High Blood Pressure In Adults Research Articles

Ambulatory blood pressure and its variability in adults born preterm.

Adults born preterm have higher blood pressure (BP) than those born at term. Most studies have focused on preterm birth, and few have assessed BP variability, an independent risk factor of cardiovascular disease. We studied the association of preterm birth with 24-hour ambulatory BP, measured by an oscillometric device, in 42 young adults born early preterm (<34 weeks), 72 born late preterm (34-36 weeks), and 103 controls (≥37 weeks). Sleep was confirmed with accelerometry in 72.4% of subjects. The 24-hour systolic BP of adults born early preterm was 5.5 mm Hg higher (95% confidence interval, 1.9-9.3), awake systolic BP was 6.4 mm Hg higher (95% confidence interval, 2.8-10.1), and sleeping systolic BP was 2.9 mm Hg higher (95% confidence interval 0.3-7.5) when adjusted for age, sex, and use of accelerometry. The differences remained similar when adjusted for height, body mass index, physical activity, smoking, parental education, maternal body mass index, smoking during pregnancy, and gestational diabetes mellitus and attenuated slightly when adjusted for maternal hypertensive pregnancy disorders. Adults born early preterm also had higher BP variability as indicated by higher individual standard deviations of systolic BP and diastolic BP. Although our results were consistent with a dose-response relationship between shorter gestation and higher BP, the difference between the late preterm and term groups was not statistically significant. Our results suggest that the higher BP in adults born early preterm is present during both waking and sleeping hours, may be more pronounced during waking hours, and is accompanied by higher individual BP variability.

PS-355 The Different Contributions Of Body Mass Index And Height During The Life Cycle In Predicting Adult Hypertension

Background and aims Birthweight and weight gain have been associated with high adult blood pressure (BP). Less well known is the association between height gain across the life cycle and hypertension (HT). The objective of the present study is to assess the independent association of body mass index (BMI) and length at birth and BMI and height gains from birth to childhood, and from childhood to adulthood with adult blood pressure and HT. Methods A prospective cohort of all living born in Ribeirao Preto, Brazil, was assessed at birth (1978/79), school-age (1987/89) and adulthood (2002/04). Data on neonatal variables, socioeconomic position and anthropometry of all three moments as well as adult risk factors for HT were present for 1141 subjects. Conditional weight analysis was performed to assess the independent association of BMI and height repeated-in-time measurements on adult HT. Results After adjustments BMI at birth (inversely: RR = 0.58; 95% CI 0.35–0.96), BMI gain in adolescence (RR = 3.39; 95% CI 1.87–6.16) and height gain in childhood (RR = 1.95; 95% CI 1.12–3.38) were associated with adult HT. Adult systolic BP was associated with BMI at birth, BMI and height gains in childhood and adolescence. Diastolic BP was associated with BMI at birth, BMI gain in childhood and adolescence, and with height gain in childhood. Conclusion Lower BMI at birth, higher height gain between birth and school age and higher BMI gain during the second decade of life were associated with adult HT. BMI and height also predict both systolic and diastolic blood pressure. Supported CNPq, FAPESP, FAEPA.

Antihypertensive medication classes used among medicare beneficiaries initiating treatment in 2007-2010.

BackgroundAfter the 2003 publication of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines, there was a 5–10% increase in patients initiating antihypertensive medication with a thiazide-type diuretic, but most patients still did not initiate treatment with this class. There are few contemporary published data on antihypertensive medication classes filled by patients initiating treatment.Methods and FindingsWe used the 5% random Medicare sample to study the initiation of antihypertensive medication between 2007 and 2010. Initiation was defined by the first antihypertensive medication fill preceded by 365 days with no antihypertensive medication fills. We restricted our analysis to beneficiaries ≥65 years who had two or more outpatient visits with a hypertension diagnosis and full Medicare fee-for-service coverage for the 365 days prior to initiation of antihypertensive medication. Between 2007 and 2010, 32,142 beneficiaries in the 5% Medicare sample initiated antihypertensive medication. Initiation with a thiazide-type diuretic decreased from 19.2% in 2007 to 17.9% in 2010. No other changes in medication classes initiated occurred over this period. Among those initiating antihypertensive medication in 2010, 31.3% filled angiotensin-converting enzyme inhibitors (ACE-Is), 26.9% filled beta blockers, 17.2% filled calcium channel blockers, and 14.4% filled angiotensin receptor blockers (ARBs). Initiation with >1 antihypertensive medication class decreased from 25.6% in 2007 to 24.1% in 2010. Patients initiated >1 antihypertensive medication class most commonly with a thiazide-type diuretic and either an ACE-I or ARB.ConclusionThese results suggest that JNC 7 had a limited long-term impact on the choice of antihypertensive medication class and provide baseline data prior to the publication of the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).

Commentary on the 2014 BP guidelines from the panel appointed to the Eighth Joint National Committee (JNC 8).

The recently published article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) has generated considerable controversy. In this commentary, we evaluate the document and compare the recommendations contained within it with those of the JNC 7 and other national and international guidelines. The evidence quality rating approach followed by the article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) disqualified nearly 98% of previous studies from review; as a result, some of the key recommendations were on the basis of expert opinion alone. We are especially concerned that the recommendation to raise the systolic/diastolic BP levels at which treatment is initiated to ≥150/≥90 mmHg in adults≥60 years old may affect cardiovascular and renal health in these patients. Additionally, we recommend that hypertension guidelines should be updated every 3-4 years with a fresh approach to the definition of target BP levels, the use of modern technology in the diagnosis of hypertension, and the treatment of hypertension in special populations not addressed in earlier guidelines.

Systolic Blood Pressure Goals to Reduce Cardiovascular Disease Among Older Adults

The 2014 Evidence-Based Guideline for the Management of High Blood pressure in Adults Report From the panel Members Appointed to the Eighth Joint National Committee (JNC 8) was recently published. This guideline recommended that older adults (≥60 years) without diabetes or chronic kidney disease with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg be initiated on antihypertensive medication with a treatment goal SBp/DBP <150/90 mm Hg. In contrast, the previous 3 JNC guidelines recommended treatment for these individuals be initiated at SBP/DBP ≥140/90 mm Hg with goal SBP/DBP <140/90 mm Hg. In this article, we review randomized trials of antihypertensive medication and observational data on SBP and DBP with cardiovascular outcomes among older adults, possible explanations underlying the different findings from these randomized trials and observational studies, and contemporary antihypertensive treatment patterns among older U.S. adults. In closing, we highlight future research needs related to hypertension and outcomes among older adults.

Prevalence and characteristics of systolic blood pressure thresholds in individuals 60 years or older.

For over 20 years, US Joint National Committee (JNC) hypertension guidelines, including JNC7, have recommended systolic and diastolic blood pressure (SBP and DBP) thresholds of 140/90 mmHg for initiating antihypertensive medication and goal attainment while on treatment for individuals without diabetes or chronic kidney disease (CKD).1, 2 The 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report from the panel members appointed to JNC8 recently recommended a higher SBP threshold (150 mmHg) for treatment initiation and goal attainment in adults 60 years and older.3 We estimated the percentage and characteristics of older US adults potentially affected by the new SBP threshold.

NLA Task Force on Statin Safety--2014 update.

1933-2874/$ see front matter 2014 http://dx.doi.org/10.1016/j.jacl.2014.03 Statins are the most widely prescribed class of medications in the United States and their benefits for lowering lowdensity lipoprotein cholesterol (LDL-C) and reducing the risk for coronary heart disease (CHD) are well documented. Statins have been the cornerstone of pharmacotherapy for the management of high blood cholesterol levels virtually since their development. The American Heart Association /American College of Cardiology 2013 guidelines recently expanded the number of individuals eligible for statin therapy by recommending it for those with: (1) clinical atherosclerotic cardiovascular disease (ASCVD), (2) LDL-C $190 mg/dL, (3) type 2 diabetes and age between 40 and 75 years with LDL-C 70 to 189 mg/dL, and (4) an estimated 10-year risk of ASCVD $7.5% and age 40 to 75 years. Considering only those who qualify according to their estimated 10-year risk of ASCVD, it has been reported that of the 101 million people in the United States age 40 to 79 years who do not have cardiovascular disease, 33 million have an estimated 10-year risk of ASCVD $7.5%, and another 13 million have a risk between 5% and 7.4%. Using crude global estimates, 920 million people worldwide would be expected to be

Evidence Supporting a Systolic Blood Pressure Goal of Less Than 150 mm Hg in Patients Aged 60 Years or Older: The Minority View

The 2014 guideline for the management of high blood pressure in adults from the panel appointed to the Eighth Joint National Committee includes a recommendation to increase the target systolic bloo...

Kidney size and function in a multi-ethnic population-based cohort of school-age children

Subclinical impaired kidney growth and function in childhood may lead to kidney diseases and high blood pressure in adulthood. We assessed the cross-sectional associations of childhood characteristics with kidney size and function in a multi-ethnic cohort. This study was embedded in a population-based cohort study of 6,397 children with a median age of 6.0 years.Kidney volume, creatinine and cystatin C blood levels, microalbuminuria and blood pressure were measured, and glomerular filtration rate (GFR) was estimated. Childhood anthropometrics were positively associated with kidney volume, creatinine level and blood pressure (all p < 0.05). We observed ethnic differences in all kidney size and function measures (all p < 0.05). Children with smaller kidneys had higher creatinine and cystatin C blood levels, leading to a lower estimated GFR [difference 5.68 ml/min/1.73 m2 (95% confidence interval 5.14-6.12) per 1 standard deviation increase in kidney volume]. Larger kidney volume was associated with an increased risk of microalbuminuria. Childhood kidney volume and function are influenced by body mass index and ethnicity. Kidney volume is related with kidney function but not with blood pressure. These results may help to identify individuals at risk for kidney disease in an early stage.

Young Adults with Spina Bifida May Have Higher Occurrence of Prehypertension and Hypertension

The aims of this study were to determine the occurrence of prehypertension and high blood pressure in adults with spina bifida (SB) and to examine relationships among blood pressure, cardiovascular disease risk factors, and SB-specific factors. This is a cross-sectional, retrospective analysis of adults with SB. SB-specific factors and cardiovascular disease risk factors were compared among subjects with high blood pressure, subjects with blood pressure in the prehypertensive range, and normotensive subjects using the χ, Kruskal-Wallis, or Fisher's exact tests. Of 225 subjects, the occurrence of prehypertension and high blood pressure was 27% (n = 22) and 27% (n = 22) for ages 18-29 yrs, 35% (n = 26) and 41% (n = 30) for ages 30-39 yrs, 18% (n = 8) and 66% (n = 29) for ages 40-49 yrs, and 21% (n = 5) and 67% (n = 16) for 50 yrs or older, respectively. Of the subjects with high blood pressure, 56% were men, 14% had obstructive sleep apnea, 14% had diabetes, 19% had renal dysfunction, 38% used tobacco, 16% had hydronephrosis, and 71% had a shunt. The groups differed significantly with respect to diabetes (P = 0.004), bladder procedures (P = 0.001), and renal dysfunction (P < 0.001), with higher proportions of subjects with high blood pressure having these comorbidities. Fewer than half of the subjects were considered normotensive. A greater proportion of young adults with SB appear to have high blood pressure compared with the general United States population. Because elevated blood pressure is an independent, modifiable risk factor of cardiovascular disease, these findings support early screening and intervention for elevated blood pressure in individuals with SB.

Natriuretic Peptide: A Probable Culprit in Prevention of Primary Cardiovascular Diseases Using β-Blockers

This letter refers to “The Value of N-Terminal Pro-B-Type Natriuretic Peptide in Determining Antihypertensive Benefit: Observations From the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)” by Welsh et al1 The 2014 evidence-based guideline for the management of high blood pressure in adults from the Eighth Joint National Committee (JNC …

Updated Guidelines for Management of High Blood Pressure

Updated Guidelines for Management of High Blood Pressure

New Guideline for Treatment of High Blood Pressure in Adults

New Guideline for Treatment of High Blood Pressure in Adults

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

Assessing the Trustworthiness of the Guideline for Management of High Blood Pressure in Adults

The article by James and colleagues1 published in JAMA contains the long-awaited guideline for hypertension issued by the panel members appointed by the National Heart, Lung, and Blood Institute (NHLBI) to the Eighth Joint National Committee (JNC 8). In the past decade, the effect of guidelines on clinical practice has increased because organizations that develop quality measures and make coverage decisions depend on guideline developers to uncover the best evidence and make specific recommendations. Because guidelines matter more, critics have questioned the processes that professional associations have used to develop guidelines. The title of the 2011 Institute of Medicine (IOM) report on quality standards for practice guidelines, Clinical Practice Guidelines We Can Trust,2 captures current concerns. Despite the efforts of the expert panel that developed the new guideline for management of hypertension, some aspects of the external review process may undermine public confidence. The NHLBI convened the JNC 8 panel in 2008. The panel decided to adhere to the standards set by the IOM study committee2 instead of following the practices of earlier JNC panels. The JNC 7 committee produced a comprehensive overview of the management of hypertension. The committee did not commission systematic reviews of the evidence. The report did not state the extent and quality of the evidence for many topics, so that the logical connection between the evidence and some recommendations was not clear. The report described conflicts of interest for committee members but did not say whether members recused themselves from voting when they had a conflict.3 As part of the guideline development process, the present hypertension guideline panel commissioned a systematic review of randomized trial evidence, evaluated the evidence, made recommendations, indicated the level of evidence supporting those recommendations, reported conflicts of interest, and recused conflicted panel members from voting. Because of these changes, this guideline adheres much more closely to the IOM standards than the JNC 7 guideline. The external review process began when the panel submitted the draft guideline to the NHLBI. According to James et al,1 the NHLBI submitted the guideline to 16 federal agencies and to 20 reviewers, all of whom were experts in hypertension. In addition, individual reviewers were expert in cardiology, nephrology, primary care, pharmacology, research (including clinical trials), biostatistics, and other related fields. The authors report that they received responses from 16 individual reviewers and 5 reviewers from federal agencies. The panel revised the guideline, completing its work in June 2013, just as the NHLBI announced that it was turning the guideline development process over to the American Heart Association and the American College of Cardiology, which jointly sponsor a respected guidelines program.4 Rather than submit the hypertension guideline for review by these organizations, the panel members submitted the guideline to JAMA, where it underwent both internal and external peer review. Thus, physicians and other readers are confronted with an important report that, although it has undergone extensive review, has not been evaluated by the specialty societies that the NHLBI designated to take responsibility for the guidelines program. The panel’s departure from usual practice leads to 4 questions. First, what are the key elements of trustworthiness in a guideline? Second, how does this guideline measure up? Third, what is the role of expert review of guidelines? Fourth, what is the pathway to guidelines that the public can trust?

End of the Joint National Committee Heritage?

The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives.1 One of the activities of NHLBI has been to appoint a Joint National Committee (JNC) to oversee the publication of reports for the prevention, detection, evaluation, and treatment of high blood pressure (BP). The first JNC report was published in 1976, with subsequent reports published every 4 to 6 years with the last one, JNC 7, being published in 2003.2 JNC 8 has been long awaited, having been variously dubbed JNC-late and JNC-wait. Well it has arrived, a decade after its predecessor, in the Journal of the American Association [ JAMA ],3 where it has been ushered in by no less than 3 editorials.4–6 But is this JNC 8? Is it the successor to JNC 7? If we read the title of the JAMA article carefully there is a clue to what may be described at best as subtle deception: “The 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8).”3 Compare this with the title of JNC 7, which was “National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.”2 All but the most skeptical readers would assume from the recent JAMA title that what they were about to …

High blood pressure in adults: What’s new in JNC 8?

The Skagerrak and Kattegat are estuarine straits of high hydrographical and ecological diversity, situated between the saline waters of the North Sea and the brackish waters of the Baltic Sea. These sustain important nursery grounds of many fish species, of which several overwinter during the larval and early juvenile stages. In order to give more insight into the communities of the overwintering ichthyoplankton in estuarine areas, we examine an annual series of observations from a standard survey carried out 1992–2010. Species differences and annual variability in distributions and abundances are described, and linkages between ichthyoplankton abundances and corresponding hydrographical information are analysed by GAM methods. Communities were dominated by herring, gobies, butterfish, sprat, pipefishes, lemon sole and European eel (i.e. glass eel), and all the sampled species showed large annual fluctuations in abundances. The species showed quite specific patterns of distribution although species assemblages with common distributional characteristics were identified. Within these assemblages, the ichthyoplankton abundances showed linkage to environmental characteristics described by bottom-depth and surface temperature and salinity. Hence the study points to a significant structuring of overwintering ichthyoplankton communities in large estuaries, based on the species habitat choice and its response to physical gradients.

2013 Canadian Hypertension Education Program Recommendations

While the 2013 Joint National Committee Guidelines for the Management of High Blood Pressure in adults still under revision and not available for discussion, this article discusses new and important recommendations from the Canadian Hypertension Education Program [Daskalopoulou SS et al. Can J Cardiol 2012].

Prevalence rates of hypertensive and obese children in a public elementary school in southern Minas Gerais State, Brazil

Many studies have disclosed that high blood pressure in adults is a disease that starts in childhood. The aim of this study was to perform a survey about the prevalence rates of hypertensive and obese children in at a public elementary school in southern Minas Gerais, as well as to verify the correlation between weight alterations and blood pressure. We evaluated 274 children, from both genders, aged between 6 and 13, from October until December 2009. This study identified 7.3% prevalence of hypertension among the evaluated children. Furthermore, it found a high percentage of obese individuals (16.4% overweight and 12.8% obese). Besides, the study showed a statistical tendency of increasing blood pressure levels due to increase in the BMI. These results show the importance of precocious diagnosis of hypertension and the need of obesity prevention, and they remark the necessity of changes in the present health care system for obtaining treatment turned to chronic conditions.

High blood pressure in adults with disabilities: Influence of gender, body weight and health behaviors

The aims of this study were to explore the mean and distribution of systolic and diastolic blood pressure, and to examine the influence of gender, body weight and health behaviors on hypertension in adults with disabilities. We analyzed the 2010 annual community health examination chart of adults with disabilities in east Taiwan. The study samples included 833 adults with disabilities whose age 30 years and over participated in the analyses. The mean value of diastolic and systolic blood pressure (mmHg) of the study participants was 76.51 ± 12.65 (range = 40-155) and 127.39 ± 20.32 (range = 77-221). Fifteen percent and 23.4% of the participants have high diastolic (>/=90 mmHg) and systolic (>/= 140 mmHg) blood pressure. There were 27.4% of the participants who had hypertension, high diastolic or/and systolic blood pressure. Finally, we found that the factors of older age (OR = 2.45, 95% CI = 1.22-4.93), overweight or obese in BMI (OR = 6.72, 95% CI = 1.90-23.78; OR = 6.76, 95% CI = 1.84-24.84), waist circumference (OR = 1.64, 95% CI = 1.03-2.61) and vegetable/fruit intake (OR = 0.61, 95% CI = 0.39-0.94) were variables that could significantly predict the hypertension condition of the subjects after controlling factors of marital status, type and level of disability. To improve the healthcare for people who suffer with and prevention for hypertension, the study highlights the health authorities should pay much attention to blood pressure condition and their determinants for people with disabilities in the communities.