predicted the presence CSVD (odds ratio [OR] = 0.93, p = 0.0023). In the ordinal logistic regression analysis adjusting for age, sex, total intracranial volume education, low-density lipoprotein cholesterol, and fasting glucose, compared with hypertensive subjects with low EDV, normotensive subjects with low, middle, and high EDV had an odds ratio of 0.656 (0.327-1.318), 0.429 (0.261-0.705), and 0.272 (0.147-0.502) for CSVD score, respectively. High SBP and low carotid flow velocities were independently associated with brain volume and CSVD. These associations may be involved in the pathophysiology of cognitive function decline.

Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome

BackgroundWorldwide, coronary heart disease (CHD) is topping the foremost important chief causes of mortality. Fragmented QRS (f-QRS) is a pattern of QRS complex in 12 leads surface ECG which showed a promising value in predicting the outcome in cardiac diseases including ischemic heart disease.We aimed to research the importance of using f-QRS as a non-invasive and cheap tool for the prediction of cardiogenic shock and mortality in acute coronary syndrome (ACS).MethodsA retrospective study includes eighty four critically ill ACS patients. Patients were classified consistent with the presence or absence of fragmented QRS into two groups (46 and 38 patients respectively). Exclusion criteria include past history of important ischemic events (MI, PCI, and CABG), permanent AF, and/or cardiomyopathy.No statistical significant differences were detected between the 2 groups as regards the age, gender, major risk factors of ischemic heart condition, cardiac bio-markers, Killip class, LVEF, updated GRACE risk score of ACS, and in-hospital mortality.ResultsA number value of f-QRS leads > 3 yields sensitivity and specificity (83.3% and 72.5% respectively) for predicting hospital mortality. The f-QRS group was further split-up according to the numbers of f-QRS leads into 2 subgroups; subgroup (A1) including patients with > 3 f-QRS leads and subgroup (A2) including patients ≤ 3 f-QRS leads. Subgroup (A2) showed considerable difference as regards some important variables including a higher SBP (P = 0.016), a slower HR (P = 0.014), a lower up-dated GRACE risk score (3.22 ± 6.95 vs 6.81 ± 12, P value 0.048), and a lower rate of hospital death (1/30 vs. 5/16, P = 0.015). Anterior f-QRS showed statistically significant higher HR, lower SBP, a higher frequency of shock, a higher updated GRACE risk score, and a higher chance of in-hospital mortality (P = 0.004) compared to non-anterior f-QRS.ConclusionThe position and number of f-QRS leads provide a non-invasive and a readily accessible tool to predict the prognosis, occurrence of cardiogenic shock, and in-hospital mortality.

Association of SBP and BMI with cognitive and structural brain phenotypes in UK Biobank.

To test for associations between SBP and BMI, with domain-specific cognitive abilities and examine which brain structural phenotypes mediate those associations. Using cross-sectional UK Biobank data (final N = 28 412), we examined SBP/BMI vs. cognitive test scores of pairs-matching, matrix completion, trail making test A/B, digit symbol substitution, verbal-numerical reasoning, tower rearranging and simple reaction time. We adjusted for potential confounders of age, sex, deprivation, medication, apolipoprotein e4 genotype, smoking, population stratification and genotypic array. We tested for mediation via multiple structural brain imaging phenotypes and corrected for multiple testing with false discovery rate. We found positive associations for higher BMI with worse reaction time, reasoning, tower rearranging and matrix completion tasks by 0.024-0.067 SDs per BMI SD (all P < 0.001). Higher SBP was associated with worse reasoning (0.034 SDs) and matrix completion scores (-0.024 SDs; both P < 0.001). Both BMI and SBP were associated with multiple brain structural metrics including total grey/white matter volumes, frontal lobe volumes, white matter tract integrity and white matter hyperintensity volumes: specific metrics mediated around one-third of the associations with cognition. Our findings add to the body of evidence that addressing cardiovascular risk factors may also preserve cognitive function, via specific aspects of brain structure.

Birth weight is inversely correlated with blood pressure: population-based study.

The current representative national cross-sectional study examines the association of birth weight and blood pressure (BP) among the adult Australian population.Questions about birth weight were added to the second round of AusDiab study. Hypertension was defined based on WHO (≥140/90), and NCEP-ATPIII (≥130/85). Both definitions were examined against the continuous birth weight and dichotomous variable of low birth weight (LBW); less than 2.5 kg, adjusting for age, BMI, physical activity, smoking, alcohol intake and socioeconomic factors. A total of 4502 respondents reported their birth weights with a mean (SD) of 3.37 (0.7) kg. Females with LBW had significantly higher mean SBP and DBP than those with normal birth weight. This relationship persisted with adjustments for various confounding factors. Males with LBW showed a trend towards a higher SBP and DBP, though NS, than normal birth weight more than 2.5 kg. LBW individuals, less than 2.5 kg were at higher risk for having high SBP hypertension at least 140/90 mmHg and at least 130/85 mmHg compared with those with normal birth weight. Among females, for each kilogramme of birth weight, there was a predicted decrease of 1.59 (0.7, 2.5) mmHg in SBP, P = 0.001 and 0.85 (0.2, 1.5) mmHg in DBP, P = 0.001; after adjustments for age, body size, physical activity, smoking status, alcohol intake and socioeconomic factors. Among males, for each kilogramme of birth weight, there was a decrease of 1.74 (0.7, 2.8) mmHg in SBP, P = 0.002 and 1.06 (0.3, 1.9) mmHg in DBP, P = 0.008 after adjustments for all confounding factor. This study has examined the association of birth weight and BP in a representative adult population. LBW was significantly associated with the risk of developing high BP.

Race modifies the association between animal protein metabolite 1-methylhistidine and blood pressure in middle-aged adults: the Bogalusa Heart Study.

Dietary factors mediate racial disparities in hypertension. However, the physiological mechanisms underlying this relationship are incompletely understood. We sought to assess the association between 1-methylhistidine (1-MH), a metabolite marker of animal protein consumption, and blood pressure (BP) in a community-based cohort of black and white middle-aged adults. This analysis consisted of 655 participants of the Bogalusa Heart Study (25% black, 61% women, aged 34-58 years) who were not taking antihypertensive medication. Fasting serum 1-MH was measured using liquid chromatography-tandem mass spectroscopy. Animal food intakes were quantified by food-frequency questionnaires. Multivariable linear regression assessed the association between 1-MH and BP in combined and race-stratified analyses, adjusting for demographic, dietary, and cardiometabolic factors. A significant dose--response relationship was observed for the association of red meat (P-trend <0.01) and poultry (P-trend = 0.03) intake with serum 1-MH among all individuals. Serum 1-MH, per standard deviation increase, had a significant positive association with SBP (β=3.4 ± 1.6 mmHg, P = 0.04) and DBP (β=2.0 ± 1.1 mmHg, P = 0.05) in black participants, whereas no appreciable association was observed in white participants. Among a subgroup of black participants with repeat outcome measures (median follow-up = 3.0 years), one standard deviation increase in 1-MH conferred a 3.1 and 2.2 mmHg higher annual increase in SBP (P = 0.03) and DBP (P = 0.03), respectively. Serum 1-MH associates with higher SBP and DBP in blacks, but not whites. These results suggest a utility for further assessing the role of dietary 1-MH among individuals with hypertension to help minimize racial disparities in cardiovascular health.

Time And Dose Of Blood Pressure Medication Improves Hidden Hypertension Risk In A Firefighter

Most firefighters (FF) are unaware of their BP levels, which increases their risk of undiagnosed hypertension. According to a recent study, BP medication taken at bedtime lowers levels more effectively and leads to a 66% decrease in the risk of fatal cardiac incidents. Using ambulatory BP (ABP) monitoring to measure BP over time is a recommended way to assess risk. PURPOSE: To provide evidence that time and dosage of BP medication can improve hypertension risk in FF. METHODS: We included 43 FF in an ongoing clinical trial. FF wore an ABP cuff for a period, and the overall average BP, daytime BP and nighttime BP levels were examined. FF also came to the lab for a clinical fasted visit including BP, body fat, and vascular health measures. For this sub-analysis, we report data from 1 FF who was found to have nocturnal hypertension and morning BP surge. RESULTS: Overall the entire group of FF were hypertensive with clinic BP of 128.7 ± 1.7/ 81.8 ± 1.2 mmHg, had high central BP measured by SphygmoCor® XCEL (121.8 ± 2.7/ 84 ± 1.5 mmHg), and had high average SBP measured by ABP (130.9 ± 1.5 mmHg). We identified several FF with nocturnal hypertension and high morning BP surge levels, and here we report on data on one. He was 53 yr old, weighed 226 lbs, had 36.1% body fat, was an uncontrolled hypertensive (140.5/84.5 mmHg), and had high central BP levels (134/81 mmHg). During the initial ABP monitoring, his daytime BP was 160.2/86.9 and nighttime BP was 178.9/87.1 mmHg. His BP rose in the morning to 203/104 mmHg and remained that level for 2hrs. The FF self-reported feeling headaches and a ‘rushing sensation’ during fire calls, so he took his ABP data to a clinician. Initially, he was prescribed BP med in AM. The doctor increased dosage and switched to nighttime medication. During follow-up ABP monitoring, the FF’s BP was much more controlled. His average daytime BP was 145.1/82.6, nighttime BP was 114.8/66.2, and morning BP was only 125/69 mmHg. CONCLUSION: With this case-study data from one FF in a larger clinical trial, we confirmed that timing and dosage of medication leads to improved BP levels. This further confirms that overall health awareness in FF is important. Fire chiefs and the firehouse medical director should encourage and increase BP monitoring. This one example proves to be a valuable anecdote when we enter firehouses and discuss our clinical trial.

Active gingival inflammation is linked to hypertension.

Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear. Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning. Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power. Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.

Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease.

Association between blood pressure (BP) variability and cardiovascular outcome remains unclear in patients with chronic kidney disease (CKD). We evaluated this association between ambulatory BP variability and cardiovascular events, mortality, and kidney disease progression in patients with CKD. From the Cardiovascular and Metabolic Disease Etiology Research Center-HIgh Risk study (2013-2018), a total of 470 patients with CKD were analyzed. Ambulatory BP variability was assessed using average real variability (ARV). Primary outcome was composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. The secondary outcome was rapid kidney function decline [estimated glomerular filtration rate (eGFR), >3 ml/min per 1.73m per year]. During a median follow-up of 51.8 (40.5-56.2) months, the incidences of all-cause death and composite outcomes were higher in the high SBP-ARV group than in the low SBP-ARV group. The Kaplan-Meier analysis showed that a high SBP-ARV, but not a high DBP-ARV and heart rate-ARV, was associated with higher composite outcome risks. In multivariable Cox analysis, a high SBP-ARV correlated with increased composite outcome risks (hazard ratio, 4.53; 95% confidence interval, 1.41-14.58). When subgroup analysis was performed (low vs. high 24-h SBP), this association was only significant in the high 24-h SBP group. The risk stratification for composite outcomes by adding SBP-ARV into the basic model and 24-h SBP, improved by 1.3%. Furthermore, the mean eGFR decline rate was faster, and the rapid eGFR decline risk was 1.68-fold higher in the high SBP-ARV group. Greater ambulatory SBP variabilities were associated with increased risks for nonfatal cardiovascular diseases, all-cause mortality, and rapid kidney function decline in patients with CKD.

Polymorphisms in genes involved in T-cell co-stimulation are associated with blood pressure in women.

In recent years, conclusive data have emerged on a relationship between immune system, especially the T-cell, and blood pressure (BP). The objective of the present study was to determine the association between BP and four polymorphisms in CD80, CD86, CD28 and CTLA4 genes that code for key proteins in the T-cell co-stimulation process, in a female cohort. To that end, an association study in a cohort of 934 women over 40years old from two hospitals was done. Raw data showed a significant association between the SNP rs1129055 of CD86 gene and BP. Analyzing this association against inheritance patterns, higher SBP (p<0.000) and DBP (p=0.005) values were observed in AA than in GG/GA genotype subjects in the largest sample cohort (Hospital 1). In multivariate linear regression studies, with adjustment for presumed independent predictors of BP, the SNP of the CD86 gene remained a predictor of SBP (p=0.001) and DBP (p=0.006), as did the SNP rs867234 of the CD80 gene for DBP (p<0.000), both resisting the Bonferroni correction for multiple comparisons. As conclusion, we report a robust association between the SNP rs1129055 of CD86 gene and BP. The SNP rs867234 of CD80 gene was also shown to be a strong predictor of DBP.

Lower urinary α-Klotho is associated with lower angiotensin-(1-7) and higher blood pressure in young adults born preterm with very low birthweight.

Early-life factors including preterm birth and VLBW increase the risk of hypertension, but the mechanisms remain poorly understood. Reductions in the anti-aging protein α-klotho are associated with hypertension, possibly due to angiotensin (Ang) II activation, but the mechanisms are incompletely understood and clinical evidence is lacking. The association of α-klotho with the alternative Ang-(1-7) pathway, which counteracts Ang II to lower BP, is undescribed. We hypothesized that lower urinary α-klotho is associated with higher BP and lower urinary Ang-(1-7) in preterm-born VLBW young adults. In a cross-sectional analysis of data from a prospective cohort of 141 preterm-born VLBW young adults, we assessed the associations among urinary α-klotho/creatinine, Ang II/creatinine, Ang-(1-7)/creatinine, Ang II/Ang-(1-7), and BP using generalized linear models adjusted for age and hypertensive pregnancy and conducted a sensitivity analysis in 32 term-born young adults. Among those born preterm, lower α-klotho/creatinine was associated with higher systolic BP (adjusted β (aβ): -2.58mmHg, 95% CI -4.99 to -0.17), lower Ang-(1-7)/creatinine (ln aβ: 0.1, 0.04-0.16), and higher Ang II/Ang-(1-7) (ln aβ: -0.14, -0.21 to -0.07). In term-born participants, α-klotho/creatinine was inversely associated with Ang II/creatinine (ln aβ: -0.15, -0.27 to -0.03) and Ang II/Ang-(1-7) (ln aβ: -0.15, -0.27 to -0.03). In preterm-born young adults with VLBW, lower urinary α-klotho/creatinine was associated with higher SBP, lower urinary Ang-(1-7)/creatinine, and higher urinary Ang II/Ang-(1-7). Reduced renal α-klotho expression could lead to renal Ang-(1-7) suppression as a novel mechanism for the development of hypertension among individuals born preterm with VLBW.

Validation of a New Instrument for Assessing Diet Quality and Its Association with Undernutrition and Non-Communicable Diseases for Women in Reproductive Age in India

Abstract Objectives India has been undergoing a rapid nutrition transition, resulting in the co-existence of undernutrition and nutrition-related non-communicable diseases (NCD). There is a need to develop and validate a diet quality assessment tool to assess risks for the double burden of disease. Methods We included 2915 non-pregnant and non-lactating women (15–49 years) from two Indian cohorts: The Andhra Pradesh Children and Parent Study and the Indian Migration Study. Using dietary data collected from FFQs, we developed a novel diet metric, the Global Diet Quality Score (GDQS). We categorized foods into 25 groups based on similarity of nutrient intake and intake patterns. Each category was assigned a positive or negative score based on prior evidence on their associations with undernutrition and NCD. Scores were calculated from the frequency and intake amounts for each category with higher scores corresponding to better diet quality (maximum total points of 49). We evaluated associations between the GDQS (overall, positive submetric, and negative submetric) and overall nutrient adequacy (&amp;gt;6/12 nutrients intake being adequate), individual micro and macronutrients, BMI, hemoglobin, systolic and diastolic blood pressure (SBP and DBP), high density lipoprotein (HDL), and total cholesterol (TC). Results The mean (SD) of the GDQS was 24 (4) points. In energy-adjusted models, positive associations were found between the overall GDQS and intakes of calcium, fiber, folate, iron, MUFA, protein, PUFA, SFA, total fat, and zinc in energy-adjusted models (r = 0.15–0.33, P &amp;lt; 0.001). Adjusted for age, GDQS was positively associated with overall nutrient adequacy. Quintile analyses showed that GDQS was positively associated with the odds of being overweight, obese and high SBP. Lower intake of foods in the GDQS negative submetric was associated with lower odds of having BMI ≥ 30 kg/m2 (OR = 0.66 (95% CI: 0.56–0.77), TC ≥200 mg/dL (0.87 (0.78–0.97), and DBP ≥ 80 mmHg (0.82 (0.74–0.92). Conclusions Among Indian women, the overall GDQS was positively associated with overall nutrient adequacy. Both the overall and negative submetric were associated with several NCD risk markers. Future studies should validate these metrics against incident diabetes and cardiovascular disease. Funding Sources Intake - Center for Dietary Assessment at FHI Solutions.

Duration of neonatal oxygen supplementation, erythropoiesis and blood pressure in young adults born preterm

BackgroundAlthough erythropoiesis is impaired and anaemia frequent in neonates born preterm, haematopoiesis in adults born preterm has not been previously studied.ObjectiveWe, thus, aimed to evaluate haemoglobin and erythropoietin levels in...

Influence of Genetic Admixture Components on CYP3A5*3 Allele-Associated Hypertension in Amerindian Populations From Northwest Mexico.

CYP3A5 metabolizes endogenous substrates and ~30% of prescription drugs. The CYP3A5 gene contains an active CYP3A5*1 allele, and a non-functional version, the CYP3A5*3 (rs776746), with consequences for drug therapeutic responses and side effects. Both CYP3A5*1 and *3 have been associated with hypertension. The frequency of CYP3A5*3 varies between populations of different ancestries, with Europeans having the highest allele frequency (> 90%). Given the importance of CYP3A5*3 in drug response and hypertension development, the aim of the present study was to evaluate the frequency of this polymorphism and its association with hypertension in vulnerable indigenous populations in Mexico. A total of 372 subjects were recruited from eight ethnic groups in Northwest Mexico. Systolic (SBP), diastolic (DBP), and median (MBP) blood pressures as well as body mass index (BMI) were measured. Ancestry was evaluated through STR analysis, and the CYP3A5*1/*3 polymorphisms were identified using real-time PCR with TaqMan® probes. Higher frequencies of CYP3A5*1 and *3 were observed in groups with higher (>90%) and lower (<90%) Amerindian ancestry, respectively. The CYP3A5*3/*3 genotype was more frequent in indigenous women with higher SBP and DBP values. On the other hand, the *1 allele showed a protective effect against both high SBP (OR, 0.38; 95% CI, 0.17–0.83, p = 0.001) and DBP (OR 0.38, 95% CI 0.18–0.81, p = 0.007) in women. This association remained significant after adjusting for BMI and age for diastolic (OR, 0.38; 95% CI, 0.17–0.84, p = 0.011) and systolic BP (OR, 0.33; 95% CI, 0.15–0.76, p = 0.005) BP levels in women. Thus, the frequency of CYP3A5*3 varies between groups and seems to depend on ancestry, and CYP3A5*1 decreases the risk of hypertension in Mexican indigenous women. This population analysis of CYP3A5*1/*3 has profound implications not only for the susceptibility to diseases, such as hypertension, but also for safer drug administration regimens, assuring better therapeutic responses and fewer side effects.

Association of Blood Pressure and Cognition after Stroke

Background and Aim: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. Methods: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. Primary outcome: Modified Mini-Mental Status Examination (3MSE; range, 0-100). Secondary outcomes: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. Results: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). Conclusions: Stroke survivors’ BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.

Blood Pressure Indices and Associated Risk Factors in a Rural West African Adult Population: Insights from an AWI-Gen Substudy in Ghana

Systolic (SBP) and diastolic blood pressure (DBP) are commonly used for cardiovascular disease (CVD) risk prediction, and pulse pressure (PP) and mean arterial blood pressure (MAP) can provide additional information. It is therefore important to understand the factors associated with these cardiovascular risk markers. This cross-sectional study involved 1839 men and women aged 40–60 years. Data on SBP, DBP, MAP, PP, sociodemography, lifestyle, anthropometry, and lipids were collected. Gender-stratified linear regression analyses were performed to determine the association between log-transformed blood pressure indices and the study variables. Age was associated with all measured blood pressure indices (p < 0.001) among men and women. Men had higher SBP (p=0.007) and PP (p < 0.001) than women. Nankana ethnicity was associated with higher PP levels (p < 0.005) in the total population. Vendor meal consumption among women was associated with higher PP levels (p < 0.05). Fruit intake among men was associated with lower PP levels (p < 0.05). Currently unmarried women had higher SBP (p < 0.005), DBP (p < 0.05), MAP (p < 0.005), and PP (p < 0.005) than currently married women. Pesticide exposure was negatively associated with SBP (p < 0.005), DBP (p < 0.005), MAP (p < 0.005), and PP (p < 0.05) among women. Increased subcutaneous fat was associated with DBP (p < 0.005) and MAP (p < 0.05) among women. Among men, hip circumference was associated with higher DBP and MAP (p < 0.05 for both associations), subcutaneous fat associated with higher SBP (p < 0.005), DBP (p < 0.001), and MAP (p < 0.001) and visceral fat was associated with higher PP (p < 0.05). In the total population, visceral fat was associated with higher DBP (p < 0.05) and MAP (p < 0.001). High-density lipoprotein cholesterol was positively associated with SBP (p < 0.005), DBP (p < 0.005), and MAP (p < 0.001) for women and positively associated with SBP, DBP, and MAP (p < 0.001 for all three) and PP (p < 0.05) for men. The association of blood pressure indices with modifiable risk factors suggests that targeted health interventions may reduce CVD risk in this population.