Lower Risk Of Hypertension Research Articles

Association between joint physical activity and healthy dietary patterns and hypertension in US adults: cross-sectional NHANES study

BackgroundLack of physical activity (PA), poor dietary habits, or other unhealthy lifestyle behaviors are potential modifiable risk factors for hypertension. It has been sufficiently demonstrated in previous studies that physical activity or healthy dietary patterns can reduce the risk of hypertension. However, no research focused on the joint effects of PA and healthy dietary patterns on hypertension in a representative sample of adults.MethodsWe used data collected from the 2007–2018 National Health and Nutrition Examination Survey. Healthy dietary patterns were assessed with the Healthy Eating Index 2015 (HEI-2015), and PA was measured using the metabolic equivalent minutes per week reported in questionnaires. We created four lifestyle categories based on the HEI-2015 and PA: (1) unhealthy diet and physically inactive (less than recommended PA), (2) healthy diet but physically inactive, (3) unhealthy diet but physically active (recommended PA), (4) healthy diet and physically active. Logistic regression was used to evaluate the association between joint PA and HEI-2015 and hypertension.ResultsA total of 24,453 participants were enrolled in the study. Compared with unhealthy diet and physically inactive individuals, only healthy diet and physically active participants (adjusted odds ratio [AOR]: 0.77, 95% CI 0.65–0.9) were negatively associated with hypertension, while healthy diet but physically inactive participants (AOR: 0.89, 95% CI 0.76–1.03) and unhealthy diet but physically active participants (AOR: 0.9, 95% CI 0.76–1.06) were not associated with hypertension.ConclusionIn a representative sample of US adults, our findings suggest that individuals with recommended PA and healthy dietary patterns have a lower risk of hypertension than those with an unhealthy diet or less than recommended PA. Healthy eating habits and regular PA are potential preventive precautions against hypertension.

Exposure to Neighborhood Greenness and Hypertension Incidence in Adults: A Longitudinal Cohort Study in Taiwan.

There are few studies on the health effects of long-term exposure to neighborhood greenness in a longitudinal setting, especially in Asian countries with high population densities. This study investigates the association between long-term exposure to neighborhood greenness and hypertension among adults in Taiwan. We selected 125,537 participants ( of age) without hypertension from Taiwan who had joined the standard medical examination program between 2001 and 2016. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI), derived from satellite images at a resolution of . The 2-y average NDVI value within a circular buffer around participants' residences was calculated. A time-varying Cox regression model was used to investigate the association between neighborhood greenness and incident hypertension. Mediation analyses were performed to examine whether the association was explained by air pollution, leisure-time physical exercise, or body mass index (BMI). Compared with living in areas within the first quartile of neighborhood greenness, living in areas within the second, third, and fourth quartiles of neighborhood greenness was found to be associated with a lower risk of hypertension, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.95 (95% CI: 0.91, 1.00), 0.95 (95% CI: 0.90, 0.99), and 0.93 (95% CI: 0.88, 0.97), respectively. Each 0.1-unit increase in the NDVI was associated with a 24% lower risk of developing hypertension (0.76; 95% CI: 0.66, 0.87), with this associations being stronger among males and those with higher education levels. This association was slightly mediated by BMI but not by air pollution or leisure-time physical exercise. Our findings suggest the protective effects of neighborhood greenness on hypertension development, especially in males and well-educated individuals. Our results reinforced the importance of neighborhood greenness for supporting health. https://doi.org/10.1289/EHP13071.

Dietary patterns associated with the incidence of hypertension among adult Japanese males: application of machine learning to a cohort study

PurposeThe previous studies that examined the effectiveness of unsupervised machine learning methods versus traditional methods in assessing dietary patterns and their association with incident hypertension showed contradictory results. Consequently, our aim is to explore the correlation between the incidence of hypertension and overall dietary patterns that were extracted using unsupervised machine learning techniques.MethodsData were obtained from Japanese male participants enrolled in a prospective cohort study between August 2008 and August 2010. A final dataset of 447 male participants was used for analysis. Dimension reduction using uniform manifold approximation and projection (UMAP) and subsequent K-means clustering was used to derive dietary patterns. In addition, multivariable logistic regression was used to evaluate the association between dietary patterns and the incidence of hypertension.ResultsWe identified four dietary patterns: ‘Low-protein/fiber High-sugar,’ ‘Dairy/vegetable-based,’ ‘Meat-based,’ and ‘Seafood and Alcohol.’ Compared with ‘Seafood and Alcohol’ as a reference, the protective dietary patterns for hypertension were ‘Dairy/vegetable-based’ (OR 0.39, 95% CI 0.19–0.80, P = 0.013) and the ‘Meat-based’ (OR 0.37, 95% CI 0.16–0.86, P = 0.022) after adjusting for potential confounding factors, including age, body mass index, smoking, education, physical activity, dyslipidemia, and diabetes. An age-matched sensitivity analysis confirmed this finding.ConclusionThis study finds that relative to the ‘Seafood and Alcohol’ pattern, the ‘Dairy/vegetable-based’ and ‘Meat-based’ dietary patterns are associated with a lower risk of hypertension among men.

Hypertension in Pregnancy Among Immigrant and Swedish Women: A Cohort Study of All Pregnant Women in Sweden.

Little is known about risks of hypertensive disorders of pregnancy in both first- and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first- and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy. A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66-0.72), and among second-generation immigrant women, it was 0.88 (0.86-0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18-1.43) and 1.12 (1.07-1.17), respectively. Both first- and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.

Effects of menstrual disorders and dysmenorrhea on cardiovascular disease: a Mendelian randomization study.

Observational studies have demonstrated associations between menstrual disorders, dysmenorrhea, and cardiovascular disease (CVD). However, it remains unclear whether these associations are causal. This study is to investigate whether menstrual disorders and dysmenorrhea causally affect the risk of CVD. The summary data for menstrual disorders (excessive menstruation and irregular menses) and dysmenorrhea were obtained from FinnGen study, summary data for CVD were obtained from UK Biobank and meta-analysis. The inverse-variance-weighted method was mainly used in the Mendelian randomization for causality analysis. Sensitivity analyses were performed by several methods under different model assumptions. Genetic liability to excessive menstruation was associated with higher risk of atrial fibrillation (odds ratio (OR), 1.078 [95% confidence interval (CI), 1.015-1.145]; P=0.014), but a lower risk of hypertension (OR, 0.994 [95% CI: 0.989-0.999]; P=0.016). Irregular menses was associated with higher risk of atrial fibrillation (OR, 1.095 [95% CI: 1.015-1.182]; P=0.02), hypertension (OR, 1.007 [95% CI: 1.000-1.013]; P=0.047), myocardial infarction (OR, 1.172 [95% CI: 1.060-1.295]; P=0.02), ischemic heart disease, (OR, 1.005 [95% CI: 1.000-1.010]; P=0.037) and coronary heart disease (OR, 1.004 [95% CI: 1.001-1.008]; P=0.026). Dysmenorrhea was associated with higher risk of atrial fibrillation (OR, 1.052 [95% CI: 1.014-1.092]; P=0.008) and Ischemic stroke (cardioembolic) (OR, 1.122 [95% CI: 1.002-1.257]; P=0.046). After Benjamini-Hochberg correction, irregular menses was associated with higher risk of myocardial infarction. We confirmed a causal relationship of excessive menstruation, irregular menses and dysmenorrhea on cardiovascular outcomes independent of sex hormone levels, with an emphasis on the link between irregular menses and myocardial infarction. These clinical features can be utilized as markers to identify women at higher risk of developing CVD in the future, recommending early clinical intervention of menstrual diseases.

Improvement and application of recommended food score for hypertension in Korean adults: the Korean Genome and Epidemiology Study.

Addressing dietary factors to lower blood pressure can be a crucial strategy at the population level to mitigate the risk of hypertension. In a prior investigation, a tailored food score was used as a dietary index relevant to hypertension among Korean adults. This current study aims to assess the association between the overall quality of the diet, taking into account more precise food components, and evaluate the risk of developing hypertension. This prospective cohort study included 5,342 adults aged 40-70 without hypertension who participated in the Korean Genome and Epidemiology Study (KoGES) from 2001 to 2016. The improved Recommended Food Score for Hypertension (iRFSH) is a modified version of the Recommended Food Score to assess the consumption of foods recommended in the Dietary Approaches to Stop Hypertension (DASH) diet for Korean foods. A higher score reflects greater consumption of recommended foods, indicative of higher dietary quality. The maximum total score is 65. High blood pressure, which includes both hypertension and prehypertension, was analyzed using Cox proportional hazard regression models to examine its prospective relationship with iRFSH. Among 2,478 males and 2,864 females with 10.8 mean years of follow-up, a higher score of iRFSH was associated with a lower risk of hypertension in the highest quintile compared to the lowest quintile [total: hazard ratio (HR): 0.79; 95% confidence interval (CI): 0.72, 0.87; female: HR: 0.71; 95% CI: 0.62, 0.83]. Higher iRFSH is associated with a lower incidence of hypertension. Our results suggest that the iRFSH may be a potential tool for assessing dietary quality and dietary patterns and predicting the risk of hypertension in Korean adults.

The association of ideal cardiovascular health metrics and incident hypertension among an urban population of Iran: a decade follow-up in Tehran Lipid and Glucose Study.

We aimed to determine the association between ideal cardiovascular health metrics (ICVHM) and the incidence of hypertension among Iranian adults. The study population included 5409Iranian adults aged ≥20 years (2088 men) without hypertension (applying the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline) at baseline. The ICVHM was defined according to the AHA's 2020 impact goals, excluding total cholesterol was replaced by non-HDL cholesterol (non-HDL-C). Multivariable Cox proportional hazards regression analysis was done to estimate the hazard ratios (HRs) for ICVHM both as continuous and categorical variables. During a median 8.5-year follow-up, 2972 new cases of hypertension were identified (men: 1,287). Non-HDL-C < 130 mg/dL in men [HR (95% CI): 0.75(0.65-0.86)] and fasting plasma glucose(FPG) < 100 mg/dL in women[HR (95% CI): 0.79(0.64-0.97)], and among both genders, being normal/overweigth status (compared to obese) and blood pressure <120/80 mmHg were associated with a lower risk for hypertension. Additionally, in both gender, a 1-point increase in the number of global ICVHM decreased the risk of hypertension by more than 10%, and having ≥5 vs. <2 ICVHM, were associated with a lower risk of hypertension by 30% (all p values < 0.05). Applying the JNC 7 guideline, the association between ICVHM, with incident hypertension, were generally similar. Having a higher number of ICVHM was associated with a lower risk of incident hypertension, using both 2017 ACC/AHA and JNC 7 guidelines, mostly attributable to keeping the ideal status of body mass index, non-HDL-C, and FPG.

Urban greenspaces and child blood pressure in China: Evidence from a large population-based cohort study

BackgroundWith the world's population steadily shifting toward urban living, children's engagement with the natural environment seems to be diminishing. This raises significant concerns about the influence of urban greenspaces on the cardiovascular health of children. ObjectiveTo assess the association between urban greenspaces exposure and blood pressure (BP) in Chinese primary schoolchildren. MethodsThis prospective cohort study used data from the Children's growth environment, lifestyle, physical, and mental health development (COHERENCE) project in Guangzhou, China. Participants included 164,853 primary schoolchildren starting from 2016/17 to 2019/20 academic year. We assessed the surrounding greenspaces at home and school by using Sentinel-2 satellite data on the normalized difference vegetation index. Prehypertension and hypertension status were defined with BP above 90th to less than the 95th percentile, at or above the 95th percentile, respectively. The association of surrounding greenness with children's BP levels and risk of prehypertension/hypertension were examined using linear mixed-effects models and Cox proportional hazards model. ResultsAmong 164,853 eligible children aged 7.21 (0.74) years, 89,190 (54.1%) were boys. Our results showed that average systolic and diastolic BP increased by 0.48 and 0.42 standard deviations, respectively, over the 3-year follow-up. We identified 23,225 new cases of prehypertension and 35,067 of hypertension status. An interquartile range increase both in home-, school- and home-school NDVI100m was significantly associated with a reduction of 0.018–0.037 in BP z-scores and a 2.7%–7.6% lower risk of hypertension. Additionally, family socioeconomic status modified the impact of home-school greenness on BP levels. Air pollution exhibited mediating effects solely in school-greenness-BP associations, while physical activity and children's BMI mainly mediated the relationships between home-greenness and BP. ConclusionThe findings of this large cohort study suggest that surrounding greenspaces are associated with lower BP levels and a decreased risk of prehypertension and hypertension in Chinese schoolchildren.

Causal Effect of Relative Carbohydrate Intake on Hypertension through Psychological Well-Being and Adiposity: A Mendelian Randomization Study.

Observations of the association between carbohydrate intake and hypertension are inconsistent, with mediating pathways unclear. We aimed to investigate the causal effect of relative carbohydrate intake on hypertension and the mediating roles of psychological well-being and adiposity. Using summary-level statistics of genome-wide association studies of European ancestry, we conducted univariable and multivariable Mendelian randomization (MR) to estimate the bidirectional causal association between relative carbohydrate intake (total energy-adjusted, mean: 42-51%) and hypertension (FinnGen: 42,857 cases/162,837 controls; UK Biobank: 77,723 cases/330,366 controls) and two-step MR to assess the mediating effects of psychological well-being indicators and adiposity traits on the association. MR estimates of hypertension from FinnGen and UK Biobank were meta-analyzed using the fixed-effect model given no heterogeneity. Meta-analyses of multivariable MR estimates from FinnGen and UK Biobank indicated that each one-SD higher relative carbohydrate intake was associated with 71% (odds ratio: 0.29; 95% confidence interval: 0.11-0.79) lower risk of hypertension, independently of other dietary macronutrients. Hypertension showed no reverse effect on carbohydrate intake. Five psychological well-being indicators and four adiposity traits causally mediated the association between relative carbohydrate intake and hypertension, including body mass index (mediation proportion: 51.37%), waist circumference (40.54%), waist-to-hip ratio (35.00%), hip circumference (24.77%), major depressive disorder (23.37%), positive affect (17.08%), depressive symptoms (16.52%), life satisfaction (16.05%), and neuroticism (11.22%). Higher relative carbohydrate intake was causally associated with lower hypertension risk, substantially mediated by better psychological well-being and less adiposity. Our findings inform causal targets and pathways for the prevention and intervention of hypertension.

Abstract 18382: Clinical and Genetic Associations of Deep-Learning Estimated Peak Oxygen Consumption From the Resting 12-Lead Electrocardiogram

Introduction: Oxygen consumption at peak exercise (VO2 peak ) is the gold standard for cardiorespiratory fitness, but prior genome-wide association studies (GWAS) have been limited by the availability of cardiopulmonary exercise testing (CPET). Recent deep learning methods to estimate VO2 peak from the resting 12-lead electrocardiogram (ECG) may enhance genetic studies of cardiorespiratory fitness. Methods: We applied a validated deep learning model (Deep ECG-VO2) to estimate VO2 peak among UK Biobank participants with a 12-lead ECG. We assessed for associations between estimated VO2 peak and incident hypertension, diabetes, and atrial fibrillation (AF) using Cox proportional hazards models adjusted for age and sex, and plotted cumulative risk of each outcome stratified by tertile of estimated VO2 peak . We then performed a multi-ancestry GWAS of estimated VO2 peak using BOLT-LMM, adjusted for age, sex, array, and the first five principal components of ancestry. Candidate genes were prioritized based on proximity to the lead variant. Results: We applied Deep ECG-VO2 to estimate VO2 peak using the resting 12-lead ECG of 40,801 UK Biobank participants (age 65±8, 52% women). Greater estimated VO2 peak was associated with lower risks of hypertension (hazard ratio per 1-standard deviation 0.76, 95% CI 0.70-0.83), diabetes (0.60, 95% CI 0.53-0.67) and AF (0.82, 95% CI 0.74-0.90). Cumulative risk of each outcome was higher with decreasing estimated VO2 peak ( Figure ). In a GWAS of estimated VO2 peak within 39,716 participants with genetic data (age 65±8, 52% women, 90% European), we identified 10 novel genome-wide significant loci, including variants near genes involved in cardiac structure ( CCDC141/TTN, BAG3) , cardiac conduction ( SCN5A ), and adiposity ( FTO ). Conclusions: Leveraging artificial intelligence-enabled estimation of VO2 peak from the resting 12-lead ECG, we identify 10 novel common genetic variants associated with cardiorespiratory fitness.

Differential Gut Microbiota, Dietary Intakes in Constipation Patients with or without Hypertension.

Diet and gut microbiota are involved in blood pressure regulations, but few studies have focused on the constipation patients. The study seeks to identify differences in gut microbiota between hypertensive and normotensive subjects in constipation patients, analyzes the relationship between dietary patterns and blood pressure, and explores mediation effects of gut microbiota. Gut microbial genera and dietary information of 186 functional constipation participants are characterized by 16S rRNA sequencing and a food frequency questionnaire. The hypertensive subjectsshows lower α-diversity and β-diversity of gut microbiota than normotensive (p < 0.05) and 17 differential microbial genera. The dried-beans intake frequency inversely correlated with systolic and diastolic blood pressure after multivariate adjustment (r = -0.273, p-FDR < 0.01; r = -0.251, p-FDR = 0.026, respectively). Logistic regression indicates that the individuals often consumed dried-beans have a lower hypertension risk than those never consumed [OR = 0.137, 95% CI: (0.022, 0.689), p = 0.022]. A marginal mediating effect of the genus Monoglobus is observed for the association between high-fiber dietary pattern and hypertension. In patients with functional constipation, hypertension-related gut microbial differences are identified. Dried-beans intake is inversely associated with blood pressure, and a genus may potentially mediate the association between high-fiber dietary pattern and hypertension.

Mental illness and cardiovascular health: observational and polygenic score analyses in a population-based cohort study.

Individuals with serious mental illness have a markedly shorter life expectancy. A major contributor to premature death is cardiovascular disease (CVD). We investigated associations of (genetic liability for) depressive disorder, bipolar disorder and schizophrenia with a range of CVD traits and examined to what degree these were driven by important confounders. We included participants of the Dutch Lifelines cohort (N = 147 337) with information on self-reported lifetime diagnosis of depressive disorder, bipolar disorder, or schizophrenia and CVD traits. Employing linear mixed-effects models, we examined associations between mental illness diagnoses and CVD, correcting for psychotropic medication, demographic and lifestyle factors. In a subsample (N = 73 965), we repeated these analyses using polygenic scores (PGSs) for the three mental illnesses. There was strong evidence that depressive disorder diagnosis is associated with increased arrhythmia and atherosclerosis risk and lower heart rate variability, even after confounder adjustment. Positive associations were also found for the depression PGSs with arrhythmia and atherosclerosis. Bipolar disorder was associated with a higher risk of nearly all CVD traits, though most diminished after adjustment. The bipolar disorder PGSs did not show any associations. While the schizophrenia PGSs was associated with increased arrhythmia risk and lower heart rate variability, schizophrenia diagnosis was not. All mental illness diagnoses were associated with lower blood pressure and a lower risk of hypertension. Our study shows widespread associations of (genetic liability to) mental illness (primarily depressive disorder) with CVD, even after confounder adjustment. Future research should focus on clarifying potential causal pathways between mental illness and CVD.

Breastfeeding is associated with reduced risks of central obesity and hypertension in young school-aged children: a large, population-based study

BackgroundPrevious studies examined the effects of breastfeeding on measured values of body circumferences or blood pressure during childhood. However, limited data are available for the association between child feeding and a specific disease diagnosed as central obesity or hypertension. Hence, we aimed to examine whether the type and duration of breastfeeding are associated with obesity/central obesity or hypertension in young school-aged children.MethodsWe matched the data obtained from a cross-sectional survey in 2019 with retrospective breastfeeding information recorded in the database. Heights, weights, waist circumferences, and blood pressures of 8480 children in first grade of primary schools in Shanghai, China were measured to diagnose obesity, central obesity, and hypertension. Data on child feeding was collected retrospectively from clinical records. Associations between the type/duration of breastfeeding and children’s measured values of body mass index, waist circumference, and blood pressure were analysed by linear regression. Associations between the type/duration of breastfeeding and risks of obesity, central obesity, and hypertension were analysed by generalised linear models.ResultsBreastfeeding duration was inversely associated with blood pressure values in children in the first grade. Each month’s increase in the duration of any breastfeeding was associated with a 0.07 mmHg decrease in systolic blood pressure (P < 0.01) and a 0.05 mmHg decrease in diastolic blood pressure (P < 0.01). Any breastfeeding > one month was associated with a reduced risk of hypertension (adjusted risk ratio 0.84; 95% CI 0.73, 0.96, P = 0.01). Exclusive breastfeeding > one month was associated with a reduced risk of central obesity (adjusted risk ratio 0.76; 95% CI: 0.60, 0.96, P = 0.02). Any breastfeeding > 12 months was linked with a lower risk of hypertension (adjusted risk ratio 0.83; 95% CI 0.70, 0.98, P = 0.03).ConclusionsLack of breastfeeding is associated with higher risks of central obesity and hypertension during middle childhood. As a potential component of the public health strategy to reduce population levels of metabolic and cardiovascular diseases, breastfeeding could be a vital prevention strategy.

Dietary carbohydrate quality index (CQI), cardio-metabolic risk factors and insulin resistance among adults with obesity

BackgroundMetabolic syndrome (MetS), as a cluster of cardiometabolic risk factors, is a global public health concern due to its increasing prevalence. Considering the previous evidence of the association between carbohydrate quality and cardiometabolic risk factors, our study was aimed to evaluate any possible association between carbohydrate quality index (CQI) and cardiometabolic risk factors among obese adults.MethodsIn this cross-sectional study, 336 apparently healthy individuals with obesity were participated. Dietary intake was assessed by a semi-quantitative Food Frequency Questionnaire (FFQ), including 168 food items validated for the Iranian population. CQI was calculated with three components of solid carbohydrates to total carbohydrates ratio, dietary fiber intake, and dietary glycemic index (GI). Body composition was determined by bioelectrical impedance analysis (BIA). Blood pressure was measured by sphygmomanometer and enzymatic methods were used to evaluate serum lipid, glucose, and insulin concentrations.ResultsSubjects in the third quartile of CQI had significantly lower systolic blood pressure (SBP) (P = 0.03) and diastolic blood pressure (DBP) (P = 0.01). Participants in the higher quartiles of CQI had more intake of energy, carbohydrates, fat, saturated fatty acid (SFA), and mono-saturated fatty acid (MUFA) (P < 0.05). Moreover, the homeostasis model assessment of insulin resistance (HOMA-IR) was decreased in the second quartile of CQI [odds ratio (OR) = 0.146, P = 0.01) after adjustment for age, body mass index (BMI), sex, physical activity, socioeconomic status (SES) and energy intake.ConclusionAccording to our findings, a higher quality of dietary carbohydrates, determined by CQI, could be associated with a lower risk of hypertension.

Dietary intakes of total, nonheme, and heme iron and hypertension risk: a longitudinal study from the China Health and Nutrition Survey.

Evidence is limited regarding the long-term impact of dietary iron intake on the development of hypertension. We investigated the association between dietary intakes of total, nonheme, and heme iron and hypertension risk in a large prospective cohort of Chinese populations over 26years. A total of 16,122 adults (7810 men and 8312 women) who participated in the China Health and Nutrition Survey (1989-2015) were included. Dietary intake was repeatedly assessed by combining three consecutive 24‑h individual dietary recalls with household food inventory weighing at each survey round. Incident hypertension was defined as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg, diagnosis by physicians, or current use of anti-hypertensive drugs. During a median follow‑up of 11.1years, 2863 men and 2532 women developed hypertension. After adjustment for non-dietary and dietary factors, a lower risk of hypertension was found in men and women with higher intakes of total, nonheme, or heme iron. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the highest vs. lowest quartiles were 0.76 (0.67, 0.87) in men and 0.85 (0.74, 0.97) in women for total iron intake, 0.77 (0.67, 0.87) in men and 0.85 (0.74, 0.98) in women for nonheme iron intake, and 0.73 (0.62, 0.87) in men and 0.69 (0.58, 0.82) in women for heme iron intake. Dose-response analyses further revealed a U-shaped association of total and nonheme iron intake and an L-shaped association of heme iron intake with hypertension risk in both men and women (all P for non-linearity < 0.001). Our findings emphasize the importance of maintaining moderate iron intake in the prevention of hypertension. Both insufficient and excess intake of iron might increase the risk of hypertension.

Determining the association of rurality and cardiovascular disease among prostate cancer survivors

PurposeRural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. Materials and MethodsData were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1–3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. ResultsResults revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). ConclusionsThis study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.

Association between composite dietary antioxidant index and hypertension: insights from NHANES

ABSTRACT Aim The association between composite dietary antioxidant index (CDAI) and hypertension remains unknown. Our study was to investigate the association of CDAI with hypertension in general adults. Methods A total of 21 526 participants were enrolled from the National Health and Nutrition Examination Surveys (NHANES). The CDAI was calculated from the intake of six dietary antioxidants. Multivariable logistic regressions were performed to explore the associations between CDAI and the prevalence of hypertension. Non-linear correlations were explored using restricted cubic splines. And the inflection point was determined by the two-piecewise linear regression. Results In the multivariate logistic regression model with full adjustment for confounding variables, the odds ratio (95% confidence interval) of CDAI associating with hypertension was 0.98 (0.97–1.00; P = .016). Besides, compared to the lowest quartile, the highest quartile of CDAI was associated with a lower risk of hypertension (0.81 [0.70–0.94]; P = .006). Furthermore, a linear association was found by restricted cubic spline, with 3.4 being the turning point. Conclusion Our study highlighted a negative linear association between CDAI and hypertension in general adults.

Sex-specific associations between daytime sleepiness, chronic diseases and mortality in obstructive sleep apnea.

Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA. Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness (N = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality. In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality. The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.

Real-world multicentre analysis of patients with hepatocellular carcinoma (HCC) treated with atezolizumab and bevacizumab (A+B): Efficacy, esophagogastroduodenoscopy (EGD) uptake and bleeding complications.

4105 Background: The IMbrave150 trial established A+B as a standard of care for HCC and an EGD within 6 months (mos) of starting treatment to detect esophagogastric varices and prevent bleeding complications was advised. However, the value of performing EGD in all patients (pts) is unknown. Methods: We conducted a retrospective analysis of all HCC pts treated with A+B between July 2020 to August 2022 at 5 cancer centres from the Canadian provinces of Ontario, Alberta and Manitoba (members of the HCC-CHORD Consortium). Pts characteristics and treatment history including efficacy, EGD details and bleeding events were collected. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were calculated. A comparative analysis was conducted to compare the correlation between the EGD uptake and bleeding events. Results: A total of 112 pts were identified (median age 66 years, 87% male, 24% East Asian, 67% liver cirrhosis, 33% HCV, 25% HBV, 15% NASH, 23% BCLC B, 71% BCLC C, 91% Child-Pugh A, 29% main portal vein invasion, 45% ALBI grade 1 and 54% ALBI grade 2). Prior to systemic, 61% had locoregional therapies. 90% received A+B as first-line therapy, while 9% received it as second-line and 1% as third-line. Outcomes of pts treated with A+B are shown. Before starting A+B, 78 pts (70%) had completed an EGD within 6 mos. Of these, 32 pts (41%) had evidence of varices on EGD, and 15 (20%) required treatment with either banding or beta-blockers. All bleeding events in this population was 15% (n=17). Bleeding rates in the EGD and non-EGD groups were 18% (n=14) and 9% (n=3), respectively. Bleeding adverse events were 5%(n=6) gastrointestinal vs 10%(n=11) non-gastrointestinal (6 epistaxis, 1 ecchymosis, 1 periodontal and 3 unspecified). The GI bleeding rates in the EGD and non-EGD groups were 6% (n=5) and 3% (n=1). Conclusions: Outcomes of HCC pts treated with A+B in Canada are comparable to those observed in the IMbrave150 trial. Our study detected and treated varices at twice the rate of the IMbrave150 trial among the EGD group, reflecting real-world treatment of a high-risk population. Yet, pts who had no EGD before starting A+B, presumably due to a low risk of portal hypertension based on physicians’ judgement, did not experience more bleeding/GI bleeding than those who had an EGD. This supports the approach of selective EGD prior to A+B, and more guidelines are needed in this area. Outcomes and response rate of patients(pts) treated with Atezolizumab with Bevacizumab in this study. [Table: see text]

Associations between multiple urinary metals and the risk of hypertension in community-dwelling older adults.

Although metal exposure has been associated with hypertension, the conclusions remain controversial, and studies investigating the predictive effect of multiple metals on hypertension are limited. In this study, we aimed to evaluate the nonlinear dose-response relationship between a single urinary metal and the risk of hypertension, and to assess the predictive effect of multiple urinary metals on hypertension. Of the Yinchuan community-dwelling elderly cohort launched in 2020, 3,733 participants (803 with hypertension and 2,930 without hypertension) were analysed in this study, and the concentrations of 13 metal elements in urine were measured. We found that urinary vanadium (odds ratio (OR): 1.16, 95% confidence interval [CI]: 1.08-1.25), molybdenum (OR: 1.08, 95% CI: 1.01-1.16), and tellurium (OR: 1.14, 95% CI: 1.06-1.22) were associated with higher risk of hypertension, whereas iron (OR: 0.92, 95% CI: 0.85-0.98) and strontium (0.92, 95% CI: 0.85-0.99) were significantly associated with lower risk of hypertension. Restricted cubic splines analysis was conducted in patients with iron concentrations of ≥ 15.48μg/g and ≤ 399.41μg/g and a strontium concentration of ≤ 69.41μg/g, results showed that the risk of hypertension decreased gradually as the urinary concentrations of these metals increased. With an increase in the vanadium concentration in urine, the risk of hypertension gradually increased. In patients with a molybdenum concentration of ≥ 56.82μg/g and a tellurium concentration of ≥ 21.98μg/g, the risk of hypertension gradually decreased as the urinary concentrations of these metals increased. Predictive scores based on the 13 metallic elements were significantly associated with a higher risk of hypertension (OR: 1.34 (95% CI: 1.25-1.45). After additionally including urinary metal concentrations as a parameter variable in the traditional hypertension risk assessment model, integrated discrimination and net reclassification increased by 8.00% (P < 0.001) and 2.41% (P < 0.001), respectively. Urinary vanadium, Mo, and Te concentrations were associated with a higher risk of hypertension, while iron and strontium concentrations were associated with a lower risk of hypertension. Multiple urinary metal concentrations can significantly improve the predictive ability of traditional hypertension risk-assessment models.