High Blood Pressure Categories Research Articles

The impact of updated clinical blood pressure guidelines on hypertension prevalence among children and adolescents.

To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020. Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined. Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017. Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort.

BackgroundThe impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated.Methods and ResultsWe studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2.ConclusionsRisk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

ObjectivesTo investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIV-positive and HIV-negative individuals. MethodsThis cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017. ResultsHIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06–7.17; aOR 1.89, 95% CI 1.54–2.34; aOR 0.60, 95% CI 0.44–0.80). In adjusted models, being in higher carotid intima–media thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78–1.00 mm: aOR 1.46, 95% CI 1.01–2.12; >1.00 mm: aOR 2.18, 95% CI 1.39–3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76–17.91; hypertension: aOR 12.62, 95% CI 3.60–44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41–2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIV-specific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17–2.22), with none for sinus tachycardia. ConclusionsHIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.

P6366High blood pressure cut-off by 130/80 mmHg in middle-ages may be valid for predicting heart failure in ages of seventies

Abstract Background ESC/ESH Guidelines (2018) recommended that treated BP values should be targeted to 130/80 mmHg or lower in most patients. However, it remains unclear whether this target in middle-aged population is associated with future development of heart failure. Purpose We conducted a retrospective analysis to determine whether high blood pressure cut-off by 130/80 mmHg in the middle-age predicts the risk of heart failure, detected by high N-terminal pro-brain natriuretic peptide (NT-proBNP) level, in the elderly in a cohort in which longitudinal blood pressure records exist. Methods The cohort consists of health check examinee who consulted the examination institute between 2015 and 2018 (n=8513), aged 70 years or older, and had previous institution-visit record at least once from 50 to 69 years old. We measured serum NT-proBNP level in the all examinee and defined the group of high NT-proBNP as ≥144 pg/ml [defined as the highest quartile, n=2135 (25%)]. The number of participants whose previous blood pressure records exists was 8123 (95%) for 65–69 years old, 6980 (82%) for 60–64 years old, 5233 (61%) for 55–59 years old, and 3018 (35%) for 50–54 years old, respectively. The each generation subgroups were divided into the three gradual categories according to the blood pressure records: SBP ≥140 and/or DBP ≥90, SBP130–139 and/or DBP80–89, and SBP &lt;130 and DBP &lt;80 mmHg. Results Categorization to high NT-proBNP group in ages of 70 or more was significantly associated with the categorization to high blood pressure, which was not only the SBP ≥140 and/or DBP ≥90 mmHg but also the SBP130–139 and/or DBP80–89 mmHg at any time points of previous blood pressure measurements. The multivariable adjusted odds ratios for having high NT-proBNP level in the elderly against the two high blood pressure categories based on the previous blood pressure measurements were shown in the Table. Table 1. Multivariable adjusted OR for high NT-proBNP level in elderly Age N SBP 130–139 and/or DBP 80–89 SBP ≥140 and/or DBP ≥90 OR P OR P 65–69 8123 1.30 &lt;0.001 1.68 &lt;0.001 60–64 6980 1.26 0.002 1.55 &lt;0.001 55–59 5233 1.25 0.013 1.41 &lt;0.001 50–54 3018 1.32 0.023 1.58 &lt;0.001 Model included age, gender, BMI, serum creatinine, hemoglobin, and presence of antihypertensive medications, and cardiac disease. Conclusion High blood pressure cut-off by 130/80 mmHg in the middle-age may be valid to predict the risk of heart failure in the elderly.

Pulse wave velocity reference values in 3,160 adults referred to a hypertension clinic for 24-hour ambulatory blood pressure monitoring

ABSTRACTBackground: Carotid-femoral pulse wave velocity (PWV) is a direct measure of aortic stiffness used in the stratification of cardiovascular risk. Its clinical application in Latin America has been limited by the absence of reference values. The objective of this study was to establish PWV reference values among adults referred to a specialized cardiology center for 24-hour ambulatory blood pressure monitoring (ABPM) in Medellín, Colombia.Methods: A descriptive study of 3,160 records of adult (older than 18 years) patients without pharmacological treatment assessed for PWV using a Mobil-O-Graph® 24-hour PWA device (IEM, Stolberg, Germany) and 24-hour ABPM with hemodynamic parameters based on suspected hypertension or hypotension was conducted. Patient records were categorized by decade of age and sub-divided based on the following 24-hour ABPM categories: normal (< 130/80 mmHg), grade I hypertension (between 130–150/80–90 mmHg), and grade II hypertension (> 150/90 mmHg).Results: PWV increased with age (r = 0,894; p < 0,001) and blood pressure category (ρ = 0,081; p < 0,001); the age-related increase was more pronounced among the patients in the higher blood pressure categories. Measures of central tendency and dispersion regarding PWV are presented, and reference values are proposed from the 90th percentile based on the age and 24-hour ABPM categories.Conclusions: PWV is directly related to age and blood pressure and can be predicted using a simple equation that includes these two variables. To stratify the cardiovascular risk of patients and make clinical decisions, the 90th percentile based on the age and 24-hour ABPM categories is recommended as a cut-off.

A17736 Earlier intervention before stage II hypertension is necessary to moderate the decline in estimated glomerular filtration rate

Objectives: The aim of this study is to examine the relationship between blood pressure level and subsequent change in eGFR using the generalized linear mixed model (GLMM) which is a new methodology considering intermediate process until outcome assessment. Methods: To address this issue, we studied 5518 general population of Watari town who received annual health-check up 2 times or more between 2009 and 2015 (mean age 62.3 ± 12.2, men 43.3 %). Anthropometry, sitting blood pressures, fasting blood and urinary albumin to creatinine ratio (UAE) from morning spot urine sample as well as current medical use were examined in each year. GLMM was used to examine the relationship between initial blood pressure categories (optimal, normal, high normal, hypertension stage I, stage II or more) and subsequent eGFR for dependent variable. Covariates were age, sex, baseline eGFR, year of examination, and the following variables at each year, or body mass index, use of antihypertensive medications, UAE, smoking, lipids, metabolic syndrome and uric acid concentration. Interaction between blood pressure categories and time was examined for optimal blood pressure as reference. Results: eGFR was declined with an advance in year in all blood pressure categories; the slope tended to be steeper in the higher blood pressure categories. There was a significant interaction between blood pressure category and time for eGFR decline only with the group of hypertension stage II or more. The interaction was still significant even after adjustments for multiple covariates. Conclusion: The eGFR declines overtime more in hypertension stage II as compared with optimal blood pressure category even considering intermediate process. Therefore, earlier intervention is strongly recommended to moderate decline in renal function.

The Burden of Modifiable Risk Factors in Newly Defined Categories of Blood Pressure

BackgroundThe 2017 American College of Cardiology/American Heart Association Guideline introduced new categories of high blood pressure. The vast majority of individuals in these newly defined categories are recommended for nonpharmacological intervention rather than antihypertensive therapy. This study sought to determine the burden of potentially modifiable risk factors of hypertension among untreated adults in the newly defined categories of blood pressure. MethodsWe analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 37,448). Potentially modifiable risk factors included abdominal obesity, high non-high-density lipoprotein (HDL) cholesterol, secondhand smoking, binge drinking, suboptimal physical activity, and low-fiber diet. ResultsAlthough the prevalence of certain modifiable risk factors decreased during the study period, the prevalence of low fiber intake, suboptimal physical activity, abdominal obesity, and binge drinking remained high during the last combined survey cycle (2011-2014). Modifiable risk factors generally demonstrated dose–response relationships with high blood pressure categories. The most common type of risk factor clustering included low fiber intake, suboptimal physical activity, high non-HDL cholesterol, and abdominal obesity, with its prevalence increasing gradually from 9.5% (95% confidence interval, 8.8%-10.3%) in the normal blood pressure group to 16.5% (95% confidence interval, 14.8%-18.3%) in the stage 2 hypertension group (Ptrend < .001). The prevalence of 4 or more modifiable risk factors per participant increased stepwise, ranging from 28.5% in the normal blood pressure group to 48.0% in the stage 2 hypertension group (Ptrend < .001). ConclusionsThe burden of potentially modifiable risk factors for hypertension shows progressive increase along the blood pressure categories and represents an important target for nonpharmacologic intervention.

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa: A focus on children and adolescents in The Gambia.

Hypertension is fast becoming a major public health problem across sub-Saharan Africa. We sought to determine the prevalence of high blood pressure (BP) and associated risk factors as indicator of preclinical hypertension in a rural Gambian population.We analyzed data on 6160 healthy Gambians cross-sectionally. Attention was given to 5 to <18-year olds (N = 3637), as data from sub-Saharan Africa on this young age group are scarce. High BP was defined as systolic blood pressure (SBP) above the 95th percentile for age-sex specific height z scores in <18-year olds employing population-specific reference values. Standard high BP categories were applied to ≥18-year olds.In <18-year olds, the multivariable analysis gave an adjusted high BP prevalence ratio of 0.95 (95% confidence interval [CI] 0.92-0.98; P = 0.002) for age and 1.13 (95% CI 1.06-1.19; P < 0.0001) for weight-for-height z score (zWT-HT); sex and hemoglobin were not shown to affect high BP. In adults age 1.05 (95% CI 1.04-1.05; P < 0.0001), body mass index z score 1.28 (95% CI 1.16-1.40; P < 0.0001), hemoglobin 0.90 (95% CI 0.85-0.96; P < 0.0001) and high fasting glucose 2.60 (95% CI 2.02-3.36; P < 0.0001, though the number was very low) were confirmed as risk factors for high BP prevalence; sex was not associated.The reported high BP prevalence and associated risk factors in adults are comparable to other studies conducted in the region. The observed high BP prevalence of 8.2% (95% CI 7.4-9.2) in our generally lean young Gambians (<18 years) is alarming, given that high BP tracks from childhood to adulthood. Hence there is an urgent need for further investigation into risk factors of pediatric high BP/hypertension even in rural African settings.

Investigation of dynamical characteristics of blood pressure and heart rate variation in different blood pressure categories

We continued investigation of variation of blood pressure and heart rate characteristics of patients groups from different blood pressure categories in the present research. We analyze dynamical features of considered data sets by means of power spectrum regression, detrended fluctuation analysis (DFA) and multifractal detrended fluctuation analysis (MF-DFA). We aim to compare dynamical characteristics of analysed data in different blood pressure categories. Special interest is the comparison of these characteristics in normal and high normal blood pressure categories. Based on the results of our analysis we show that scaling features of considered data sets are different in different blood pressure categories. The most interesting is the fact that by their dynamical features normal and high normal categories are different for all considered physiological characteristics. The obtained results point to the fact that important quantitative and qualitative changes occur in these looking close guidelines categories, which finally lead to transition of dynamical system to pathological condition typical for grade I hypertension category.

Blood pressure level and hypertension awareness and control differ by marital status, sex, and ethnicity: a population-based study.

Population-based studies about factors associated with blood pressure (BP) levels and hypertension awareness and control are lacking in Israel. We aimed to identify covariables of BP level (across the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) categories) and hypertension awareness and control. Participants (n = 763; aged 25-74 years) were randomly selected from the population registry and stratified by sex, age, and ethnicity (Arab or Jewish). Sociodemographic, lifestyle, chronic morbidity, drug therapy, and measured anthropometric and BP data were collected. Hypertension was defined as physician diagnosis, antihypertension drug therapy, or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Standardized hypertension prevalence was 32.5%. Age and body mass index were positively associated with being in a higher JNC-7 category. In multivariable analysis, the association between gender and JNC-7 category depended upon marital status. Of those with hypertension (n = 315), 66.0% were aware of their status, and 26.0% exhibited adequate BP control. Using "aware-and-controlled" as the outcome reference category, the odds ratio (OR) of being aware and uncontrolled was 1.9 (95% confidence interval (CI) = 1.3-2.9) for 10-year age increment. The OR of being unaware and uncontrolled was 5.6 (95% CI = 2.0-15.8) for Arabs vs. Jews, 5.6 (95% CI = 1.4-22.3) for single/divorced vs. married participants, 3.9 (95% CI = 1.7-9.2) for those with <3 visits to the family physician per year, and 0.1 (95% CI = 0.02-0.4) for those with self-reported cardiovascular disease. Sociodemographic factors and primary healthcare service utilization are associated with hypertension awareness and control. Specially focused outreach may be needed to improve hypertension awareness among Arabs, certain subgroups not traditionally considered to be at high risk, and those who have less contact with the healthcare system.

Hypertension prevalence and Framingham risk score stratification in a large HIV-positive cohort in Uganda

To report the prevalence of hypertension and projected 10-year absolute risk of acute cardiovascular disease in a large prospectively followed cohort of HIV-positive youth and adults beginning antiretroviral therapy in sub-Saharan Africa. HIV-positive individuals seeking HIV treatment, ages 13 years and older, were assessed for repeated blood pressure measurements over the first year following initiation of antiretroviral therapy, including serum total cholesterol, high-density lipoprotein, CD4 cell count and related clinical and laboratory measurements. Outcomes include hypertension, defined according to the 7th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories, and Framingham Risk Score based 10-year cardiovascular disease risk estimates. Five thousand, five hundred and sixty-three patients had at least two blood pressure measurements on at least two separate occasions during the first year of antiretroviral therapy [median age of therapy initiation 34, first and third quartile (Q1-Q3) 28-40 years, 1841 (33.1%) men, baseline CD4 cell count 161 cells/μl (Q1-Q3 72-231 cells/μl]. Hypertension was diagnosed in 1551 patients [27.9%, 95% confidence interval (CI) 26.7- 29.1] including 786 (14.1%, 95% CI 13.2-15.1) who met criteria for stage 2 hypertension. The age-standardized prevalence for Ugandans aged 13 or more was 24.8% (95% CI 23.8-26.1). Among those with complete laboratory studies (n=1102), nearly all women were in the 10% or less 10-year Framingham Risk Score category, but 20% of men were at at least 10% or more long-term risk of acute cardiovascular disease. Efforts to combine HIV treatment with vascular disease risk factor prevention and management are urgently needed to address noncommunicable disease multimorbidity in HIV-positive persons in sub-Saharan Africa, particularly in men.

Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women

Blood pressure (BP) categories defined by systolic BP (SBP) and diastolic BP (DBP) are commonly used. However, the BP category-specific risk of cardiovascular disease (CVD) has not been thoroughly investigated in different age groups. The aim of this study was to assess long-term CVD risk and its impact according to BP categories and age group. Pooling individual data from 10 cohorts, we studied 67 309 Japanese individuals (40-89 years old) who were free of CVD at baseline: we categorized them as belonging to three age groups: 'middle-aged' (40-64 years), 'elderly' (65-74 years) and 'very elderly' (75-89 years). BP was classified according to the 2009 Japanese Society of Hypertension Guidelines. Cox models were used to estimate adjusted hazard ratios for CVD deaths. We observed 1944 CVD deaths over a mean follow-up of 10.2 years. In all age groups, the overall relationship between BP category and CVD risk was positive, with a greater strength observed for younger age groups. We observed a trend of increased risk from SBP/DBP ≥ 130/85 mm Hg in the very elderly, and a significant increase from SBP/DBP ≥ 120/80 mm Hg in the other age groups. The population attributable fractions (PAFs) of CVD death in reference to the SBP/DBP<120/80 mm Hg category ranged from 23.4% in the very elderly to 60.3% in the middle-aged. We found an overall graded increase in CVD risk with higher BP category in the very elderly. The PAFs suggest that keeping BP levels low is an important strategy for primary CVD prevention, even in an elderly population.

Abstract 2882: The Combined Impact of Glucose Abnormality and Blood Pressure Category on Carotid Atherosclerosis in a General Urban Japanese Population: The Suita Study

Introduction: Diabetes Mellitus (DM) and hypertension (HT) have been proven to be risk factors for cardiovascular diseases and stroke. However, few studies have examined the relationships of carotid artery intima-media thickness (IMT) with combination of glucose abnormality and blood pressure (BP) categories in a general population. We assessed the hypothesis that the effect of the risks of these factors on carotid atherosclerosis was more accentuated with combination of higher categories on glucose and BP in a general urban Japanese population. Methods: Participants (35-93 years of age; 1,844 women and 1,602 men) who gave written informed consent were randomly selected from a general urban population (between 2002 and 2004). Carotid atherosclerosis was evaluated by high-resolution ultrasonography (7.5MHz) with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb (Bulb), and internal and external carotid arteries. Mean IMT was defined as the mean of the IMT of the proximal and distal walls for both sides of the CCA at a point 10 mm proximal to the beginning of the dilation of each Bulb. Maximum IMT was assessed in the entire scanned area. Stenosis (&gt;=25%) was defined as a condition in which a plaque occupied more than 25% of the lumen circumference of an artery on a cross-sectional scan. Serum glucose categories (normoglycemia, impaired fasting glucose [IFG] and DM) were defined according to the 2003 ADA recommendations. BP categories (optimal, normal, high-normal BP and HT) were defined on the basis of the ESH-ESC 2007 criteria. The association of serum glucose categories with the carotid atherosclerotic indexes was investigated through logistic regression analysis considering potential confounding risk variables including BP category. Results: Compared with normoglycemic subjects, the mean and maximum IMTs were significantly greater in women with DM (mean: 0.836 vs 0.802 p=0.001, maximum: 1.370 vs 1.205 p&lt;0.001) and in men with IFG (mean: 0.858 vs 0.838 p=0.004, maximum: 1.511 vs 1.439 p=0.038) and DM (mean: 0.885 vs 0.838 p&lt;0.001, maximum: 1.631 vs 1.439 p&lt;0.001). Compared with normoglycemic subjects, the odds ratios (OR) (95% confidence intervals [CI]) for stenosis was 1.67 (1.22-2.30) in subjects with DM. Compared with optimal BP subjects, the OR (95% CI) for stenosis was 1.52 (1.15-2.01) in subjects with HT. In combination, the OR for stenosis with optimal, normal, high-normal BP and HT were 1(reference), 1.96, 2.48 and 2.71 with normoglycemia, 1.99, 1.83, 2.26 and 2.88 with IFG and 7.04, 2.18, 3.42 and 4.09 with DM (P-value for interaction=0.049). Conclusion: Compared with normoglycemic subjects, the mean and maximum IMTs were significantly greater in women with DM and in men with IFG and DM and stenosis was significantly greater in subjects with DM. The impact of each glucose category on the stenosis was more evident in subjects with a higher BP category.

Metabolic characteristics of prehypertension: role of classification criteria and gender

We tested whether men and women in the European Society of Hypertension (ESH) high normal and normal blood pressure (BP) categories, all included in the the Seventh Joint National Committee (JNC 7) prehypertension group, share similar metabolic characteristics and whether they differ from men and women with optimal BP (<120/80 mmHg). BP (multiple measurements with a standardized automatic device), insulin sensitivity (euglycaemic clamp), oral glucose tolerance test (OGTT), carotid intima-media-thickness (IMT, echo), family history (questionnaire), physical activity (accelerometer), and anthropometrics (bioimpedance) were evaluated in the 1384 healthy European individuals ranging from 30-60 years participating in the multicentre study Relationship between Insulin Sensitivity and Cardiovascular disease (RISC). BMI and waist-to-hip ratio were higher (both P < 0.05 adjusted for age and recruiting centre) in men and women with high normal (but not normal) BP with respect to optimal BP. Similarly, in women (after adjustment for study centre, age, physical activity, and waist), serum triglycerides and carotid IMT were higher in those with high normal (but not normal) BP; moreover, in this group there was a higher prevalence of glucose-intolerance (21.8 versus 9.7%, P = 0.02) and insulin sensitivity tended to be lower (P = 0.07). Insulin sensitivity and diastolic blood pressure were weakly related variables displaying a nonlinear association with a threshold below the normal BP values and no interaction with family history of hypertension. The JNC 7 category prehypertension identifies a dishomogeneous group of individuals whereas the ESH classification, particularly in women, was more accurate in identifying both the predisease and the healthy phenotype. Insulin resistance is not a major characteristic of the condition of prehypertension.

Pulse Pressure, Prehypertension, and Mortality: The San Antonio Heart Study

Prehypertension increases mortality risk. Pulse pressure is also associated with increased mortality. Nevertheless, the impact of pulse pressure on the relationship between prehypertension and mortality is not known in individuals who are free of diabetes and cardiovascular disease. Cox regression analysis was used to examine mortality risk among 3,632 (97.0%) participants in the San Antonio Heart Study (age range, 25-64 years; mean follow-up, 15.2 years). Results were adjusted for age, sex, ethnicity, education, body mass index (BMI), smoking, and total cholesterol concentration. The Seventh Report of the Joint Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) categories were used for blood pressure staging: normal, <120/80 mm Hg; prehypertension, 120-139/80-89 mm Hg. Prehypertension prevalence was 31.6% at baseline. There were 218 deaths during the follow-up period. Prehypertension-predicted mortality (all-cause, hazard ratio (HR) 1.49 (1.12-1.99); cardiovascular, HR 1.79 (1.07-3.02)). Relative to normal blood pressure plus pulse pressure in the lower tertile, prehypertension plus pulse pressure in the upper tertile was associated with increased mortality (all-cause, HR 2.14 (1.38-3.32); cardiovascular, HR 2.47 (1.13-5.39)); however, prehypertension plus pulse pressure in the lower tertile was not significantly associated with mortality (all-cause, HR 1.19 (0.52-2.67); cardiovascular, HR 0.43 (0.05-3.40)). Prehypertension increases mortality risk (all-cause and cardiovascular) in individuals who are free of diabetes and cardiovascular disease. Nevertheless, this relationship is not evident in individuals with narrow pulse pressure. Therefore, pulse pressure may be a relevant measure of blood pressure for the definition of normal blood pressure.

Validation of Microlife BP W100 wrist device assessed according to the European Society of Hypertension and the British Hypertension Society protocols

The objective of this study was to determine the accuracy of the Microlife BP W100 device for blood pressure measurement. The device evaluations were performed in 85 participants, by using both the protocol of the European Society of Hypertension (ESH) and the protocol of the British Hypertension Society (BHS). Initially, the data from 33 participants were examined according to the ESH protocol. Furthermore, 52 participants were then enrolled to fulfill the BHS protocol requirements. In all participants, sequential same arm measurements were made by two trained observers. The device passed all three phases of the ESH protocol for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and was graded A according to the criteria of the BHS protocol for both SBP and DBP. The A/A grade was achieved in low (<130/80 mmHg), medium (130-160/80-100 mmHg) and high (>160/100 mmHg) blood pressure categories. Mean blood pressure difference between BP W100 and observers in the 85 participants was 0.1+/-5.3 mmHg for SBP and 1.1+/-3.4 mmHg for DBP, and thus, the device also met the requirements of the Association for the Advancement of Medical Instrumentation. In conclusion, these data show that the Microlife BP W100 wrist monitor satisfied the recommended ESH accuracy levels and achieved A/A grade of the BHS protocol across a wide range of blood pressure.

Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey

BackgroundThe prevalences of both hypertension and vitamin D insufficiency are high in the United States. Recent clinical trials and animal studies have suggested that vitamin D insufficiency may be associated with elevated blood pressure. ObjectiveWith cross-sectional data, we sought to determine whether vitamin D concentrations were related to systolic blood pressure (SBP) in the third National Health and Nutrition Examination Survey (1988–1992). DesignBlood pressure was classified with 5 categories from the Joint National Committee 7 with a sixth category added to distinguish participants with normotensive SBP (<110 mm Hg) from those with high-normal SBP (110–119 mm Hg). We used predicted marginals to estimate the conditional means of serum 25 hydroxyvitamin D [25(OH)D] and to test for trend across blood pressure categories. We used linear regression to explore the association between vitamin D, blood pressure, and age. ResultsLower 25(OH)D concentrations were associated with a higher blood pressure category in whites (P < 0.001); however, when controlling for age, the association was no longer significant. Concentrations of 25(OH)D > 80 nmol/L decreased the age-related increase in SBP by 20% compared with participants having 25(OH)D concentrations < 50 nmol/L (P < 0.001). Only 8% of blacks had 25(OH)D concentrations > 80 nmol/L. ConclusionsSBP is inversely associated with serum vitamin D concentrations in nonhypertensive white persons in the United States. This observation provides a rationale for studies on the potential effects of vitamin D supplementation as a method to reduce SBP in persons at risk of hypertension.

Sequelae of Systemic Hypertension in Alcohol Abstainers, Light Drinkers, and Heavy Drinkers

A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can confound the study of the long-term risks of alcohol-related hypertension. We therefore studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers among 127,212 subjects with BP and alcohol intake ascertained at 1978 to 1985 health examinations. Subsequent cardiovascular end points included mortality risk, hospitalization risk, and outpatient diagnosis of hypertension. Analyses were performed for all subjects and stratified by 5 alcohol-drinking categories (from never drinkers to >or=3 drinks/day). With <120/80 mm Hg as the referent, Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for 3 higher BP categories (120 to 129/80 to 84, 130 to 139/85 to 89, and >or=140/90 mm Hg). The covariates were age, gender, race, body mass index, education, and smoking. The risk of all outcomes was progressively higher for increasing BP categories, with a similarly increased risk for abstainers, light drinkers, and heavy drinkers. The interaction tests for alcohol and BP were not statistically significant for the mortality and hospitalization outcomes. Interpretation was limited by an inability to separate subjects with increased BP from alcohol consumption from those with other etiologies. In conclusion, the data indicate that the risks of hypertension are similar regardless of the amount of alcohol consumption.

Outcomes of black and white hypertensive individuals after 30 years of follow-up.

Outcomes of a 30-year follow-up for the participants of the Charleston Heart Study were studied with elevated blood pressure assessed using various classifications. The traditional categories of > or = 140/90 mmHg, > or = 160/95 mmHg and isolated systolic hypertension, as well as high normal and the four stages of high blood pressure were utilized in analyses. Prevalence rates of hypertension were, in general, higher among blacks compared to whites. Blacks had higher prevalence rates of hypertension and greater prevalence of high blood pressure at younger ages. Risk ratios were higher for black and white hypertensives than their normotensive counterparts. Blacks were found to have substantially higher population attributable risk proportions, particularly at the higher blood pressure categories. The results suggest that the standard clinical classifications of hypertension as related to mortality are appropriate for blacks and white.