Important Predictors Of Hypertension Research Articles

#1386 Hypertension is associated with deterioration of kidney function among patients with systemic lupus erythematosus, with or without lupus nephritis

Abstract Background and Aims Systemic lupus erythematosus (SLE) frequently involves the kidneys, contributing to morbidity and mortality among this population. While hypertension often coexists with kidney involvement, it is not represented in the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index. Its effect on the morbidity and mortality of the SLE population in the Middle East should be evaluated. Our aims is to characterize the role of hypertension in Israeli SLE patients and identify variables associated with decreased eGFR over time. Method This retrospective study, conducted between 2014–2023 included adult patients with a diagnosis of SLE for at least 12 months. Kidney involvement was assessed based on a diagnosis of lupus nephritis (LN) on kidney biopsy. Hypertension was diagnosed based on documented diagnosis. Systolic and diastolic blood pressures were collected as continuous variables at multiple time-points. Associated variables, including socio-demographics, disease-related characteristics, kidney-related factors, comorbidities and all-cause mortality were assessed. Results A total of 182 patients were followed for a mean duration of 16.2 ± 13.8 years. Fifty-nine patients (32.4%) had chronic hypertension. Hypertension was more prevalent among SLE patients with LN [odds ratio (OR) 1.5, 95% CI 0.8-2.9, p = 0.23] as well as patients with chronic kidney disease (OR 7.2, 95% CI 1.9-27.7, p = 0.001). Patients with chronic hypertension had significantly relatively high rate of proteinuria at last follow-up (54.7%). On univariate analysis, patients with hypertension had higher rates of end-stage kidney disease (ESKD) (11.9% vs 1.6%, p = 0.003), heart failure (20.3% vs. 0.8%, p < 0.001), and all-cause mortality (16.9% vs. 0%, p < 0.001). All deaths (n = 10) occurred among hypertensive patients. LN and age were the most important predictors of hypertension on multivariate analysis (OR 6.2, 95% CI 2.4-16, p < 0.001; OR 1.1, 95% CI 1.1-1.2 p < 0.001, respectively). Repeated measures analysis showed that hypertension was significantly associated with decreased eGFR among SLE patients with or without LN (Fig. 1). Systolic and diastolic blood pressure were significantly correlated with age and inversely correlated with eGFR at last follow-up (Spearman's correlation coefficient 0.4, p < 0.01; 0.1, p = 0.07; −0.4, p < 0.01; −0.2, p = 0.04, respectively). Conclusion Hypertension is prevalent among Israeli patients with SLE, constituting a substantial comorbidity associated with ESKD, heart failure and mortality, irrespective of LN presence. Routine assessment and vigorous treatment of hypertension should be part of the management of patients with SLE.

RELATIONSHIP OF NECK CIRCUMFERENCE WITH HYPERTENSION AND OBESITY AMONG EARLY ADOLESCENT, SCHOOL GOING CHILDREN (10 - 15 YEARS)

The prevalence of child obesity is rapidly increasing worldwide. These conditions pose a major public health problem because they are associated with various chronic disease. Obesity having several risk factors for later cardiovascular and metabolic problems. Chronic and insidious nature of these disorders close monitoring in childhood is required to prevent long-term effects. The present study was undertaken to evaluate the relationship between the risk of HTN and high NC alone and also in the combinations with other anthropometric indices among the adolescents. This community based cross sectional study was carried out during November 2019 to January, 2020 among the adolescents aged 10-15 years living in Midnapore, a district town of eastern India and its adjacent areas. This study indicated that 6.53% of the adolescents were suffering from hypertension and the prevalence of obesity as determined by BAZ>1SD were 7.42% while 20.18% of the participants were suffering from central obesity as diagnosed by high WC. High NC was observed among 8.31% participants. The present study clearly indicated that high NC is the most important predictor of hypertension among the adolescents.

Ambient air pollutants aggravate association of snoring with prevalent hypertension: results from the Henan Rural Cohort

AimWe aimed to assess if snoring and ambient air pollutants were jointly associated with prevalent hypertension in a cross-sectional study. MethodsA total of 28440 participants aged 18–79 years were obtained from the Henan Rural Cohort. Snoring evaluated using Pittsburgh sleep quality index (PSQI) scale was classified into ‘Never’, ‘<3 times/week’ and ‘≥3 times/week’ groups. Concentrations of air pollutants (PM1, PM2.5, PM10, and NO2) were evaluated by a satellite-based spatiotemporal model. The independent and joint associations between snoring and air pollutants on prevalence of hypertension were analyzed by logistic regression models. ResultsThe mean age of all participants was 56.0 ± 12.2 years. The frequencies and prevalence of participants with hypertension were 3666 (32.39%) in men and 5576(32.57%) in women, respectively. The odds ratio (OR) and 95% confidence interval (CI) of participants with snoring frequency of <3 times/week, ≥3 times/week was 1.10(1.02–1.20), and 1.15(1.08–1.23) for hypertension, compared to those without snoring. Participants with a snoring (≥3 times/week) and higher exposure concentrations of PM1, PM2.5, PM10, and NO2 had 2.58-fold(95% CI: 2.30–2.90), 3.03-fold(95% CI: 2.69–3.41), 2.89-fold(95% CI: 2.57–3.25) and 2.75-fold(95% CI: 2.44–3.10) for hypertension, compared to those without snoring and low concentrations of air pollutants. Additionally, participants with high PM1 and ≥3 times/week snoring (OR: 1.32, 95% CI: 1.18–1.48) was at a higher likelihood for prevalent hypertension, compared to those without snoring and with high PM1. ConclusionsSnoring and high ambient air pollutants might be important predictors of hypertension, and higher concentration of PM1 might aggravate the association between snoring and hypertension.

Sodium and Potassium Intakes and Their Ratio in Adults (18-90 y): Findings from the Irish National Adult Nutrition Survey.

An individual’s sodium to potassium intake ratio (Na:K) has been shown to be an important predictor of hypertension. The aim of this study was to estimate the mean 24 h urinary Na, K and Na:K of Irish adults and to identify the foods that determine Na:K in a nationally representative sample of Irish adults. This study was based on data from the Irish National Adult Nutrition Survey (2008–2010) (NANS), which collected spot urine samples and dietary data in a nationally representative sample of Irish adults aged 18+ years. The mean urinary molar Na:K of Irish men and women was 1.90 and 2.15, respectively, which exceed target molar ratios of ≤1.0 and ≤2.0. The mean estimated 24-h urinary excretion of Na was 4631 mg for men and 3525 mg for women, which exceed target maximum population intakes for all gender and age groups. The mean estimated 24-h urinary excretion of K was 3894 mg for men and 2686 mg for women, with intakes in women of all ages and older men (65+ years) below current recommendations. The key foods positively associated with a lower Na:K were fruits, vegetables, potatoes, breakfast cereals, milk, yogurt and fresh meat, while the foods negatively associated with a lower Na:K were breads, cured and processed meats and butters and fat spreads. Strategies to reduce sodium and increase potassium intakes are necessary to lower population Na:K, which may help to reduce the burden of hypertension-related diseases in the Irish population.

Estimates of Sodium and Potassium intake and their molar ratio in Irish children: Preliminary findings from NCFSII

AbstractThe Food Safety Authority of Ireland (FSAI) have set target maximum daily salt intakes for children (4–6y: 3 g, 7–10y: 5 g, 11–14y: 6g) while the European Food Safety Authority (EFSA) have set Adequate Intakes (AI) for potassium of 1100mg/d, 1800mg/d and 2700mg/d for children of the same respective age groups. An individual's sodium to potassium (Na:K) intake ratio is an important predictor of hypertension and the World Health Organization (WHO) recommend a Na:K intake ratio of ≤ 1.0mmol/mmol for both adults and children. Although the morbidities associated with hypertension may not be seen until adulthood, blood pressure in childhood has a significant association with blood pressure in adulthood. Therefore, estimation of Na:K intake ratios (best measured by urinary excretion) in children may predict their susceptibility to hypertension related diseases in later life. The aim of this study was to estimate sodium and potassium intake and mean molar Na:K intake ratio of Irish children and to assess compliance with dietary guidance.Morning spot urine samples were collected for 572 children aged 5–12 years (95% of total sample) as part of the nationally representative Irish National Children's Food Survey II (2017–2018) (NCFSII; www.iuna.net). Samples were transported, processed and stored using best practice procedures. Urinary excretion of sodium and potassium were measured using a Randox RX Daytona and were corrected for gender and age-specific 24-hour urine volume estimations based on 24-hour urine volume estimates from Australian children. SPSS Version 25 was used for all analyses.Mean 24-hour urinary sodium excretion was 2018mg/d, equivalent to an average salt excretion of 5.0g/d exceeding the FSAI maximum target intake for all age groups except 11–12 year olds. Mean 24-hour urinary potassium excretion was 1411mg/d with mean intakes below the AI from EFSA for all age groups with the exception of 5–6 year olds. The mean molar Na:K ratio of Irish children was 2.8 for boys and 3.4 for girls. Only 5% of Irish children met the WHO recommendation for a Na:K ratio of ≤ 1.0mmol/mmol.High intakes of sodium and low intakes of potassium reported in this study result in a low compliance with the WHO recommendation of a Na:K ratio ≤ 1.0mmol/mmol. This may lead to a higher risk of hypertension and related morbidities in later life. Based on these findings, dietary interventions to combat hypertension related diseases (such as lowering sodium and increasing potassium intakes) should be implemented from childhood.

Incidence and Predictors of Systemic Hypertension among Cohort of HIV/AIDS Infected Patients in Health Facilities of South Ethiopia

Growing body of epidemiologic evidence suggests that there are a number of modifiable risk factors that lead to increased incidence of hypertension in low income countries. Besides non modifiable factors like age, highly active antiretroviral treatments are believed to be increase the risk of hypertension in Human Immuno Virus patients. But studies disagree as to whether there are a greater incidence of hypertension among HIV/AIDS patients and the role of antiretroviral therapy. The Study was conducted in public health institution of Gamo-Gofa zone by using Retrospective cohort study design. Simple random sampling techniques with stratified sampling with proportional to size allocation were used to select HIV patients. The data were collected by registered Anti Retroviral Treatment Provider nurses, by using structured questionnaire which was adapted from the World Health Organization STEPS instrument. The data were cleaned to check for its completeness, consistency and the presence of missed values and variables, and then it was entered into a pre-designed format in Epi-Info version 7 and transferred to SPSS version 21 and Stata for further analysis. Frequencies, mean, median, quartile and standard deviation were used to describe the data. After necessary assumption of logistic regression model was checked, bivariable and multiple logistic regression models were fitted to see the predictors of hypertension. A total of 834 HIV/AIDS infected (95.4% response rate) were included in this study. The mean systolic and diastolic BP were 115.7 mmHg (±16.1 SD) and 74.9 mmHg (±12.4 SD). The cumulative incidence of hypertension was 20% (95% CI: 19.9 - 20.03), in equal proportion in Pre-HAART (20.1%) and HAART (20.0%) receiving patients. The study revealed modifiable; monthly income (AOR; 2.26, 95% CI (1.26, 4.05)), Occupational status (AOR, 0.36, 95% CI; (0.17, 0.78)), Body mass index (AOR: 12.6, (95% CI: 5.32, 29.8)) and non-modifiable family history of hypertension (AOR: 2.18, 95% CI: 1.32, 3.58) as important predictors of hypertension among HIV infected patients. There was high incidence of hypertension among HIV infected patients which may reflect insights for intervention. The investigators accept the null hypothesis that there is association between HAART intervention and incidence of Hypertension.

Predictors of Perceived Salt Intake and Actual Salt Intake in Romania. Implications for public policy

Salt intake is one of the important predictors of hypertension, a widespread chronic disease among adults. Much remains to be known about its causes, especially in the Romanian context, where there is a scarcity of analyses on this particular topic. Its predictors are relevant for public policy in order to evaluate what strategy should be adopted given actual levels of salt intake and the way people think about their levels of salt intake. Our analyses focus on actual and perceived salt intake. Data for this analysis come from the SEPHAR project, gathered in 2016 (wave 3), a nationally representative sample of Romanians. After noting a major discrepancy between perceived and actual levels of salt intake, we used two regressions with actual and perceived salt intake as dependent variables and three types of factors as independent variables: socio-demographic (age, gender, region, type of locality, education), lifestyle (fat diet, alcohol consumption, active lifestyle, and smoking) and related diseases (obesity and diabetes). Results show Romanians have similar levels of salt intake perceptions independently of the characteristics considered, except fat diet and diabetes, and similar levels of actual salt intake except age and gender, even though previous research shows that there are differences between individuals across these characteristics when it comes to considering hypertension as a dependent variable. We conclude by noting policy interventions regarding salt intake based on the results of this research, especially the need to update the current Romanian TV campaign to reduce salt intake or similar campaigns from other countries.

Predictors of Perceived Salt Intake and Actual Salt Intake in Romania. Implications for public policy

Salt intake is one of the important predictors of hypertension, a widespread chronic disease among adults. Much remains to be known about its causes, especially in the Romanian context, where there is a scarcity of analyses on this particular topic. Its predictors are relevant for public policy in order to evaluate what strategy should be adopted given actual levels of salt intake and the way people think about their levels of salt intake. Our analyses focus on actual and perceived salt intake. Data for this analysis come from the SEPHAR project, gathered in 2016 (wave 3), a nationally representative sample of Romanians. After noting a major discrepancy between perceived and actual levels of salt intake, we used two regressions with actual and perceived salt intake as dependent variables and three types of factors as independent variables: socio-demographic (age, gender, region, type of locality, education), lifestyle (fat diet, alcohol consumption, active lifestyle, and smoking) and related diseases (obesity and diabetes). Results show Romanians have similar levels of salt intake perceptions independently of the characteristics considered, except fat diet and diabetes, and similar levels of actual salt intake except age and gender, even though previous research shows that there are differences between individuals across these characteristics when it comes to considering hypertension as a dependent variable. We conclude by noting policy interventions regarding salt intake based on the results of this research, especially the need to update the current Romanian TV campaign to reduce salt intake or similar campaigns from other countries. Keywords: Salt intake perceptions, actual salt intake, public policy, SEPHAR, regression

Predictors of hypertension in Oman

Background: According to the Oman World Health Survey in 2008, the prevalence of hypertension in Oman is about 40%. Hypertension is associated with old people, male gender, smoker and impaired glucose tolerance. The objective of the study was to find out the important predictors of hypertension in Oman.Methods: A cross sectional study in Omani adults more than 18 years of age was conducted. Blood pressure was measured and participants were classified as having hypertension. Height and weight was measured and body mass index was used to classify obesity by WHO guidelines. Multiple logistic regression was used to find the predictors of hypertension.Results: Increase in age and body mass index were found to be important covariates of hypertension. People in the age group of 30 to 50 years were at high risk of hypertension (OR 1.6, p&lt;0.05); likelihood increased to three times in more than 50 years age group (p&lt;0.01) in univariate analysis. Overweight had almost 2 times (p&lt;0.05) and obese had five times (p&lt;0.01) more likelihood of hypertension than normal weight people. People with less education had more likelihood of hypertension. Smokers (OR 2.9, p&lt;0.01) and males (OR 1.5, p&lt;0.05) were at a higher risk of hypertension than non-smokers and females in multivariate analysis. Percentage accuracy of classification was 67.4%.Conclusions: Age more than 50 years, male gender, BMI more than 30 and smoking were important predictors of hypertension in the study population.

LB.02.01] HOMA INDEX AS A PREDICTOR OF HYPERTENSION IN A PEDIATRIC OBESE POPULATION

Objective: Find predictors of hypertension in obese children diagnosed with ABPM and office BP Design and method: we studied 20 obese children (age 13 ± 0.9 ys, 11 M 9 F) enrolled in our Pediatric Division, with mean BMI of 30.3 ± 4.3, height 1.53 ± 0.11 and weight 72.2 ± 16.6. We evaluated a clinic visit, blood samples, blood pressure measurements (BP office mean of 3 measurements), 24 h ambulatory blood pressure (ABPM), echocardiogram and intimal media thickness (IMT) of common carotid artery. Results: Mean BP office was: systolic 121 ± 12 mmHg, diastolic 65 ± 10 mmHg; mean 24 h ABPM was: systolic 127 ± 10 mmHg and diastolic 70.2 ± 6.24 mmHg; diurnal systolic ABPM 121.9 ± 10.7mmHg, nocturnal 109.1 ± 10.5mmHg; diurnal diastolic ABPM: 75.1 ± 7.9 mmHg, nocturnal 62 ± 5.6 mmHg. For 24 h ABPM pediatric criteria, 2 patients were >90%percentile for sex, age and height for normal-high blood pressure values and 7 pt were>95% for hypertension criteria. Regardless percentile (%) BP criteria for children we observed that for systolic nocturnal BP 2 subjects were>90% and 7>95% and for diastolic BP 4 subjects>90% and 4 >95%. In general ABPM showed 11 patients as hypertensive, 7 were>95% for systolic and 2>95% only for diastolic. Considering predictors of arterial hypertension in our population we figured out that: (i) HOMA index has a positive correlation with systolic office BP (p = 0.03) and (ii) a borderline correlation with mean systolic ABPM (p = 0.06). Interestingly in our paediatric population, in patients defined as hypertensive for the 95% criteria with the ABPM monitoring, HOMA index was significantly different between hypertensive and non-hypertensive children (p = 0.05) Conclusions: In conclusion our preliminary report show that: (i) ABPM has a better sensitivity in diagnosing arterial hypertension versus office BP measurement and that (ii) HOMA index is an important predictor of hypertension in healthy obese children.

ISH NIA PS 03-08 THE ROLE OF BODY FAT AND FAT DISTRIBUTION IN HYPERTENSION RISK IN URBAN BLACK SOUTH AFRICAN WOMEN

Objective: The objectives of this study were: (1) to examine how different measures of body composition are associated with blood pressure (BP) and incident hypertension; (2) to determine the association between baseline or change in body composition, and hypertension; and (3) to determine which body composition measure best predicts hypertension in Black South African women. Design and Method: The sample comprised 478 non-hypertensive women, aged 29–53 years. Body fat and BP were assessed at baseline and 8.3 years later. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) and anthropometry. Hypertension was diagnosed based on a systolic/diastolic BP ≥ 140/90 mmHg, or medication use at follow-up. Results: All body composition measures increased (p < 0.0001) between baseline and follow-up. BP increased by ≥ 20%, resulting in a 57.1% cumulative incidence of hypertension. Both DXA- and anthropometric-derived measures of body composition were significantly associated with BP, explaining 3–5% of the variance. Baseline BP was the most important predictor of hypertension (adjusted OR: 98–123%). Measures of central adiposity were associated with greater odds (50–65%) of hypertension than total adiposity (44–45%). Only change in anthropometric-derived central fat mass predicted hypertension (adjusted OR: 32–40%). Conclusions: This study highlights that body composition is not a major driver of hypertension. DXA measures of body composition do not add to hypertension prediction beyond anthropometry, which is especially relevant for African populations globally, taking into account the severely resource limited setting found in these communities.

The Role of Body Fat and Fat Distribution in Hypertension Risk in Urban Black South African Women.

Developing countries are disproportionately affected by hypertension, with Black women being at greater risk, possibly due to differences in body fat distribution. The objectives of this study were: (1) To examine how different measures of body composition are associated with blood pressure (BP) and incident hypertension; (2) to determine the association between baseline or change in body composition, and hypertension; and (3) to determine which body composition measure best predicts hypertension in Black South African women. The sample comprised 478 non-hypertensive women, aged 29–53 years. Body fat and BP were assessed at baseline and 8.3 years later. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) (n = 273) and anthropometry. Hypertension was diagnosed based on a systolic/diastolic BP ≥140/90 mmHg, or medication use at follow-up. All body composition measures increased (p<0.0001) between baseline and follow-up. SBP and DBP increased by ≥20%, resulting in a 57.1% cumulative incidence of hypertension. Both DXA- and anthropometric-derived measures of body composition were significantly associated with BP, explaining 3–5% of the variance. Baseline BP was the most important predictor of hypertension (adjusted OR: 98–123%). Measures of central adiposity were associated with greater odds (50–65%) of hypertension than total adiposity (44–45%). Only change in anthropometric-derived central fat mass predicted hypertension (adjusted OR: 32–40%). This study highlights that body composition is not a major determinant of hypertension in the sample of black African women. DXA measures of body composition do not add to hypertension prediction beyond anthropometry, which is especially relevant for African populations globally, taking into account the severely resource limited setting found in these communities.

Associations between particulate matter composition and childhood blood pressure — The PIAMA study

BackgroundChildhood blood pressure is an important predictor of hypertension and cardiovascular disease in adulthood. Evidence for an association between ambient particulate matter (PM) exposure and blood pressure is increasing, but little is known about the relevance of different PM constituents. ObjectivesWe investigated the association between particulate matter composition and blood pressure at age 12years. MethodsAnnual average concentrations of copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc in particles with diameters of less than 2.5μm (PM2.5) and 10μm (PM10) were estimated by land-use regression modeling for the home addresses of the participants of the prospective PIAMA birth cohort study. Associations between element concentrations and blood pressure measurements performed at age 12years were investigated by linear regression with and without adjustment for confounders. ResultsAfter adjustment for potential confounders we found statistically significant positive associations of diastolic blood pressure with iron, silicon, and potassium in PM10 in children who lived at the same address since birth [mean difference (95% confidence interval) 0.67 (0.02;1.31) mmHg, 0.85 (0.18;1.52) mmHg, and 0.75 (0.09;1.41) mmHg, respectively, per interquartile range increase in exposure]. Also, we found marginally significant (p<0.1) positive associations between iron and silicon in PM2.5 and diastolic blood pressure. Part of the observed effects was found to be attributable to NO2, a marker of exhaust traffic emissions. ConclusionsExposure to particulate matter constituents, in particular iron may increase blood pressure in children. The possible association with iron may indicate the health relevance of non-exhaust emissions of traffic.

P264 Nocturnal Heart Rate in Patients with Obstructive Sleep Apnoea

BackgroundObstructive sleep apnoea (OSA) is the most common sleep disorder and a significant risk factor for cardiovascular disease. In addition, heart rate is an important predictor of hypertension and a...

Hypertension and Childhood Obesity: A Whirling Tango. A Review of the Dance Steps

Despite large sensitization, excess weight, hypertension and cardiovascular risk factors in children and adolescents are extending more and more, as a real new ‘epidemic’. Always more attention has been paid on epidemiology, causes, consequences and factors related to increase blood pressure values among young people. For the first time during 2009, the recommendations of the European Society of Hypertension for the management of high blood pressure in children and adolescents were published, remarking that the most important condition related to paediatric hypertension is the excess weight. The negative metabolic effects of obesity on blood pressure begin early during childhood and track through adolescence into adulthood. Waist circumference and waist-to-height ratio have emerged as better adiposity indicators than body mass index and important predictors of hypertension and cardiovascular risk. Also insulin resistance and high uric acid plasma levels have been advocated as relevant risk factors in children. Moreover a correlation between adipocytokines, in particular leptin and adiponectin, and hypertension and cardiovascular damage in children has been suggested. Obesity-associated hypertension results related to heart damage ( particularly an increase of the left ventricular mass), renal involvement ( presence of microalbuminuria) and autonomic alterations. As first therapy approach in hypertensive children, fundamental is the role of lifestyle measures: reduction of excess weight, increase of physical activity and limitation of sodium in the diet represent the main aspects of this kind of intervention.

Impact of Hypertension on Morpho-physiological Traits in Rural and Urban Jat Females of Haryana, North India

KEYWORDS Hypertension. Normotensive. Morpho-Physiological Traits. Rural-Urban Jat Females. Haryana ABSTRACT The aim of the present cross-sectional study was to assess the impact of hypertension on morpho- physiological traits in rural and urban Jat females of Haryana (North India). For this 300 rural (normotensive=230, hypertensive=70) and 300 urban (normotensive=213, hypertensive= 87) females in the age range of 40 t o 70 years were studied for nine morphological (anthropometric) and four physiological traits. Comparison revealed that rural normotensive females were taller and heavier than hypertensive females, whereas among urban subjects, normotensive females were taller and significantly (p< 0.05) lighter than hypertensive females. All t he five skinfold thicknesses at biceps, triceps, supra-iliac, subscapular and calf showed greater values among normotensive females than hypertensive females in both the rural and urban subjects. Rural and urban Jat females demonstrated higher haemoglobin concentration a nd manua l strength a mong normotensives a s compared to hypertensive subjects. Pulse rate of hypertensive females was significantly (p<0.001) higher than normotensives i n both the rural as well as urban groups of Jat females. Binary logistic regression analysis of urban Jat females suggested that BMI (OR=5.06, CI=1.15-22.18), waist circumference (OR=2.89, CI=0.83-10.10) and pulse rate (OR=1.17, CI=1.11- 1.24) were important predictors of hypertension, whereas for ru ral Ja t fema les important determinant s of hypertension were BMI (OR=1.26, CI=0.44-3.59) and pulse rate (OR=1.15, CI=1.08-1.22).

Household Air Pollution and Children's Blood Pressure

To the Editor: Childhood blood pressure (BP) is an important predictor of hypertension and cardiovascular risk later in life1; risk factors for elevated BP in children remain mostly unknown. Ambient air pollution is associated with impaired vascular health, oxidative stress, and systemic inflammation in children.2 Limited evidence suggests that household air pollution is associated with higher BP in adult women,3–5 but this relationship has not been studied in children. Half the world's population uses biomass and coal for energy6; thus, even a small effect of household air pollution on BP in childhood could have large cardiovascular implications. We investigated the association between exposure to household air pollution from biomass combustion and BP in Chinese children. We recruited school-aged children from 180 rural households cooking with biomass in Yunnan, China. Detailed information on the study population, exposure assessment, and quality control is published elsewhere.7 Participants wore a small backpack containing equipment to measure personal exposure to particles <2.5 μg in aerodynamic diameter (particulate matter [PM]2.5) over a 24-hour period. PM2.5 samples were analyzed for mass and black carbon (BC) (eAppendix 1, https://links.lww.com/EDE/A592). We measured children's BP before and after pollution exposure measurement, using an automated device (Omron-705). We also collected household sociodemographic and health information, including caffeine intake, exposure to cigarette smoke, physical activity, and 24-hour salt and monosodium glutamate intake, and we measured each child's height and weight. Mother's BP was assessed in a 40% subsample (eAppendix 2, https://links.lww.com/EDE/A592). We investigated the associations between personal PM2.5 and BC exposures and BP using one- and two-pollutant multivariate regression models. Pollution measures were transformed to the natural log scale to account for their skewedness toward high values (eAppendix 3, https://links.lww.com/EDE/A592). We enrolled 240 children (47% girls). Mean age was 10.3 years (95% confidence interval: 10.0–10.6; range: 5–14 years), average body mass index was 15.3 kg/m2 (15.0–15.6), and 85% lived with a smoker (eTable 1, https://links.lww.com/EDE/A592). Personal 24-hour PM2.5 exposure ranged from 14 to 393 μg/m3 (geometric mean = 53 μg/m3 [46–61]). BC exposure ranged between 2.0 and 9.6 μg/m3 (geometric mean = 3.2 μg/m3 [3.1–3.3]). PM2.5 and BC exposures were moderately correlated (Pearson r = 0.41). In the single-pollutant multivariate regression models, a 1-ln(μg/m3) increase in PM2.5 was associated with small decreases in systolic BC (−1.8 mmHg [95% confidence interval: −3.6, 0.1]) and diastolic BC (−0.5 mmHg [−2.1 to 1.2]). Similarly, a 1-ln(μg/m3) increase in BC was also associated with small decreases in systolic BC (−2.2 mmHg [−5.4 to 1.0]) and diastolic BC (−0.4 mmHg [−3.3 to 2.6]). In two-pollutant models, the effect of PM2.5 exposure on BP was largely unchanged; however, the effect of BC was greatly weakened (Table). Sensitivity analyses included adjustment for maternal BP, restricting the analysis to smaller age-groups, and transforming BP into quantiles; none of these affected the qualitative interpretation of our results (eAppendix 4, https://links.lww.com/EDE/A592).Table: Multivariate Adjusted Associations of Personal PM2.5 and Black Carbon Exposure With Blood Pressure Using One- and Two-pollutant ModelsaWe found that increased PM2.5 and BC exposures were not associated with higher BP among children in households cooking with biomass. Our findings do not support our previous study of older women in this setting, showing a positive relationship between PM exposure and BP. Possible explanations include the lower levels and shorter durations of PM exposure among children compared with adult women7 (eAppendix 5, https://links.lww.com/EDE/A592). Older women would be more likely than young children to experience a resetting of BP-regulating mechanisms to higher levels, as a result of repeated acute increases in BP after PM inhalation. We also cannot rule out the possibility of residual confounding by difficult-to-measure or unmeasured covariates in this cross-sectional study. Future longitudinal studies could advance our understanding of the vascular effects of household air pollution in children and should incorporate measures of PM pollution exposure and BP over a span of years. Jill Baumgartner Institute on the Environment College of Food, Agricultural and Natural Resource Sciences University of Minnesota St. Paul, MN [email protected] Yuanxun Zhang College of Resources and Environment Graduate University of the Chinese Academy of Sciences Beijing, China James J. Schauer Department of Civil and Environmental Engineering College of Engineering University of Wisconsin Madison, WI Majid Ezzati MRC-HPA Centre for Environment and Health Department of Epidemiology and Biostatistics School of Public Health, Imperial College London, United Kingdom Jonathan A. Patz Global Health Institute School of Medicine and Public Health University of Wisconsin Madison, WI Leonelo E. Bautista Department of Population Health Sciences School of Medicine and Public Health University of Wisconsin Madison, WI

Kako antropometrijski indeksi koreliraju s Kardiovaskularnim rizicima u Hrvatskoj?Presječna studija.

SummaryBackgroundUsefulness of anthropometric indices (AI) as predictors of CV risk is unclear and remains controversial.Material/MethodsTo evaluate the correlation between AI and CV risk factors in the Croatian adult population and to observe possible differences between coastal and inland regions and urban and rural settlements. CRISIC-fm (ISRCTN31857696) is a prospective, randomized cohort study conducted in GP (general practitioner) practices in Croatia. Between May and July 2008, 59 GPs each recruited 55 participants aged ≥40 years, who visited a practice for any reason. Height, weight, waist and hip circumference and blood pressure were measured. Blood samples were analyzed in accredited laboratories.ResultsOut of 2467 participants (61.9% women, 38.1% men), 36.3% were obese, with fewer in coastal than inland areas. More obese people were in rural areas. Logistic regression showed BMI was the most important predictor of hypertension, diabetes and dyslipidemia in both regions (except for diabetes in the coastal area), and for urban and rural settlements (except for diabetes in rural areas). WtHR was a significant predictor for hypertension and dyslipidemia in the coastal (but only for hypertension in the inland area), and in urban settlements (in rural only for hypertension). None of the AI showed significant correlation with total CV risk, but WC and BMI did with stroke risk. Receiver operating curve (ROC) analyses showed that WtHR was a better predictor than all other AI for hypertension and dyslipidemia.ConclusionsResults encourage the use of BMI and WtHR as important tools in predicting CV risk in GP’s practice.

Inter-practice variation in diagnosing hypertension and diabetes mellitus: a cross-sectional study in general practice

BackgroundPrevious studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. Therefore, in the present study inter-practice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by 1) using a multi-level design and 2) adjusting for patient and practice characteristics.MethodsData were used from the Netherlands Information Network of General Practice (LINH) in 2004. Of all 168.045 registered patients, the presence of hypertension, diabetes mellitus and all available ICPC coded symptoms and diseases related to hypertension and diabetes, were determined. Also, the characteristics of practices were used in the analyses. Multilevel logistic regression analyses were performed.ResultsThe 95% prevalence range for the practices for the prevalence of diagnosed hypertension and diabetes mellitus was 66.3 to 181.7 per 1000 patients and 22.2 to 65.8 per 1000 patients, respectively, after adjustment for patient and practice characteristics. The presence of hypertension and diabetes was best predicted by patient characteristics. The most important predictors of hypertension were obesity (OR = 3.5), presence of a lipid disorder (OR = 3.0), and diabetes mellitus (OR = 2.6), whereas the presence of diabetes mellitus was particularly predicted by retinopathy (OR = 8.5), lipid disorders (OR = 2.8) and hypertension (OR = 2.7).ConclusionAlthough not the optimal case-mix could be used in this study, we conclude that even after adjustment for patient (demographic variables and risk factors for hypertension and diabetes mellitus) and practice characteristics (practice size and presence of a practice nurse), there is a wide difference between general practices in the prevalence rates of diagnosed hypertension and diabetes mellitus.