Hypertensive Parents Research Articles

Abstract MP049: Evaluating Hypertension Risk Prediction Models in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: A hypertension risk prediction model was developed in the Framingham Heart Study (FHS), but its use among young adults has not been validated. The purpose of this study was to determine the predictive ability of the FHS hypertension model in a cohort of young adults and compare its performance with a model with pre-hypertension as the only predictor. Methods: This study included 4453 participants, aged 18–30 years at enrollment, from the Coronary Artery Risk Development in Young Adults (CARDIA) Study who attended 2 consecutive exams between the baseline (1985-86) and seventh examinations (2005–06). Data were pooled such that the interval between any 2 consecutive exams was 1 time period (median=2.9 years); participants contributed up to 6 time periods at risk for hypertension. Participants with prevalent hypertension or diabetes at the start of each risk period were excluded from that and subsequent risk periods. The FHS hypertension model includes the following variables: age, sex, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, parental hypertension, current smoking, and an age-DBP interaction term at the baseline for each risk period. Incident hypertension was defined as SBP≥140 mmHg, DBP≥ 90 mmHg, or new use of antihypertensive medications. Pre-hypertension was defined as 120≤SBP≤139 mmHg or 80≤SBP≤89 among those not meeting hypertension criteria. The c-statistic was used to assess model discrimination and the Hosmer-Lemeshow chi-square statistic was used to assess model calibration based on quintiles of risk for hypertension. Results: The crude hypertension incidence rate was 13.2 per 1,000 person-years. The FHS hypertension model performed well in identifying those who did and did not develop hypertension (c-statistic=0.87, 95% CI=0.86, 0.88) and was better than a model with pre-hypertension as the only predictor (c-statistic=0.73, 95% CI=0.71, 0.75). The predicted risk from the FHS hypertension model was systematically lower than the observed hypertension incidence in each quintile (Hosmer-Lemeshow χ2= 2649.35; p<0.001). Using CARDIA’s hypertension incidence rate and mean levels of its risk factors to recalibrate the model, the differences between predicted risk and observed hypertension incidence improved but the predicted risk overestimated observed risk in the bottom 4 quintiles and underestimated observed risk in the top quintile (Hosmer-Lemeshow χ2= 47.31; p<0.001). Conclusions: The FHS model performed well in identifying those who developed hypertension in this cohort study of young adults. This model performed better than a pre-hypertension only model, but calibration was poor. The FHS hypertension model may be a useful tool for discriminating individuals with and without a high risk for hypertension and could lead to improvements in targeted prevention strategies for young adults.

Aortic stiffness and flow-mediated dilatation in normotensive offspring of parents with hypertension

Although hypertension has been shown to be one of the most important risk factors for atherosclerosis, data about the presence of subclinical atherosclerosis in normotensive offspring with parental history of hypertension are scarce. Accordingly, the current study was designated to evaluate flow-mediated dilatation and aortic stiffness, which are early signs of atherosclerosis in young subjects with parental history of hypertension. A total of 140 [corrected] healthy, non-obese subjects in the age group of 18-22 years were included in this study and divided into two groups. The first group included 70 offspring of hypertensive parents and the second group included 70 offspring of normotensive parents as controls. In all subjects, endothelium-dependent and endothelium-independent vasodilatation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. Offspring of hypertensive parents demonstrated higher values of aortic stiffness (7.1 plus or minus 1.88 and 6.42 plus or minus 1.56, respectively) but lower distensibility (9.47 plus or minus 1.33 and 11.8 plus or minus 3.36 square centimetres per dyne per 106) and flow-mediated dilatation (4.57 plus or minus 1.3 versus 6.34 plus or minus 0.83 percent, p equals 0.0001, respectively) than offspring of hypertensive parents. We observed blunted endothelium-dependent dilatation and aortic stiffness in offspring of hypertensive parents compared with offspring of normotensive [corrected] parents. This is evident in the absence of overt hypertension and other diseases, suggesting that parental history of hypertension is a risk for subclinical atherosclerosis and it may contribute to the progression to hypertension and overt atherosclerosis in later life.

Influence of parental history of hypertension on screen time and physical activity in young offspring

Epidemiological data on the relationship between parental hypertension and lifestyle factors among children are limited. We assessed the associations between positive parental history of hypertension with a range of indicators of sedentariness (television viewing, computer and videogame usage) and physical activity (outdoor and indoor activity) among prepubertal children. Six-year-old (1765 of 2238 eligible) students from a random cluster sample of 34 Sydney schools were examined. Parents completed questionnaires about their medical conditions and the child's activities. If the biological mother and/or father had hypertension, then this was classified as positive parental history of hypertension. Parents of 160 (9.2%) children gave a positive family history of hypertension. After adjusting for age, sex, ethnicity, parental education and employment and exposure to passive smoking, children with, compared with those without, a family history of hypertension were more likely to spend above the median time (hours/day) watching television and playing videogames [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.02-1.96; OR 1.52, CI 1.12-2.06, respectively]. The offspring of hypertensive parents were more likely to spend above the median time in total physical activity (OR 1.67, 95% CI 1.23-2.27). Maternal (but not paternal) hypertension was associated with increased time spent watching television (P = 0.03) and in outdoor activity (P = 0.01). Parental hypertension influences the time that prepubertal offspring spend in both active and sedentary pursuits. These findings highlight potential factors that could be addressed in the development of cardiovascular disease-preventive measures starting early in life among the offspring of hypertensive parents.

The Cross Sectional Study of Anthropometric Parameters in Young Healthy Individuals having Parental History of Hypertension

Backgound: The adverse association of cardiovascular risk factors in both children and adults with parental history of disease is well recognized. A family history of hypertension has been shown to be a risk factor for the subsequent development of disease. This study is aimed to compare any observed differences in the mean BPs, BMI, Hip waist ratio in children of hypertensive and normotensive parents. Methodology: A cross sectional study was conducted among the 100 students of faculty of medicine of a University. Blood pressure and anthropometric measurements were taken. Results: Among the 100 participants studied, 63% were male and the average age was 19.76 years (SD ±2.01) with a median of 20 years, varying from 18 to 24 years. The mean systolic blood pressure in males with history of hypertensive parents was 131.7 ± 13.5 as against 121.2 ± 10.1 in females with history of hypertensive parents. The difference was statistically significant (p<0.002). The mean diastolic blood pressure was also significantly higher in males with history of hypertensive parents than females with history of hypertensive parents (86.2 ± 11.3 in males versus 78.7 ± 10.3 in females). The BMI positive correlation with systolic blood pressure (SBP) and diastolic blood pressure (DBP) was found. Conclusion: The findings of the present study suggest the need of monitoring the BP of children of hypertensive parents. Health care providers, therefore have an important role to play in educating families and children about approaches that are useful in preventing hypertension.

Renal FMD may not confer a familial hypertensive risk nor is it caused by ACTA2 mutations

Renal fibromuscular dysplasia (FMD) can cause hypertension, and previous reports suggest that FMD is familial. We hypothesized that, in families containing an individual with proven FMD, relatives of index cases would have an increased risk of hypertension. ACTA2 mutations cause a spectrum of extra-renal arteriopathy, leading to our second hypothesis that mutations are implicated in FMD. The blood pressure of first-degree relatives was measured using standard devices and, when indicated, with 24-h ambulatory monitoring. Leucocyte DNA was obtained from FMD index cases and ACTA2 sequenced. Thirteen unrelated index cases, aged 2-32 (median 15) years, were recruited. Blood pressure was assessed in 40 first-degree relatives, comprising 22 parents aged 28-58 (median 44) years and 18 siblings aged 3-30 (median 13) years. Hypertension was evident in six (27%) parents but in none of the eight adult siblings. Of the ten screened siblings aged less than 18years, one teenager was pre-hypertensive (90th-95th centile), the remainder being normotensive. No ACTA2 mutations were found in 13 index cases. Hypertension was evident in 20% of all assessed adult first-degree relatives and is therefore not increased relative to 25% of the adult population. Although hypertensive parents did not undergo angiography to assign FMD status, this observation, together with the lack of hypertension in 18 siblings, indicates that FMD is unlikely to confer an excess hypertension risk in first-degree relatives up to middle-age. Furthermore, in our cohort, FMD was not caused by ACTA2 mutations.

Endothelial‐Mediated Coronary Flow Reserve and Its Relation to Mitral Annular Tissue Doppler Velocities in Offspring of Hypertensive Parents

Although coronary flow reserve (CFR) is reduced in hypertensive patients, data regarding the endothelial response of coronary vasomotion and its relation to left ventricular (LV) function in their offspring is limited. To investigate the endothelial response of coronary flow, using cold pressor test (CPT), in offspring of hypertensive parents and its impact on LV diastolic function. The study population consisted of 32 healthy young offspring (mean age 23.5 ± 7.1 years) of hypertensive parents and 26 aged matched volunteers (healthy offspring of normotensive parents) as controls. Coronary blood flow velocities were recorded in all subjects at rest and after CPT; a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities. Doppler echocardiographic assessment was performed using both conventional and tissue Doppler assessment. Coronary diastolic peak velocities at rest was comparable between the two groups (27.1 ± 6.2 vs 26.4 ± 5.8; P > 0.05); but the velocities were significantly lower after CPT in offspring of hypertensive parents (P < 0.02), with highly significant lower CFR (P < 0.0001). Conventional echo-Doppler variables were comparable in both groups, whereas tissue Doppler assessment demonstrated significant LV diastolic dysfunction among offspring of hypertensive parents. The CPT-CFR was significantly correlated to tissue Doppler diastolic dysfunction in this group (For Em, Am and Em/Am, r was 0.65, 0.59 and 0.61, respectively, and P < 0.001). Offspring of hypertensive parents have coronary endothelial dysfunction that appears in response to physiological stimuli (CPT). The coronary endothelial dysfunction is associated with latent LV diastolic dysfunction.

Normotensive Male Offspring of Essential Hypertensive Parents Show Early Changes in Left Ventricular Geometry Independent of Blood Pressure

For the purpose of detecting early left ventricle (LV) abnormalities in normotensive offspring of hypertensive parents (EH+), 23 normotensive sedentary male EH+ (age 25 ± 3 years) and 20 matched offspring of normotensive families (EH-), underwent: clinic bloop pressure (BP) measurement, 24-hour ambulatory BP monitoring (ABPM), frequency-domain parameters of autonomic heart rate control and conventional and Doppler tissue echocardiographic (DTE) study of both ventricles, including relative wall thickness (RWT) as an index of LV remodeling. EH+ subjects had slightly higher office systolic and diastolic (P < 0.05), average 24-hour systolic (P < 0.001), diastolic (P < 0.01), and mean BP (P < 0.05). No between-group differences were detected for heart rate variability, LV mass and systolic and diastolic function in both ventricles. RWT was greater in EH+ (0.38 ± 0.05 vs. 0.34 ± 0.03 SD; P < 0.01), which was significantly related, at the univariate analysis, to the condition of EH+ (P < 0.004) and to the clinic and ambulatory BP parameters as well (P = 0.06-0.01). However, at the stepwise multiple regression analysis, with RWT used as the dependent variable, only the condition of EH+ was independently associated with RWT (P < 0.008), whereas BP did not. RWT, according to receiver operating characteristic curves analysis, predicted the condition of EH+ (cutoff point 0.369, specificity 90%, sensitivity 65%). Our data suggest that an higher RWT, as an index towards LV concentric remodeling, is the earliest change in LV geometry in EH+ subjects, independent of any slight elevation in BP. Thus, RWT measurement may be a quite specific tool to detect early LV alterations due to the condition of EH+.

Parental History of Hypertension Is Associated With Narrower Retinal Arteriolar Caliber in Young Girls

We aimed to assess the associations between parental history of hypertension and indicators of cardiovascular risk (retinal vessel diameter, presence of obesity, and elevated blood pressure) in prepubertal children. There were 1739 (77.7% of those eligible) 6-year-old students (863 girls and 876 boys) who were examined from a random cluster sample of 34 Sydney schools. Parents completed questionnaires about their medical conditions, including whether they have/had hypertension. Retinal images were taken with a digital fundus camera, and retinal vessel caliber was quantified using computer software. Anthropometric (height, weight, percentage of body fat, and body mass index) and blood pressure measures were collected. There were 160 children (9.2%) with a positive parental history of hypertension (either biological mother and/or father). Children with a positive versus negative parental history of hypertension had significantly higher body mass index (16.8 versus 16.5 kg/m(2); P=0.04) and systolic blood pressure (101.3 versus 99.8 mm Hg; P=0.01). Girls with positive versus negative parental history of hypertension had significantly higher diastolic blood pressure (≈3.1 mm Hg; P=0.01) and narrower retinal arteriolar caliber (≈4.3 μm; P=0.0004). Positive parental history of hypertension was not associated with mean retinal vascular caliber among boys. We show that a positive parental history of hypertension in healthy prepubertal girls, but not boys, is associated with narrower retinal arteriolar vessels, likely conveying a predisposition to develop hypertension later in life. These findings may indicate the need for cardiovascular disease prevention measures starting early in life among offspring of hypertensive parents.

Intergenerational social mobility and the risk of hypertension

BackgroundLow socioeconomic status (SES) has been linked to increased risk of hypertension, a known risk factor for cardiovascular disease. How the risk is altered by intergenerational social mobility is not...

Premenopausal Women Have Increased Risk of Hypertensive Target Organ Damage Compared with Men of Similar Age

The impact of high blood pressure (BP) on target organs (TO) in premenopausal women is not well known. The purpose of this study was to describe gender differences in TO involvement in a cohort of young-to-middle-aged subjects screened for stage 1 hypertension and followed for 8.2 years. Participants were 175 women and 451 men with similar age (range 18-45 years). Ambulatory BP at entry was 127.5±12.5/83.7±7.2 mm Hg in women and 131.9±10.3/81.0±7.9 mm Hg in men. Ambulatory BP, albumin excretion rate (AER), and echocardiographic data (n=489) were obtained at entry, every 5 years, and before starting antihypertensive treatment. Female gender was an independent predictor of final AER (p=0.01) and left ventricular mass index (LVMI) (p<0.001). At follow-up end, both microalbuminuria (13.7% vs. 6.2%, p=0.002) and left ventricular hypertrophy (LVH) (26.4% vs. 8.8%, p<0.0001) were more common among women than men. In a multivariable Cox analysis, after adjusting for age, lifestyle factors, body mass, ambulatory BP, heart rate, and parental hypertension, female gender was a significant predictor of time to development of microalbuminuria (p=0.002), with a hazard ratio (HR) of 3.06, (95% confidence interval [CI] 1.48-6.34) and of LVH (p=0.004), with an HR of 2.50 (1.33-4.70). Inclusion of systolic and diastolic BP changes over time in the models only marginally affected these associations, with HRs of 3.13 (1.50-6.55) and 3.43 (1.75-6.70), respectively. These data indicate that premenopausal women have an increased risk of hypertensive TO damage (TOD) and raise the question about whether early antihypertensive treatment should be considered in these patients.

Restricted Blood Flow Exercise on Vascular Function in African Americans With and Without Parental Hypertension

In the Surgeon General Report on Physical Activity and Health, resistance exercise is a recommendation. A popular modality in increasing muscle strength is the restriction of blood flow (RBF) during exercise. A concern is the hypoxic exercise may adversely affect the vascular function. Equivocal findings have been found regarding RBF exercise on the blood vessels in healthy disease free individuals. How RBF exercise influence vascular function in healthy individuals at risk for cardiovascular disease (CVD) has not been addressed. PURPOSE: To determine the effect of RBF exercise on lower leg vascular function in healthy individuals at risk for developing hypertension. METHODS: Seven healthy young adult African-Americans with a parental history of hypertension, and 7 similar subjects without a parental history of hypertension served as volunteers. One leg was randomly chosen for a 3-week period of low intensity training with 30% of the 1-repetition maximum load, 3 times per week under conditions of partial RBF (occlusion pressure of systolic blood pressure plus 1/3) and the other leg was the untrained control. Calf blood flow was measured using the method of venous occlusion strain-gauge plethysmography. Resting and reactive hyperemic blood flow (flow-mediated dilation) was made in both limbs, and flow was calculated by the slope of volume over the first cardiac cycle using commercial software. RESULTS: Baseline reactive hyperemic flow-mediated dilation (FMD) was less in the subjects with a parental history of hypertension than the subjects without a parental history of hypertension (P< 0.05). After training, motor strength increased in the trained and untrained control muscles of the groups with and without a history of hypertension (P< 0.05). Lower leg hyperemic response of FMD decreased in the trained legs of both groups (P< 0.05). Pooling of pre-training and post-training values showed a larger decrement of FMD in the subjects without a parental history of hypertension than with a history of hypertension (P< 0.05). CONCLUSION: RBF exercise is associated with an increase muscular strength and a decrease in endothelia function. RBF exercise may need to be cautiously prescribed to the general population with and without risk for CVD. This work was supported in part by grant 2 G12 RR003048 the RCMI Program.

Cardiovascular Reactivity to Mental and Physical Stress in Offspring of Hypertensive Parents from Large Omani Arab Families

Cardiovascular Reactivity to Mental and Physical Stress in Offspring of Hypertensive Parents from Large Omani Arab Families

Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training

Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 ± 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO(2MAX); n = 16), or CME (50-60% of VO(2MAX); n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HR(MAX) and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 ± 4.9 vs. 20.6 ± 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO(2RCP); 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO(2MAX); 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TT(AT); 62.0 vs. 37.7, p = 0.048), TT(RCP) (49.3 vs. 32.9, p = 0.032), and TT(MAX) (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.

The impact of early menopause on risk of coronary artery disease (PREmature Coronary Artery Disease In Women – PRECADIW case-control study)

Despite improved understanding of atherothrombosis pathophysiology, risk factors associated with premature coronary artery disease (CAD) in women are poorly recognized. A single-centre, case-control study comprised 323 women (less than 55 years) with established CAD, enrolled between April 2005 and January 2008, and 347 age-matched healthy women selected from the Multi-Center All-Polish Health Survey. We aimed to assess the relationship of menopause and premature CAD. In multivariate analysis smoking, parental history of premature CVD, diabetes, menopause and hypertension were the strongest risk markers for premature CAD with ORs (95% CI): 3.83 (2.52-5.82); 3.08 (1.85-5.14); 2.89 (1.59-5.23); 2.82 (1.91-4.19); 2.39 (1.16-3.54). The most significant association was found for early postmenopause in a model including the early and late stage of postmenopause (≤ and >3 years of its onset), with OR 4.55 (95% CI 2.82-7.35), higher than other risk factors. The receiver operating characteristic (ROC) curves area revealed a significant increase from 0.81 in that model that included traditional risk factors and parental premature CVD to 0.85 after addition of the early and late stage of postmenopause. We have shown that smoking and early postmenopausal stage (≤3 years) are the most important determinants of premature CAD followed by parental CVD, diabetes and hypertension.

Determinants of Blood Pressure in Preschool Children

Background— Hypertension is the leading risk factor for cardiovascular disease. Although accumulating evidence suggests tracking of blood pressure from childhood into adult life, there is little information regarding the relative contributions of genetic, prenatal, biological, behavioral, environmental, and social determinants to childhood blood pressure. Methods and Results— Blood pressure and an array of potential anthropometric, prenatal, environmental, and familial risk factors for high blood pressure, including parental smoking habits, were determined as part of a screening project in 4236 preschool children (age 5.7±0.4 years). Smoking was reported by 28.5% of fathers and 20.7% of mothers, and by both parents 11.9%. In addition to classic risk factors such as body mass index, prematurity, low birth weight, and parental hypertension, both systolic (+1.0 [95% confidence interval, +0.5 to +1.5] mm Hg; P =0.0001) and diastolic blood pressure (+0.5 [+0.03 to +0.9] mm Hg; P =0.03) were higher in children of smoking parents. Parental smoking independently affected systolic blood pressure ( P =0.001) even after correction for other risk factors, such as body mass index, parental hypertension, or birth weight, increasing the likelihood of having a systolic blood pressure in the top 15% of the population by 21% (2% to 44%; P =0.02). Conclusions— In healthy preschool children, parental smoking is an independent risk factor for higher blood pressure, adding to other familial and environmental risk factors. Implementing smoke-free environments at home and in public places may provide a long-term cardiovascular benefit even to young children.

Sympathovagal Imbalance in Prehypertensive Offspring of Two Parents versus One Parent Hypertensive.

Objective. Though prehypertension has strong familial predisposition, difference in pathophysiological mechanisms in its genesis in offspring of both parents and single parent hypertensive have not been elucidated. Methods. Body mass index (BMI), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), HR and BP response to standing, deep breathing difference, BP response to handgrip and spectral indices of heart rate variability (HRV) were analyzed in normotensive offspring of two parents hypertensive (Group I), normotensive offspring of one parent hypertensive (Group II), prehypertensive offspring of two parents hypertensive (Group III) and prehypertensive offspring of one parent hypertensive (Group IV). Results. Sympathovagal imbalance (SVI) in prehypertensive offspring was observed due to increased sympathetic and decreased vagal activity. In group III, SVI was more prominent with greater contribution by vagal withdrawal. LF-HF ratio, the marker of SVI was correlated more with diastolic pressure, 30 : 15 ratio and E : I ratio in prehypertensives and the degree of correlation was more in group III prehypertensives. Conclusion. Vagal withdrawal plays a critical role in development of SVI in prehypertensive offspring of hypertensive parents. The intensity of SVI was more in offspring of two parents hypertensive compared to single parent hypertensive.

Aldosterone, Plasma Renin Activity, and Aldosterone/Renin Ratio in a Normotensive Healthy Pediatric Population

Primary aldosteronism is an important cause of secondary hypertension and is suspected in adults with an aldosterone/renin ratio > or =25. The normal aldosterone/renin ratio is unknown in children. The aim was to establish serum aldosterone, plasma renin activity, and aldosterone/renin ratio values in a healthy pediatric population. A cross-sectional study was performed in 211 healthy normotensive children (4 to 16 years old). Two subgroups of normotensive children were obtained: with hypertensive parents (NH) (n=113) and normotensive parents (n=98). Blood samples for measuring serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. In subjects with aldosterone/renin ratio > or =25, the chimeric CYP11B1/CYP11B2 gene was investigated by long-extension PCR. Results are expressed as median [Q(1)-Q(3)]. NH and normotensive parents groups were similar in serum aldosterone (6.5 [3.6 to 9.0] ng/dL versus 6.5 [2.9 to 9.7] ng/dL; P=0.968) and plasma renin activity (2.3 [1.6 to 3.1] versus 2.4 [1.7 to 3.7] ng/mL per hour; P=0.129). The aldosterone/renin ratio was higher in the NH group, but this difference did not reach statistical significance (2.8 [1.9 to 4.1] versus 2.5 [1.4 to 4.0], P=0.104). In one subject of the NH group, the chimeric CYP11B1/CYP11B2 gene was detected. We demonstrated that normal aldosterone/renin ratio values in a healthy pediatric population without NH were lower than those reported for an adult normotensive population.

Blood Pressure Variability

A series of articles1–4⇓⇓⇓ published recently in The Lancet and Lancet Neurology raise an interesting issue that has implications for both the clinical management of hypertension and future research in hypertension, particularly in the development and use of different classes of blood pressure (BP)–lowering drugs. These studies, which were led by Peter Rothwell at the John Radcliffe Hospital in Oxford, United Kingdom, suggest that, whereas there is undoubted and well-proven benefit in the current practice of reducing mean BP to prevent cardiovascular events, there may be additional benefit in also reducing BP variability (BPV), especially to prevent stroke. The studies suggest, moreover, that different classes of drugs are superior to others in reducing BPV (calcium channel blockers being best and the β-blocker atenolol being worst). However, these articles, by virtue of their sheer volume (≈50 pages of printed text and many pages of supplementary web appendix data), could overwhelm all but the most stoic readers, and misinterpretation of the data could lead to confusion and have an adverse effect on clinical practice. It is important, therefore, to assess the scientific reality and determine how attention to BPV might benefit patients with hypertension. In the first analysis, systolic BPV between visits and maximum BP reached in 4 cohorts of patients with previous transient ischemic attacks were strong predictors for subsequent stroke.1 In treated hypertensive patients in the Anglo-Scandinavian Cardiac Outcome Trial-Blood Pressure Lowering Arm systolic BPV between visits was also a strong predictor of stroke and coronary events independent of mean clinic or ambulatory BP measurement (ABPM). BPV on ABPM was a weaker predictor overall but was related to visit-to-visit variability. Traditional measures of variability, such as SD and coefficient of variation (CV), were used in these analyses, but one of the problems encountered in the …

RELATION OF PARENTAL HISTORY OF HYPERTENSION AND FOLLOW-UP CHANGES OF ARTERIAL STIFFNESS PARAMETERS: PP.10.397

Objectives: Central aortic blood pressure and aortic augmentation index (AI) are independent risk factor for cardiovascular events. Cross-sectional data confirms the relationship between family history of hypertension and parameters of structure and function of the large arteries in adult offspring. The objective of the present study was to assess differences in 5-years follow - up changes in BP parameters and AI in relation to parental history of hypertension. Methods: We recruited 201 members from random families (100 parent and 101 offspring (age at baseline: 58.5 and 28.9 years). From 75 normotensive descendants 9 were with a negative family history of hypertension, 36 with one hypertensive parents and 30 with both hypertensive parents. Initially and after follow up 4.8 ± 0.4 years we recorded the radial arterial waveform using the SphygmoCor device and evaluated peripheral AI (pAI) and central AI (cAI). Significance levels of between-group comparisons of the change from baseline were assessed by a general linear model that adjusted for baseline value and post-hoc Tukey test for multiple comparison. Results: In both groups with parental history of hypertension we observed significant increase in peripheral and central systolic blood pressure (SBP) during follow-up. We found higher increase in central SBP with lesser decrease in central diastolic BP in offspring with both hypertensive parents in comparison to participants with negative family history of hypertension (pTukey < 0.05). We observed significant elevation of brachial AI only in offspring with both hypertensive parents. Changes in central AI were more pronounced in both groups with parental history of hypertension, however this increase in cAI was higher in offspring with both hypertensive parents in comparison to those without hypertension in family (6.6 vs -3.0 (%); pTukey < 0.05). Conclusions: Parental history of hypertension enhances follow-up changes in BP and augmentation index. Our findings indicate that central parameters more effectively indicate differences in changes of systolic BP and arterial wall stiffening in relation to parental history of hypertension than brachial one.

EFFECT OF EXERCISE ON BLOOD PRESSURE REACTIVITY TO STRESSORS AND ON DEVELOPMENT OF HYPERTENSION: 5D.04

Objective: Exaggerated stress reactivity may contribute to the development of hypertension and cardiovascular disease. We investigated the effect of regular physical activity on the hemodynamic response to a psychophysiological stressor, public speaking, and on development of hypertension. Design and Methods: We assessed 75 sedentary and 44 active stage 1 hypertensive subjects aged 29 ± 9 years never treated for hypertension with consistent activity habits during the follow-up, and 63 normotensive subjects of control. The blood pressure (BP) response to public speaking was assessed with beat-to-beat non-invasive finger recording. Definition of incident hypertension was based either on clinic or 24-hour BP measurement. Data were adjusted for age, sex, body mass index, parental hypertension, smoking, alcohol, coffee use, and baseline BP. Results: The BP response to public speaking was greater in the hypertensive (42.0 ± 21.7/21.0 ± 11.9 mmHg) than the normotensive (31.2 ± 17.3/16.0 ± 7.8 mmHg) subjects (age-and-sex-adjusted P = 0.018/0.009). Among the hypertensives, sedentary subjects showed increased BP reactivity to the speech test (45.2 ± 22.6/22.2 ± 11.5 mmHg, p < 0.01/ < 0.001 versus controls), while physically active subjects had a response similar to that of controls (35.4 ± 18.5/18.5 ± 11.5 mmHg, p = n.s.). During a median follow-up of 71 months, ambulatory BP did not virtually change in the active subjects (−0.9 ± 7.8/−0.0 ± 4.7 mmHg) and increased in their sedentary peers (2.8 ± 9.8/3.2 ± 7.4 mmHg, p versus active = 0.08/0.003). Active subjects were less likely to develop incident hypertension than sedentary ones. In a multivariable Cox regression, the hazard ratio (HR) was 0.49(CI,0.27–0.89) for clinic hypertension and 0.56(CI,0.33–0.95) for ambulatory hypertension. The systolic BP response to public speaking was a weak predictor of future hypertension (p = 0.06) and inclusion of this variable into the Cox model only slightly decreased the strength of the association of physical activity with outcome with HRs = 0.54(0.30–0.96) and 0.59(0.35–0.99), respectively. Conclusions: Regular physical activity attenuates the BP reaction to psychosocial stressors and delays the development of hypertension. However, reduced reactivity to stressors seems to be only partially responsible for the long-term effect of exercise on BP.