Long-term Risk Of Hypertension Research Articles

Long-term Outcomes Associated With Post-kidney Donation Pregnancy Complications.

Kidney donors have increased risk of postdonation gestational hypertension (gHTN) and preeclampsia. In the general population, pregnancy complications are associated with long-term maternal risk. However, little data exist on whether donors with postdonation pregnancy-related complications have similar increased long-term risks. We studied whether postdonation gHTN, preeclampsia/eclampsia, or gestational diabetes (gDM) was associated with increased risk of developing hypertension, DM, cardiovascular disease, or estimated glomerular filtration rate <45 mL/min/1.73 m 2 . Postdonation pregnancies with complications were matched to pregnancies without complications based on time from donation. Incidence of outcomes was compared using sequential Cox regression with robust standard errors. Donors with predonation pregnancy complications were excluded. Models were adjusted for age at pregnancy, gravidity, year of donation, and family history of hypertension, DM, and heart disease. Of the 384 donors with postdonation pregnancies (median [quartiles] follow-up of 27.0 [14.2-36.2] y after donation), 39 experienced preeclampsia/eclampsia, 29 gHTN without preeclampsia, and 17 gDM. Median interval from donation to first pregnancy with preeclampsia was 5.1 (2.9-8.6) y; for gHTN, 3.7 (1.9-7.8) y; and for gDM, 7.3 (3.7-10.3) y. Preeclampsia/eclampsia (hazard ratio [HR] 2.70; 95% confidence interval [CI], 1.53-4.77) and gHTN (HR 2.39; 95% CI, 1.24-4.60) were associated with development of hypertension. Preeclampsia/eclampsia (HR 2.15; 95% CI, 1.11-4.16) and gDM (HR 5.60; 95% CI, 1.41-22.15) were associated with development of DM. Pregnancy-related complications were not associated with increased risk of cardiovascular disease or estimated glomerular filtration rate <45 mL/min/1.73 m 2 . In our single-center study, postdonation preeclampsia, gHTN, or gDM was associated with long-term risk of hypertension or DM.

Abstract P207: Heterogeneity in Obesity in Relation to Related to Hypertension: Investigating the Role of Metabolic Pathways

Background: While obesity is associated with hypertension, there is heterogeneity in risk by weight status and we know little about whether and which metabolic pathways play a role in exacerbating differential risk across weight status categories. Methods: Fasting blood was collected at the Yr. 20 follow-up exam in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We conducted Ultra-High-Performance Liquid Chromatography high resolution mass spectrometry untargeted metabolomics in 1,769 individuals (ages 37-54, 58% female, 66% Black) classified as normotensive (no hypertension diagnosis or medication and SBP/DBP ≤ 130/80). We identified 7,522 metabolomic peaks and 8 principal components, which we included in a multivariable-adjusted proportional hazards model with an interaction term to assess whether the association between these metabolite measures and incident hypertension (HTN) varied by BMI. We then employed multivariate analysis using Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) models using 70% of the sample within each obesity category to predict incident HTN at ten years in normal weight, overweight and obese groups based on the high dimensional metabolomics data. The remaining 30% of individuals in each obesity category were then used to evaluate the predictive value of the OPLS-DA models. Finally, we used mummichog software and Fisher’s exact tests, to conduct pathway enrichment analysis using data from both the individual peak and the OPLS-DA models. Results: We identified 723 metabolites where the association with long term risk of HTN differed by BMI, although none were statistically significant after adjustment for multiple comparisons. However, we found strong evidence of effect modification for metabolites via principal components and OPLS-DA. For the 3 rd principal component, which explained 5% of the variation across all peaks, we found a significant interaction with BMI (p-value = 0.0043). In external test data sets, OPLS-DA models predicted incident HTN relatively well in normal weight individuals (AUC of 77%) but not well in overweight and obese individuals (AUC of 49% and 56% respectively). We identified several pathways with a differential HTN risk by BMI shown in the OPLS-DA and proportional hazards models. In the phenylamine pathway there was substantial differentiation between those with and without incident HTN risk for normal weight only and across the lysine degradation pathway only for individuals who were obese. Conclusions: Our findings identify variation in hypertension risk by BMI, with suggestive evidence for a role of metabolomic pathways and combinations of metabolites. Overall, metabolites predicted 10-year incident hypertension very well in individuals of normal weight (but not obese status), indicating heterogeneity in hypertension risk by weight status.

Preterm Delivery and Long-term Risk of Hypertension in Women

Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women. To examine the long-term risks of chronic hypertension associated with preterm delivery in a large population-based cohort of women. This national cohort study assessed all 2 195 989 women in Sweden with a singleton delivery from January 1, 1973, to December 31, 2015. Data analyses were conducted from March 8, 2021, to August 20, 2021. Pregnancy duration identified from nationwide birth records. New-onset chronic hypertension identified from primary care, specialty outpatient, and inpatient diagnoses using administrative data. Cox proportional hazards regression was used to compute hazard ratios (HRs) while adjusting for preeclampsia, other hypertensive disorders of pregnancy, and other maternal factors. Cosibling analyses were assessed for potential confounding by shared familial (genetic and/or environmental) factors. In 46.1 million person-years of follow-up, 351 189 of 2 195 989 women (16.0%) were diagnosed with hypertension (mean [SD] age, 55.4 [9.9] years). Within 10 years after delivery, the adjusted HR for hypertension associated with preterm delivery (gestational age <37 weeks) was 1.67 (95% CI, 1.61-1.74) and when further stratified was 2.23 (95% CI, 1.98-2.52) for extremely preterm (22-27 weeks of gestation), 1.85 (95% CI, 1.74-1.97) for moderately preterm (28-33 weeks of gestation), 1.55 (95% CI, 1.48-1.63) for late preterm (34-36 weeks of gestation), and 1.26 (95% CI, 1.22-1.30) for early-term (37-38 weeks of gestation) compared with full-term (39-41 weeks of gestation) delivery. These risks decreased but remained significantly elevated at 10 to 19 years (preterm vs full-term delivery: adjusted HR, 1.40; 95% CI, 1.36-1.44), 20 to 29 years (preterm vs full-term delivery: adjusted HR, 1.20; 95% CI, 1.18-1.23), and 30 to 43 years (preterm vs full-term delivery: adjusted HR, 95% CI, 1.12; 1.10-1.14) after delivery. These findings were not explained by shared determinants of preterm delivery and hypertension within families. In this large national cohort study, preterm delivery was associated with significantly higher future risks of chronic hypertension. These associations remained elevated at least 40 years later and were largely independent of other maternal and shared familial factors. Preterm delivery should be recognized as a lifelong risk factor for hypertension in women.

Predictive generalized varying-coefficient longitudinal model.

We propose a nonparametric bivariate varying coefficient generalized linear model to predict a mean response trajectory in the future given an individual's characteristics at present or an earlier time point in a longitudinal study. Given the measurement time of the predictors, the coefficients vary as functions of the future time over which the prediction of the mean response is concerned and illustrate the dynamic association between the future response and the earlier measured predictors. We use a nonparametric approach that takes advantage of features of both the kernel and the spline methods for estimation. The resulting coefficient estimator is asymptotically consistent under mild regularity conditions. We also develop a new bootstrap approach to construct simultaneous confidence bands for statistical inference about the coefficients and the predicted response trajectory based on the coverage rate of bootstrap estimates. We use the Framingham Heart Study to illustrate the methodology. The proposed procedure is applied to predict the probability trajectory of hypertension risk given individuals' health condition in early adulthood and to examine the impact of risk factors in early adulthood on a long-term risk of hypertension over several decades.

Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children

The long-term risk of hypertension in children after surgery for congenital heart disease (CHD) is unclear. To assess the incidence of hypertension after cardiac surgery in children with CHD. A multicenter retrospective matched cohort study was conducted in Ontario, Canada, using administrative databases. A total of 3600 children with surgical repair of CHD were matched to 10 children (n = 36 000) from the general population without CHD on age, sex, index date, rurality, and neighborhood income. Diagnosis of hypertension over a median follow-up time of 9.8 years (interquartile range, 6.8-12.9 years) after surgery. The last follow-up was March 31, 2019. Overall, in 3600 children with surgical repair of CHD, the median age at first surgery was 150 days (interquartile range, 40-252 days) and 2005 (55.7%) were boys. During follow-up, 445 (12.4%) children with surgical repair of CHD developed hypertension compared with 398 (1.1%) in the matched control group. The incidence rate of hypertension in children who received surgery for CHD was 141.3 (95% CI, 128.8-155.1) per 10 000 person-years compared with children in the matched control group, who had a rate of 11.1 (95% CI, 10.1-12.3) per 10 000 person-years. The risk of hypertension was higher in children with index surgical dates at an age of less 150 days compared with those who had surgical dates at an age of 150 days or older (P = .006 for interaction). The risk of hypertension was increased in children with more complex surgery, particularly children with hypoplastic left heart syndrome (49 of 140 [35.0%]), and in children who received dialysis (22 of 126 [17.5%]; hazard ratio, 1.67; 95% CI, 1.09-2.56) during the index cardiac surgery hospitalization. The incidence of long-term hypertension in this study was 12 times higher in children with surgical repair of CHD compared with children in the matched control group. The findings suggest that interventions aimed at reducing the long-term risk of hypertension after cardiac surgery in this population are needed.

Spontaneous superimposed preeclampsia: chronology and expression unveiled by temporal transcriptomic analysis.

Preeclampsia (PE), a multifactorial pregnancy-specific syndrome accounting for up to 8% of pregnancy complications, is a leading cause of maternal and fetal morbidity and mortality. PE is also associated with long-term risk of hypertension and stroke for both mother and fetus. Currently, the only "cure" is delivery of the baby and placenta, largely because the pathogenesis of PE is not yet fully understood. PE is associated with impaired vascular remodeling at the maternal-fetal interface and placental insufficiency; however, specific factors contributing to this impairment have not been identified. To identify molecular pathways involved in PE, we examined temporal transcriptomic changes occurring within the uterus, uterine implantation sites, and placentae from the Dahl salt-sensitive (Dahl S) rat model of superimposed PE compared with Sprague Dawley (SD) rats. We hypothesized that targeted gene analysis and whole transcriptome analysis would identify genetic factors that contribute to development of the preeclamptic phenotype in the Dahl S rat and unveil novel biomarkers, therapeutic targets, and mechanistic pathways in PE. Quantitative real-time PCR (qRT-PCR) and whole genome microarray analysis were performed on isolated total RNA from uterus (day 0), uterine implantation sites (days 7 and 10), and placenta (days 14 and 20). We found 624, 332, 185, and 366 genes to be differentially expressed between Dahl S (PE) and SD (normal pregnancy) on days 0, 7, 10, and 14, respectively. Our data revealed numerous pathways that may play a role in the pathophysiology of spontaneous superimposed PE and allow for further investigation of novel therapeutic targets and biomarker development.

Renal Consequences of Gestational Diabetes Mellitus in Term Neonates: A Multidisciplinary Approach to the DOHaD Perspective in the Prevention and Early Recognition of Neonates of GDM Mothers at Risk of Hypertension and Chronic Renal Diseases in Later Life

Fetal exposure to gestational diabetes mellitus (GDM) seems to stimulate a negative impact on the kidneys. Renal volumes and urinary biomarkers of renal function and tubular impairment and injury were evaluated in 30–40-day old newborns of GDM mothers (n = 139) who needed insulin therapy during pregnancy. We found that neonates of mothers who maintained strict control over normoglycemia (n = 65) during pregnancy and fulfilled the other criteria of the GDM management program showed no differences compared to control (n = 55). Conversely, those (n = 74), whose mothers did not maintain glycemic control and were not compliant to the management program, exhibited significantly lower levels of renal volumes and higher activity of N-acetyl-β-d-glucosaminidase and cathepsin B. Differences due to maternal pre-gestational and gestational body mass index (BMI) as well as to maternal weight gain were demonstrated. Our findings indicate that a multidisciplinary approach, which involves an appropriate management of GDM, prevents the negative effects of GDM on the kidneys at 30–40 days of postnatal age, indicating the fundamental role of glycemic control, as well as of an adequate range of maternal weight gain. Total renal volume, cortical volume, and urinary activity of N-acetyl-β-d-glucosaminidase and cathepsin B may be suggested as indicators for the early recognition of GDM neonates at long-term risk of hypertension and kidney disease.

Abstract P176: Heart-Healthy Dietary Patterns Are Inversely Related to Hypertension Among Women With History of Preeclampsia: A Cohort Study in Mexico

Objective: Although history of preeclampsia increases a woman′s risk of developing hypertension (HTN) in adulthood, it remains unclear whether a heart-healthy post-pregnancy diet could ameliorate some of this risk. Therefore, we evaluated whether adherence to dietary patterns is related with HTN among women with prior preeclampsia Methods: At baseline, 4,781 women without HTN reported at least one pregnancy with preeclampsia in the 2008 Mexican Teachers’ Cohort follow-up cycle. From the baseline food frequency questionnaire (FFQ) we derived diet scores based on the American Heart Association (AHA) 2020 Goals and the Dietary Approaches to Stop Hypertension (DASH). The AHA score has 5 items: fruits and vegetables, fish, whole grain, sugar-sweetened beverages and sodium, whereas the DASH diet has 8: low-fat dairy, nuts/legumes, fruits, vegetables, whole grain, red and processed meats, sugar-sweetened beverages, and sodium. Incident HTN reported in 2011, was defined as high blood pressure diagnosed by a medical doctor or currently taking antihypertensive treatment. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) of HTN by comparing women in the lowest score quintile to women in the highest score quintile, using log-binomial regression after adjusting for common risk factors for HTN as well as health care provider, demographic regions and indigenous heritage. Results: The mean age (SD) of women affected by preeclampsia was 41(7) years and BMI of 28(5) kg/m 2 . Over the 3-year study period, 555(12%) women developed incident HTN, which was higher that the incidence of HTN among women with normotensive pregnancies (6%). Women with the highest AHA scores had 0.82(95% CI 0.68,1.06) times the risk of developing HTN than women with lowest scores (p-trend=0.04). Similarly, highest adherence to the DASH diet had 0.74(95% CI 0.57,0.96) times the risk of developing HTN than women with the lowest score(p-trend=0.03). When individual components of the diet were separately evaluated, only sodium intake was associated with HTN. Specifically, women who consumed ≥2,500 mg/day of sodium had 1.18(0.92,1.52) times the risk of HTN compared to women who consumed &lt;1,500 mg/day. Adherence to the AHA and DASH scores and sodium intake were also related to risk of HTN among 57,063 women without a history of preeclampsia; however the associations were weaker for highest adherence to AHA (RR 0.86 [95%CI 0.78,0.96]),DASH RR 0.87 [95%CI 0.78, 0.97]),and RR 1.13 [95% CI 1.01,1.26] for ≥2,500 vs. &lt;1,500 mg/day of sodium. Conclusion: Greater adherence to AHA and DASH diet patterns were inversely related to risk of HTN among Mexican women with a history of preeclampsia and even though lower sodium intake was also related to HTN, the FFQ underestimates absolute sodium intake. Nevertheless, post-partum recommendations on diet quality in this high-risk group may provide one strategy to prevent long-term risk of HTN.

Long-Term Risk of Hypertension and Chronic Kidney Disease in Living Kidney Donors

ObjectiveThe aim of this study was to assess the long-term risks of chronic kidney disease and arterial hypertension in living kidney donors. MethodsDonors who were followed for more than 1 year after nephrectomy were included. We assessed each donor's blood pressure, urine protein, and estimated glomerular filtration rate (eGFR). ResultsThe follow-up rate was 11% (154 out of 1,356 donors), only 19% of whom were followed by nephrologists. Blood pressure had increased from 113/75 to 116/77 mm Hg (P < .01), urinary protein excretion after donation did not increase, and renal function was well preserved after donor nephrectomy. However, 33 patients (21.4%) showed a decreased eGFR of <60 mL/min/1.73 m2, and 3 donors developed end-stage renal disease that required renal replacement therapy. ConclusionsThe follow-up rate of living donors after donation was low, and we observed an increased risk of developing chronic kidney disease after donation.

P2-8 Late night energy intake: association with long-term risk of hypertension in the British birth cohort 1946

BackgroundThe role of circadian rhythm of energy and macronutrient intake in influencing cardiometabolic risk factors is increasingly recognised. However, little is known of the association between time of energy intake...

Hypertensive Disorders of Pregnancy and Long-Term Risk of Hypertension: What Do Ontario Prenatal Care Providers Know and What Do They Communicate?

ObjectivesThe objective of this study was to ascertain the knowledge base of Ontario maternity care providers (family physicians, obstetrician-gynaecologists, and midwives) regarding the future health risks of gestational hypertension and preeclampsia and the practices with respect to communication of these risks. MethodsIn 2004, all obstetricians (639) and midwives (249) in Ontario and a random sample of 600 Ontario family physicians were mailed a survey and a reminder. Non-responders were also sent a second, and in some cases, a third copy of the survey. The survey addressed areas of knowledge, reported practices, and both patient and interprofessional communication. Descriptive analysis was used for the responses. ResultsThe overall response rate was 42%. The majority of respondents were familiar with the long-term risks of gestational hypertension and preeclampsia. Although maternity care providers stated that they inform women with these conditions about their subsequent risks and recommend follow-up, only 36% usually inform the women’s primary care providers about that subsequent risk. Only 58% of family physicians reported that they are usually informed by the maternity care providers about their patients who developed hypertension in pregnancy, compared with the 83% of maternity care providers who reported that they usually communicate this information to family physicians. ConclusionWe have identified weaknesses in knowledge base and communication amongst Ontario maternity care providers that suggest that the identification and follow-up of women with hypertensive disorders of pregnancy is not occurring. These deficiencies would be amenable to directed educational activities, including reviews, presentations, and the development and implementation of guidelines.

Effect of supplementation with antioxidants upon long-term risk of hypertension in the SU.VI.MAX study: association with plasma antioxidant levels

To assess the effects of supplementation with a combination of antioxidant vitamins and trace elements, at nutritional doses, upon the 6.5-year risk of hypertension in the SU.VI.MAX trial. To describe the association between baseline plasma antioxidant levels and the same long-term risk using observational data from the study. A total of 5086 adults from the SU.VI.MAX trial, a randomized primary prevention trial. Compared with the placebo group, no effect of supplementation upon the 6.5-year risk of hypertension could be detected (odds ratio, 1.04 and 95% confidence interval, 0.87-1.23 in men; and odds ratio, 1.10 and 95% confidence interval, 0.95-1.29 in women). Furthermore, compared with men in the first tertile, those in the second and third tertiles of serum baseline levels of beta-carotene presented a lower risk of hypertension in both the placebo and supplementation groups. Multivariate-adjusted odds ratios (95% confidence interval) were 0.70 (0.44-1.12) and 0.53 (0.33-0.86) in the placebo group, and were 0.59 (0.37-0.94) and 0.67 (0.42-1.07) in the supplementation group. In women, a decreasing trend was observed with vitamin C levels and risk of hypertension in the intervention group. No association could be shown between vitamin E and trace element plasma levels and the risk of hypertension. Despite an inverse association between baseline plasma levels of beta-carotene in men and the risk of developing hypertension, we could not demonstrate any beneficial effect of low-dose antioxidant supplementation upon the 6.5-year risk of hypertension in the randomized analysis.

Weight Loss in Overweight Adults and the Long-term Risk of Hypertension: The Framingham Study

Weight Loss in Overweight Adults and the Long-term Risk of Hypertension: The Framingham Study

Prospective cohort study of retinal vessel diameters and risk of hypertension

Objective To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension.Design Population based prospective cohort study.Setting Beaver Dam eye study.Participants 2451 normotensive people aged...

Psychosocial factors and risk of hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Although psychosocial factors are correlated, previous studies on risk factors for hypertension have typically examined psychosocial factors individually and have yielded inconsistent findings. To examine the role of psychosocial factors of time urgency/impatience (TUI), achievement striving/competitiveness (ASC), hostility, depression, and anxiety on long-term risk of hypertension. DESIGN, SETTING, AND STUDY POPULATION: A population-based, prospective, observational study using participant data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. A total of 3308 black and white adults aged 18 to 30 years (when recruited in 1985 and 1986) from 4 US metropolitan areas and followed up through 2000 to 2001. Fifteen-year cumulative incidence of hypertension (systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or taking antihypertensive medication). The incidence of hypertension at year 15 was 15% from baseline and 13.6% from year 5. After adjusting for the same set of hypertension risk factors and each of the psychosocial factors of TUI, ASC, hostility, depression, and anxiety in 5 separate logistic regression models, higher TUI and hostility were significantly associated with risk of developing hypertension at 15-year follow-up for the total sample. Compared with the lowest score group, the adjusted odds ratio (OR) for TUI was 1.51 (95% confidence interval [CI], 1.12-2.03) for a score of 1; 1.47 (95% CI, 1.08-2.02) for a score of 2; and 1.84 (95% CI, 1.29-2.62) for a score of 3 to 4 (P for trend =.001). Compared with the lowest quartile group, the adjusted OR for hostility was 1.06 (95% CI, 0.76-1.47) for quartile 2; 1.38 (95% CI, 1.00-1.91) for quartile 3; and 1.84 (95% CI, 1.33-2.54) for quartile 4 (P for trend <.001). No consistent patterns were found for ASC, depression, or anxiety. Race- and sex-specific analyses and multivariable models with simultaneous adjustment for all 5 psychosocial factors and other hypertension risk factors had generally similar results. Among young adults, TUI and hostility were associated with a dose-response increase in the long-term risk of hypertension.

Intrauterine programming of hypertension by glucocorticoids

An ever increasing body of evidence indicates that cardiovascular disease is determined by prenatal experience of undernutrition. Animal experiments suggest that in addition to maternal dietary interventions, exposure of the fetus to glucocorticoid hormones may programme fetal physiology and metabolism, such that cardiovascular functions are permanently altered. Through nutritional regulation of maternal-placental-fetal hormone interactions long term risk of hypertension may be established long before exposure to adult lifestyle factors more usually associated with cardiovascular mortality.