Incidence Of Hypertension Research Articles

Risk factors for prevalent and incident hypertension in rheumatoid arthritis: data from the Canadian Early Arthritis Cohort.

Hypertension (HTN) is a common comorbidity in RA. This study aimed to explore the prevalence and incidence of HTN and baseline factors associated with incident HTN in early RA (ERA). Data were from the Canadian Early Arthritis Cohort (CATCH), an inception cohort of ERA patients having <1 year of disease duration. HTN was determined by patient- or physician-reported diagnosis, the use of anti-hypertensives and/or blood pressure. Multivariable logistic regression was performed to determine baseline factors associated with prevalent and incident HTN in this population. The study sample included 2052 ERA patients [mean age 55 years (s.d. 14), 71% female). The prevalence of HTN at study enrolment was 26% (23% in females and 34% in males). In both sexes, prevalent HTN was associated with older age, diabetes and hyperlipidaemia. HTN was associated with being overweight or high alcohol consumption in females. Of the RA patients who did not have HTN at enrolment, 24% (364/1518) developed HTN during the median follow-up period of 5 years (range 1-8). Baseline factors significantly associated with incident HTN were older age, being overweight, excess alcohol consumption and having hyperlipidaemia. Incident HTN was associated with high alcohol consumption in males and with hyperlipidaemia in females. RA-associated disease factors and treatments were not significantly associated with prevalent or incident HTN. Early RA patients had a high incidence of hypertension with the highest risk in older patients with traditional cardiovascular risk factors.

Relation between frailty and hypertension is partially mediated by physical activity among males and females in the Canadian Longitudinal Study on Aging.

Frailty reflects the heterogeneity in aging and may lead to the development of hypertension and heart disease, but the frailty-cardiovascular relationship and whether physical activity modifies this relationship in males and females are unclear. We tested whether higher frailty was positively associated with hypertension and heart disease in males and females and whether habitual movement mediated this relationship. The relationship between baseline frailty with follow-up hypertension and heart disease was investigated using the Canadian Longitudinal Study on Aging at 3-year follow-up data (males: n = 13,095; females: n = 13,601). Frailty at baseline was determined via a 73-item deficit-based index, activity at follow-up was determined via the Physical Activity Scale for the Elderly, and cardiovascular function was self-reported. Higher baseline frailty level was associated with a greater likelihood of hypertension and heart disease at follow-up, with covariate-adjusted odds ratios of 1.08-1.09 (all, P < 0.001) for a 0.01 increase in frailty index score. Among males and females, sitting time and strenuous physical activity were independently associated with hypertension, with these activity behaviors being partial mediators (except male-sitting time) for the frailty-hypertension relationship (explained 5-10% of relationship). The strength of this relationship was stronger among females. Only light-moderate activity partially mediated the relationship (∼6%) between frailty and heart disease in females, but no activity measure was a mediator for males. Higher frailty levels were associated with a greater incidence of hypertension and heart disease, and strategies that target increases in physical activity and reducing sitting may partially uncouple this relationship with hypertension, particularly among females.NEW & NOTEWORTHY Longitudinally, our study demonstrates that higher baseline frailty levels are associated with an increased risk of hypertension and heart disease in a large sample of Canadian males and females. Movement partially mediated this relationship, particularly among females.

Novel immune classification based on machine learning of pathological images predicts early recurrence of hepatocellular carcinoma.

Immune infiltration within the tumor microenvironment (TME) plays a significant role in the onset and progression of hepatocellular carcinoma (HCC). Machine learning applied to pathological images offers a practical means to explore the TME at the cellular level. Our former research employed a transfer learning procedure to adapt a convolutional neural network (CNN) model for cell recognition, which could recognize tumor cells, lymphocytes, and stromal cells autonomously and accurately within the images. This study introduces a novel immune classification system based on the modified CNN model. Patients with HCC from both Beijing Hospital and The Cancer Genome Atlas (TCGA) database were included in this study. Additionally, least absolute shrinkage and selection operator (LASSO) analyses, along with logistic regression, were utilized to develop a prognostic model. We proposed an immune classification based on the percentage of lymphocytes, with a threshold set at the median lymphocyte percentage. Patients were categorized into high or low infiltration subtypes based on whether their lymphocyte percentages were above or below the median, respectively. Patients with different immune infiltration subtypes exhibited varying clinical features and distinct TME characteristics. The low-infiltration subtype showed a higher incidence of hypertension and fatty liver, more advanced tumor stages, downregulated immune-related genes, and higher infiltration of immunosuppressive cells. A reliable prognostic model for predicting early recurrence of HCC based on clinical features and immune classification was established. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was 0.918 and 0.814 for the training and test sets, respectively. In conclusion, we proposed a novel immune classification system based on cell information extracted from pathological slices, provides a novel tool for prognostic evaluation in HCC.

Common carotid artery intima media thickness (CIMT) in patients with prediabetes and newly diagnosed type 2 diabetes mellitus

AimTo evaluate the relationship between common carotid artery intima media thickness (CIMT) in patients with prediabetes and new-onset diabetes mellitus without proven cardiovascular disease and some classic cardio-metabolic risk factors. Patients and methodsThe study included 461 obese patients with an average age of 53.2 ± 10.7 years, divided into three groups - group 1 without carbohydrate disturbances (n = 182), group 2 with prediabetes (n = 193) and group 3 with newly diagnosed diabetes mellitus (n = 86). ResultsThe patients with new-onset diabetes had significantly higher mean CIMT values compared to those with prediabetes or without carbohydrate disturbances and a higher frequency of abnormal IMT values. CIMT correlated significantly with age, systolic BP, diastolic BP and fasting blood glucose and showed a high predictive value for the presence of diabetic neuropathy and sudomotor dysfunction. Patients with abnormal CIMT values had a higher incidence of arterial hypertension, dyslipidemia, metabolic syndrome, peripheral neuropathy, and sudomotor dysfunction. Patients who developed type 2 diabetes during follow-up had a significantly higher initial mean CIMT, which showed the highest predictive value for the risk of new-onset diabetes, with CIMT≥0.7 mm having 53 % sensitivity and 83 % specificity for the risk of progression to diabetes mellitus. ConclusionPatients with new-onset diabetes mellitus had significantly greater intima media thickness of the common carotid artery and a greater frequency of abnormal CIMT values compared to those with normoglycemia and prediabetes. CIMT has a high predictive value for the presence of diabetic neuropathy, sudomotor dysfunction and the risk of new onset diabetes.

Associations of TSH, free T3, free T4, and conversion ratio with incident hypertension: results from the prospective Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction.

Risk factors for acute kidney injury and kidney relapse in patients with lupus podocytopathy.

Patients with lupus podocytopathy show a high incidence of acute kidney injury (AKI) and relapse, but the risk factors and mechanisms were unclear. This study analysed the clinicopathological features and risk factors for AKI and relapse in lupus podocytopathy patients. The cohort of lupus podocytopathy was generated by screening the biopsies of patients with lupus nephritis (LN) from 2002 to 2022 and was divided into the mild glomerular lesion (MGL) and focal segmental glomerulosclerosis (FSGS) groups based on glomerular morphological characteristics. The acute (ATI) and chronic (CTI) tubulointerstitial lesions were semi-quantitatively scored. Logistic and Cox regressions were employed to identify the risk factors for AKI and relapse, respectively. Among 6052 LN cases, 98 (1.6%) were diagnosed as lupus podocytopathy, with 71 in the MGL group and 27 in the FSGS group. All patients presented with nephrotic syndrome and 33 (34.7%) of them had AKI. Seventy-seven (78.6%) patients achieved complete renal response (CRR) within 12weeks of induction treatment, in which there was no difference in the CRR rate between glucocorticoid monotherapy and combination therapy with glucocorticoids plus immunosuppressants. Compared with the MGL group, patients in the FSGS group had significantly higher incidences of hypertension and haematuria; in addition, they had higher Systemic Lupus Erythematosus Disease Activity Index 2000, ATI and CTI scores but a significantly lower CRR rate. Urinary protein ≥7.0g/24h and serum C3 ≤0.750g/l were independent risk factors for AKI. During a median follow-up of 78months, 57 cases (60.0%) had relapse and none reached the kidney endpoint. Failure to achieve CRR within 12weeks, maintenance with glucocorticoid monotherapy and AKI at onset were independent risk factors for kidney relapse. In this study, histological subtypes of lupus podocytopathy were found to be associated with clinical features and treatment response. In addition, several risk factors associated with AKI occurrence and kidney relapse were identified.

Physical activity volume, frequency, and intensity: Associations with hypertension and obesity over 21 years in Australian women

BackgroundOptimal patterns of accrual of recommended levels of physical activity (PA) for prevention of hypertension and obesity are not known. The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years. Specifically, we investigated whether, for the same weekly volume of PA, the number of sessions (frequency) and vigorousness of PA (intensity) were associated with a reduction in the occurrence of hypertension and obesity in women. MethodsData from the 1973–1978 and 1946–1951 cohorts of the Australian Longitudinal Study on Women's Health were analyzed (n = 20,588; 12%–16% with a Bachelor's or higher degree). Self-reported PA, hypertension, height, and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021. Generalized Estimating Equation models with a 3-year lag model were used to investigate the association of PA volume (metabolic equivalent min/week) (none; 33–499; 500–999; ≥1000, weekly frequency (none; 1–2 times; 3–4 times; 5–7 times; ≥8 times), and the proportion of vigorous PA to total volume of PA (none; 0%; 1%–33%; 34%–66%; 67%–100%) with odds of hypertension and obesity from 2000 to 2021. ResultsThe cumulative incidence of hypertension was 6% in the 1973–1978 and 23% in the 1946–1951 cohort; 27% of women in the 1973–1978; and 15% in the 1946–1951 cohort developed obesity over the period. Overall, a higher volume of PA was associated with reduced odds of hypertension and obesity. When the volume of PA was considered, the odds of hypertension did not vary according to the frequency or intensity of PA. However, increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obesity. ConclusionPA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity. Incorporating more sessions, particularly of vigorous-intensity PA, may provide extra benefits for the prevention of obesity.

Prediction of 24-Hour Urinary Sodium Excretion Using Machine-Learning Algorithms.

Accurate quantification of sodium intake based on self-reported dietary assessments has been a persistent challenge. We aimed to apply machine-learning (ML) algorithms to predict 24-hour urinary sodium excretion from self-reported questionnaire information. We analyzed 3454 participants from the NHS (Nurses' Health Study), NHS-II (Nurses' Health Study II), and HPFS (Health Professionals Follow-Up Study), with repeated measures of 24-hour urinary sodium excretion over 1 year. We used an ensemble approach to predict averaged 24-hour urinary sodium excretion using 36 characteristics. The TOHP-I (Trial of Hypertension Prevention I) was used for the external validation. The final ML algorithms were applied to 167 920 nonhypertensive adults with 30-year follow-up to estimate confounder-adjusted hazard ratio (HR) of incident hypertension for predicted sodium. Averaged 24-hour urinary sodium excretion was better predicted and calibrated with ML compared with the food frequency questionnaire (Spearman correlation coefficient, 0.51 [95% CI, 0.49-0.54] with ML; 0.19 [95% CI, 0.16-0.23] with the food frequency questionnaire; 0.46 [95% CI, 0.42-0.50] in the TOHP-I). However, the prediction heavily depended on body size, and the prediction of energy-adjusted 24-hour sodium excretion was modestly better using ML. ML-predicted sodium was modestly more strongly associated than food frequency questionnaire-based sodium in the NHS-II (HR comparing Q5 versus Q1, 1.48 [95% CI, 1.40-1.56] with ML; 1.04 [95% CI, 0.99-1.08] with the food frequency questionnaire), but no material differences were observed in the NHS or HPFS. The present ML algorithm improved prediction of participants' absolute 24-hour urinary sodium excretion. The present algorithms may be a generalizable approach for predicting absolute sodium intake but do not substantially reduce the bias stemming from measurement error in disease associations.

Endogenous estrogen exposure and hypertension risk; a population-based cohort study with about two decades of follow-up.

The impact of endogenous estrogen exposure (EEE) on hypertension (HTN) incidence has not been investigated yet. This study aimed to evaluate HTN incidence in women with different endogenous estrogen durations. Information was gathered from the Tehran Lipid and Glucose Study (TLGS) to conduct current research. At the initiation of the study, 4463 post-menarche normotensive women, including 3599 premenopausal and 864 menopausal women, were included. EEE was calculated for each woman, and they were followed up for the HTN event. According to the EEE, the hazard ratios and 95% confidence intervals (CI) for the HTN event were presented using Cox proportional hazards regression models (unadjusted and adjusted). The median (interquartile range) of follow-up (between menarche and the date of HTN incidence or last follow-up) was 33.2(25.1, 42.3) years. The event of menopause occurred in 31.8% of participants. The unadjusted model's findings illustrated that the EEE z-score was inversely associated with HTN incidence in post-menarcheal women [unadjusted hazard ratio (HR) 0.47, 95% CI 0.44, 0.50], meaning that the risk of HTN decreased by 53% for every 1-SD rise in the EEE z-score. After adjusting for potential confounders, the results showed no statistically significant changes (adjusted HR 0.46, 95% CI 0.43-0.49). In participants with prehypertension at baseline, the hazard of HTN decreased by 56% per 1-SD rise in the EEE z-score. This longitudinal study demonstrated the protective effect of a longer EEE duration on HTN risk, even among those with prehypertension status.

Comparing clinical profiles, in-hospital complications and one-year cerebrovascular events in typical and midventricular TTS-results from a retrospective study between two third-level centers

Abstract Funding Acknowledgements None. Background Apical ballooning is considered the typical form of Takotsubo syndrome (TTS) and occurs in about 75-80% of cases. Midventricular (MV) is the most frequent atypical variant and represents about 15% of TTS. Clinical and analytical characteristics, early complications and the risk of cerebrovascular events (CVEs) between these two specific groups are poorly studied. Purpose of the study To investigate the clinical profile, laboratory variables, in-hospital complications and one-year CVEs between typical and MV variants of TTS. Methods we retrospectively examined the patients admitted to two third-level hospitals with a diagnosis of TTS. A total of 248 TTS met InterTAK diagnostic criteria. Clinical features, myocardial enzymes, echocardiographic variables, early complications and one-year CVEs were assessed. Results Of 248 patients diagnosed with TTS, a total of 205 (83%) patients presented with typical and 43 (17%) with MV variant of TTS. Patients with MV form were younger (age mean ± SD 68 ± 12 vs 74 ± 11 years, p value = 0.002) and had a lower incidence of hypertension (46% vs 73%; p value &amp;lt; 0.001) than those with apical variant. On admission, patients with MV form presented a lower degree of left ventricular dysfunction (EF mean ± SD, 44 ± 9% vs 41 ± 9%, p value = 0.018) and a tendence not to present left ventricular outflow tract obstruction (LVOTO) (0 vs 9%, p value = 0.049). Lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels on admission (median [IQR], 881 [99 – 3049] pg/mL vs 3466 [677 - 9067] pg/mL, p value &amp;lt;0.001) and at peak (3150 [947- 4437] pg/mL vs 4622 [1886 - 13163] pg/mL, p value = 0.005) were observed in MV group compared to the typical form. In-hospital cardiovascular (CV) complications were frequently observed (46% in the overall population) and appeared to be more frequent in the typical variant (51% vs 33%, p value= 0.035); in particular, we reported a higher prevalence of AF (16% vs 2%, p value = 0.022). The number of CS and VT cases is remarkable in both the subgroups (13% vs 7%; 5% vs 2%), with a higher prevalence in the typical form, even if not reaching a statistically significant difference between the two groups (p= 0.437; p= 0.695). No significant differences were observed in LV thrombosis, and in on admission and one-year CVEs between the two groups, although with a higher prevalence in the typical variant (respectively 3 vs 0, 10 vs 1 and 5 vs 0). Conclusions MV TTS presents some differences in clinical characteristics, analytical values and echocardiographic parameters compared to the typical variant. In-hospital CV complications are remarkable, and more frequently observed in typical variant, although not reaching a statistically significant difference in CS and VT. Similarly, more CVE were observed in the typical TTS group, although in the absence of a statistical significance. The importance of close monitoring in the acute phase is confirmed for both variants under study.

Geographical Disparities in Hypertension Incidence Rate in Iran 2004-2016: Bayesian Spatial Analysis

Introduction: Cardiovascular diseases such as coronary heart disease, heart failure, arrhythmia, and cardiomyopathy all include hypertension as a key risk factor. Research has shown that the early detection and treatment of hypertension and its risk factors, as well as public health policies to reduce behavioral risk factors, have led to a gradual reduction in mortality caused by heart disease and stroke in high-income countries in the past three decades. Trends in hypertension incidence have been monitored at the national level in Iran. The aim of this study examine province-level disparities in Hypertension incidence from 2004 to 2016. Methods: Use the Non-Communicable Diseases Risk-Factors Surveillance in the Islamic Republic of Iran STEPs registry data. to estimate the incidence rate of hypertension for all provinces in 2004, 2006-2009, 2011, and 2016 using a Bayesian spatial model with Markov chain Monte Carlo algorithm in OpenBUGS version 3.2.3 and R version 4.2.2. Results: The estimated Hypertension incidence rate in total increased from 19.87 per 1000 people (95% credible interval 14.28, 25.48) in 2004 to 193.02 (171.92, 220.48) in 2016. According to the estimates of 2016, we found that the provinces of Markazi, Ardabil, and Semnan had the highest rate of hypertension, and the provinces of Hormozgan, and Sistan-Baluchistan had the lowest rate. Our findings show that Khorasan, North, Alborz, and Semnan have the most significant percentage change in incidence rate from 2004-2016. Conclusion: To reduce the prevalence of hypertension in Iranian regions, it is crucial to develop regular hypertension screening programs, especially among the elderly

CLINICAL RELEVANCE OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN ACUTE MYOCARDIAL INFARCTION PATIENTS

Objectives: Poor cardiovascular outcomes have been linked to high-sensitivity C-reaction protein (hs-CRP), a biomarker of residual inflammatory risk. Whether or not a patient has diabetes mellitus, evaluate the relationship among hs-CRP levels estimated at hospital admission and in-hospital consequences and death. Methods: This prospective cohort study included 100 acute myocardial infarction (AMI) patients with both non-ST elevation myocardial infarction (STEMI) and STEMI who were admitted to the cardiac care critical care unit intensive therapy unit. Results: Diabetics had a considerably higher incidence of hypertension (p=0.001) and dyslipidemia (p=0.001) compared to non-diabetics. Diabetics exhibited a significantly higher mean hs-CRP level (6.76±1.12 vs. 3.65±0.98 mg/dL; p=0.01) than non-diabetics. Meanwhile, compared to non-diabetics, diabetics utilized significantly more aspirin (p=0.001), beta-blockers (p=0.001), angiotensin receptor blockers (ARBs) (p=0.01), and statins (p=0.001). Furthermore, compared to those with hs-CRP &lt;3 mg/L, those with hs-CRP ≥3 mg/dL had a significantly higher incidence of dyslipidemia (p=0.001) and hypertension (p=0.001). Conclusion: The results of the current study demonstrated that hs-CRP upon admission is a valid predictor of hospital morbidity and death in patients with AMI who are diabetic or non-diabetic. Individuals with diabetes showed greater CRP levels than non-diabetic AMI patients did.

Correlation Between Knowledge and Attitude with Practice Toward Hypertension in The Community of Sidikalang District in Dairi Regency

Background: Hypertension contributes to 71% of deaths in the world and 85% of them are found in developing countries. In Indonesia, it is reported that 91.3 million people suffer from hypertension which contributes to 35% of deaths of the population in Indonesia. The high incidence of hypertension is known to be closely related to a lack of knowledge and attitudes toward hypertension. Therefore, it is necessary to know the relationship between knowledge, attitudes and prac, tices toward hypertension. Method: This study used a cross-sectional research design. The sample in this study was the people of Sidikalang District who met the inclusion and exclusion criteria. The data used is primary data obtained using a questionnaire instrument and using the consecutive method. Results. Test results Chi-Square showed that there was no relationship between age (p&gt;0.05), gender (p&gt;0.05), and education (p&gt;0.0.5) on knowledge and attitudes towards hypertension. Age (p=0.304) and education (p=0.150) showed there was no relationship with practice toward hypertension, and gender (and p=0.032) showed there was a relationship with practice toward hypertension. The level of knowledge (p=0.005) and attitude (p=0.000) show that there is a relationship with practice toward hypertension. Conclusion: There is a relationship between knowledge and attitude with practice toward hypertension in the Sidikalang District community.

Association between the triglyceride-glucose index and subclinical left ventricular systolic dysfunction in obese patients

BackgroundThe association between the triglyceride–glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients.MethodsA total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index.ResultsObese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031).ConclusionsWe concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.

Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension

Hypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment. To determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension. This was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded. Incident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension. The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression. A total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls. Children diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.

Screening for Hypertension in adolescents living with HIV: Protocol for a cluster randomized trial to improve guideline adherence.

Although AIDS-related deaths have reduced with increased access to antiretroviral care, cardiovascular disease-related morbidities among persons living with HIV are rising. Contributing to this is the higher incidence of Hypertension among Persons Living with HIV. The duration of exposure to the virus and antiretroviral drugs plays a vital role in the pathogenesis, putting perinatally infected children and adolescents at higher risk than behaviorally-infected ones, supporting the calls for increased surveillance of Hypertension among them. Despite the availability of guidelines to support this surveillance, the blood pressure (BP) of adolescents living with HIV (ADLHIV) is not checked during clinical visits. This study aims to assess the effect of a theory-based intervention on healthcare workers' adherence to the guidelines for hypertension screening among adolescents. A multi-facility cluster-randomized study will be conducted. The clusters will be 20 antiretroviral therapy sites in the Greater Accra Region of Ghana with the highest adolescent caseload. Data will be extracted from the folders of adolescents (10-17 years) who received care in these facilities six months before the study. The ART staff of intervention facilities will receive a multicomponent theory of planned behaviour-based intervention. This will include orientation on hypertension risk among ADLHIV, provision of job aids and pediatric sphygmomanometers. Six months after the intervention, the outcome measure will be the change from baseline in the proportion of ADLHIV whose BP was checked during clinical visits. The calculated sample size is 400 folders. This study will generate evidence on the effectiveness of a multicomponent theory-based intervention for improving the implementation of clinical practice guidelines. PACTR202205641023383.

Relationship between socioeconomic status and hypertension incidence among adults in southwest China: a population-based cohort study

PurposeTo investigate the correlation between socioeconomic status (SES) and the incidence of hypertension among adults aged 18 or above in southwest China.MethodsA multistage proportional stratified cluster sampling method was employed to recruited 9280 adult residents from 12 counties in southwest China, with all participants in the cohort tracked from 2016 to 2020. The questionnaire survey gathered information on demographics, lifestyle habits, and household income. The physical exam recorded height, weight, and blood pressure. Biochemical tests measured cholesterol levels. The chi-square test was employed to assess the statistical differences among categorical variables, while the Cox proportional hazards regression model was applied to evaluate the association between socioeconomic status (SES) and the incidence of hypertension.ResultsThe finally effective sample size for the cohort study was 3546 participants, after excluding 5734 people who met the exclusion criteria. Adults in the highest household income group had a significantly lower risk of hypertension compared to those in the lowest income group (HR = 0.636, 95% CI: 0.478–0.845). Besides, when compared to individuals in the illiterate population, the risk of hypertension among adults with elementary school, junior high school, senior high school and associate degree educational level decreased respectively by 34.4% (HR = 0.656, 95%CI: 0.533–0.807), 44.9% (HR = 0.551, 95%CI: 0.436–0.697), 44.9% (HR = 0.551, 95%CI: 0.405–0.750), 46.1% (HR = 0.539, 95%CI: 0. 340–0.854). After conducting a thorough analysis of socioeconomic status, compared with individuals with a score of 6 or less, the risk of hypertension in participants with scores of 8, 10, 11, 12, and greater than 12 decreased respectively by 23.9% (HR = 0.761, 95%CI: 0.598–0.969), 29.7% (HR = 0.703, 95%CI: 0.538–0.919), 34.0% (HR = 0.660, 95%CI: 0.492–0.885), 34.3% (HR = 0.657, 95%CI: 0.447–0.967), 43.9% (HR = 0.561, 95%CI: 0.409–0.769).ConclusionThe findings indicate a negative correlation between socioeconomic status and hypertension incidence among adults in southwest China, suggesting that individuals with higher socioeconomic status are less likely to develop hypertension.

FREQUENCY OF EARLY STENT THROMBOSIS (ACUTE AND SUBACUTE) IN PATIENTS PRESENTING WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION (STEMI) UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION (PCI)

Sudden cardiac stent thrombosis (ST) is a severe clinical risk that can lead to high fatality rates. However, data are scarce on the prevalence of early ST events following ‘primary percutaneous coronary intervention’ (pPCI) and the characteristics that predict it, particularly among Pakistani patients. Objective: The objective is to determine possible indicators and evaluate ‘the frequency of acute and sub-acute stent thrombosis’ (ST) after ‘primary percutaneous coronary intervention’ (PCI). Methods: Five hundred individuals who had undergone primary PCI were enrolled from July 2022 to December 2023. Telephone follow-up assessments were used to gather information on 30-day results, including death rates, recurrence of symptoms, and episodes of ST. ‘ST was classified as acute’ (occurring ‘during the procedure’) or ‘sub-acute’ (‘occurring within 30 days post-procedure) using standardised criteria established by the ‘Academic Research Consortium. Results: In this study, 500 patients were enrolled, primarily male (80.4%, 362 patients). ‘Stent thrombosis’ (either acute or sub-acute) was observed in 6.8% of patients, with 10.1% (4) classified as definite ST and the remaining 91.9% (34) as probable ST. Male patients were more prevalent among those who developed ST, along with a higher incidence of hypertension, diabetes, reduced left ventricular ejection fraction (LVEF) pre-PCI, and higher Killip Class. Patients with ST experienced a higher in-hospital mortality rate compared to those without ST, with a p-value of 0.02. Notably, ‘Killip Class’ (‘III-IV’) emerged as ‘an independent ST predictor in this patient cohort. These findings underscore the importance of risk assessment and vigilant management, particularly in patients presenting with higher Killip Class and other associated risk factors, to mitigate ST occurrence and adverse outcomes following primary PCI. Conclusion: Early stent thrombosis (ST) appears relatively common in patients undergoing primary PCI. Those with diabetes and hypertension face an elevated risk of ST, while patients presenting in ‘Killip Class III-IV’ demonstrate an ‘independent predictive’ factor for early ST.

ASSOCIATION OF HYSTERECTOMY WITH HYPERTENSION INCIDENCE IN KOREAN WOMEN: A NATIONWIDE COHORT STUDY

Objective: Although several observational studies have reported a higher risk of cardiovascular events in women who underwent hysterectomy, the underlying mechanism is unclear, and limited data exist regarding the effect of hysterectomy on the incidence of hypertension. We sought to evaluate the association between hysterectomy and the development of hypertension in Korean women aged 40–59 years. Design and method: In this Korean nationwide cohort study, 803,255 women aged 40-59 years were selected for analysis from January 1, 2002, to December 31, 2011. In total, 13,650 pairs were included in the hysterectomy and non-hysterectomy groups after 1:1 propensity score matching for age at 5-year intervals, year of inclusion, socioeconomic status, body mass index, residential region, Charlson comorbidity index, menarcheal age, menopause, diabetes, dyslipidemia, physical activity, smoking history, alcohol consumption, menopausal hormone therapy before inclusion, adnexal surgery history, uterine leiomyoma, and endometriosis. The primary outcome was the development of hypertension during follow-up. The participants were followed-up until December 31, 2020. Data analysis was performed from July 16, 2022 to January 07, 2023. Results: During median follow-up periods (10.6 years [IQR 9.2-12.6]; 10.9 years [IQR 9.2-12.7]), the incidence of hypertension was 22/1,000 person-years and 20/1,000 person-years for the hysterectomy and non-hysterectomy groups, respectively. The hysterectomy group had a significantly higher rate of development of hypertension than that of the non-hysterectomy group (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17). The risk was prominent in women whose hemoglobin level increased by &gt;2g/dL post-hysterectomy. In women who had an adnexa-sparing hysterectomy, the incidence of hypertension was higher (HR, 1.15; 95% CI 1.08-1.23, P &lt;0.001) than that in the non-hysterectomy group. Conclusions: In this nationwide cohort study of Korean women revealed that hysterectomy was independently associated with an increased risk of hypertension among women aged 40 to 59. In particular, this risk elevation was prominent when the hemoglobin level increased by &gt;2g/dL after hysterectomy, suggesting that hemorheologic changes following hysterectomy may have an impact on the occurrence of hypertension.

Application of artificial intelligence in hypertension.

Hypertension is an important modifiable risk factor for morbidity and mortality associated with cardiovascular disease. The incidence of hypertension is increasing not only in Korea but also in many Western countries due to the aging of the population and the increase in unhealthy lifestyles. However, hypertension control rates remain low due to poor adherence to antihypertensive medications, low awareness of hypertension, and numerous factors that contribute to hypertension, including diet, environment, lifestyle, obesity, and genetics. Because artificial intelligence (AI) involves data-driven algorithms, AI is an asset to understanding chronic diseases that are influenced by multiple factors, such as hypertension. Although several hypertension studies using AI have been published recently, most are exploratory descriptive studies that are often difficult for clinicians to understand and have little clinical relevance. This review aims to provide a clinician-centered perspective on AI by showing recent studies on the relevance of AI for patients with hypertension. The review is organized into sections on blood pressure measurement and hypertension diagnosis, prognosis, and management.