Maternal History Of Hypertension Research Articles

Angiotensin receptor blocker induced fetopathy: two case reports and literature review

The administration of angiotensin type 2 receptor blockers (ARBs) during pregnancy is known to cause ARB fetopathy, including renal insufficiency. We aimed to analyze the outcomes of two patients who survived ARB fetopathy and perform an accompanying literature review. Case 1 was exposed antenatally from a gestational age of 30 weeks to valsartan because of maternal pregnancy-induced hypertension. The patient presented with oliguria immediately after birth, and renal replacement therapy was administered for 24 days. Seven years after birth, renal function was indicative of stage 2 chronic kidney disease (CKD) with impaired urinary concentration. Case 2 had a maternal history of hypertension and transient ischemic attack and was treated with olmesartan until 30 weeks of pregnancy. Renal replacement therapy was performed for 4 days since birth. After 8 years, the patient is with CKD stage 2, with intact tubular function. Recent reports suggest that ARB fetopathy might manifest as renal tubular dysgenesis and nephrogenic diabetes insipidus, in contrast to mild alterations of glomerular filtration. Tubular dysfunction may induce CKD progression and growth retardation. Patients with ARB fetopathy should be monitored until adulthood. The ARB exposure period might be a critical factor in determining the severity and manifestations of fetopathy.

Relationship between infant hypothyroidism and maternal thyroid disease

Background: Due to the very high complications of neonatal hypothyroidism in the country, neonatal screening program is performed for timely diagnosis and treatment of neonates. The aim of this study to investigate the relationship between infant hypothyroidism and maternal thyroid disease. Methods: This cross-sectional study was done on 195 neonates with a diagnosis of hypothyroidism. Necessary data were collected by a checklist and then analyzed by statistical methods in statistical package for the social sciences (SPSS) version 21 by statistical methods. Results: Of all mothers, 21.0% had a history of thyroid disease. There was no statistically significant relationship between maternal age and infant thyroid stimulating hormone (TSH). There was no significant relationship between the history of maternal hypothyroidism and maternal hypothyroidism (during experiments) with the amount of TSH in the newborn. There was a direct and significant relationship between maternal TSH level and maternal free T4. But there was no statistically significant relationship between infant TSH level and maternal TSH level and free T4. There was no significant difference in neonatal TSH levels with maternal anti-TPO status. There was no significant relationship between the history of maternal diabetes and the history of maternal hypertension with neonatal TSH. There was no significant difference in neonatal TSH levels by maternal thyroid status. Conclusions: In the present study, no significant relationship was found between the incidence of neonatal hypothyroidism and the presence of thyroid disease in mothers. The existence of different genetic and environmental factors and the significant impact of each of these factors can justify this result.

11. Association of Family History of Hypertension with the Age Onset that being Diagnosed of Hypertension in Essential Hypertension Patients

Background: Essential hypertension (EH) has unknown cause, but there are several risk factors that can influence its occurrence. Family history is one of the non-modifiable risk factors that affect the age onset. Previous studies shown that individuals with a family history of hypertension have an earlier onset age of diagnosis. This is the first study conducted in Indonesia, especially the population in Manado. Objective: To determine the association between family history of hypertension and age onset at diagnosis of hypertension in EH patients. Method: Retrospective cohort study design and consecutive sampling in 120 EH patients. Subjects were classified by onset age at EH diagnosis (<55 and $55 years old), analyzed by Chi-square test and logistic regression. Results: Onset age at diagnosis of EH had a significant association with family history of hypertension (p = <0.001; OR = 5.972). Family history of hypertension have a significant association with age onset at diagnosis of EH (p = 0.004). Paternal and maternal history of hypertension had the highest chance of being diagnosed earlier with hypertension (OR = 8.056), followed by the group with maternal history (OR = 5.667), and paternal (OR = 4.792). Conclusion: There was a significant association between family history of hypertension and age onset at EH diagnosis, where subjects with family history of hypertension had higher chance of being diagnosed with hypertension at an earlier age. The group with both paternal and maternal history of hypertension had the highest chance of being diagnosed with hypertension at an earlier age.

Sirenomelia or “mermaid syndrome”: an extremely rare case in Indonesiasia

Sirenomelia, also known as mermaid syndrome, is a very rare lethal congenital disorder with multisystem malformations, characterized by fusion of the lower limbs. Here we report a preterm neonate with fusion of the lower limbs. The baby was born by cesarean section to a 27-year-old primigravida mother at 35 weeks and 3 days’ gestation. There was no maternal history of hypertension, heart disease, asthma, or diabetes mellitus. At birth, the infant did not cry, had weak tone, a heart rate (HR) of <60 beats per minute (BPM), an Apgar score of 1/2, and a birth weight of 2,300 grams. The infant had an imperforate anus and no urogenital openings or external genitalia. There was a small penis-like protrusion without an aperture, such as in cases of ambiguous genitalia. The two lower limbs were fused, with five toes on each foot. Despite neonatal resuscitation, the infant died within 75 minutes of birth. The child was diagnosed with sirenomelia. This case report aims to emphasize the importance of early prenatal diagnosis and education of the patient’s family.

An Exploratory Analysis of Maternal Health Variables Increasing the Severity of Congenital Heart Disease in Infants.

Congenital heart defects (CHD) are the most prevalent birth anomaly and leading cause of infant morbidity and mortality worldwide. Heart defects are often attributed to chromosomal abnormality or environmental factors, but most causes remain unknown. The purpose of this analysis was to explore maternal health variables and the relationships to birth outcomes in infants with CHD. Secondary analysis of data from the Wisconsin Pediatric Cardiac Registry. Maternal history of CHDs (odds ratio [OR] = 2.38; 95% confidence interval [CI], 1.42-3.98) and serious health conditions (OR = 1.537; 95%: CI, 1.08-2.17) increase infant risk and CHD severity. Maternal history of hypertension, serious health conditions, CHD, obesity, and income were predictors of birth weight (R² = 0.049, P < .05). Maternal history of hypertension, influenza, serious health conditions, and housing were predictors of gestational age (R2 = 0.045, P < .05). Birth weight (BW) and gestational age (GA) did not correlate to the severity of CHD in this study (simple vs complex, BW = -0.014, GA = 0.011, r). Maternal well-being influences the health of infants born with CHD. Positive maternal health contributes to near-normal birth weight and gestational age. Nurses must discuss optimal reproductive life planning strategies for decreasing risk of CHD and other infant disorders.

Modeling Pathways From the Perinatal Factors to the Vascular Risk Phenotype at the End of the Second Decade of Life: Birth Cohort, Brazil.

Risk factors act around birth increasing future vascular risk. In this study, we analysed the pathways from perinatal factors to the vascular risk phenotype (VRP) in adolescents including indirect pathways mediated by obesity in adolescence. Data from a Brazilian cohort were collected at birth and at 18 to 19 years (follow-up). A theoretical model was constructed to analyze the association between variables at birth (socioeconomic status, prepregnancy body mass index, mother's age, history of maternal hypertension, maternal smoking, gestational age at birth, birth weight, sex, delivery type) and at follow-up (smoking and excess weight) with the VRP, using structural equation modeling. VRP was a continuous latent variable, representing the shared variance of blood pressure indictors and carotid-femoral pulse wave velocity. Males had higher VRP (standardized coefficient [SC], 0.561; P<0.001). Higher prepregnancy body mass index was associated with higher VRP (SC, 0.140; P=0.032). Gestational age <34 weeks had a total (SC, 0.259; P=0.002) and direct effect (SC, 0.354; P=0.018) on VRP. Cesarean delivery had a total effect, albeit borderline, on VRP (SC, 0.159; P=0.066). Excess weight at follow-up was the main determinant of a high VRP (SC, 0.470; P<0.001). Male sex, cesarean section, gestational age <34 weeks, pregestational excess weight, and excess weight in adolescents were associated with increased VRP at 18 to 19 years of age.

Uterine leiomyomata: a retrospective study of correlations with hypertension and diabetes mellitus from the Japan Nurses’ Health Study

We performed a scrutiny survey of self-reported uterine leiomyomata (UL) to investigate the associations of parental history with hypertension and personal history of hypertension in the UL cases in Japanese women. Questionnaires that included items on the sites of UL determined by imaging techniques and surgical procedure were mailed to 2015 women with a self-reported UL at a baseline survey of the Japan Nurses’ Health Study (n = 15,019). We found that women with a past history and a maternal history of hypertension had an increase in their risk of UL. A maternal history of hypertension was significantly associated with an increase in the risk of UL in women without a past history of hypertension but not in the women with a past history of hypertension. A past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL. Women of reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL.Impact StatementWhat is already known on this subject? A positive association of uterine leiomyomata (UL) with a past history of hypertension has been found but the association of a parental history of hypertension with UL has not yet been clarified.What do the results of this study add? Maternal hypertension, as well as a personal history of hypertension, was associated with an increased risk of UL and a past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL.What are the implications of these findings for clinical practice and/or further research? Women of a reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL.

The Effect of Parental Medical History on the Prevalence of Cerebrovascular Diseases in Their Children in an Iranian Population.

Introduction:Still a controversial issue, family history is known as a risk factor for the development of Cerebrovascular Diseases (CVD). In this study, we aimed to evaluate the relationship between parental history and risk of CVD in their offspring in Iranian population.Methods:Isfahan Cohort Study (ICS) included total 6504 healthy participants which were randomly selected through a two-stage cluster sampling method from three districts. The participants were followed prospectively for 10 years. The diagnosis of CVD were confirmed by expert panelist. Clinically validated history of CVD was established for definition of parental history of CVD. Types of history were categorized into paternal, maternal, both parents, and no history.Results:The prevalence of CVD is generally higher among female offspring compared with male ones (P<0.001). The relative risk of CVD with maternal history was not significant (95%CI=0.95–2.29). By adjusted model analysis, history of CVD in both parents affected the risk of CVD in their male children (RR=2.13, P=0.033, 95%CI). By crude model analysis, maternal history of CVD (P=0.047), history of CVD in both parents (P=0.032), and maternal history of hypertension (P=0.005) were determined as risk factors of CVD in offspring. Indeed, the mean age of CVD in offspring decreases based on this order: history of hypertension in parents, paternal history of CVD in both parents, maternal history of CVD, and no history (P<0.001).Conclusion:Early and regular screening for CVD development is necessary in female offspring of the families with the present history of CVD from maternal side. This group are at risk and should be considered as the target group for screening and taking preventive measures.

Transient hyperaldosteronism and neonatal hypertension: Case series and literature review

Neonatal hypertension is an uncommon but important problem in Neonatal Intensive Care Unit. The most common cause of neonatal hypertension is renovascular disease. In premature neonates, hypertension has been associated with the use of postnatal steroids, maternal history of hypertension, umbilical artery catheterization, acute kidney injury, and bronchopulmonary dysplasia (BPD). The exact mechanism of hypertension in BPD infants is unknown. We present a case series of premature infants with BPD and hypertension associated with transient hyperaldosteronism in the absence of any other cause for the elevated blood pressure. All infants responded to aldosterone antagonists. Transient hyperaldosteronism may have a role in the pathogenesis of hypertension associated with BPD.

Perancangan Aplikasi Untuk Memprediksi Seseorang Menderita Penyakit Hipertensi Menggunakan Data Mining

Hipertensi merupakan salah satu penyakit gangguan pada pembuluh darah. Di Indonesia, penderita penyakit hipertensi mengalami peningkatan sebesar 3,6% setiap tahunnya. Terjadinya peningkatan hipertensi dikarenakan oleh kurang pedulinya masyarakat akan kesehatan, serta karena kurangnya waktu untuk melakukan konsultasi kepada dokter ahli atau pakar. Tujuan dalam penelitian ini (1) Data yang diperoleh dapat digunakan untuk memprediksi seseorang menderita hipertensi. (2) Aplikasi yang dibuat mudah untuk digunakan dan memiliki akurasi yang tinggi untuk memprediksi. Metode yang digunakan dalam penelitian ini adalah menggunakan data mining dengan metode klasifikasi Naïve Bayes Clasification yang merupakan pengklasifikasian dengan metode probabilitas dan statistik. Dalam pengumpulan data yang dibutuhkan untuk Data Mining dengan cara memberikan kuesioner kepada pasien yang berkunjung ke rumah sakit X selama 3 minggu dengan atribut yaitu usia, jenis kelamin, berat badan, tinggi badan, perokok, jenis rokok, jumlah rokok, konsumsi minuman beralkohol, aktifitas fisik, jumlah jam tidur, konsumsi daging, konsumsi sayuran, kadar garam, riwayat hipertensi ayah, riwayat hipertensi ibu. Kesimpulan (1) Dengan menggunakan Data Mining pasien dapat langsung mengetahui apakah pasien tersebut menderita hipertensi berdasarkan pola hidup yang dimilikinya. (2) Aplikasi yang telah dibangun dapat digunakan karena memiliki akurasi yang cukup tinggi sebesar 88% serta memiliki sensitivitas sebesar 77%, spesifitas 96%. (3) Penggunaan naïve bayes untuk memprediksi seseorang menderita penyakit hipertensi dapat digunakan karena memiliki akurasi yang tinggi sebesar 88%.

A case control analysis investigating risk factors and outcomes for nephrocalcinosis and renal calculi in neonates

Studies on outcomes and risk factors for neonatal nephrocalcinosis (NC) and renal calculi (RC) are limited, and often do not include controls for comparison. We conducted a case-control analysis to identify risk factors associated with NC and/or RC in neonates and studied the natural course of these anomalies. Infants diagnosed with NC/RC on ultrasound within the first year of life and corresponding gestational age- and gender-matched controls were identified from the neonatal intensive care unit database at our institution over a 10-year period. Risk factors assessed included: low birth weight, small for gestational age, nephrotoxic drugs, respiratory support therapy, use of total parental nutrition (TPN), surgeries, history of UTIs, creatinine at presentation, and history of maternal hypertension. Unadjusted odds ratios were estimated. Chi square analysis was performed for binary variables and the Mann-Whitney U test for continuous variables. Outcomes examined include time to resolution of NC/RC, renal function, and hypertension. We identified 22 cases of NC/RC with corresponding matched controls. Median follow-up was 28 months (IQR 0-122 months). History of urinary tract infections (UTI) was the only variable significantly associated with the presence of NC/RC (OR 5.62, 95% CI 1.12-31.1, p<0.013) (Table). All other known risk factors were comparable in both groups. There was no difference in the incidence of hypertension (OR 2.94, 95% CI 0.40-33.82, p=0.216) at diagnosis or last follow-up between the groups. Resolution of NC/RC was observed in 72.7%, during a median follow-up of 12.1 months. Mean urinary calcium/creatinine ratio for the NC/RC group was 2.3±1.5 at diagnosis and 0.96±0.8 at last follow-up. Most NC/RC in infants resolve without surgical intervention but some infants require medical therapy and follow-up. Risk factors for NC/RC in neonates continue to be poorly defined because of the quality of studies available. Our study provides further adjustment for confounders but has a small sample size and is restricted to neonates from an intensive care unit. Most cases of NC/RC resolve spontaneously without surgical intervention. The mean time to resolution is 12.1 months, without untoward consequences in terms of hypertension. A history of UTIs is the only identified risk factor identified in this study which is associated with a significant increased risk of neonatal nephrocalcinosis and/or renal calculi. Larger prospective studies are warranted to confirm these findings.

Maternal Risk Factors Associated With Low Birth Weight in Tigray Region, Northern Ethiopia, 2010

Background : Low birth weight has been defined by the World Health Organization as weight at birth of less than 2,500 grams. The mortality rates are particularly high among high-risk pregnancies and births and in countries like Ethiopia particularly Tigray where adequate primary health care services for maternal and child health, such as prenatal care, delivery and postnatal care, are not universally available to all the populations. It is therefore imperative to identify risk factors for low birth weight in various communities in Tigray in order to come up with feasible intervention strategies to minimize the problem. Objectives; to assess the maternal risk factors associated with low birth weight in Tigray region governmental hospitals 2010. Methods: A Facility based case control study was employed on 151 cases and 302 controls from April 26 to May 6, 2010. Maternal factors like age, parity, pre height, inter-pregnancy birth interval, obstetric history (mode of delivery, history of abortions) and maternal life history were studied. Result: The study was carried out in 7 governmental owned hospitals of Tigray. The mean maternal age of all study participants was 25.53 years. One of the most significant findings to emerge from this study is the maternal age. Analysis by age group revealed a significant positive relationship between age less than 18 years and risk of low birth weight. The other variables that were found to have a statically significant relationship with low birth weight were gravidity greater than 5 and 1, parity greater than 5 and 1, gestational age <37 weeks, inter-pregnancy interval(<18 month), antenatal care attendance (<4), history of hypertension and anaemia were found to be statistically significant. All these factors are interrelated. Conclusion and recommendation: in this study maternal age, gravidity, parity, gestational age of <37 weeks, inter-pregnancy interval of <18 months, antenatal care attendance (<4), history of hypertension and anemia had a statically significant relationship with low birth weight. So health care providers should provide brief counseling on ANC attendance, effect of age, and history of maternal anemia and hypertension during pregnancy based on scientific counseling principles and adequate time of counseling should be emphasized

Performance of parental history for the targeted screening of hypertension in children

Several guidelines recommend universal screening for hypertension in childhood and adolescence. Targeted screening to children with parental history of hypertension could be a more efficient strategy than universal screening. Therefore, we assessed the association between parental history of hypertension and hypertension in children, and estimated the sensitivity, specificity, negative, and positive predictive values of parental history of hypertension for hypertension in children. The present study was a school-based cross-sectional study including 5207 children aged 10-14 years from all public 6th grade classes in the Canton of Vaud, Switzerland. Children had hypertension if they had sustained elevated blood pressure over three separate visits. In children, the prevalence of hypertension was 2.2%. Some 8.5% of mothers and 12.9% of fathers reported to be hypertensive. Maternal history of hypertension (odds ratio 2.0, 95% confidence interval 1.2-3.3) and paternal history of hypertension (odds ratio 2.2, 95% confidence interval 1.4-3.6) were independent risk factors for hypertension in children. Nevertheless, the sensitivity of parental history of hypertension for the identification of hypertension in children was low (from 4% for both parents' positive history up to 41% for at least one parent's positive history). Positive predictive values were also low (between 4 and 5%). Children with hypertensive parents were at higher risk of hypertension. Nevertheless, parental history of hypertension helped only marginally to identify hypertension in offspring. Targeting screening only toward children with a parental history of hypertension may not be a substantially better strategy to identify hypertension in children compared with universal screening.

Index of Suspicion in the Nursery

A male infant is born at 38 weeks’ gestation via emergency repeat cesarean delivery after the mother presented in labor with thick meconium-stained amniotic fluid present. Apgar scores are 2, 7, and 8 at 1, 5, and 10 minutes, respectively. After initial resuscitation in the delivery room that required intubation and suctioning of meconium, the infant is transferred to the neonatal intensive care unit. Respiratory support is weaned to high-flow nasal cannula. Hypoglycemia and neutropenia are found on initial blood work. A blood culture is performed, and ampicillin and cefotaxime are administered for high clinical suspicion of neonatal infection. Maternal blood work includes blood type O, Rh positive, and negative antibody screen result. The mother tests negative for hepatitis B, human immunodeficiency virus, group B Streptococcus, and syphilis. She is immune to rubella. She did not have prolonged rupture of placental membranes or fever. There is no maternal history of hypertension or preeclampsia. On physical examination, the infant weighs 3.2 kg, and vital signs are as follows: pulse oxygen saturation, 96% to 100% on 4-L/min high-flow nasal cannula with a fraction of inspired oxygen of 0.40; respiratory rate, 46 to 83 breaths per minute; heart rate, 110 to 160 beats per minute; blood pressure, 89/52 mm Hg; and afebrile. The infant is alert, and newborn reflexes are intact. There is no pallor, petechiae, ecchymosis, or jaundice. Peripheral perfusion is normal. Findings of the remainder of the physical examination are unremarkable. Laboratory studies on admission reveal the following: hemoglobin, 12.2 g/dL (122 g/L); hematocrit, 34.5% (0.35); platelet count, 149 × 103/μL (149 × 109/L); …

A 20-Day-Old Boy with a Blue Skin Lesion

A 20-day-old boy presented for evaluation of a blue nodule on the right shoulder that had been present since birth. The mother noted no changes in the size of the lesion since birth, and no bleeding or ulceration was noted. The patient's past medical history was unremarkable. He was a full-term baby born at 39 weeks gestation via a normal, spontaneous vaginal delivery. The pregnancy was uncomplicated. The mother had no history of maternal hypertension and had no history of chorionic villus sampling or amniocentesis. The patient was not taking any medications and had no known allergies. Physical exam revealed a well-developed, well-nourished male in no apparent distress. A full skin exam revealed a 1.8 cm × 2 cm discrete, blue-purple vascular nodule with coarse surface telangiectasias and a surrounding rim of pallor on the right shoulder. There was no bleeding or breakdown noted. There was no lymphadenopathy present.

Abstract 364: Maternal History of Hypertension and Incident Atrial Fibrillation According to Blood Pressure Category in a General Urban Population: The Suita Study

Objective: Atrial fibrillation (AF) is the most common tachyarrhythmia and is a strong risk factor for stroke. However, few prospective studies have examined the relation between a parental history of hypertension and the incidence of AF in a general population. We assessed the hypothesis that a parental history of hypertension is associated with an increased risk of incident AF in an urban general population in Japan. Methods: A total of 6,918 participants (30~84 years old) initially free of AF were prospectively followed up for incident AF in the Suita Study. Standard 12-lead electrocardiograms were obtained from all subjects in the supine position. Each record was coded independently by 2 well-trained physicians using the Minnesota Code. Participants were diagnosed with AF if AF or atrial flutter was present on electrocardiograms obtained during a biannual routine health examination or if AF was indicated as a present illness by questionnaires responses or by medical records. Well-trained nurses obtained information on parental history of hypertension and lifestyle. Blood pressures (BP) were taken as the average of the second and third measurements. BP categories were defined by the following criteria: normal BP (&lt;120/80 mm Hg), prehypertension (120~139/80~89 mm Hg), and hypertension (&gt;140/90 mm Hg and/or antihypertensive drug user). Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed after adjusting for age, sex, body mass index, diabetes, hyperlipidemia, smoking, and drinking at baseline. Results: In 87,164 person-years of follow-up, 244 incident AF events occurred. The adjusted HRs (95% CIs) of incident AF were 1.56 (1.09~2.24) for hypertension and 1.48 (1.02~2.14) for a maternal history of hypertension. Compared with normal BP and non-maternal history of hypertension, the adjusted HRs (95% CIs) of incident AF were 1.61 (1.10~2.35) for hypertension without a maternal history of hypertension, and 2.29 (1.19~4.40) and 1.95 (1.08~3.50) for prehypertension and hypertension with a maternal history of hypertension, respectively. Conclusions: A maternal history of hypertension is a predictor of incident AF. For persons with a maternal history of hypertension, BP control would be under normal BP for AF prevention.

Mitochondrial tRNAMet mutation is associated with clinical and biochemical characteristics in primary hypertension

Mitochondrial DNA mutations have been increasingly associated with various diseases. An association between the mitochondrial tRNA gene mutation, tRNAMet, and primary hypertension has been suggested. In the present study, the association between the tRNAMet mutation and the development of primary hypertension was investigated by assessing clinical and biological indicators in 800 patients with primary hypertension. General [gender, age, age of onset, body mass index (BMI) and family history] and clinical data (routine blood counts, blood biochemistry profiles and color Doppler echocardiography) were obtained. Venous blood samples were drawn from all the subjects for the separation of white blood cells (WBCs) and DNA extraction. Mitochondrial tRNAMet was amplified using PCR, purified and sequenced; samples identified to have a mutation were sequenced in triplicate for validation. Comparisons were made between 7 hypertensive patients with mutations (0.875%) and 10 age-, gender- and medication‑matched hypertensive patients without mutations (controls). A maternal history of hypertension was present in 57.1% of patients with tRNAMet mutations and only 20.0% of patients without mutations. Notably, tRNAMet mutations were associated with a significantly earlier age of hypertension onset, decreased red blood cell (RBC) counts and hemoglobin (Hb) levels and increased total cholesterol (TC), triacylglycerol (TG), high‑density lipoprotein cholesterol (HDL-C) and glucose levels (all P<0.05). Heart structure and function differences were also assessed between the two groups. In conclusion, mitochondrial tRNAMet mutations may induce changes in tRNA structure and function, which contributes to the pathogenesis of primary hypertension by disturbing blood lipid metabolism, the steady state of blood cells and cardiac structure and function.

Maternal History of Hypertension and Blood Pressure Response to Potassium Intake: The GenSalt Study

The relation between parental history of hypertension and blood pressure response to potassium intake is unknown. A 7-day high-sodium followed by a 7-day high-sodium plus potassium dietary-feeding study was conducted from 2003 to 2005 among 1,871 Chinese participants. Those with a maternal history of hypertension had larger systolic blood pressure responses to potassium compared with those without: -4.31 (95% confidence interval (CI): -4.99, -3.62) mm Hg versus -3.35 (95% CI: -4.00, -2.70) mm Hg, respectively (P(difference) = 0.002). A consistent trend was observed for diastolic blood pressure responses: -1.80 (95% CI: -2.41, -1.20) mm Hg versus -1.35 (95% CI: -1.95, -0.74) mm Hg, respectively (P = 0.07). Stronger associations between early onset maternal hypertension and blood pressure responses were noted, with systolic blood pressure decreases of -4.80 (95% CI: -5.65, -3.95) mm Hg versus -3.55 (95% CI: -4.17, -2.93) mm Hg and diastolic blood pressure decreases of -2.25 (95% CI: -3.01, -1.50) mm Hg versus -1.42 (95% CI: -1.99, -0.85) mm Hg among those with early onset maternal hypertension versus those without, respectively (P = 0.001 and 0.009, respectively). Odds ratios for high potassium sensitivity were 1.36 (95% CI: 0.96, 1.92) and 1.60 (95% CI: 1.08, 2.36) for those with maternal hypertension and early onset maternal hypertension, respectively (P = 0.08 and 0.02, respectively). Potassium supplementation could help to reduce blood pressure among those with a maternal history of hypertension.

983 MATERNAL HISTORY OF HYPERTENSION PREDICTS BLOOD PRESSURE RESPONSE TO POTASSIUM INTAKE

Objective: To examine the relationship between parental history of hypertension and blood pressure responses to dietary potassium. Methods: We conducted a dietary-feeding study that included a 7-day high-sodium followed by a 7-day high-sodium plus potassium intervention among 1,871 Chinese participants. Blood pressure was measured on the last 3 days of each intervention phase. Parental hypertension status was ascertained during a baseline examination. Results: Those with a maternal history of hypertension had larger multivariable-adjusted systolic blood pressure responses (95% confidence interval) to potassium intake compared to those with no maternal history: -4.33 (-5.08, -3.57) versus -3.36 (-4.11, -2.62) mmHg, respectively (p-value = 0.003). A consistent trend was observed for diastolic blood pressure responses: -1.81 (-2.45, -1.17) versus -1.35 (-1.98, -0.72), respectively (p-value = 0.08). We noted a stronger association between early-onset maternal hypertension (diagnosed before age 65) and blood pressure responses. Participants with a history of early-onset maternal hypertension compared to those without had systolic blood pressure decreases of -4.74 (-5.64, -3.84) versus -3.54 (-4.26, -2.83) mmHg, respectively (p-value = 0.002) and diastolic blood pressure decreases of -2.25 (-3.01, -1.48) versus -1.38 (-1.99, -0.77) mmHg, respectively (p-value = 0.006). Odds ratios (95% confidence intervals) for high potassium-sensitivity were 1.36 (0.96, 1.93) and 1.62 (1.10, 2.39) for those with a maternal history of hypertension and early-onset hypertension, respectively (p-values = 0.08 and 0.01, respectively). Paternal hypertension was not associated with potassium-sensitivity. Conclusions: Maternal history of hypertension strongly predicted blood pressure responses to potassium intake. Potassium supplementation could be a particularly important strategy for blood pressure reduction among this subgroup of individuals.

Abstract 16737: Maternal Hypertension is More Often Observed Among Hypertensive Patients, and Associates to SNPs of the X Chromosome

Family history of hypertension (HTN) is present in as many as 70-80% of all patients with primary HTN. It was recently noted that in some selected pedigrees, HTN is transmitted according to a diaginic pattern. However, it is not known whether the general population, differences can be observed between maternal or paternal familiarity in the transmission of HTN. We analyzed the CampaniaSalute database of the Hypertension Clinic of the Federico II University of Naples in Southern Italy, comprising 12.520 (6.868 males and 5.636 females) cases, which were compared with 6.352 non HTN patients present in database. For both groups we calculated the “odd” value for a family history of HTN. Among the HTN group, family history is present in 75% of cases (odds 3.77), whereas in the Non HTN group, occurs in only 26%, (0.94). The odds ratio (OR) indicates that familiarity increases the risk of developing hypertension 2.91 times (2.67-3.17, p &lt;0.001). We found that in mothers HTN (HTN-M) occurs in 32% of cases [OR 3.01 (2.66-3.41, p &lt;0.001)], in fathers (HTN-F) occurs in 18% [2.31 (2.01-2.68, p &lt;0.001)] and in both parents (HTN-Both) in 15% of cases [3.45 (2.87-4.01, p&lt;0.001)]. Such a pattern is similar between male and female patients. Given the higher prevalence of maternal familiarity, we assessed in 375 male HTNs (which bear the same X chromosome of the mother), the presence of polymorphisms on the sexual chromosome that associate with maternal history of HTN, using the Illumina 300K chip technology. In particular, four polymorphisms (ie, rs2182289, rs1317098, rs2346677, and rs2346678) showed a different distribution with a p value &lt;0.0005, being less frequent in male patients with HTN-M compared with male patients with no HTN in the family (respectively 22.1 vs 36.4%, 16.4 vs 30.6%, 9.0 vs 19.4%, 8.6 vs 19.4%). A similar pattern although less significant was observed in female patients, which bear x chromosomes from both parents. These results suggest that polymorphisms on the X chromosome associate with the maternal transmission of HTN.