Impact Of High Blood Pressure Research Articles

Advancements in Ocular Vascularization Analysis Using Deep Learning Techniques – A Systematic Review

In this review, we have investigated the critical examination of ocular vascularization for clinical assessment, specifically in the context of retinopathies associated with systemic disorders. The study emphasizes the impact of high blood pressure and diabetes on the development of hypertensive and diabetic retinopathy, respectively. Traditionally, identifying and classifying blood vessels in medical imaging has been time-consuming and prone to errors. The introduction of Machine Learning (ML), particularly Deep Learning (DL) methods, has revolutionized the process, allowing for more efficient and precise identification and categorization of blood vessels. The research proposes a cutting-edge ML framework utilizing Convolutional Neural Networks (CNNs) and ensemble learning to optimize blood vessel segmentation and classification. The primary goal is to enhance both speed and efficiency, addressing common challenges in processing medical images. The application of these advanced algorithms not only represents a technological achievement but also a significant stride towards personalized and accurate medical care. Our review consolidates existing research findings, compares methodologies, and highlights the progress in ML techniques that have improved the speed and efficacy of blood vessel segmentation, particularly in ophthalmology.

Aktifitas Fisik Menjadi Faktor Dominan Kejadian Hipertensi pada Pasien Rawat Jalan di Puskesmas Kecamatan Cipayung Periode Januari-April Tahun 2023

Hypertension is an increase in systolic blood pressure exceeding 140 mmHg and diastolic blood pressure exceeding 90 mmHg. The long-term impact of high blood pressure can lead to damage to various organs such as the heart, kidneys, and brain. In 2019, 34 percent of the population in Jakarta experienced the risk of hypertension, both mild and severe. Based on data from the Cipayung District Health Center in 2022, hypertension ranked first among the top 10 most frequently visited diseases on a monthly basis. This research aims to study and explain the relationship between lifestyle and the occurrence of hypertension in outpatients at the Cipayung District Health Center during the period of January-April 2023. The study design of this research is cross-sectional. Data collection is sourced from secondary data obtained from the medical records of the Cipayung District Health Center. The population in this study consists of outpatients who visited the Cipayung District Health Center with data collected from January to April 2023, totaling 1152 individuals, and all of them were analyzed.
 Based on the analysis results, it is known that age, gender, education level, physical activity, and salt consumption significantly influence the occurrence of hypertension. Physical activity is the most dominant risk factor influencing the occurrence of hypertension with an odds ratio of 29.714 and a 95% confidence interval of 19.543 - 45.178. Therefore, it is expected that the health center can enhance health promotion efforts and interventions targeting at-risk groups to prevent hypertension in the Cipayung Health Center area. Additionally, establishing sports clubs and healthy Diet Community Kitchens that can be participated in by the community can be beneficial. Increasing community engagement in healthy living can also reduce the risk of hypertension in the population.
 
 Keywords : Hypertension, Physical Activity, Health Center, Cipayung

MACHINE LEARNING IN HYPERTENSION DETECTION: A STUDY ON WORLD HYPERTENSION DAY DATA

Objective: Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection. We aimed to explore whether a machine learning (ML) algorithm can help identifying individual predictors of hypertension. Design and method: We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. Demographic information (age, sex, BMI), self-reported information on cardio- vascular risk factors (hypertension, diabetes, smoking, high cholesterol, kidney disease, family history of cardiovascular diseases), sleep complaints (snoring, witnessed apneas, daytime sleepiness) and prior cardiovascular diseases (previous cardio and cerebrovascular events, previous myocardial infarction) as well as information about the awareness of hypertension and its health consequences were collected through the questionnaire. We computed the performance (sensitivity and specificity) of standard screening programmes as recommended by World Health Organisation and of five different ML algorithms, exploiting different balancing techniques (oversampling and undersampling). Results: A total of 20206 individuals (mean age 50.89 years, 51.65% females) have been included for analysis. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others (Table 1). However, Random Forest provides the most interesting balance between sensitivity and specificity with a greater Area Under the Curve compared to the standard screening programs (Table 1). Conclusions: Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models. Table 1: Performance in the test set of the three experimented schemes, original, oversampling and undersampling the training set, and of the medical protocol evaluation.

High blood pressure mediated the effect of fasting insulin level on nonalcoholic fatty liver disease risk: A Mendelian randomization study.

The interactions between fasting insulin levels, high blood pressure and nonalcoholic fatty liver disease (NAFLD) are still unclear. We examined the causal mechanisms between these three cardiometabolic traits using Mendelian randomization (MR) approach by utilizing genetic instruments. Three different genome-wide association studies resources of European ancestry were utilized for the present study. Two-sample MRs were used to assess causal effects between fasting insulin levels, high blood pressure and NAFLD. Multivariate MR was used to calculate the mediating effect. The inverse variance-weighted method was used as the main analysis method. Our study confirmed a causal effect of fasting insulin levels (IVW-OR = 9.54, P = 0.001) and high blood pressure (IVW-OR = 3.926, P = 0.005) on NAFLD risk. And fasting insulin level was positively casually associated with high blood pressure risk (IVW-OR = 1.170, P < 0.001). However, the impact of high blood pressure on fasting insulin levels was still uncertain because of the presence of horizontal pleiotropy. Reverse MR showed NAFLD had a positive correlation with fasting insulin levels (IVW-OR = 1.010, P < 0.001) and a negative causal effect on high blood pressure risk (IVW-OR = 0.997, P = 0.037). Combined the multivariate MR result revealed high blood pressure partially mediated the contribution of fasting insulin level to NAFLD risk (proportion mediated: 9.091%). Our study suggests there is a bidirectional causal relationship between fasting insulin levels and NAFLD. High blood pressure seems to play a mediating role in the development of NAFLD caused by changes in fasting insulin levels. However, it is uncertain whether high blood pressure is a mediator between NAFLD and the risk of fasting insulin level.

Machine Learning in Hypertension Detection: A Study on World Hypertension Day Data

Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection. We aimed to explore whether a machine learning (ML) algorithm can help identifying individuals predictors of hypertension. We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. A total of 20206 individuals have been included for analysis. We tested five ML algorithms, exploiting different balancing techniques. Moreover, we computed the performance of the medical protocol currently adopted in the screening programs. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others. However, Random Forest provides interesting performances (0.818 sensitivity – 0.629 specificity) compared with medical protocols (0.906 sensitivity – 0.230 specificity). Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models.

Long-term Kidney Function Evolution in Living Kidney Donors: A Single Center Experience

Living donor kidney transplant is the best treatment for end-stage kidney disease, posing minimal perioperative morbimortality for the donor, although long-term consequences are subject of debate if donor acceptance widens. We present a retrospective observational study analyzing clinical, demographic, and analytical variables throughout the follow-up period of 60 kidney donors whose procedures were performed between 1985 and 2021 at our hospital. Donors were divided according to their previous high blood pressure status, analyzing kidney function and other clinical parameters throughout follow-up. There were no statistically significant differences, although there was a trend toward a higher uric acid levels and lower high-density lipoprotein cholesterol in predonation patients with hypertension, not yielding an excess of end-stage kidney disease between groups at the end of the follow-up. We also analyzed the evolution of estimated glomerular filtration rate (eGFR), dividing patients into tertiles, which resulted in none of the parameters associating a higher rate of progression. All donors had an eGFR >71 mL/min/1.73 m2 at the time of donation. Over time, a decline in eGFR <60 mL/min/m/1.73 m2 was observed in 26 patients (53.6%), measured by Chronic Kidney Disease Epidemiology Collaboration estimation and in 55.4% of the total (31 patients) by Modification of Diet in Renal Disease. At our center, kidney donors with adequate predonation eGFR, although presenting a reduction in postnephrectomy eGFR, remain stable afterward, with none of them reaching an eGFR <30 mL/min/1.73 m2. We found no differences in the impact of high blood pressure on long-term eGFR, nor predictive factors influencing the rate of eGFR decline. Studies with larger number of patients are needed to confirm these results.

The impact of hypertension on mortality and the risk of developing geriatric syndromes

Background. Hypertension (HTN) is a major risk factor for the development of cardiovascular disease in young and middle age, however, data on its effect on cardiovascular risk in older adults are contradictory. Objective. To evaluate the impact of high blood pressure on mortality and the course of major geriatric syndromes in the population aged 65 years and older. Design and methods. The prospective cohort Crystal study (2 examinations, 9 years of follow-up), the cross-sectional cohort Eucalyptus study. Sample: a random sample of community-dwelling older adults aged 65 and older (n = 1007). Main parameters: blood pressure, analysis of drug treatment, medical history, laboratory tests, comprehensive geriatric assessment. Results. HTN has been identified as a risk factor for myocardial infarction, cognitive decline, slow gait speed and low muscle strength. However, in people with frailty and slow gait speed, the presence of HTN was associated with a lower risk of all-cause mortality. The lowest risk of all — cause mortality in participants with a slow gait speed was found with systolic blood pressure 140-159 mm Hg [risk ratio (95 % confidence interval) 0,049 (0,009-0,283)], with frailty — with systolic blood pressure 160-180 mm Hg [risk ratio (95 % confidence interval) = 0,109 (0,016-0,758)]. Conclusions. HTN retains its negative predictive value in older adults and is associated with an increased risk of cardiovascular complications, decreased cognitive and physical functions, but a lower risk of mortality in people with frailty and a low level of physical function. An individual approach and an obligatory assessment of the level of physical function in older patients are required when prescribing antihypertensive therapy.

Hypertensive Nephropathy: Prevalence, Patient’s Profiles and Evolution in a University Hospital at Dakar

Background: Hypertensive nephrosclerosis is chronic impact of high blood pressure on the kidney. The objective of this study was to determine prevalence, clinical presentation, and evolution of hypertensive nephrosclerosis in patients admitting in our service. Patients and Methods: We performed a retrospective, descriptive and analytical study in nephrology department of Aristide Le Dantec University Hospital in Dakar during a period of 05 years. Patients with long-term hypertension, hypertensive retinopathy, left ventricular hypertrophy, and progressive kidney failure were included. Results: 461 patients were included. Hospital prevalence was 7.7%. Mean age was 56.95±13.23 years and sex ratio was 1.07. Uncontrolled high blood pressure has been found in 400 patients. Mean systolic blood pressure was 168.34 ± 27.57 mmHg. Mean diastolic blood pressure was 97.28±19.59 mmHg. On the urine dipstick, 44 patients had proteinuria (&lt;2cross). Mean GFR, was 22.02±17.78 ml/min. Antihypertensive treatment was administered as bitherapy in 232 patients (50.3%). On admission, 47 patients (10.2%) had already started dialysis. At 12 months, 406 patients were regularly followed. Blood pressure was normal in 138 patients and serum creatinine decreased in 74 patients. Advanced age (p=0.0001) and female gender (p =0.0001) were correlated with a low level of GFR. The high 24 hours proteinuria level was unfavorable factor on GFR (p = 0.004). Conclusion: This study shows a high prevalence of hypertensive nephropathy in our study population. His evolution to end stage of kidney disease is inevitable, hence the importance of prevention and early management of hypertension in black subjects

AMBULATORY BLOOD PRESSURE MONITORING IN HEART FAILURE WITH PRESERVED EJECTION FRACTION PATIENTS

Objective: 120 hypertensive patients (pts) aged 67,8 ± 1,2 years. 30 pts with essential hypertension (EH), 90 pts with EH complicated by heart failure with preserved ejection fraction (HFpEF), NYHA class II. Design and method: Doppler echocardiography, office BP measuring and ambulatory BP monitoring, 6 -minute walk test. Results: The increased values of office systolic BP (SBP) were determined in both groups (154,3 ± 1,4 mm Hg in HFpEF pts and 145,5 ± 2,3 mm Hg in EH pts, p &lt; 0,01). But mean 24-h (141,0 ± 1,5 mm Hg vs 131,6 ± 1,9 mm Hg, p &lt; 0,001), daytime (144,6 ± 1,5 mm Hg vs 136,7 ± 2,0 mm Hg, p &lt; 0,01) and nighttime (134,0 ± 1,8 mm Hg vs 121,5 ± 3,2 mm Hg, p &lt; 0,05) BP values were significantly higher in HFpEF patients. There is no limiting impact of high blood pressure (in the range up to 154,3 ± 1,4 mm Hg) on physical activity in patients with initial stages of HFpEF. Office DBP values were comparable in two groups and did not exceed the recommended range. Mean 24-h DBP values slightly exceeded the upper limits in both groups. 24-h pulse BP in HFpEF pts was 63,2 ± 0,9 mm Hg compared to 54,9 ± 1,4 mm Hg in EH pts, (p &lt; 0,05). 54 HFpEF pts (60,0%) demonstrated abnormal pattern of day/night SBP dynamics and 37 pts (41,1%) - abnormal pattern of DBP, in case of EH - 43,3 % and 20,0 %, respectively. The normal BP circadian rhythm was recorded in 12 (40,0 %) EH pts compared to 16 (17,8 %) HFpEF pts (x2 = 6,21; p &lt; 0,05). Conclusions: HFpEF patients demonstrated insufficient control of office and 24-h BP. 82,2% of HFpEF patients were characterized by pathological types of BP circadian rhythm with dominating non-dipper type confirming the increased risk of cardiovascular events in HFpEF patients. Inadequate control of blood pressure is an important factor in the development of chronic heart failure with preserved ejection fraction. Mean ambulatory systolic BP level, unlike the office systolic BP, is independently associated with the development of HFpEF.

Different Influence of Blood Pressure on New-Onset Atrial Fibrillation in Pre- and Postmenopausal Women: A Nationwide Population-Based Study.

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RELATIONSHIP OF HYPERTENSION WITH PATIENTS HAVING DIABETES AT CLINICAL SETUPS OF PAKISTAN

Abstract Objective: Hypertension and Diabetes both are the facets of metabolic syndrome, a pathologic condition that usually includes obesity and cardiovascular diseases. While in some patients Diabetes mellitus and hypertension both recurrently occurs and probably have synergistic disadvantageous effects on the cardiovascular system. The objective of the current study was to sort out the potential relationship and the impact of high blood pressure on patients who had diabetes. Design and method: This was a prospective, observational study in which 470 hypertensive patients who had confirmed diagnosis of diabetes type II were enrolled in this study. Samples were from age group of 30–60 years in which 130 males and 340 females were observed. All enrolled hypertensive patients had a diastolic blood pressure greater than 90 mmHg and systolic blood pressure greater than 138mmHg. Results: Findings shows that Calcium Channel Blockers, Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs) are preferred agents for Hypertension associated with type 2 Diabetes. In case if targeted blood pressure is not achieved addition of a thiazide diuretic occurs in regimen because it is the preferred 2nd line therapy for hypertension associated with diabetic patients. In another perspective weight loss also seems to be beneficial in the hypertension associated with obesity and diabetes. Candestran and Lisinopril was the most prescribed drugs in earlier patients with hypertension associated with the type 2 diabetes. Conclusions: According to the research findings with the usage of the prescribed drugs blood pressure was controlled while alteration of drugs has seen in some cases as well. Chlorthalidone, Candestran and Lisinopril were the most prescribed and seen to be most effective.

Blood Pressure Screening Campaign in the Adult Population

Background: World Health Organization estimated that 1 in 4 men and 1 in 5 women have hypertension (HTN). Considering the impact of high blood pressure (BP) identification to prevent its related complications. Objectives: This study was performed to describe the first national BP screening program conducted in Babol, north of Iran. Methods: In this historical cohort carried out at Babol University of Medical Sciences, data related to the 2019 BP screening mass campaign in adult people ≥ 30 years were collected. BP less than 120/80 mm Hg was considered as normal, and mean BP ≥ 140/90 mm Hg or taking antihypertensive medication was defined as hypertension. When the systolic pressure was 120 - 139 or the diastolic pressure was 80 - 90 mm Hg, the person was classified as a prehypertensive case. Results: Totally, 220,241 adult people, with a mean age of 49.82 ± 14.26 years were screened, of whom 42,107 cases (19.1%; 95% CI: 18.95 - 19.28%) had hypertension, 112,406 cases (51.0%) had normal BP, and 65,728 cases (29.8%) were diagnosed as prehypertensive cases. After controlling for demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married individuals (adjusted OR = 1.23; 95% CI: 1.19 - 1.27; P &lt; 0.0001) and those living in urban regions (adjusted OR = 1.84; 95% CI: 1.79 - 1.88; P &lt; 0.0001). The prevalence of hypertension showed no significant difference between men and women (P = 0.476). Conclusions: As nearly one in five adults had hypertension, and nearly 30% were diagnosed as prehypertensive individuals, a continuous BP screening program is recommended in this region. High BP was observed more in older and married cases and in people living in urban regions.

Evidence for wall shear stress-dependent t-PA release in human conduit arteries: role of endothelial factors and impact of high blood pressure.

Tissue plasminogen activator (t-PA) converts plasminogen into the serine protease plasmin, which in turn degrades fibrin clots. This study assessed whether an increase in shear stress is associated in humans in vivo with the release of t-PA in peripheral conduit arteries, the impact of high blood pressure and the role of NO and CYP450-derived epoxyeicosatrienoic acids (EETs). Local t-PA levels were quantified at baseline and during a sustained increase in radial artery wall shear stress induced by hand skin heating (from 34 to 44 °C) in a total of 25 subjects, among whom 8 were newly diagnosed essential hypertensive patients. The impact of the brachial infusion of NO synthase (L-NMMA) and CYP450 inhibitors (fluconazole) on t-PA release was assessed. The increase in shear stress induced by heating was associated with an increase in local t-PA release (from 3.0 ± 0.5 to 19.2 ± 5.5 ng/min, n = 25, P < 0.01). The magnitude of t-PA release was positively correlated with the increase in shear stress (r = 0.64, P < 0.001) and negatively correlated with mean blood pressure (r = -0.443, P = 0.027). These associations persisted after multiple adjustments for confounding factors. Finally, t-PA release was reduced by L-NMMA and to a larger extent by the combination of L-NMMA and fluconazole without a change in shear stress. The increase in wall shear stress in the peripheral conduit arteries induces a release of t-PA by a mechanism involving NO and EETs. The alteration of this response by high blood pressure may contribute to reducing the fibrinolytic potential and enhancing the risk of arterial thrombosis during exercise.

Antihypertensive Treatment Can Delay Cognition Decline in Middle-Aged and Older Chinese between 2011 and 2015: Results from the China Health and Retirement Longitudinal Study

Background: Observational studies have compared non-hypertensive to hypertensive individuals to evaluate the impact of high blood pressure on cognition. Clinical trials have examined cognition outcomes in hypertensive patients receiving new vs standard treatments to assess the impact of better treatments on cognition. No studies to date have compared outcomes in hypertensive individuals with or without hypertensive treatment and non-hypertensive controls. Methods: We examined blood pressure change and antihypertensive treatment in a national sample of 10,958 participants aged 45 years and older followed every two years between 2011 and 2015 in the China Health and Retirement Longitudinal Study. Cognition was measured by a composite score (range: 0-21) of episodic memory and mental intactness. Findings: At baseline, the study included 1,907 hypertensive individuals who reported treatment, 1,925 who reported no treatment, and 7,126 non-hypertensive controls. Untreated hypertensive individuals show a larger cognition decline than controls without hypertension, especially when aged 65 or older (Cognition score change: -0.65, 95% CI: -0.97, -0.34). Patients on hypertensive treatment show less cognition decline than those reporting no treatment (Score difference: 0.56, 95% CI: 0.18, 0.94). Similar changes were seen among participants aged 55-64 years. The largest impact of hypertension on cognition decline was seen among participants with less than primary school education. This group also benefited the most from hypertension treatment. Little cognition decline over time was seen among participants younger than 55 years. Interpretation: Our findings suggest that antihypertensive treatment may be effective in preventing the cognition decline over time associated with this condition, especially in the older people or people with less education. Funding Statement: None. Declaration of Interests: The authors have no competing interests. Ethics Approval Statement: Not required.

Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents.

To provide a technical summary of the methodology used to generate the 2017 "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents," an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. English-language observational studies and randomized trials. Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were archived. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.

Prevalence of hypertension among young adults in a Jaipur district of Rajasthan, India

Background: Young adults are failed to observe in studies on impact of high blood pressure as they are esteemed to be at a low risk of developing the complication or disease. Study of disease prevalence and their relation with life style habits provide the information required to develop interventional strategies. The objectives were to estimate the prevalence of hypertension among young adults in Jaipur district, Rajasthan and to study the impact of life style habits like tobacco use and alcohol consumption on hypertension.Methods: Data were collected from 390 college students aged 18 years and older in selected degree college by a cross-sectional survey. Blood pressure recordings, anthropometric measurements as well as socio-demographic characteristics were collected.Results: High blood pressure was observed in 152 out of the 390 students (38.97%), of which the 20 (5.13%) are hypertensive, majority were newly diagnosed (65%). Prevalence of high blood pressure among male students was higher (40.29% compared to 37.5% among female students). Out of total 33.85% and 5.12 % of the students were found to pre-hypertensive and hypertensive respectively. Prevalence of hypertension was found higher among those with a history of smoking or alcohol consumption.Conclusions: Majority of students with high blood pressure (hypertensive stage) were previously undiagnosed. A large number of students were in pre-hypertensive stage. Their early identification and right intervention at right time will lessen the impact of high blood pressure in productive age.

Hypertension and renal function deterioration in black Africans with autosomal polycystic kidney disease

Background: High blood pressure (HBP) is a leading cause of end-stage renal disease (ESRD) in black African populations and it is frequently associated with autosomal polycystic kidney disease (ADPKD). We assessed the impact of HBP on progression of renal disease in black Africans with ADPKD. Objectives and Methods: We performed a retrospective study between 1995 and 2010 in nephrology out-patient clinic. ADPKD was diagnosed according to recent unified criteria add reference and seventh Joint National Committee classification was used for HBP definition. Statistical analyzes were performed with Stata 12 (Statacorp LP, TX, USA). Results: We included 71 patients (39 males and 32 females) with a mean age of 47±5 years. Prevalence of hypertension was 71.8% and it was present at diagnosis of ADPKD in 48 patients (67.6%). Median delay between HBP and ADPKD diagnosis was 25.6 months. Mean systolic/diastolic blood pressure was 168±30/96±16 mm Hg. After median follow-up of 1823 days, adjusted incidence rate of ESRD in hypertensive and normotensive patients was respectively 0.05 events/100,000 patient-years and 0.03 events/100,000 patient-years ( P =0.02). Anti-hypertensive therapy included angiotensin-converting-enzyme (ACE) inhibitors in 51% of patients, but less than 1/3 normalized their blood pressure. At univariate analysis, ESRD was correlated with age, gender, body mass index, HBP and proteinuria. Multiple logistic regression analysis identified age (odds ratio (OR)=1.14; P =0.06) and HBP (OR=1.67; P =0.02) as associated with ESRD. Conclusion: Hypertension with organ damage is frequent in black African patients with ADPKD. Age and HBP at diagnosis were the main factors associated with ESRD.

Patient knowledge of blood pressure target is associated with improved blood pressure control in chronic kidney disease

ObjectiveTo describe patient hypertension knowledge and associations with blood pressure measurements. MethodsPatients with chronic kidney disease (CKD) were asked about the impact of high blood pressure on kidneys and their target blood pressure goal. Systolic blood pressure was measured using automated sphygmomanometers. ResultsIn 338 adults with hypertension and pre-dialysis CKD, the median [IQR] age was 59 [47,68] years, 45% [n=152] were women, and 18% [n=62] were non-white. Lower systolic blood pressure (SBP) was associated with female sex (SBP mmHg median [IQR] 132 [117,149] women vs. 137 [124,152] men; p=0.04), less advanced CKD (SBP 134 [122,147] stages 1–2 vs. 132 [118,148] stage 3 vs. 140 [125,156] stages 4–5; p=0.01), and patient ability to correctly identify SBP goal (SBP 134 [119,150] correct vs. 141 [125,154] incorrect; p=0.05). In adjusted analysis, knowledge of blood pressure goal remained independently associated with lower SBP (−9.96mmHg [−19.97, −1.95] in correct respondents vs. incorrect; p<0.001). ConclusionPatient knowledge of goal blood pressure is independently associated with improved blood pressure control. Practice implicationsInterventions to improve patient knowledge of specific blood pressure targets may have an important role in optimizing blood pressure management.

Health-related quality of life and awareness of hypertension

It has been shown that individuals with hypertension have poorer health-related quality of life (HRQoL) than normotensive individuals. However, little is known about the impact of high blood pressure and the awareness to have hypertension on HRQoL. In this cross-sectional population-based study, we evaluated 901 cardiovascular risk patients aged 45 to 70 years without serious comorbidities. Hypertension was detected in 497 (55%) of the patients, in whom 137 (28%) had previously undiagnosed hypertension confirmed with home blood pressure measurement. Before the diagnosis of hypertension was made, the patients filled Short-Form Health Survey (SF-36) to assess their HRQoL. Glucose homeostasis was assessed with 2 h oral glucose tolerance test. Patients who were aware of their hypertension had lower scores in physical functioning and general health than patients without hypertension and patients who were unaware of hypertension. There were no differences for mental components of SF-36 between these study groups. The prevalence of obesity and newly diagnosed type 2 diabetes was higher in patients with known hypertension than among other study groups. Impaired HRQoL in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type 2 diabetes or obesity, not high blood pressure per se.

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.