Hypertension Odds Ratio Research Articles

The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007–2018)

Aim To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management. Methods Data from six NHANES cycles (2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship. Results This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52–0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29–1.98), Q3 (1.99–3.08), and Q4 (3.09–5.56) levels compared to Q1 (0.18–1.28) were 1.41 (95% CI: 0.60–3.33), 0.48(95% CI: 0.20–1.16), and 0.35 (95% CI: 0.16–0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009). Conclusion Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.

The Impact of High BMI on Pregnancy Outcomes and Complications in Women with PCOS Undergoing IVF-A Systematic Review and Meta-Analysis.

(1) Background: Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse pregnancy outcomes. The objective of this systematic review was to clarify the role of a PCOS-related high body mass index (BMI) in these unfavourable pregnancy outcomes. (2) Methods: A comprehensive search of electronic databases was conducted to identify studies investigating the impact of high BMI on pregnancy outcomes in women with PCOS undergoing IVF. RevMan software (v5.4) was used to calculate the odds ratio (OR) and 95% confidence interval (CI). (3) Results: Nineteen eligible studies (n = 7680) were identified, including 16 retrospective cohort studies (n = 6934), two prospective cohort studies (n = 525), and one cross-sectional study (n = 221). Pooled analysis showed significantly higher odds of clinical pregnancy (OR, 1.16 [95% CI, 1.04-1.29]; z = 2.73; p = 0.006; I2 = 30%) and livebirths (OR, 1.88 [95% CI, 1.56-2.27]; z = 6.54; p < 0.0001; I2 = 55%) in women with PCOS with a normal versus a high BMI. Meta-analysis showed significantly increased odds of miscarriages in women with PCOS with a high versus a normal BMI (OR, 0.76 [95% CI, 0.60-0.95]; z = 2.42; p = 0.02; I2 = 53%). Pooled analysis of three studies (n = 993) showed significantly higher ORs of gestational diabetes mellitus (OR 3.96 [95% CI 1.62-9.68]; z = 3.01; p = 0.003; I2 = 58%) and gestational hypertension (OR 2.16 [95% CI 1.32-3.54]; z = 3.05; p = 0.002; I2 = 68%) in women with PCOS with a high versus a normal BMI. Meta-analysis of three studies reported significantly greater odds of a caesarean section for women with PCOS with a high versus a normal BMI (OR 0.45 [95% CI 0.29-0.69]; z = 3.66; p = 0.0003; I2 = 0%). (4) Conclusions: The increased likelihood of adverse pregnancy outcomes observed in women with PCOS undergoing IVF seems to be attributable to a PCOS-related high BMI.

Associations between patterns of blood heavy metal exposure and health outcomes: insights from NHANES 2011–2016

BackgroundExtensive research has explored the association between heavy metal exposure and various health outcomes, including malignant neoplasms, hypertension, diabetes, and heart diseases. This study aimed to investigate the relationship between patterns of exposure to a mixture of seven heavy metals and these health outcomes.MethodsBlood samples from 7,236 adults in the NHANES 2011–2016 studies were analyzed for levels of cadmium, manganese, lead, mercury, selenium, copper, and zinc. Cluster analysis and logistic regression identified three distinct patterns of mixed heavy metal exposure, and their associations with health outcomes were evaluated.ResultsPattern 1 exhibited higher odds ratios (ORs) for malignancy during NHANES 2011–2012 (OR = 1.33) and 2015–2016 (OR = 1.29) compared to pattern 2. Pattern 3 showed a lower OR for malignancy during NHANES 2013–2014 (OR = 0.62). For hypertension, pattern 1 displayed higher ORs than pattern 2 for NHANES 2011–2012 (OR = 1.26), 2013–2014 (OR = 1.31), and 2015–2016 (OR = 1.41). Pattern 3 had lower ORs for hypertension during NHANES 2013–2014 (OR = 0.72) and 2015–2016 (OR = 0.67). In terms of heart diseases, pattern 1 exhibited higher ORs than pattern 2 for NHANES 2011–2012 (OR = 1.34), 2013–2014 (OR = 1.76), and 2015–2016 (OR = 1.68). Pattern 3 had lower ORs for heart diseases during NHANES 2013–2014 (OR = 0.59) and 2015–2016 (OR = 0.52). However, no significant trend was observed for diabetes. All three patterns showed the strongest association with hypertension among the health outcomes studied.ConclusionsThe identified patterns of seven-metal mixtures in NHANES 2011–2016 were robust. Pattern 1 exhibited higher correlations with hypertension, heart disease, and malignancy compared to pattern 2, suggesting an interaction between these metals. Particularly, the identified patterns could offer valuable insights into the management of hypertension in healthy populations.

The relationship between fermented and nonfermented dairy products consumption and hypertension among premature coronary artery disease patients: Iran premature coronary artery disease study.

Dairy products may affect hypertension (HTN) risk. The aim of this study was to examine the association between fermented and nonfermented dairy foods and HTN in a sample of premature coronary artery disease (PCAD) subjects. This cross-sectional study was performed on 1854 PCAD patients. A 110-item food frequency questionnaire was used to assess dietary intakes. HTN was considered if systolic blood pressure was 140 mmHg and higher and/or diastolic blood pressure was 90 mmHg and higher. The odds ratio of HTN across the quartiles of different types of dairy products was evaluated by binary logistic regression. The mean (SD) of dairy products consumption was 339.8 (223.5) g/day, of which 285.4 g/day was fermented dairy products. In the crude model, participants in the fourth quartile of fermented dairy products had lesser risk of HTN compared to the bottom quartile (OR = 0.70, 95% CI: 0.52, 0.96; p for trend = .058). However, after considering the possible confounders, the significance disappeared. Subjects in the top quartile of high-fat fermented dairy products had 34% lower risk for HTN compared to the bottom quartile (95% CI: 0.49, 0.88; p for trend < .001). Adjustment for potential risk factors weakened the association but remained significant (OR = 0.73, 95% CI: 0.53, 1.01; p for trend = .001). Nonsignificant relation was detected between low-fat fermented, low-fat nonfermented, and high-fat nonfermented dairy products and HTN. Moderate consumption of high-fat fermented dairy products, in a population with low consumption of dairy foods, might relate to reduced likelihood of HTN.

Cardiometabolic diseases according to the type and degree of hearing loss in noise-exposed workers.

This study aimed to determine the association between cardiometabolic diseases, including metabolic syndrome, hypertension, and diabetes, and the type and degree of hearing loss in noise-exposed workers. A total of 237,028 workers underwent air conduction pure tone audiometry in 2015 to assess their health and diagnose cardiometabolic diseases. The study defined metabolic syndrome, hypertension, and diabetes using blood pressure, fasting blood sugar, cholesterol, and triglyceride levels. Mid-frequency hearing loss was defined as ≥ 30 dB at 2,000 Hz, whereas high-frequency hearing loss was ≥ 40 dB at 4,000 Hz. The average air conduction hearing thresholds at these frequencies were used to determine hearing loss degrees. The odds ratio (OR) of combined exposure to noise and night-shift work in all cardiometabolic diseases was higher than that of noise exposure alone. The risk of cardiometabolic diseases was dose-response, with higher hearing loss causing higher ORs. The ORs of hypertension compared with the normal group were 1.147 (1.098-1.198), 1.196 (1.127-1.270), and 1.212 (1.124-1.306), and those of diabetes were 1.177 (1.119-1.239), 1.234 (1.154-1.319), and 1.346 (1.241-1.459) for mild, moderate, and moderate-severe hearing loss, respectively. Workers who are exposed to noise tend to demonstrate high risks of hearing loss and cardiometabolic diseases; thus, bio-monitoring of cardiometabolic diseases, as well as auditory observation, is necessary.

Impact of patient characteristics on heart failure and cardiomyopathy onset related to pregnancy from 1997 to 2019. Swedish nationwide register-based study

Abstract Background The aetiology of heart failure (HF) in young patients is heterogenic. Cardiomyopathies are common causes in young patients, that often unmask in situations of higher physical demands, as pregnancy or delivery, presenting with HF signs and symptoms. Peripartum cardiomyopathy (PPCM) is one form associated with delivery. However, even other, such as dilated or hypertrophic cardiomyopathy may present during pregnancy. Despite major advances in care, there is still a lack of knowledge about factors that trigger heart failure onset during pregnancy and delivery. Aim To evaluate the association of baseline characteristics for HF and cardiomyopathy (CM) onset related to delivery, and investigate incidence rate for HF and cardiomyopathies related to delivery over time. Method All women 18 to 50 years registered in the National Patient Register (NPR) from 1st January 1997 to 31st December 2019 were included. Time of delivery was obtained from the Swedish Medical Birth Register (MBR), time of death from the Cause of Death Register. Women with HF, CM and peripartum cardiomyopathy (PPCM) were identified from the NPR with international classification codes for disease ICD-10: I50, I42, I43 and 090.3, used for the first time 90 days prior or 180 days after delivery, and other comorbidities. Patients were compared with five controls without HF or CM from the Total Population Register matched by age, year of delivery, and county. Linear regression was used to test trend changes in use of ICD codes. The impact of baseline characteristics for onset av HF, CM and PPCM in patient compared to controls is presented as odds ratio (OR). Body mass index (BMI) was registered at the beginning of pregnancy. Results Between 1997 and 2019 we identified 2 347 723 deliveries, and 694 women with HF, CM or PPCM, median age 33 (29; 37) years and 3 465 controls. Out of those 493 (71%) had HF, 201 (29%) had any CM and 195 (28.1%) had PPCM. Over time the incidence rate of all conditions increased significantly, se Figure 1. Median BMI at the start of pregnancy increased significantly over time in patients with HF from 22 (20;28) to 27 (23;32), beta 0.1323 (p = 0.0216). Compared to controls patients with congenital heart disease OR at 18.32 (10.04-33.41), valve disease OR at 22.65 (8.55-60.03), arrythmia OR at 7.45 (4.06-13.67), hypertension OR at 7.89 (4.26-14.63), diabetes mellitus type II OR at 8.07 (2.63-24.74) and gestational diabetes OR at 3.93 (2.54-6.07) (all p&amp;lt;0.001) to for HF, CM or PPCM onset related to delivery, also BMI &amp;gt;22,5 at the beginning of pregnancy, lower education level and income, se Figure 2. Conclusion Over 22 years we observed a significant increase in the incidence rate of HF and CM related to delivery. BMI already &amp;gt;22,5 was associated with higher risk for HF or any CM onset in relation to delivery.

Association of TyG index with prehypertension or hypertension: a retrospective study in Japanese normoglycemia subjects.

The objective of our study was to investigate the potential association between the triglyceride and glucose (TyG) index and the occurrence of prehypertension or hypertension in a cohort of normoglycemic Japanese subjects. The NAGALA physical examination program was conducted in 1994 at Murakami Memorial Hospital in Gifu City, Japan. For our retrospective study, we selected 15,450 participants who had taken part in this program. Our aim was to explore the potential link between the TyG index, a surrogate marker for insulin resistance, and the presence of prehypertension (pre-HTN) or hypertension (HTN). Our analysis included adjustments for clinical demographic attributes and serum biomarkers. Logistic regression was employed to assess the relationship between the TyG index and the likelihood of pre-HTN or HTN. A total of 15,450 study subjects were included in our analysis. Notably, the prevalence of both pre-HTN and HTN displayed an ascending trend with increasing quartiles of the TyG index. In our comprehensive multivariable logistic regression analysis, when evaluating TyG as a continuous variable, the adjusted odds ratio (OR) for pre-HTN was OR 1.31 [95% CI 1.11-1.56], while for HTN, it was OR 1.76 [95% CI 1.24-2.5] within the fully adjusted model (model 3). When TyG was stratified into quartiles within model 3, the adjusted ORs for pre-HTN were OR 1.16 [95% CI 1.02-1.31], OR 1.22 [95% CI 1.06-1.41], and OR 1.31 [95% CI 1.08-1.59], respectively, using quartile 1 as the reference. The adjusted ORs for HTN in quartiles 2, 3, and 4 were OR 1.22 [95% CI 0.89-1.66], OR 1.4 [95% CI 1.02-1.91], and OR 1.48 [95% CI 1.02-2.15], respectively, within the same model and analysis, with quartile 1 as the reference. Subgroup analysis indicated that the TyG index exhibited a significant positive correlation with the risk of hypertension or prehypertension, except in the subgroup aged ≥65 years. Our study highlights a robust correlation between the TyG index and the likelihood of pre-HTN or HTN in normoglycemic Japanese subjects. This underscores the potential clinical relevance of the TyG index in refining early hypertension management strategies. Nonetheless, the validation of these findings necessitates larger studies with extended follow-up periods.

White blood cell and platelet distribution widths are associated with hypertension: data mining approaches.

In this paper, we are going to investigate the association between Hypertension (HTN) and routine hematologic indices in a cohort of Iranian adults. The data were obtained from a total population of 9704 who were aged 35-65 years, a prospective study was designed. The association between hematologic factors and HTN was assessed using logistic regression (LR) analysis and a decision tree (DT) algorithm. A total of 9704 complete datasets were analyzed in this cohort study (N = 3070 with HTN [female 62.47% and male 37.52%], N = 6634 without HTN [female 58.90% and male 41.09%]). Several variables were significantly different between the two groups, including age, smoking status, BMI, diabetes millitus, high sensitivity C-reactive protein (hs-CRP), uric acid, FBS, total cholesterol, HGB, LYM, WBC, PDW, RDW, RBC, sex, PLT, MCV, SBP, DBP, BUN, and HCT (P < 0.05). For unit odds ratio (OR) interpretation, females are more likely to have HTN (OR = 1.837, 95% CI = (1.620, 2.081)). Among the analyzed variables, age and WBC had the most significant associations with HTN OR = 1.087, 95% CI = (1.081, 1.094) and OR = 1.096, 95% CI = (1.061, 1.133), respectively (P-value < 0.05). In the DT model, age, followed by WBC, sex, and PDW, has the most significant impact on the HTN risk. Ninety-eight percent of patients had HTN in the subgroup with older age (≥58), high PDW (≥17.3), and low RDW (<46). Finally, we found that elevated WBC and PDW are the most associated factor with the severity of HTN in the Mashhad general population as well as female gender and older age.

Determinants of lipid-lowering medication prescribing in a multi-ethnic adult population diagnosed with familial hypercholesterolaemia in South London.

Familial hypercholesterolaemia (FH) (prevalence 1 in 250) is an inherited condition that significantly increases risk of premature cardiovascular disease. Early diagnosis can potentially normalise cardiovascular risk with lipid-lowering medicines (statins and fibrates). Only 7% of patients with FH are identified in the UK. Improving identification, and understanding disparities in ascertainment and management, is an NHS priority. To assess determinants of lipid-lowering prescribing in ethnically diverse adults with an FH code. METHOD: Retrospective cross-sectional analysis of Lambeth DataNet, containing anonymised adult patient data from 41 practices in South London. Stata 17 was used to run sequential multilevel logistic regression models, adjusted for practice effects, to estimate the odds of no lipid-lowering prescription in FH-coded adults; this was assessed across 10 ethnic groups and other patient-level factors: demographic, socioeconomic, lifestyle, comorbidities, and practice factors (consultation frequency and practice list size). One hundred and sixty-one of 801 (20%) of adults with an FH code received no lipid-lowering medication. The fully adjusted model for no lipid-lowering prescriptions showed the following associations: age (years) odds ratio (OR) 0.93 (P<0.001, 95% confidence interval [CI] = 0.91 to 0.95), male sex OR 0.47 (P = 0.002, 95% CI = 0.29 to 0.76), diabetes OR 0.26 (P = 0.04, 95% CI = 0.70 to 0.96), hypertension OR 0.30 (P<0.01, 95% CI = 0.12 to 0.72), and frequency of GP attendance OR 0.48 (P = 0.03, 95% CI = 0.24 to 0.94). Sensitivity analyses examining determinants of high-intensity statin prescribing found similar results. The study suggests important determinants of lipid-lowering prescribing in an ethnically diverse adult population included older age, male sex, hypertension, and diabetes. Ethnicity showed no significant associations with lipid-lowering prescribing after adjusting for other determinants including deprivation measures.

Impact of healthy lifestyles on risk of hypertension in the Chinese population: finding from SHUN-CVD study.

Lifestyle factors are known to play a role in the development of hypertension. We aimed to study the relationship between lifestyle and hypertension in a Chinese population. This study involved 3,329 participants (1,463 men and 1,866 women) aged 18-96 years in the Shenzhen-Hong Kong United Network on Cardiovascular Disease. A healthy lifestyle score was derived from 5 factors: no smoking, no alcohol consumption, active physical activity, normal body mass index, and a healthy diet. Multiple logistic regression was used to investigate the relationship between lifestyle score and hypertension. The influence of each lifestyle component on hypertension was also assessed. In the overall population, 950 (28.5%) participants had hypertension. The risk of hypertension decreased with increasing healthy lifestyle scores. Compared with participants with the lowest score (score: 0), the multivariable odds ratios (ORs) and corresponding 95% confidence intervals for participants with scores 3, 4, and 5 were 0.65 (0.41-1.01), 0.62 (0.40-0.97), and 0.37 (0.22-0.61), respectively (P for trend <0.001). After adjusting for age, sex, and diabetes, the score was associated with hypertension risk (P for trend = 0.005). Compared with a lifestyle score of 0, the adjusted OR for hypertension for participants with a score of 5 was 0.46 (0.26-0.80). The risk of hypertension is inversely related to the healthy lifestyle score. This reinforces the need to address lifestyle to reduce the risk of hypertension.

Effects of Overweight and Obesity on Hypertension in Adolescents: A Meta-Analysis

Background: Hypertension is currently starting to show a trend in prevalence that continues to increase at a younger age and is a major cause of premature death in the world. In adolescents, hypertension is more common who are overweight or obese. This study aims to examine the effect of overweight and obesity on the incidence of hypertension in adolescents using a meta-analysis.Subjects and Method: Meta-analysis was carried out using the PRISMA flow chart and the PICO model. Population: adolescents aged 10 to 19 years. Intervention: overweight and obesity. Comparison: normoweight. Outcome: hypertension). The databases used are PubMed, Science Direct, Springer Link, and Google Scholar with the keywords (hypertension OR "High Blood Pressure") AND "BMI Status" AND (adolescent OR teenager) AND "cross sectional". There were 9 cross-sectional studies published in 2012-2022 with odds ratio (OR) effect size that met the inclusion criteria. Analysis was performed with RevMan 5.3.Results: A meta-analysis was conducted on 9 articles with a cross-sectional study design originating from China, South Korea, India, Turkey, Tunisia, Lithuania and Poland involving 63,239 adolescents aged 10-19 years. The results of the meta-analysis showed that overweight adolescents were 2.44 times more likely to experience hypertension compared to normal weight adolescents (aOR= 2.44; 95%CI= 1.87 to 3.19; p&lt;0.001), and obese adolescents were more likely to experience hypertension 4.53 times compared with normal weight adolescents (aOR= 4.53; 95% CI= 3.10 to 6.61; p&lt;0.001).Conclusion: Being overweight and obese can increase the risk of developing hypertension in adolescents. Keywords: overweight, obesity, hypertension, adolescents, meta-analysis Correspondence: Nurussyifa Afiana Zaen. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: nurussyifaaz20@gmail.com. Mobile: +6287723131415.

The relationship between physical activity and diabetes in middle-aged and elderly people.

To investigate the association between diabetes symptoms and physical activity (PA) levels among middle-aged and older Chinese adults. Data for this study were obtained from 2018 Charles data. Z test, logistic regression analysis, and linear hierarchical regression analysis were performed in 5352 individuals aged ≥50 years with complete information. In terms of diabetes, 6.8% of the middle-aged and elderly people with diabetes were detected, and 93.2% of the middle-aged and elderly people without diabetes symptoms. The proportion of middle-aged and elderly people with high PA levels was 50.5%, and the proportion of middle-aged and elderly people with low PA was 49.5%. There was a significant positive correlation between low PA and diabetes (P < .05). After adjusting demographic characteristics (gender, registered permanent residence type, education level, age, widowhood) and health status characteristics (poor mood, asthma, hyperlipidemia, disability, memory disease, self-assessment of health status, hypertension, smoking, stroke, depression), there was still a statistical significance between PA level and diabetes (P < .05). The risk of diabetes of middle-aged and elderly people in China increases with age, while the risk of diabetes of middle-aged and elderly people with low level of PA is higher. The risk of diabetes is high among middle-aged and elderly people who are old, have poor self-evaluation health, suffer from hyperlipidemia, memory disease, and asthma. The middle-aged and old people should increase their PA levels to prevent and improve diabetes.

Undiagnosed hypertension in Croatia

To determine the prevalence of undiagnosed hypertension in Croatia, and to assess its association with various demographic, socioeconomic, lifestyle, and health care usage factors. We used the data from European Health Interview Survey wave 3, conducted in Croatia in 2019. The representative sample consisted of 5461 individuals aged 15 years and older. The association of undiagnosed hypertension with various factors was assessed with simple and multiple logistic regression models. The factors that contribute to undiagnosed hypertension were identified by comparing undiagnosed hypertension with normotension in the first model and with diagnosed hypertension in the second model. In the multiple logistic regression model, women and older age groups had lower adjusted odds ratio (OR) for undiagnosed hypertension than men and the youngest age group. Respondents living in the Adriatic region had a higher adjusted OR for undiagnosed hypertension than those living in the Continental region. Respondents who did not consult their family doctor in the previous 12 months and those who did not have their blood pressure measured by a health professional in the previous 12 months had a higher adjusted OR for undiagnosed hypertension. Undiagnosed hypertension was significantly associated with male sex, age from 35 to 74, overweight, lack of consultation with a family doctor, and living in the Adriatic region. The results of this study should be used to inform preventive public health measures and activities.

Association Between 25(OH)D Levels and Primary Arterial Hypertension

Abstract This study seeks to determine whether patients from a family physician’s practice have an association between 25(OH)D levels and primary arterial hypertension (AH). The study included a total of 1068 patients who were tested for vitamin D status. Data from their outpatient medical records were analysed: sex, age, body mass index, glomerular filtration rate, and the history of AH. Primary arterial hypertension was diagnosed in 63% of the patients. The mean vitamin D level in the study population was 25 ng/ml, and the largest group, or 36%, was found to have vitamin D deficiency (20–29 ng/ml). Odds ratio (OR) for hypertension was not inversely correlated with higher vitamin D levels. No statistically significant increase was observed in OR in a multi-factor analysis. The relevant hypertension ORs were 1.8 (0.4–7.5), 1.1 (0.3–4.5), 1.7 (0.4–7.2) and 0.7 (0.1–4.8) 30 ng/ml to 45 ng/ml, 20 to 29 ng/ml, 10 to 19 ng/ml, and &lt; 10 ng/ml compared to the group of ³ 45 ng/ml. No association was found between 25(OH)D levels and the primary arterial hypertension in study participants.

Social and Metabolic Determinants of Prevalent Hypertension in Men and Women: A Cluster Analysis from a Population-Based Study.

Essential hypertension (HTN) has a complex spectrum of pathophysiological determinants and current guidelines provide limited information on high-risk groups that should be targeted for its primary prevention. The objective of our research was to identify clusters of social and metabolic factors associated with prevalent HTN in men and women from a population-based survey in Romania. Of the 1477 participants in the main study, 798 with complete data were analyzed here. Using two-step cluster analysis, one high-risk cluster in women and two high and intermediate risk for prevalent HTN in men were identified. Older age, rural area, lower education, and higher burden of metabolic factors characterized clusters with higher risk, while intermediate risk in men was characterized by a more metabolically healthy phenotype in younger individuals. In logistic regression, men in Cluster 1 vs. those in Cluster 3 had an odds ratio (OR) of 9.6 (95%CI: 4.6; 20.0), p < 0.001 for prevalent HTN, while OR for Cluster 2 vs. Cluster 3 was 3.2 (95%CI: 1.4; 7.4), p = 0.005. In women, the OR for HTN was 10.2 (95%CI: 5.7; 18.5) if assigned to Cluster 2 vs. Cluster 1, p < 0.001. These results pointed out the subgroups and communities that the primary prevention of HTN should be prioritized in.

PS-P09-9: DIETARY PATTERNS AND HYPERTENSION AMONG STROKE-FREE AFRICANS IN THE SIREN STUDY

Objective: This study assessed the relationship of dietary patterns (derived from the frequency of food consumption) with hypertension among stroke-free controls recruited from Nigeria and Ghana in the Stroke Investigation Research and Educational Network (SIREN) study. Design and Methods: This study was a matched case-control study with 1500 hypertensives randomly selected and matched for the country of residence, age and sex with 1500 normotensives in the SIREN study. Factor analysis using principal component analysis was used to summarise food information and seven dietary patterns (DP); vegetables, poultry product and organ meat, whole-grain and fruit drinks, fried foods and sweetened drinks, red meat, processed foods and fruits were identified. Hypertension was defined as one of the following conditions; systolic blood pressure of 140mmHg/greater or diastolic blood pressure of 90mmHg/greater or previous diagnosis or use of antihypertensive medications. Multivariable adjusted logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for hypertension by the median of factors scores in each DP (adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases and obesity) at a two-sided P &lt; 0.05. Results: Mean age was 56.2 ± 13.5years and multivariable-adjusted OR (95%CI) for odds of hypertension by the median (with &lt; median of factor score as reference) of DPs revealed higher consumption of whole grains and fruit drinks; 0.83 (0.73, 0.96; P = 0.01) was associated with lower odds of hypertension, but higher consumption of processed foods; 1.18 (1.00, 1.40; P = 0.04) was associated with higher odds of hypertension. Furthermore, multivariable-adjusted OR (95%CI) of hypertension for other DPs include; 0.88 (0.74, 1.04; P = 0.13) for vegetables; 0.89 (0.75, 1.05; P = 0.16) for poultry product and organ meat; 0.90 (0.76, 1.06; P = 0.21) for fruits; 0.90 (0.77, 1.07; P = 0.23) for fried foods and sweetened drinks and 1.03 (0.87, 1.21; P = 0.76) for red meat. Conclusion: Diet rich in whole grains was associated with lower hypertension risk, but higher consumption of processed foods was related to a deleterious hypertension risk. Also, higher consumption of plant-based diets presented a suggestive inverse relationship with hypertension, but diets dense with red meat presented a suggestive deleterious hypertension risk.

The association of the Korean Healthy Eating Index with chronic conditions in middle-aged single-person households.

This study investigated the association between dietary quality based on the Korean Healthy Eating Index (KHEI), and the prevalence of chronic conditions among middle-aged individuals (40-60 ys of age) living alone. The participants were selected (1,517 men and 2,596 women) from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018 and classified into single-person households (SPH) and multi-person households (MPH). Nutrient intake, KHEI, and the prevalence of chronic conditions were compared according to household size. The odds ratios (ORs) of chronic conditions were analyzed according to the tertile levels of KHEI by gender within each household size category. Men in SPH had a significantly lower total KHEI score (P < 0.0001) and a lower prevalence of obesity (OR, 0.576) than those in MPH. For men, the adjusted ORs for obesity, hypertension, and hypertriglyceridemia in the first tertile (T1) of KHEI scores within SPH compared with the third tertile (T3) were 4.625, 3.790, and 4.333, respectively. Moreover, the adjusted OR for hypertriglyceridemia in the T1 group compared to the T3 group within the MPH was 1.556. For women, the adjusted ORs for obesity and hypertriglyceridemia in T1 compared to T3 within the SPH were 3.223 and 7.134, respectively, and 1.573 and 1.373 for obesity and hypertension, respectively, within MPH. A healthy eating index was associated with a reduced risk of chronic conditions in middle-aged adults. Greater adherence to a healthy eating index could lower the risk of chronic conditions in middle-aged adults living alone.

Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis

BackgroundThe objective was to determine the effects of continuous infusion of hypertonic saline solutions on outcomes of patients with brain injury. MethodsPreferred Reported Items for Systemic Reviews and Meta-Analysis guidelines were followed. We searched the MEDLINE and COCHRANE clinical trials register (through December 2021) and reference lists of articles. We included all clinical trials conducted in brain-injured patients hospitalized in intensive care units evaluating continuous infusion of hypertonic saline solution (osmolarity above 308 mOsm/L). Two reviewers extracted data that were checked by two others. The primary outcome was the in-hospital mortality rate. The main secondary outcomes were the rates of intracranial hypertension, an unfavorable neurological outcome at day 90, and adverse events. ResultsWe identified 23 clinical trials reporting the use of continuous infusion of hypertonic saline solution in brain-injured patients. The primary outcome was available in 10 studies (n = 1883 patients). The odds ratio (OR) for in-hospital death with the intervention was 0.68 (95% confidence interval (CI), 0.54−0.85, I2 = 0%). In the subgroup of studies including only traumatic brain-injured patients (7 studies, n = 1521 patients), the OR for the primary outcome was 0.74 (95%CI 0.57−0.95) with the intervention. The OR for intracranial hypertension and unfavorable neurological outcome at day 90 were 0.66 (95%CI 0.49−0.88, I2 = 42%, n = 787 patients) and 0.61 (95%CI 0.46−0.81, I2 = 15%, n = 956 patients), respectively. Regarding safety, the OR of acute kidney injury and severe hypernatremia were 0.82 (95%CI 0.47–1.44, I2 = 0%) and 3.38 (95%CI 2.16–5.27, I2 = 24%). ConclusionsContinuous hypertonic saline solution infusion reduced in-hospital mortality without increasing the risk of unfavorable neurological outcome at day 90 in brain-injured patients hospitalized in intensive care units. Given the inclusion of observational and heterogeneous studies, further randomized studies are needed before developing recommendations for implementation at the bedside. Systematic review registrationPROSPERO CRD42021221367. Registered 13 May 2021.

Autoimmune Hemolytic Anemia and Increased Stroke Risk in the United States: A Population-Based Study

Introduction Autoimmune hemolytic anemia (AIHA) is a clinically heterogeneous collection of disorders characterized by the presence of autoantibodies against the patient's erythrocytes. AHIA has been associated with an increased risk of thromboembolic events, including stroke. A recent nationwide cohort study from Denmark and France showed an increased risk of ischemic stroke compared to the general population. However, no extensive studies have been done in the United States (US); hence, we conducted a study of stroke and AIHA in the US population. Methods This is a retrospective study from 1999 to 2022. We analyzed data from a nationwide commercial database (Explorys, IBM) that aggregates records from 26 healthcare systems spread over 50 states with almost 80 million patients. It is a cloud-based platform in which participating institutions provide de-identified data from electronic health records. Pooled data is then standardized and normalized. Explorys uses Systemized Nomenclature of Medicine - Clinical Terms (SNOMED CT) coding for medical diagnosis. We identified adult patients (over 18 years old) with the diagnosis of AIHA. Patients with stroke were identified with the following SNOMED-CT diagnosis "cerebrovascular accidents''. In addition, we obtained information on risk factors for stroke, including sex, age over 65 years, and comorbidities known to be a risk factor, including hypertension, atrial fibrillation, diabetes mellitus, hyperlipidemia, smoking, and obesity.Multivariable logistic regression adjusting for all covariates was created to test for stroke. Results were presented as odds ratio (OR) with a corresponding 95% confidence interval (CI). All tests were two-sided, and a p-value ≤ 0.01 was considered statistically significant. Results An adult population of 69,339,860 were included. AHIA was diagnosed in 12,800 patients (less than 1 per 100,000) and stroke was diagnosed in 238,860 (0.34%). AIHA population characteristics were; females 7,720 (60%), age over 65 years 7,510 (59%), stroke 260 (2%), hypertension 8,260 (65%), hyperlipidemia 6,580 (51%), diabetes mellitus 4,030 (31%), obesity 3,080 (24%), atrial fibrillation 2,650 (21%), and smoking 1,080 (14%). Baseline characteristics are shown in table 1. Statically significant OR of covariates tested is as follows; hypertension OR 9.35 (95% CI 9.22-9.49), AHIA OR 2.75 (95% CI 2.49 - 3.01), atrial fibrillation OR 2.59 (95% CI 2.57 - 2.62), diabetes mellitus 2.44 (95% CI 2.42, 2.47), hyperlipidemia OR 1.96 (95% CI 1.94, 1.98), smoking OR 1.5 (95% CI 1.94, 1.98), age over 65 years OR 1.19 (95% CI 1.18, 1.20), and male OR 0.85 (95% CI 0.84, 0.85). Multivariable logistic regression of factors associated with stroke is shown in table 2. Discussion and conclusion This is the largest population-based study analyzing the association between AIHA and stroke, and we included the most relevant confounding risk factors in our analysis. As expected, the strongest risk factor associated with stroke was hypertension. What was surprising was that AIHA followed it as the second strongest risk factor, which exceeded atrial fibrillation as a risk factor. Limitations of the retrospective design of the study are numerous. They include lack of patient-level data, the subtype of stroke, the subtype of AIHA, the severity of AIHA, temporality, medications used, and their implications on stroke risk, and inaccuracies in coding. A potential explanation for increased thrombosis includes depletion of nitric oxide as a consequence of intravascular hemolysis with resultant enhanced platelet adhesions, and another possible mechanism is the release of procoagulant microparticles during hemolysis. While there is an ongoing trial looking into long-term apixaban in the primary prevention of venous thromboembolism in AIHA (NCT05089227), no active study is looking into minimizing stroke risk. Prospective studies to affirm association, risk stratifies patients, and ultimately test the utility of prophylactic anticoagulation are most needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Frequent vegetable consumption is inversely associated with hypertension among indigenous Africans.

The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa. This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans. We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or previous diagnosis or use of antihypertensive medications) from 16 445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) in the Stroke Investigative Research and Educational Network and Africa Wits-INDEPTH partnership for Genomic studies. Vegetable consumption (in servings/week) was classified as 'low' (<6). 'moderate' (6-11), 'sufficient' (12-29), and 'high' (≥30). Odds ratios (ORs) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using 'low' consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P < 0.05. The mean age of participants was 53.0 ( ± 10.7) years, and 7552 (45.9%) were males, whereas 7070 (42.9%) had hypertension. In addition, 6672(40.6%) participants had 'low' vegetable consumption, and 1758(10.7%) had 'high' vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using 'low' consumption as reference) were 1.03 (95% CI: 0.95, 1.12) for 'moderate' consumption; 0.80 (0.73, 0.88) for 'sufficient', and 0.81 (0.72, 0.92) for 'high' consumption, P-for-trend <0.0001. Indigenous Africans who consumed at least 12 servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.