Incident Cases Of Hypertension Research Articles

Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa.

BackgroundOne of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort.MethodsWe conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004–2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.ResultsAmong 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3–5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3.ConclusionOver 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.

Initial therapeutic choices for hypertension in the Portuguese Sentinel Practice Network

Introduction and ObjectivesFinding out which drugs are chosen to treat incident cases of hypertension may help in interpreting prevalent use of antihypertensive agents. We aimed to determine the proportion of patients who begin treatment with each antihypertensive drug class, which physicians initiate treatment and whether family physicians alter prescriptions initiated by others, and to compare the prescribing patterns of family physicians and other specialists. MethodsIn this cohort-nested cross-sectional study between 2014 and 2015 within the Portuguese Sentinel Practice Network, family physicians notified incident cases of hypertension, reporting treatment, who issued the initial prescription and whether treatments initiated by other physicians were changed. ResultsA total of 681 incident cases were notified. The initial prescription was issued by the patient's family physician in 86.9% of cases (95% CI: 84.2-89.3%). The most frequently used agents were angiotensin-converting enzyme inhibitors (51.3% of patients, 95% CI: 47.5-55.0%), thiazide and thiazide-like diuretics (32.2%, 95% CI: 28.8-35.8%), and angiotensin receptor blockers (21.4%, 95% CI: 18.5-24.7%). Compared to other specialists, family physicians used less beta-blockers (20.4 vs. 5.9%, p<0.001) and loop diuretics (8.2 vs. 0.8%, p=0.003). Prescriptions initiated by other specialists were changed by family physicians in 11.6% of cases (95% CI: 6.0-19.6%). ConclusionAngiotensin-converting enzyme inhibitors were the most frequently prescribed antihypertensive class. Most diagnoses were made by the patient's own family physician. Prescriptions initiated by other specialists were usually continued by family physicians. Prescribing patterns were similar between family physicians and other specialists, except for lower use of beta-blockers and loop diuretics.

Body mass index, waist circumference, body fat mass, and risk of developing hypertension in normal-weight children and adolescents

Background and aimsWe prospectively examined the association between three adiposity indices, including body mass index (BMI), waist circumference (WC), and percentage of body fat (PBF), and risk of hypertension in normal-weight Chinese children. Methods and resultsThe current study included 1526 (713 boys and 813 girls) normal-weight Chinese children (age 6–14 years old), who were free of hypertension at baseline (2014). Heights, body weight, WC, and PBF (estimated by bioelectrical impedance analysis) were measured at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure, according to age- and sex-specific 95th percentile for Chinese children. We used Cox proportional hazards model to calculate the association between exposures and hypertension. We identified 88 incident hypertension cases during two years of follow up. High BMI was associated with high risk of developing hypertension after adjusting for potential confounders. The adjusted hazard ratio for hypertension was 2.88 (95% CI: 1.24, 6.69) comparing two extreme BMI quartiles. Each SD increase of BMI (≈1.85 kg/m2) was associated with a 32% higher likelihood to developing hypertension (Hazard ratio = 1.32; 95% CI: 1.003, 1.73). In contrast, we did not find significant associations between WC or PBF and higher hypertension risk (p-trend >0.2 for both). ConclusionHigh BMI, but not WC and PBF, was associated with high risk of hypertension in normal-weight Chinese children.

Abstract P184: Meat Cooking Methods and Risk of Hypertension: Results From Three Prospective Cohort Studies

Background: The role of open-flame and/or high-temperature cooking (grilling/barbequing, broiling, or roasting) and doneness preferences (rare, medium, or well-done) in the association between meat consumption and risk of hypertension remains unknown. This study aimed to examine cooking methods for meats (red meats, chicken, or fish) in relation to hypertension risk among men and women who consumed meat regularly (≥2 servings/week). Methods: Study population consisted of 32,925 women from the Nurses’ Health Study (NHS 1996-2012), 53,852 women from the NHSII (2001-2013), and 17,104 men from the Health Professionals Follow-Up Study (HPFS 1996-2012), who were free of hypertension, diabetes, cardiovascular disease, and cancer at baseline. Results: We documented 37,123 incident hypertension cases during 1.06 million person-years of follow-up. After multivariate adjustments of covariates including total consumption of red meats, chicken, and fish, a higher frequency of open-flame and/or high-temperature cooking and a preference for higher meat doneness level were both independently associated with an increased hypertension risk. When comparing open-flame and/or high-temperature cooking &gt;15 times/month with &lt;4 times/month, the pooled hazard ratio (HR) and 95% confidence interval (CI) of hypertension was 1.17 (1.12, 1.21; P trend &lt;0.001). When comparing the extreme quartiles of meat doneness level score, the pooled HR (95% CI) of hypertension was 1.15 (1.12, 1.19; P trend &lt;0.001). The associations persisted when data were analyzed by individual meat groups: comparing extreme groups, for red meats, the pooled HR (95% CI) of hypertension was 1.18 (1.13, 1.23; P trend &lt;0.001) for open-flame and/or high-temperature cooking and 1.15 (1.12, 1.19; P trend &lt;0.001) for high meat doneness level; for white meats (chicken and fish), the pooled HR (95% CI) of hypertension was 1.12 (1.08, 1.16; P trend &lt;0.001) for open-flame and/or high-temperature cooking and 1.10 (1.07, 1.14; P trend &lt;0.001) for high meat doneness level. Moreover, levels of estimated intake of heterocyclic aromatic amines (HAAs) were also independently associated with an increased risk of hypertension. Comparing extreme quintiles of HAAs, the pooled HR (95% CI) of hypertension was 1.16 (1.13, 1.21; P trend &lt;0.001). These associations were attenuated but remained significant when further adjusting for baseline body mass index. Conclusions: Our results suggest that, independent of the amount of meat consumption, open-flame and/or high-temperature cooking and high doneness level for both red meats and white meats are associated with an increased risk of hypertension.

Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study.

The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress. We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables. During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures. R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.

Migraine and the risk of incident hypertension among women.

Background Few studies have examined whether migraine is associated with an increased risk of incident hypertension. Methods We performed a prospective cohort study among 29,040 women without hypertension at baseline. Women were classified as having active migraine with aura, active migraine without aura, a past history of migraine, or no history of migraine. Incident hypertension was defined as new physician diagnosis or newly self-reported systolic or diastolic blood pressure ≥140 mmHg or ≥90 mmHg respectively. Cox proportional hazards models were used to evaluate the association between migraine and incident hypertension. Results During a mean follow-up of 12.2 years, 15,176 incident hypertension cases occurred. Compared to those with no history of migraine, women who experience migraine with aura had a 9% increase in their risk of developing hypertension (95% CI: 1.02, 1.18); women who experience migraine without aura had a 21% increase in their risk of developing hypertension (95% CI: 1.14, 1.28); and women with a past history of migraine had a 15% increase in their risk of developing hypertension (95% CI: 1.07, 1.23). Conclusions Women with migraine have a higher relative risk of developing hypertension compared to women without migraine.

Coffee consumption and risk of hypertension: a systematic review and dose-response meta-analysis of cohort studies.

Some debates exist regarding the association of coffee consumption with hypertension risk. We performed a meta-analysis including dose-response analysis aimed to derive a more quantitatively precise estimation of this association. PubMed and Embase were searched for cohort studies published up to 18 July 2017. Fixed-effects generalized least-squares regression models were used to assess the quantitative association between coffee consumption and hypertension risk across studies. Restricted cubic spline was used to model the dose-response association. We identified eight articles (10 studies) investigating the risk of hypertension with the level of coffee consumption, including 243,869 individuals and 58,094 incident cases of hypertension. We found no evidence of a nonlinear dose-response association of coffee consumption and hypertension (P nonlinearity = 0.243). The risk of hypertension was reduced by 2% (relative risk (RR) = 0.98, 95% confidence interval (CI) 0.98-0.99) with each one cup/day increment of coffee consumption. With the linear cubic spline model, the RRs of hypertension risk were 0.97 (95% CI 0.95-0.99), 0.95 (95% CI 0.91-0.99), 0.92 (95% CI 0.87-0.98), and 0.90 (95% CI 0.83-0.97) for 2, 4, 6, and 8 cups/day, respectively, compared with individuals with no coffee intakes. This meta-analysis provides quantitative evidence that consumption of coffee was inversely associated with the risk of hypertension in a dose-response manner.

Relation of Coronary Artery Calcium and Extra-Coronary Aortic Calcium to Incident Hypertension (from the Multi-Ethnic Study of Atherosclerosis)

Arterial calcification reflects an atherosclerotic process associated with vascular stiffness. Whether baseline coronary artery calcium (CAC) and extra-coronary calcium (ECC), measured using noncontrast computed tomography imaging, are associated with incident hypertension is poorly understood. We studied participants from the Multi-Ethnic Study of Atherosclerosis without measured or self-reported hypertension at baseline. Incident hypertension was defined by blood pressure criteria (BP, ≥140/90 mmHg), BP medication use, or both, and was assessed at in-person visits. We analyzed incident hypertension using multivariable-adjusted discrete-time proportional hazards models. Net reclassification improvement (NRI) assessed whether CAC reclassified hypertension risk when added to the Framingham hypertension risk score. Among 3,304 subjects analyzed, mean age was 59 ± 10 years; 48% were male and 42% were white. There were 1,283 incident hypertension cases over a median (interquartile range) follow-up time of 10.6 (4.5, 11.5) years. Each 1-unit increase in ln(CAC+1) was independently associated with a 12% higher risk of hypertension (95% confidence interval [CI] 9% to 16%). Relative to CAC = 0, patients with CAC >400 had a hazard ratio for incident hypertension of 2.2 (95% CI 1.8 to 2.9). There was no interaction by age, gender, or baseline BP (p = 0.43, 0.19, 0.09, respectively). Continuous NRI analyses demonstrated that CAC can reclassify risk of incident hypertension; NRI = 0.19 (95% CI 0.10 to 0.26). Furthermore, all measurements of ECC were significantly associated with incident hypertension, even after adjustment for CAC (hazard ratios ranging from 1.36 to 1.38). In conclusion, patients with CAC and ECC are at markedly higher risk of incident hypertension and may benefit from more intensified prevention efforts.

Individual and Combined Effects of Dietary Factors on Risk of Incident Hypertension: Prospective Analysis From the NutriNet-Santé Cohort.

Dietary intake is pointed as one of the major determinants in hypertension development. Data in the area are mostly obtained from cross-sectional studies. We aimed to investigate the prospective association between (1) individual nutritional factors and (2) adherence to the Dietary Approach to Stop Hypertension and the risk of incident hypertension in a large cohort study. We prospectively examined the incidence of hypertension among 80 426 French adults participating in the NutriNet-Santé cohort study. Self-reported sociodemographic, lifestyle health questionnaires and dietary consumption assessed by three 24-hour records were completed at baseline and yearly thereafter. Associations between quartiles (Q) of nutrients and food groups and adherence to Dietary Approach to Stop Hypertension diet and hypertension risk were assessed by multivariable Cox proportional hazards models. During a mean follow-up of 3.4±2.1 years, 2413 cases of incident hypertension were documented. Dietary intakes of sodium (Q4 versus Q1): hazard ratio (HR)=1.17 (95% confidence interval [CI], 1.02-1.35), potassium: HR=0.82 (95% CI, 0.72-0.94), animal protein: HR=1.26 (95% CI, 1.11-1.43), vegetable protein: HR=0.85 (95% CI, 0.75-0.95), fiber: HR =0.81 (95% CI, 0.71-0.93), magnesium: HR=0.77 (95% CI, 0.67-0.89), fruit and vegetables: HR=0.85 (95% CI, 0.74-0.97), whole grain: HR=0.84(95% CI, 0.76-0.93), nuts: HR=0.72 (95% CI, 0.63-0.83), and red and processed meat: HR=1.25 (95% CI, 1.11-0.42) were associated with risk of hypertension. Besides, adherence to the Dietary Approach to Stop Hypertension was strongly inversely associated with incident hypertension: (Q4 versus Q1) HR=0.66 (95% CI, 0.58-0.75). Our results confirmed the association of several nutritional factors intake and incident hypertension and highlighted that adopting a global healthy diet could strongly contribute to the prevention of hypertension.

OP.6C.05] NUTRITION AND INCIDENT HYPERTENSION IN A LARGE POPULATION OF FRENCH ADULTS

Objective: Hypertension is the most prevalent chronic disease worldwide. Dietary intake is pointed as one of the major determinants in his development. Data in the area are mostly obtained from cross-sectional studies. We aimed to investigate the association between 1) Nutritional factors, 2) Adherence to the Dietary Approach to Stop Hypertension (DASH) and the risk of incident hypertension in a large cohort study. Design and method: We prospectively examined the risk of hypertension among 80,426 French adults participating in the NutriNet-Santé cohort study. Self-reported socio-demographic, lifestyle and health data were assessed at baseline and yearly, using a web-based questionnaire; three 24 h- records provided dietary data and validated score reflecting adherence to DASH were calculated. Associations between quartiles of nutrients, food groups, adherence to healthy diet and hypertension risk were assessed by multivariate (adjusted for age, sex, body mass index, family history of hypertension, sociodemographic and lifestyle factors) Cox proportional hazards models. Results: During a mean follow-up of 3.4 ± 2.1 years, 2,413 incident cases of hypertension were documented. Among nutrients, those whose intakes were associated with hypertension risk were (Q4 vs. Q1) sodium: hazard ratio (HR) HR = 1.17 (95% CI, 1.02–1.35), potassium: HR = 0.82 (95% CI, 0.72–0.94), animal protein: HR = 1.26 (95% CI, 1.11–1.43), vegetable protein: HR = 0.85 (95% CI, 0.75–0.95), fiber: HR = 0.81 (95% CI), magnesium: HR = 0.77 (95% CI, 0.67–0.89). Among food groups, consumption of fruits and vegetables, whole grain, legumes and nuts were associated with lower risk of hypertension [HRs = 0.85 (95% CI, 0.74–0.97); 0.84 (95% CI, 0.76–0.93); 0.87 (95% CI, 0.76–1.00); 0.72 (95% CI, 0.63–0.83), respectively] and meat consumption with a greater risk (HR = 1.25 (95% CI, 1.11–0.42)). Adherence to the DASH was inversely associated with incident hypertension: HR = 0.66 (95% CI, 0.58–0.75). Conclusions: Our results confirmed the association of several nutrients and food groups intake and incident hypertension, and highlighted that adopting a global healthy diet could strongly contribute to the prevention of hypertension.

Association of elevated resting pulse rate with increased risk of hypertension development in children: A prospective study in Suzhou, China.

Background:Elevated resting heart rate (RHR) or resting pulse rate (RPR) is associated with increased risk of hypertension development. However, information is limited to adults. The purpose of this study is to analyze this association among Chinese children in a prospective design.Methods:A total of 4861 children who participated in the Blood Pressure Surveillance Program (2011–2017) were selected in this research. To investigate the association between RPR and hypertension development, children were divided into 4 groups according to the quartiles of RPR at baseline. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression model.Results:Over a mean follow-up of 3.0 ± 0.1 years, there were 384 cases of incident hypertension. Compared to boys and girls in the 1st quartile, those in the 4th quartile were 1.73 (95% CI 1.13, 2.65), 2.22 (95% CI 1.43, 3.45) times more likely to have hypertension, respectively. Every 10 bpm increase in RPR was associated with a 26% greater risk of hypertension development in boys (OR: 1.26; 95% CI 1.10, 1.44), while this risk was 1.28 (95% CI 1.13, 1.44) in girls. Baseline blood pressure (BP) and body mass index (BMI) did not have significant interactions with RPR on risk of hypertension development.Conclusion:This study confirms the relationship between elevated RPR and increased risk of hypertension development in children, independent of confounders including baseline BP and BMI. An elevated RPR could be considered as a risk factor for the assessment of hypertension, no matter from a clinical setting or a public health perspective.

Abstract P187: Socioeconomic Status and Hypertension in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Individual and area-level socioeconomic status (SES) are associated with hypertension incidence and blood pressure changes in midlife. However, examination of the relationship between SES and late-life hypertension incidence are limited. Methods: ARIC Study participants free of hypertension at visit 4 (1996-1998) were followed by annual and semi-annual calls through December 31, 2013 for incidence of hypertension, defined as a self-reported diagnosis or use of antihypertensive medications. Individual and neighborhood SES indicators were assessed at study baseline (using criteria listed in the Table). Among individuals with follow-up and complete data (N=3,374) associations were examined using Cox regression models. Results: Among men and women with a median baseline blood pressure of 118/68 mg Hg, mean age was 61 years (SD ± 5.5), 45% were female, 12% were Black, and 21.7% had an annual household income of &lt;$25,000 ($36,941 in 2016 dollars). The median neighborhood SES summary z-score was lower among Black (-6.29) compared to White participants (1.69). Over median follow-up of 9.44 years, 1,876 incident hypertension cases were observed. In analyses adjusted for covariates, White participants with high, as compared to low and intermediate measures of SES had lower incidence of hypertension in late life (Table). Results were less consistent among Blacks, possibly due to the smaller sample size and therefore more limited power. After accounting for individual-level SES, there was no association between neighborhood-level SES and incident hypertension. Conclusion: Both neighborhood and individual SES are related to late life incidence of hypertension, at least among Whites. Understanding the mechanisms, such as the role of access to care, for these associations can guide prevention strategies.

Coffee, tea, caffeine, and risk of hypertension: The Singapore Chinese Health Study.

The relationship between coffee and tea, and risk of hypertension remains controversial in Western populations. We investigated these associations in an Asian population. The Singapore Chinese Health Study is a population-based prospective cohort that recruited 63,257 Chinese aged 45-74years and residing in Singapore from 1993 to 1998. Information on consumption of coffee, tea, and other lifestyle factors was collected at baseline, and self-reported physician-diagnosed hypertension was assessed during two follow-up interviews (1999-2004, 2006-2010). We identified 13,658 cases of incident hypertension after average 9.5years. Compared to those who drank one cup of coffee/day, the hazard ratios (HR) and 95% confidence intervals (CI) were 0.87 (0.83-0.91) for <weekly drinkers and 0.93 (0.86-1.00) for ≥3 cups/day drinkers. Compared to <weekly drinkers, daily drinkers of black or green tea had slight increase in risk, but these risk estimates were attenuated and became non-significant after adjustment for caffeine. After adjusting for coffee, there was a stepwise dose-response relationship between caffeine intake and hypertension risk; compared to the lowest intake (<50mg/day), those in the highest intake (≥300mg/day) had a 16% increase in risk; HR 1.16, 95% CI 1.04-1.31 (p trend = 0.02). Drinking coffee <1 cup/week or ≥3 cups/day had lower risk than drinking one cup/day. Caffeine may account for increased risk in daily tea drinkers and in those who drank one cup of coffee/day. The inverse U-shaped association with coffee suggests that at higher doses, other ingredients in coffee may offset the effect of caffeine and confer benefit on blood pressure.

Physical Activity and Incident Hypertension in African Americans: The Jackson Heart Study.

There is limited empirical evidence to support the protective effects of physical activity in the prevention of hypertension among African Americans. The purpose of this study was to examine the association of physical activity with incident hypertension among African Americans. We studied 1311 participants without hypertension at baseline enrolled in the Jackson Heart Study, a community-based study of African Americans residing in Jackson, Mississippi. Overall physical activity, moderate-vigorous physical activity, and domain-specific physical activity (work, active living, household, and sport/exercise) were assessed by self-report during the baseline examination (2000-2004). Incident hypertension, assessed at examination 2 (2005-2008) and examination 3 (2009-2013), was defined as the first visit with systolic/diastolic blood pressure ≥140/90 mm Hg or self-reported antihypertensive medication use. Over a median follow-up of 8.0 years, there were 650 (49.6%) incident hypertension cases. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing participants with intermediate and ideal versus poor levels of moderate-vigorous physical activity were 0.84 (0.67-1.05) and 0.76 (0.58-0.99), respectively (P trend=0.038). A graded, dose-response association was also present for sport/exercise-related physical activity (Quartiles 2, 3, and 4 versus Quartile 1: 0.92 [0.68-1.25], 0.87 [0.67-1.13], 0.75 [0.58-0.97], respectively; P trend=0.032). There were no statistically significant associations observed for overall physical activity, or work, active living, and household-related physical activities. In conclusion, the results of the current study suggest that regular moderate-vigorous physical activity or sport/exercise-related physical activity may reduce the risk of developing hypertension in African Americans.

Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project.

Some available evidence suggests that high consumption of ultra-processed foods (UPFs) is associated with a higher risk of obesity. Collectively, this association and the nutritional characteristics of UPFs suggest that UPFs might also be associated with hypertension. We prospectively evaluated the relationship between UPF consumption and the risk of hypertension in a prospective Spanish cohort, the Seguimiento Universidad de Navarra project. We included 14,790 Spanish adult university graduates who were initially free of hypertension at baseline who were followed for a mean of 9.1 years (SD, 3.9 years; total person-years: 134,784). UPF (industrial formulations of chemical compounds which, beyond substances of common culinary use such as salt, sugar, oils, and fats, include substances also derived from foods but not used in culinary preparations) consumption was assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hypertension incidence. During follow-up, 1,702 incident cases of hypertension were identified. Participants in the highest tertile of UPF consumption had a higher risk of developing hypertension (adjusted HR, 1.21; 95% CI, 1.06, 1.37; P for trend = 0.004) than those in the lowest tertile after adjusting for potential confounders. In this large prospective cohort of Spanish middle-aged adult university graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confirm our results.

Urine Albumin/Creatinine Ratio Below 30mg/g is a Predictor of Incident Hypertension and Cardiovascular Mortality.

BackgroundMicroalbuminuria is associated with cardiovascular disease (CVD) mortality, but whether lower levels of urine albumin excretion similarly predict CVD is uncertain. We investigated associations between urine albumin:creatinine ratio (UACR) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all‐cause and CVD mortality, during a maximum of 11 years of follow‐up.Methods and ResultsIndividuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of UACR were studied. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest UACR quartile as reference) at follow‐up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine‐hundred sixty‐three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow‐up. In the fully adjusted models, there was a significant HR for the association between UACR and incident hypertension (highest UACR quartile HR 1.95 [95% CI 1.51, 2.53], P‐value for trend across UACR quartiles P<0.001). In contrast, the association between UACR and incident diabetes mellitus was not significant (highest UACR quartile, HR 1.15 [95% CI 0.79, 1.66], P‐value for trend P=0.20). For CVD mortality, with increasing UACR quartiles, there was a significant increase in HR across quartiles, P=0.029, (for all‐cause mortality, P=0.078).ConclusionsLow levels of albuminuria, UACR below 30 mg/g, are associated with increased risk of incident hypertension and CVD mortality at follow‐up, but are not associated with increased risk of incident diabetes mellitus.

MPS 17-06 Baseline and change in uric acid concentration over time are associated with incident hypertension in large Korean cohort

Objective: It is uncertain whether high baseline uric acid (UA) or change in UA concentration over time is related to development of incident hypertension. To investigate relationships between: a) baseline serum uric acid concentration and b) change in UA concentration and incident hypertension. Design and Method: 96,606 Korean individuals (with follow up UA data available for 56,085 people) participating in a health check program was undertaken. Cox regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for incident hypertension comparing baseline UA quartiles to the lowest UA quartile, and comparing individuals with an increase in UA to those with a decrease in UA concentration over time. Results: 96606 individuals were followed for up to 8 years (median follow-up 3.3 years; IQR, 1.9 to 5.1). 10,405 cases of incident hypertension occurred. In the fully adjusted regression model, there was a significant increase in aHR across increasing UA quartiles at baseline (p value for trend < 0.001 and 0.001 in men and women, respectively), with aHRs comparing the highest to the lowest UA quartiles of 1.29 (95% CI 1.20, 1.39) in men and 1.24 (95% CI 1.09, 1.42) in women. Additionally, stable or increasing UA concentration over time was associated with increased risk of incident hypertension, particularly in participants with baseline UA concentration ≥median (aHRs 1.14 [95% 1.03–1.26] and 1.17 [95% 0.98–1.40] in men and women, respectively). Conclusions: High initial UA concentration and increases in UA concentration over time should be considered independent risk factors for hypertension.

Abstract 093: Salt-sensitivity, Salt-resistance, and Incidence of Hypertension

It is well known that blood pressure (BP) responses to dietary sodium intake vary among individuals (salt-sensitivity and salt-resistance). However, it is unknown whether salt-sensitivity and salt-resistance predict the risk of hypertension. We conducted a dietary sodium intervention study among 1,906 Han Chinese in 2003-05 and followed the study participants in 2008-09 and 2011-12. The dietary intervention included a 7-day low-sodium feeding (51.3 mmol/day) and a 7-day high-sodium feeding (307.8 mmol/day). Three BP measurements were obtained during each of the 3 days of baseline observation and on days 5, 6, and 7 of each intervention period. We used latent class models to identify subgroups that share a similar underlying trajectory in BP responses to sodium intervention. Over an average of 7.4 years of follow-up, we identified 514 incident hypertension cases. The mean (standard deviation) change in systolic BP during low-sodium and high-sodium interventions according to salt-sensitive and -resistant groups are shown in the following table. In addition, age, sex, and baseline BP-adjusted and multiple-adjusted odds ratios (95% CI) of incident hypertension are shown in the following table. These data indicate that high responses or non-responses to dietary sodium intervention are related to the risk of hypertension. Furthermore, this is the first prospective cohort study to indicate that individuals with either salt-sensitivity or salt-resistance are at an increased risk for hypertension and should be targeted for dietary intervention.

Baseline and Change in Uric Acid Concentration Over Time Are Associated With Incident Hypertension in Large Korean Cohort.

It is uncertain whether high-baseline uric acid (UA) or change in UA concentration over time is related to development of incident hypertension. To investigate relationships between: (i) baseline serum UA concentration and (ii) change in UA concentration and incident hypertension. About 96,606 Korean individuals (with follow-up UA data available for 56,085 people) participating in a health check program was undertaken. Cox regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident hypertension according to UA quartiles regarding the lowest UA quartile as the reference, and also according to change in UA concentration comparing individuals with an increase in UA to those with a decrease in UA concentration over time. Total follow up time was 8 years (median follow-up 3.3 years; interquartile range, 1.9-5.1). About 10,405 cases of incident hypertension occurred. In the fully adjusted regression models, the HRs (95% CI) for incident hypertension comparing the highest vs. the lowest quartiles of UA were 1.29 (1.19-1.38) in men and 1.24 (1.09-1.42) in women, with statistically significant P for trend for both gender. Additionally, stable or increasing UA concentration over time was associated with increased risk of incident hypertension, particularly in participants with baseline UA concentration ≥median (aHRs 1.14; 95% CI (1.03-1.26) and 1.18; 95% CI (0.98-1.40) in men and women, respectively). High initial UA concentration and increases in UA concentration over time should be considered independent risk factors for hypertension.

Multivitamin use and the risk of hypertension in a prospective cohort study of women.

Despite the widespread use of multivitamin supplements, little is known regarding their effects on blood pressure (BP) and the development of hypertension. We, therefore, sought to prospectively investigate how multivitamin use was associated with incident hypertension among middle-aged and older women. We studied 28 157 women from the Women's Health Study aged at least 45 years and free of cardiovascular disease, cancer, and hypertension at baseline. Women reported information on a wide range of lifestyle, clinical, and dietary factors, including multivitamin and other supplement use at baseline. Hypertension was identified on baseline and annual follow-up questionnaires. Incident hypertension was defined as either a new diagnosis of hypertension by a physician, initiation of antihypertensive medication, newly reported SBP at least 140 mmHg, or DBP at least 90 mmHg during follow-up. During a mean follow-up of 11.5 years, we identified 16 316 cases of incident hypertension. We found that neither baseline (hazard ratio = 1.03, 95% confidence interval: 1.00, 1.07) nor time-varying multivitamin use (hazard ratio = 0.97, 95% confidence interval: 0.94-1.00) were associated with the risk of incident hypertension in multivariable-adjusted models. When we investigated the duration of multivitamin use reported at baseline, we also observed no association with the risk of hypertension. The results from this prospective study of middle-aged and older women suggest that neither baseline multivitamin use nor time-varying multivitamin use is associated with the risk of developing hypertension.