mmHg Higher Systolic Blood Pressure Research Articles

The association of obesogenic environments with weight status, blood pressure, and blood lipids: A cross-sectional pooled analysis across five cohorts

In this observational cross-sectional study, we investigated the relationship between combined obesogenic neighbourhood characteristics and various cardiovascular disease risk factors in adults, including BMI, systolic blood pressure, and blood lipids, as well as the prevalence of overweight/obesity, hypertension, and dyslipidaemia. We conducted a large-scale pooled analysis, comprising data from five Dutch cohort studies (n = 183,871). Neighbourhood obesogenicity was defined according to the Obesogenic Built-environmental CharacterisTics (OBCT) index. The index was calculated for 1000m circular buffers around participants’ home addresses. For each cohort, the association between the OBCT index and prevalence of overweight/obesity, hypertension and dyslipidaemia was analysed using robust Poisson regression models. Associations with continuous measures of BMI, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were analysed using linear regression. All models were adjusted for age, sex, education level and area-level socio-economic status. Cohort-specific estimates were pooled using random-effects meta-analyses. The pooled results show that a 10 point higher OBCT index score was significantly associated with a 0.17 higher BMI (95%CI: 0.10 to 0.24), a 0.01 higher LDL-cholesterol (95% CI: 0.01 to 0.02), a 0.01 lower HDL cholesterol (95% CI: −0.02 to −0.01), and non-significantly associated with a 0.36 mmHg higher systolic blood pressure (95%CI: −0.14 to 0.65). A 10 point higher OBCT index score was also associated with a higher prevalence of overweight/obesity (PR = 1.03; 95% CI: 1.02 to 1.05), obesity (PR = 1.04; 95% CI: 1.01 to 1.08) and hypertension (PR = 1.02; 95% CI: 1.00 to 1.04), but not with dyslipidaemia. This large-scale pooled analysis of five Dutch cohort studies shows that higher neighbourhood obesogenicity, as measured by the OBCT index, was associated with higher BMI, higher prevalence of overweight/obesity, obesity, and hypertension. These findings highlight the importance of considering the obesogenic environment as a potential determinant of cardiovascular health.

Mendelian randomization study of the relevance of blood pressure to vascular mortality among 150,000 participants in the mexico city prospective study

Abstract Background Mendelian randomization (MR) studies are commonly used to reduce confounding and reverse-causality when estimating the effects of risk factors on disease and provide estimates of effects over the whole life-course. However, most previous MR studies have been conducted in populations of European-ancestry. We used MR to investigate the effect of systolic blood pressure (SBP) on vascular mortality at ages 35-74 in a large prospective study of Mexican adults. Methods Between 1998 and 2004, 150,000 adults aged ≥35 years were recruited into the Mexico City Prospective Study and followed for median 19 years(1,2). Using 886 externally-selected single nucleotide polymorphisms (SNPs)(3) we created a genetic risk score for SBP (GRS-SBP). Those taking an antihypertensive drug at recruitment had their SBP adjusted by +6 mmHg(2) (adjustment by +15 mmHg rather than +6 mmHg was done in a sensitivity analysis). Cox regression and the MR ‘ratio’ method were then used to estimate the causal effect of SBP on vascular mortality at ages 35-74 years. Analyses were adjusted for age at risk, sex, residential district, education, smoking, alcohol consumption, physical activity, adiposity, diabetes mellitus and the first 7 genetic principal components. They excluded those aged ≥75 years, had incomplete data, or had prior vascular disease or any other chronic condition (except diabetes). Alternative MR approaches (inverse-variance-weighted, weighted median and MR Egger) were used for sensitivity analyses. Conventional epidemiological analyses of the association between SBP and mortality after correction for regression dilution bias were also done. Results Among 127,849 included individuals, the GRS-SBP explained 1.9% of baseline SBP variation. Those in the top fifth of the GRS-SBP distribution had 6.6 mmHg higher SBP and twice the prevalence of self-reported hypertension and antihypertensive drug use than those in the bottom fifth, but the GRS-SBP was uncorrelated with other factors. The strength of association between GRS-SBP and measured SBP was broadly similar in men and women, at different ages, and between people with different proportions of Amerindian genetic ancestry. Using the ratio method and a single estimate of the association of GRS-SBP with SBP, each 10 mmHg higher genetically predicted SBP was associated with 58% higher vascular mortality at ages 35-74 years (RR 1.58, 95% CI 1.27-1.96), including 69% higher ischaemic heart disease mortality (RR 1.69, 95% CI 1.31-2.16) and 65% higher stroke mortality (RR 1.65, 1.15-2.33). These genetic estimates were somewhat larger than conventional observational associations of usual SBP to risk. Alternative MR approaches found no evidence of pleiotropy and yielded similar conclusions. Conclusions These MR analyses confirm that blood pressure is a major cause of premature death from vascular diseases in Mexican adults.

Blood Levels of Angiotensinogen and Hypertension in the Multi-Ethnic StudyofAtherosclerosis (MESA).

Angiotensinogen is the proximal precursor of the angiotensin peptide hormones of the renin-angiotensin-aldosterone system (RAAS). Clinical trials are ongoing targeting angiotensinogen for the treatment of hypertension and heart failure. The epidemiology of angiotensinogen is not well defined, particularly its relationship to ethnicity, sex, and blood pressure (BP)/hypertension. The authors sought to determine the relationship of circulating angiotensinogen levels to ethnicity, sex, BP, incident hypertension, and prevalent hypertension in a modern sex-balanced ethnically diverse cohort. Plasma angiotensinogen levels were measured in 5,786 participants from the MESA (Multi-Ethnic Study of Atherosclerosis). Linear, logistic, and Cox proportional hazards models were utilized to examine the associations of angiotensinogen with BP, prevalent hypertension, and incident hypertension, respectively. Angiotensinogen levels were significantly higher in females than males and differed across self-reported ethnicities with the ordering (from highest to lowest): White, Black, Hispanic, and Chinese adults. Higher levels were associated with higher BP and odds of prevalent hypertension, after adjusting for other risk factors. Equivalent relative differences in angiotensinogen were associated with greater differences in BP in males vs females. In males not taking RAAS-blocking medications, a standard deviation increment in log-angiotensinogen was associated with 2.61mmHg higher systolic BP (95%CI: 1.49-3.80), while in females the same increment in angiotensinogen was associated with 0.97mmHg higher systolic BP (95%CI: 0.30-1.65). Significant differences in angiotensinogen levels are present between sexes and ethnicities. A positive association is present between levels and prevalent hypertension and BP, which differs between sexes.

Association of American Identity with Cardiovascular Health in South Asian Americans: The MASALA Study.

Ethnic and national identity may influence cardiovascular health (CVH)-related behaviors, such as dietary preference. To better understand how acculturation is related to CVH among South Asian American adults, we evaluated the association of self-rated American identity with CVH factors among participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Multivariable linear regression quantified the associations of self-rated American identity [1 (low American identity) to 10 (high American identity)] with CVH factors, including measures of cholesterol, blood pressure, and blood glucose. The role of diet quality, physical activity, and social support in mediating these associations was evaluated. Participants (n = 771) lived in the United States for an average of 27 (SD 11) years. The mean self-rated American identity score was 5.5 (2.4). After adjustment, a 5-point higher American identity score was associated with 6.5 mg/dL higher low-density lipoprotein cholesterol, 6.6 mg/dL higher total cholesterol, 2.9 mmHg higher systolic blood pressure, and 1.4 mmHg higher diastolic blood pressure. Accounting for diet quality, physical activity, or social support does not alter these associations. Higher self-rated American identity is associated with worse CVH factors among South Asian American adults.

High Dietary Sodium, Measured Using Spot Urine Samples, is Associated with Higher Blood Pressure among Young Adults in Haiti.

Hypertension (HTN) is the leading cardiovascular disease (CVD) risk factor in Haiti and is likely driven by poverty-related social and dietary factors. Salt consumption in Haiti is hypothesized to be high but has never been rigorously quantified. We used spot urine samples from a subset of participants in the population-based Haiti Cardiovascular Disease Cohort to estimate population mean daily sodium intake. We compared three previously validated formulas for estimating dietary sodium intake using urine sodium, urine creatinine, age, sex, height, and weight. We explored the association between dietary sodium intake and blood pressure, stratified by age group. A total of 1,240 participants had spot urine samples. Median age was 38 years (range 18-93), and 48% were female. The mean dietary sodium intake was 3.5-5.0 g/day across the three estimation methods, with 94.2%-97.9% of participants consuming above the World Health Organization (WHO) recommended maximum of 2 g/day of sodium. Among young adults aged 18-29, increasing salt intake from the lowest quartile of consumption (<3.73 g/day) to the highest quartile (>5.88 g/day) was associated with a mean 8.71 mmHg higher systolic blood pressure (SBP) (95% confidence interval: 3.35, 14.07; p = 0.001). An association was not seen in older age groups. Among participants under age 40, those with SBP ≥120 mmHg consumed 0.5 g/day more sodium than those with SBP <120 mmHg (95% confidence interval: 0.08, 0.69; p = 0.012). Nine out of 10 Haitian adults in our study population consumed more than the WHO recommended maximum for daily sodium intake. In young adults, higher sodium consumption was associated with higher SBP. This represents an inflection point for increased HTN risk early in the life course and points to dietary salt intake as a potential modifiable risk factor for primordial and primary CVD prevention in young adults.

The causal associations of circulating amino acids with blood pressure: a Mendelian randomization study

BackgroundCirculating levels of amino acids were associated with blood pressure (BP) in observational studies. However, the causation of such associations has been hypothesized but is difficult to prove in human studies. Here, we aimed to use two-sample Mendelian randomization analyses to evaluate the potential causal associations of circulating levels of amino acids with BP and risk of hypertension.MethodsWe generated genetic instruments for circulating levels of nine amino acids by conducting meta-analyses of genome-wide association study (GWAS) in UK Biobank participants with metabolomic data (n = 98,317) and another published metabolomics GWAS (n = 24,925). Data on the associations of the genetic variants with BP and hypertension were obtained in the UK Biobank participants without metabolomic data (n = 286,390). The causal effects were estimated using inverse-variance weighted method.ResultsSignificant evidence consistently supported the causal effects of increased branched-chain amino acids (BCAAs, i.e., leucine, isoleucine, and valine) levels on higher BP and risk of hypertension (all P < 0.006 after Bonferroni correction except for Pleucine-on-diastolicBP = 0.008). For example, per standard deviation higher of genetically predicted isoleucine levels were associated with 2.71 ± 0.78 mmHg higher systolic BP and 1.24 ± 0.34 mmHg higher diastolic BP, as well as with 7% higher risk of hypertension (odds ratio: 1.07, [95% CI: 1.04–1.10]). In addition, per standard deviation higher of genetically predicted glycine level was associated with lower systolic BP (− 0.70 ± 0.17 mmHg, P = 4.04 × 10−5) and a lower risk of hypertension (0.99 [0.98–0.99], P = 6.46 × 10−5). In the reverse direction, genetically predicted higher systolic BP was associated with lower circulating levels of glycine (− 0.025±0.008, P = 0.001).ConclusionsThis study provides evidence for causal impacts of genetically predicted circulating BCAAs and glycine levels on BP. Meanwhile, genetically predicted higher BP was associated with lower glycine levels. Further investigations are warranted to clarify the underlying mechanisms.

Investigating a possible causal relationship between maternal serum urate concentrations and offspring birthweight: a Mendelian randomization study.

Higher urate levels are associated with higher systolic blood pressure (SBP) in adults, and in pregnancy with lower offspring birthweight. Mendelian randomization (MR) analyses suggest a causal effect of higher urate on higher SBP and of higher maternal SBP on lower offspring birthweight. If urate causally reduces birthweight, it might confound the effect of SBP on birthweight. We therefore tested for a causal effect of maternal urate on offspring birthweight. We tested the association between maternal urate levels and offspring birthweight using multivariable linear regression in the Exeter Family Study of Childhood Health (EFSOCH; n = 872) and UK Biobank (UKB; n = 133 187). We conducted two-sample MR to test for a causal effect of maternal urate [114 single-nucleotide polymorphisms (SNPs); n = 288 649 European ancestry] on offspring birthweight (n = 406 063 European ancestry; maternal SNP effect estimates adjusted for fetal effects). We assessed a causal relationship between urate and SBP using one-sample MR in UKB women (n = 199 768). Higher maternal urate was associated with lower offspring birthweight with similar confounder-adjusted magnitudes in EFSOCH [22 g lower birthweight per 1-SD higher urate (95%CI: -50, 6); P = 0.13] and UKB [-28 g (95% CI: -31, -25); P = 1.8 × 10-75]. The MR causal effect estimate was directionally consistent, but smaller [-11 g (95%CI: -25, 3); PIVW = 0.11]. In women, higher urate was causally associated with higher SBP [1.7 mmHg higher SBP per 1-SD higher urate (95%CI: 1.4, 2.1); P = 7.8 × 10-22], consistent with that previously published in women and men. The marked attenuation of the MR result of maternal urate on offspring birthweight compared with the multivariable regression result suggests previous observational associations may be confounded. The 95% CIs of the MR result included the null but suggest a possible small effect on birthweight. Maternal urate levels are unlikely to be an important contributor to offspring birthweight.

Association of Volatile Organic Compound Exposure with Blood Pressure in the National Health and Nutrition Examination Survey (2011-2016)

BACKGROUND AND AIM Volatile organic compounds (VOCs) are environmental pollutants generated from a variety of different combustion sources, consumer and household products, and tobacco smoke. Exposure to VOCs has been associated with cardiovascular disease (CVD) risk factors, such as increased blood pressure (BP); however, limited research has been conducted in the general population. We hypothesized that higher levels of VOC exposure are associated with higher BP. METHODS To examine the relationship between VOC exposure and BP, we acquired and combined three cycles of data from the National Health and Nutrition Examination Survey (NHANES) over the years 2011-2016 for a final sample size of n=5,616 participants. Ultra-performance liquid chromatography/mass-spectrometry was used to measure the levels of 27 urinary VOC metabolites. Metabolites were adjusted for urinary creatinine and multiple measures of systolic and diastolic BP were averaged. Linear regression models adjusted for age, sex, race, education, BMI, smoking status, HDL, cholesterol, triglycerides, diabetes, blood pressure medications, eGFR, and NHANES cycle year were used to estimate associations between VOC metabolites and BP. RESULTS Participants were 52% female, median age of 47, 32% had hypertension, and 7.4% had diabetes. Urinary VOC metabolites were higher among tobacco users than non-users, except for metabolites of benzene, cyanide, and toluene. We found a 0.6 (95% CI: 0.2, 1.0) mmHg higher systolic BP per interquartile range of 1,3-butadiene metabolite, DHBMA. In subgroup analysis, this association was independent of age and persisted in women, non-tobacco users, Mexican Americans, and individuals not diagnosed with CVD or hypertension. Urinary metabolites of acrolein were associated with systolic BP in non-tobacco users, Non-Hispanic Blacks, women, and individuals not diagnosed with CVD or hypertension. CONCLUSIONS These results suggest exposures to VOCs, particularly acrolein and 1,3-butadiene, may be relevant, yet understudied contributors to CVD risk in the general population. KEYWORDS blood pressure, vocs, cvd, chemicals

Use of traditional medicine and control of hypertension in 12 Sub-Saharan African countries: the EIGHT cross-sectional study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Camille Lassale is supported by a fellowship from “La Caixa” Foundation (ID 100010434). The fellowship code is LCF/BQ/PR21/11840003 Background Use of traditional medicine (TM), is widespread in Sub-Saharan Africa as treatment option for a wide range of disease. We aimed to describe the profile of TM users and estimate the association with blood pressure (BP) and control of hypertension among hypertensive patients in a pan-African study. Methods We included 2128 participants in the cross-sectional EIGHT study, who attended an outpatient consultation in the cardiology departments of 12 Sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). We describe patients’ characteristics according to TM use. We modelled the odds of uncontrolled hypertension, severe hypertension, and complications of hypertension by multivariable mixed logistic regression, and the linear association with systolic and diastolic BP by linear regression, all adjusted for age, sex, individual wealth index, adherence to hypertension conventional treatment, and country. Results A total of 512 (24%) of participants reported using TM, and this percentage varied drastically across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be male, with poor treatment adherence, reporting missing treatment because it is too expensive, and presenting any complication of hypertension. TM use was associated with greater odds of hypertension (OR=1.30; 95% confidence interval: 0.99, 1.70), severe hypertension (OR=1.34; 1.04, 1.74) and of any complication of hypertension (OR=1.27; 1.01, 1.60), driven by renal complication (OR=1.57; 1.07, 2.29). Use of TM was associated with a 3.87 mmHg higher systolic BP and 1.75 mm Hg higher diastolic BP compared to no use. Conclusions In this cross-sectional study of patients with hypertension in 12 Sub-Saharan African countries, we identified that the use of traditional medicine was associated with a poorer control of hypertension and more complications.

Relationship of indoor solid fuel use for cooking with blood pressure and hypertension among the elderly in China

Indoor air pollution caused by solid fuel use for cooking affects 2.5 billion people worldwide and may elevate blood pressure (BP) and increase the burden of hypertension. Although the elderly are the most at risk of an elevated BP and hypertension, few studies have evaluated the effect of indoor solid fuel use for cooking on BP in persons over the age of 65. Therefore, in this study, we randomly selected 8067 elderly people over 65 years of age from the 2018 Chinese Longitudinal Healthy Longevity Survey to determine the impact of indoor solid fuel use on BP/hypertension. The results showed that, compared with those who cooked with clean fuel, those who cooked with solid fuel had a 1.87 mmHg higher systolic blood pressure, a 0.09 mmHg higher diastolic blood pressure, a 0.97 mmHg higher pulse pressure, and a 1.22 mmHg higher mean arterial pressure. However, we did not find any association between indoor solid fuel use and hypertension. We further observed that northern China residents, women, people aged over 90 years, hypertensive and heart patients, and those with natural ventilation in the kitchen that used indoor solid fuel experienced a greater BP impact. Replacing solid fuel with clean fuel may be an important way to lower BP. Regarding this, priority access to clean fuel should be given to the susceptible population, including the elderly aged ≥ 75 years, northern China residents, women, and hypertensive and heart patients.

Access to dental care and blood pressure profiles in adults with high socioeconomic status.

BackgroundReduced access to dental care may increase cardiovascular risk; however, socioeconomic factors are believed to confound the associations. We hypothesized that the relation persists despite economic wellness and high education, with reduced access to dental care affecting cardiovascular risk at least in part through its effect on blood pressure (BP), possibly mediated by systemic inflammation.MethodsWe first assessed the sociodemographic and clinical characteristics related to last dental visit timing (≤ or >6 months; self‐reported) using national representative cross‐sectional data. Then, the association of last dental visit timing with clinic BP was selectively investigated in highly educated, high income participants, further matched for residual demographic and clinical confounders using propensity score matching (PSM). The mediating effect of systemic inflammation was formally tested. Machine learning was implemented to investigate the added value of dental visits in predicting high BP over the variables included in the Framingham Hypertension Risk Score among individuals without an established diagnosis of hypertension.ResultsOf 27,725 participants included in the population analysis, 46% attended a dental visit ≤6 months. In the PSM cohort (n = 2350), last dental visit attendance >6 months was consistently associated with 2 mmHg higher systolic BP (P = 0.001) and with 23 to 35% higher odds of high/uncontrolled BP compared with attendance ≤6 months. Inflammation mildly mediated the association. Access to dental care improved the prediction of high BP by 2%.ConclusionsDental care use impacts on BP profiles independent of socioeconomic confounders, possibly through systemic inflammation. Regular dental visits may contribute to preventive medicine.

Changes in blood pressure patterns of hypertensive patients at Okcheon-gun public health center before and after the COVID-19 pandemic

Objective: The purpose of this study was to investigate the effect of discontinuation of periodic follow-up at a public health center in Okcheon-gun, Chungcheongbuk-do on the blood pressure management of hypertensive patients who visited the public health center regularly. The outpatient clinic of the public health center was totally shut down from March 1, 2020 to April 21, 2020, and then re-opened from April 22, focusing on chronic disease patients.Methods: The study group was selected among patients who visited the re-opened clinic from April 22 to the end of May, diagnosed with hypertension, and had a regular follow-up in the public health center. Through the health center medical records, the blood pressure of each patient was analyzed before and after the COVID-19 pandemicResults: Out of a total of 573 patients that visited the center, 306 patients (53.4%) were treated for hypertension, and among them, 235 patients were enrolled. The average blood pressure of all subjects was 136.9/78.0mmHg after the COVID-19 pandemic, which is 4.4mmHg higher systolic blood pressure(SBP)(P &lt; 0.001) and 1.7mmHg higher diastolic blood pressure(DBP)(P &lt; 0.05) than the average blood pressure before the COVID-19 pandemic. For the clinical control status of the SBP, 55% of all subjects maintained the status of ‘controlled’ before and after the COVID-19 pandemic, 15% maintained the ‘uncontrolled’ state, 23% changed from ‘controlled’ to ‘uncontrolled’, and 7.7% changed from ‘uncontrolled’ to ‘controlled’ state. The number of patients with uncontrolled state showed a high increase(McNemar’s chi-square test, P &lt; 0.001).Conclusions: The blood pressure of hypertensive patients managed by Okcheon public health center showed a significant increase of 4.4/1.7mmHg after termination of regular follow-up in response to the COVID-19 pandemic for about 2 months. The number of patients with a clinical status of uncontrolled SBP also increased significantly from 23% to 37%.

Abstract MP64: Higher Visit-to-Visit Blood Pressure Variability In Early And Middle Childhood Is Associated With Higher Blood Pressure In Adolescence

Background: In young adults, higher blood pressure (BP) and visit-to-visit BP variability are independent risk factors for incident cardiovascular disease. No studies have examined if BP and visit-to-visit BP variability during early and middle childhood are independently associated with elevated BP during adolescence. Addressing this question can provide targets for primordial prevention of high BP. Hypotheses: Higher BP and BP variability in early and middle childhood are independently associated with higher BP in adolescence. Methods: We studied 476 children in the Boston Birth Cohort (enrolled 1998-2016) who had BP measured in early (1 to &lt;6 y) or middle childhood (6 to &lt;13y) and in adolescence (13 to &lt;18 y). We modelled visit-to-visit BP variability using variability independent of the mean (VIM). We used linear regression models to examine the associations of mean BP and BP VIM in early and middle childhood (exposures) with mean BP in adolescence (outcome) and adjusted for potential confounders (see Table footnote). Results: After multivariable adjustment, a 1-SD higher level of systolic BP (SBP) in early and middle childhood was associated with a 1.89 (95% CI: 1.03, 2.75) and a 4.31 (95% CI: 3.58, 5.03) mmHg higher SBP in adolescence, respectively. A 1-SD higher level of SBP VIM in early and middle childhood was associated with a 1.46 (95% CI: 0.54, 2.38) and a 0.89 (95% CI: 0.05, 1.73) mmHg higher SBP in adolescence, respectively. Higher diastolic BP (DBP) in early and middle childhood was also associated with higher adolescence DBP, but the magnitude was smaller in comparison with SBP results ( Table ). Childhood DBP VIM was not associated with DBP in adolescence. Conclusion: In this prospective US predominantly minority birth cohort, both BP levels and variability during early and middle childhood are associated with higher BP in adolescence. Our findings underscore the need for health professionals to collect early-life BP data to facilitate opportunities for the primordial prevention of high BP in adolescence and beyond.

Low Level of Serum Cadmium in Relation to Blood Pressures Among Japanese General Population.

Hypertension (HT) is an important risk factor for mortality and morbidity. Previous studies showed that cadmium (Cd) was associated with increased blood pressures and the prevalence of HT. This study hypothesized that Cd, regardless of its level, may increase blood pressures/HT. The objective of this study was to examine the associations between alow level of serum Cd concentration and blood pressures/HT among a general population in the Iwaki area, Japan. This was a cross-sectional study, conducted in the Aomori prefecture with 1144 volunteers aged over 19 years old, who were participants of the Iwaki health check-up in 2014. The study assessed questionnaire survey, body composition, and serum Cd concentrations. Median serum Cd concentration was 0.06 ng/mL (interquartile range 0.05-0.08 ng/mL) among our study population. Compared to the lowest quintile of serum Cd concentration group, the highest quintile of serum Cd concentration group had 4.9 mmHg higher systolic blood pressure (SBP) (95% confidence interval [CI] 1.53-8.31, p < 0.01) and 2.4 mmHg higher diastolic blood pressure (DBP) (95% CI 0.36-4.34, p < 0.05), compared to the lowest quintile group. Similarly, the highest quintile of serum Cd concentration group had 1.7 times higher prevalence of HT (95% CI 1.10-2.51, p < 0.05) than the lowest quintile group. This study identified that higher serum Cd concentration was significantly, positively, associated with SBP and DBP and HT prevalence. This study provided evidence for the associations between environmental exposure to Cd and blood pressures/HT which should be considered for future preventive measures.

Long-Term Air Pollution and Blood Pressure in an African American Cohort: the Jackson Heart Study

African Americans are disproportionately affected by high blood pressure, which may be associated with exposure to air pollutants, such as fine particulate matter and ozone. Among African American Jackson Heart Study participants, this study examined associations between 1-year and 3-year mean fine particulate matter and ozone concentrations with prevalent and incident hypertension at Visits 1 (2000-2004, n=5,191) and 2 (2005-2008, n=4,105) using log binomial regression. Investigators examined associations with systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure using linear regression and hierarchical linear models, adjusting for sociodemographic, behavioral, and clinical characteristics. Analyses were conducted in 2017-2019. No associations were observed between fine particulate matter or ozone concentration and prevalent or incident hypertension. In linear models, an IQR increase in 1-year ozone concentration was associated with 0.67 mmHg higher systolic blood pressure (95% CI=0.27, 1.06), 0.42 mmHg higher diastolic blood pressure (95% CI=0.20, 0.63), and 0.50 mmHg higher mean arterial pressure (95% CI=0.26, 0.74). In hierarchical models, fine particulate matter was inversely associated with systolic blood pressure (-0.72, 95% CI= -1.31, -0.13), diastolic blood pressure (-0.69, 95% CI= -1.02, -0.36), and mean arterial pressure (-0.71, 95% CI= -1.08, -0.33). Attenuated associations were observed with 1-year concentrations and at Visit 1. Positive associations were observed between ozone and systolic blood pressure, diastolic blood pressure, and mean arterial pressure, and inverse associations between fine particulate matter and systolic blood pressure, diastolic blood pressure, and mean arterial pressure in an African American population with high (56%) prevalence of hypertension. Effect sizes were small and may not be clinically relevant.

Superior hypertension control with betablockade in the European Sleep Apnea Database

Abstract Background Arterial hypertension is highly prevalent and frequently difficult to control in patients with obstructive sleep apnea (OSA). High sympathetic activity is a hallmark physiological phenomenon in OSA. We hypothesized that antihypertensive drugs with sympathetic inhibitory properties, in particular beta blockers (BB), may be particularly efficacious in OSA patients. Methods Hypertensive OSA patients receiving blood pressure lowing treatment in the European Sleep Apnea Database (ESADA) were analyzed (n=5818, 69% men, age 58±11 years, body mass index 33±7 kg/m2, apnea hypopnea index 34±26 events/h). Antihypertensive medications (BB, diuretic, renin-angiotensin blocker [RAB], calcium channel blocker [CCB], and centrally acting antihypertensive [CAH]) were classified according to ATC code. Office blood pressure was compared in patients with mono- or combination therapy controlling for confounders. Results Poorly controlled systolic blood pressure according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 [95% CI, 1.4–3.0], 3.0 [1.9–4.1] and 3.0 [1.7–4.7] mmHg higher systolic blood pressure compared with those on BB (adjusted model, p=0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, systolic blood pressure was 3.3 [2.4–4.3], 2.2 [1.3–4.3] and 2.3 [1.4–3.3] mmHg higher in those on CCB/RAB, diuretic/RAB or BB/RAB compared with those on BB/diuretic (adjusted model, p&amp;lt;0.001, 0.019 and 0.001, respectively). Conclusions Uncontrolled blood pressure was common in OSA patients with antihypertensive medication. Patients treated with BB alone or in combination with diuretic was associated with a lower systolic pressure in this large clinical cohort. Funding Acknowledgement Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)

Associations of PM2.5 Exposure with Blood Pressure among Pregnant Women in Rural India: Evidence from the HAPIN Trial

Background: The Household Air Pollution Intervention Network (HAPIN) is an ongoing multi-center randomized controlled trial aimed at assessing the impact of a liquified petroleum gas (LPG) cooking stove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from solid fuel burning on cardiovascular outcomes on pregnancy, we sought to determine whether exposure to PM2.5 (as an indicator pollutant of HAP) was associated with gestational blood pressure (GBP) among 800 adult women in India, one of the HAPIN trial centers. Methods: Mixed-effects models were used to examine the association between PM2.5 exposure and BP, determined by repeated 24-hour personal exposure and GBP monitoring at baseline (&lt; 20 gestational weeks [GW]), second (24-28 GW) and third (32-36 GW) follow-up visits. Preliminary data from 799 mothers were included in regression analysis. Among these, 220 completed two measurements and 527 completed three measurements. Results: We found a significant positive association between nephelometric PM2.5 exposure and systolic blood pressure (SBP): on average, each IQR µg/m3 increase in PM2.5 exposure was associated with 0.05 mmHg higher SBP [0.002, 0.1]. A non-significant positive relationship was observed for diastolic blood pressure (DBP). Additionally, we observed a significant difference in SBP and DBP between the two study sites - Villupuram and Nagapattinam. Conclusion: This study added new evidence regarding the relationship between HAP exposure and BP among Indian women during pregnancy, a critical window for both mother and child’s life-course health. Preliminary results of this longitudinal study suggest that HAP from solid fuel burning is associated with higher blood pressure, particularly SBP, in pregnant women over the second and third trimester, controlling for maternal age, BMI, and gestational age.

Development of Hypertension and Cardiac Hypertrophy is associated with Endothelial Cell Dysfunction in Npr1 Gene‐disrupted Mice

Atrial and brain natriuretic peptides (ANP and BNP) are cardiac hormones that elicit natriuretic, diuretic, vasorelaxant, and antiproliferative responses, all of which contribute to lowering blood pressure and blood volume. ANP and BNP bind to guanylyl cyclase ‐A/natriuretic peptide receptor ‐A (GC‐A/NPRA), which is considered to be the major natriuretic peptide receptor that synthesizes the intracellular second messenger cGMP. The objective of the present study was to examine the effect of Npr1 (coding for NPRA) gene‐disruption on the process of endothelial cell dysfunction in the development of hypertension and cardiac hypertrophy. We used six‐month old mice having different copies of Npr1 gene (0‐copy, 1‐copy, and 2‐copy). The blood pressure and echocardiographic measurements were performed in each group. Blood was collected by direct cardiac puncture and cardiac tissues were harvested and snap frozen in liquid nitrogen. The 0‐copy (Npr1−/−) mice showed 35–45 mmHg higher systolic blood pressure (SBP) as compared to 2‐copy (Npr1+/+) mice. Echocardiographic measurements of Npr1 gene‐disrupted 1‐copy (Npr1+/−) and 0‐copy mice showed significant increased LVEDD (27% in 0‐copy and 10% in 1‐copy mice), intraventricular septal wall thickness (IVSTDD, 30% in 0‐copy and 15% in 1‐copy mice), and reduced fractional shortening by 24% in 0‐copy and 12% in 1‐copy mice as compared with control mice. There was also a significant increase in plasma levels of plasminogen activator inhibitor‐1 (PAI‐1; 2.2‐fold), soluble intracellular adhesion molecule (sICAM; 1.8‐fold), soluble vascular cell adhesion molecule (sVCAM; 30%). In the present study, increased plasma levels of sICAM, sVCAM, and PAI‐1 suggested the involvement of endothelial cell dysfunction in producing cardiac hypertrophy in Npr1 null mutant mice. Our results implicate that ANP/NPRA signaling promotes inhibitory effect on the agents, which cause endothelial dysfunction in the heart leading to cardiac hypertrophy and cardiac remodeling.Support or Funding InformationThis work was supported by NIH grant (HL062147).

In utero exposure to gestational diabetes mellitus and cardiovascular risk factors in youth: A longitudinal analysis in the EPOCH cohort.

To examine associations of maternal gestational diabetes mellitus (GDM) with offspring cardiovascular biomarkers from late childhood through adolescence. We used mixed effects linear regression models to examine associations of maternal GDM (n = 92 cases of 597) with average offspring levels of serum lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and systolic blood pressure (SBP) across two research visits spanning approximately 10.6 and 16.9 years of age. In sex-stratified analysis, we evaluated the impact of adjustment for sociodemographic characteristics, pubertal status, physical activity and total energy intake, maternal body mass index (BMI), GDM treatment, and child's BMI. After adjusting for child's age, pubertal status, race/ethnicity, and maternal education and smoking, GDM exposure was associated with higher total (0.38 [95% CI, 0.16-0.61] mmol/L) and LDL cholesterol (0.34 [95% CI, 0.14-0.53] mmol/L) in girls. These estimates were robust to adjustment for lifestyle characteristics and maternal BMI but were attenuated after accounting for GDM treatment with no appreciable change following further adjustment for current BMI. In boys, maternal GDM corresponded with 4.50 (1.90-7.10) mmHg higher SBP. This association persisted after accounting for sociodemographic/lifestyle characteristics, maternal BMI, and GDM treatment but was attenuated after adjusting for current BMI. Maternal GDM is related to offspring lipid profile and SBP in a sex-specific manner.

Parental smoking and blood pressure in children and adolescents: a national cross-sectional study in China

BackgroundCurrent evidence on the health effects of passive smoking on childhood blood pressure is limited and inconsistent. We investigated the associations between exposure to parental smoking and blood pressure in children and adolescents.MethodsA cross-sectional analysis was performed in a national sample of 42,745 children and adolescents (50.2% boys) aged 7–18 years from seven provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Information on parental smoking was collected through questionnaire. Multivariable linear regression and logistic regression was used to investigate the associations of parental smoking with blood pressure and prevalent hypertension, respectively.ResultsThe reported parental smoking rates were 49.7 and 50.2% in boys and girls, respectively. After adjustment for a range of potential confounders, exposure to parental smoking was associated with 0.44 [95% confidence interval (CI): 0.16, 0.72] mmHg and 0.26 (95% CI: 0.04, 0.47) mmHg higher SBP and DBP in girls. Girls exposed to parental smoking were also more likely to have hypertension compared with those without exposure (odds ratio = 1.11, 95% CI: 1.02, 1.20). No significant associations were found in boys.ConclusionsExposure to parental smoking was associated with increased blood pressure and higher prevalence of hypertension in girls, but not in boys. Urgent strategies are needed for the promotion of smoking-free environment, especially for children and adolescents.