mmHg Lower Systolic Blood Pressure Research Articles

Household fuel use and the regression from prehypertension to normotension among Chinese middle-aged and older adults: a cohort study.

To examine the association of household fuel use with prehypertension regression among middle-aged and older people based on the China Health and Retirement Longitudinal Study (CHARLS), we included a total of 3501 participants with prehypertension at baseline, and they were followed up from 2011-2012 to 2015-2016 with information on blood pressure and household solid fuel use (heating and cooking fuels). Cox proportional hazards regression models were used to explore the hazard ratio (HR) and 95% confidence interval (CI) between fuel use and prehypertension regression. Additionally, we investigated the impact of switching fuels (2011-2013) on the regression to normotension during the 4-year follow-up. Linear regression was used to examine the effect of household fuel use on changes in blood pressure. Compared to solid fuel users, those who used clean fuel for heating at baseline had a positive effect on the regression of prehypertension (HR: 1.28, 95% CI: 1.08-1.53). Participants who used clean fuels for both heating and cooking had increased odds for the regression of prehypertension (HR: 1.32, 95% CI: 1.09-1.60). Compared to consistent solid fuel users, those who consistently used clean fuel for heating had a higher likelihood of transitioning from prehypertension to normotension (HR: 1.36, 95% CI: 1.06-1.73) and exhibited 2.45 mmHg lower systolic blood pressure. In conclusion, household clean fuel use for heating was positively associated with the regression of prehypertension to normotension. Furthermore, switching from solid fuel to clean fuel for heating could reduce the risk of prehypertension in Chinese middle-aged and older adults.

Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study

Objective To explore in a primary care setting the associations between patients’ daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.

Associations between major dietary patterns and blood pressure among Southwest Chinese: A cross-sectional analysis based on the China Multi-Ethnic Cohort (CMEC) study

Background and aimsIn the less developed multi-ethnic regions (LEMRs) of Southwest China, the associations between dietary patterns and blood pressure (BP) values remain unclear. We aimed to investigate such associations and related effect modifiers. Methods and resultsThis study included 81,433 participants from the China Multi-Ethnic Cohort Study. Dietary intakes during the year before the interview were measured with the Quantitative Food Frequency Questionnaire. Three major dietary patterns that were highly in line with geographical and ethnic distributions of the study population, i.e., “Sichuan Basin,” “Yunnan-Guizhou Plateau,” and “Qinghai-Tibet Plateau,” were derived using principal component factor analysis. The multilinear regression model combined with inverse probability of exposure weighting was used to estimate the associations between dietary patterns and BP values.Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern (characterized by urban lifestyles) was associated with 2.67 mmHg lower systolic blood pressure (SBP) (95% CI: −3.07 to −2.27) and 0.89 mmHg lower diastolic blood pressure (95% CI: −1.12 to −0.65). In contrast, both the Yunnan-Guizhou Plateau (characterized by agricultural lifestyles) and the Qinghai-Tibet Plateau dietary patterns (characterized by nomadic lifestyles) showed positive associations with BP. In the stratified analysis, the associations between dietary patterns and SBP were significantly stronger in women than in men for all three kinds of dietary patterns. ConclusionBoth major dietary patterns and their associations with BP showed a substantial disparity in LEMRs of Southwest China. Dietary patterns in regions of higher socioeconomic status are more conducive to reducing the rising of BP, especially for women and urban residents, which might provide insights into the BP control in LEMRs of Southwest China.

423.12: Dietary Protein Intake and Blood Pressure After Living Kidney Donation

Background: High dietary protein intake is associated with worsening kidney function especially in at-risk patients such as living kidney donors; high blood pressure is a known risk factor for kidney disease. Whether pre-donation protein intake contributes to post-donation blood pressure is unknown. Methods: A single-center cohort study included living kidney donors undergoing living kidney donation in 2021 and divided the patients into 2 groups: low and high pre-donation protein intake defined by dietary protein intake estimated from 24-hour urine collection <1 (LPI) and ≥1 (HPI) g/kg/day, respectively. Association between dietary protein intake and systolic blood pressure during the first two weeks post-donation was evaluated by multiple linear regression. Results: Of 14 living kidney donors, mean±SD was 44±12 and 50% were female. Half of the study population were in the LPI group with a mean dietary protein intake of 0.8±0.1 g/kg/day and the remaining seven patients in the HPI group had a dietary protein intake of 2.2±2.5 g/kg/day (meandifference HPI vs LPI 1.4; p 0.172; 95%CI -0.7, 3.5). Dietary sodium intake was not different between the two groups (mean sodium intake of LPI 3,171±1,315 and of HPI 4,058±1,135 g/day, meandifferenc HPI vs LPI 887; p 0.202; 95%CI -544, 2,318; Figure 1). Mean systolic blood pressure of LPI and HPI groups were 135±8 and 121±7 mmHg, respectively (meandifference LPI vs HPI 14; p 0.007; 95%CI 5, 23). Compared to the LPI group, the HPI group had 14 mmHg lower systolic blood pressure (β -14; p 0.007; 95%CI -23, -5; Figure 2). After adjusted by age, gender, ethnicity, pre-donation body mass index, dietary sodium intake (<4 vs ≥4 g/day), and the interaction term between dietary protein intake and dietary sodium intake, the magnitude and direction of the association between dietary protein intake and systolic blood pressure remain the same (β -13, p 0.043, 95%CI -26, -0.6) and dietary sodium intake did not modify the association (Pinteraction 0.498). Conclusions: Higher dietary protein intake during pre-donation is inversely associated with SBP level without the effect of dietary sodium intake. Although HPI is associated with adverse kidney outcomes, the protective association between HPI and high blood pressure may involve physiological change after donor nephrectomy and further studies with long-term follow-up are required.

Calcium supplementation for prevention of primary hypertension.

Hypertension is a major public health problem that increases the risk of cardiovascular and kidney diseases. Several studies have shown an inverse association between calcium intake and blood pressure, as small reductions in blood pressure have been shown to produce rapid reductions in vascular disease risk even in individuals with normal blood pressure ranges. This is the first update of thereviewto evaluate the effect of calcium supplementation in normotensive individuals as a preventive health measure. To assess the efficacy and safety of calcium supplementation versus placebo or control for reducing blood pressure in normotensive people and for the preventionof primary hypertension. The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to September 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 9), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and theUS National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. We selected trials that randomised normotensive people to dietary calcium interventions such as supplementation or food fortification versus placebo or control. We excluded quasi-random designs. The primary outcomes were hypertension (defined as blood pressure ≥ 140/90 mmHg) and blood pressure measures. Two review authors independently selected trials for inclusion, abstracted the data and assessed the risks of bias. We used the GRADE approach to assess the certainty of evidence. The 2020 updated search identified four new trials. We included a total of 20 trials with 3512 participants, however we only included 18 for the meta-analysis with 3140 participants. None of the studies reported hypertension as a dichotomous outcome. The effect on systolic and diastolic blood pressure was: mean difference (MD) -1.37 mmHg, 95% confidence interval (CI) -2.08, -0.66; 3140 participants; 18 studies; I2 = 0%, high-certainty evidence; and MD -1.45, 95% CI -2.23, -0.67; 3039 participants; 17 studies; I2 = 45%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for those younger than 35 years was: MD -1.86, 95% CI -3.45, -0.27; 452 participants; eightstudies; I2 = 19%, moderate-certainty evidence; MD -2.50, 95% CI -4.22, -0.79; 351 participants; sevenstudies ; I2 = 54%, moderate-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for those 35 years or older was: MD -0.97, 95% CI -1.83, -0.10; 2688 participants; 10 studies; I2 = 0%, high-certainty evidence; MD -0.59, 95% CI -1.13, -0.06; 2688 participants; 10 studies; I2 = 0%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for women was: MD -1.25, 95% CI -2.53, 0.03; 1915 participants; eight studies; I2 = 0%, high-certainty evidence; MD -1.04, 95% CI -1.86, -0.22; 1915 participants; eight studies; I2 = 4%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for men was MD -2.14, 95% CI -3.71, -0.59; 507 participants; five studies; I2 = 8%, moderate-certainty evidence; MD -1.99, 95% CI -3.25, -0.74; 507 participants; five studies; I2 = 41%, moderate-certainty evidence, respectively. The effect was consistent in both genders regardless of baseline calcium intake. The effect on systolic blood pressure was: MD -0.02, 95% CI -2.23, 2.20; 302 participants; 3 studies; I2 = 0%, moderate-certainty evidence with doses less than 1000 mg; MD -1.05, 95% CI -1.91, -0.19; 2488 participants; 9 studies; I2 = 0%, high-certainty evidence with doses 1000 to 1500 mg; and MD -2.79, 95% CI -4.71, 0.86; 350 participants; 7 studies; I2 = 0%, moderate-certainty evidence with doses more than 1500 mg. The effect on diastolic blood pressure was: MD -0.41, 95% CI -2.07, 1.25; 201 participants; 2 studies; I2 = 0, moderate-certainty evidence; MD -2.03, 95% CI -3.44, -0.62 ; 1017 participants; 8 studies; and MD -1.35, 95% CI -2.75, -0.05; 1821 participants; 8 studies; I2 = 51%, high-certainty evidence, respectively. None of the studies reported adverse events. An increase in calcium intake slightly reduces both systolic and diastolic blood pressure in normotensive people, particularly in young people, suggesting a role in the prevention of hypertension. The effect across multiple prespecified subgroups and a possible dose response effect reinforce this conclusion. Even small reductions in blood pressure could have important health implications for reducing vascular disease. A 2 mmHg lower systolic blood pressure is predicted to produce about 10% lower stroke mortality and about 7% lower mortality from ischaemic heart disease. There is a great need for adequately-powered clinical trials randomising young people. Subgroup analysis should involve basal calcium intake, age, sex, basal blood pressure, and body mass index. We also require assessment of side effects, optimal doses and the best strategy to improve calcium intake.

Calcium supplementation for prevention of primary hypertension.

Hypertension is a major public health problem that increases the risk of cardiovascular and kidney diseases. Several studies have shown an inverse association between calcium intake and blood pressure, as small reductions in blood pressure have been shown to produce rapid reductions in vascular disease risk even in individuals with normal blood pressure ranges. This is the first update of thereviewto evaluate the effect of calcium supplementation in normotensive individuals as a preventive health measure. To assess the efficacy and safety of calcium supplementation versus placebo or control for reducing blood pressure in normotensive people and for the preventionof primary hypertension. The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to September 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 9), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and theUS National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. We selected trials that randomised normotensive people to dietary calcium interventions such as supplementation or food fortification versus placebo or control. We excluded quasi-random designs. The primary outcomes were hypertension (defined as blood pressure ≥ 140/90 mmHg) and blood pressure measures. Two review authors independently selected trials for inclusion, abstracted the data and assessed the risks of bias. We used the GRADE approach to assess the certainty of evidence. The 2020 updated search identified four new trials. We included a total of 20 trials with 3512 participants, however we only included 18 for the meta-analysis with 3140 participants. None of the studies reported hypertension as a dichotomous outcome. The effect on systolic and diastolic blood pressure was: mean difference (MD) -1.37 mmHg, 95% confidence interval (CI) -2.08, -0.66; 3140 participants; 18 studies; I2 = 0%, high-certainty evidence; and MD -1.45, 95% CI -2.23, -0.67; 3039 participants; 17 studies; I2 = 45%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for those younger than 35 years was: MD -1.86, 95% CI -3.45, -0.27; 452 participants; eightstudies; I2 = 19%, moderate-certainty evidence; MD -2.50, 95% CI -4.22, -0.79; 351 participants; sevenstudies ; I2 = 54%, moderate-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for those 35 years or older was: MD -0.97, 95% CI -1.83, -0.10; 2688 participants; 10 studies; I2 = 0%, high-certainty evidence; MD -0.59, 95% CI -1.13, -0.06; 2688 participants; 10 studies; I2 = 0%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for women was: MD -1.25, 95% CI -2.53, 0.03; 1915 participants; eight studies; I2 = 0%, high-certainty evidence; MD -1.04, 95% CI -1.86, -0.22; 1915 participants; eight studies; I2 = 4%, high-certainty evidence, respectively. The effect on systolic and diastolic blood pressure for men was MD -2.14, 95% CI -3.71, -0.59; 507 participants; five studies; I2 = 8%, moderate-certainty evidence; MD -1.99, 95% CI -3.25, -0.74; 507 participants; five studies; I2 = 41%, moderate-certainty evidence, respectively. The effect was consistent in both genders regardless of baseline calcium intake. The effect on systolic blood pressure was: MD -0.02, 95% CI -2.23, 2.20; 302 participants; 3 studies; I2 = 0%, moderate-certainty evidence with doses less than 1000 mg; MD -1.05, 95% CI -1.91, -0.19; 2488 participants; 9 studies; I2 = 0%, high-certainty evidence with doses 1000 to 1500 mg; and MD -2.79, 95% CI -4.71, 0.86; 350 participants; 7 studies = 8; I2 = 0%, moderate-certainty evidence with doses more than 1500 mg. The effect on diastolic blood pressure was: MD -0.41, 95% CI -2.07, 1.25; 201 participants; 2 studies; I2 = 0, moderate-certainty evidence; MD -2.03, 95% CI -3.44, -0.62 ; 1017 participants; 8 studies; and MD -1.35, 95% CI -2.75, -0.05; 1821 participants; 8 studies; I2 = 51%, high-certainty evidence, respectively. None of the studies reported adverse events. An increase in calcium intake slightly reduces both systolic and diastolic blood pressure in normotensive people, particularly in young people, suggesting a role in the prevention of hypertension. The effect across multiple prespecified subgroups and a possible dose response effect reinforce this conclusion. Even small reductions in blood pressure could have important health implications for reducing vascular disease. A 2 mmHg lower systolic blood pressure is predicted to produce about 10% lower stroke mortality and about 7% lower mortality from ischaemic heart disease. There is a great need for adequately-powered clinical trials randomising young people. Subgroup analysis should involve basal calcium intake, age, sex, basal blood pressure, and body mass index. We also require assessment of side effects, optimal doses and the best strategy to improve calcium intake.

Association of managerial position with cardiovascular risk factors: A fixed-effects analysis for Japanese employees.

Objectives:Although higher occupational classes have been reported to be associated with better health, researchers do not fully understand whether such associations derive from the position or individual characteristics of the person in that position. We examined the association between being a manager and cardiovascular disease (CVD) risk factors using unique panel data in Japan that annually observed employees’ occupational class and health conditions.Methods:We analyzed data for 45 888 observations from a Japanese company from 2013 through 2017. The association between being a manager and CVD risk factors (metabolic risks and health-related behaviors) were evaluated using simple pooled cross-sectional analyses with adjustment for age, sex, marital status, and overtime-working hours. We further incorporated employee-level fixed-effects into the models to examine whether the associations were subject to individual time-invariant factors.Results:The pooled cross-sectional analyses showed that, compared to non-managers, managers had 2.0 mg/dl lower low density lipoprotein cholesterol (LDL-C) level, 1.4 mmHg-lower systolic blood pressure, and 0.2 kg/m2 lower body mass index (BMI). After adjusting for employee-level fixed-effects, being a manager was associated with a significantly 2.2 mg/dl higher LDL-C level. However, the associations between an individual’s management status and blood pressure or BMI were not significant. Furthermore, managers were 5.5% less likely to exercise regularly and 6.1% less likely to report sufficient sleep in the fixed-effects models, although the pooled cross-sectional analyses did not demonstrate these significant associations.Conclusions:Our findings suggest the necessity of considering these unfavorable health risks associated with being promoted to a manager.

Breast milk n-3 long-chain polyunsaturated fatty acids and blood pressure: an individual participant meta-analysis

PurposeIt is controversial whether a higher intake of n-3 long-chain polyunsaturated fatty acids (n-3 LC PUFA) through breastfeeding is associated or not to a lower blood pressure (BP) during childhood. We aimed to clarify this point by undertaking a meta-analysis involving the data from seven European birth cohorts.MethodsWe searched https://www.birthcohort.net for studies that had collected breast milk samples, and had at least one BP measurement in childhood. Principal investigators were contacted, and all agreed to share data. One additional study was identified by contacts with the principal investigators. For each cohort, we analyzed the association of breast milk n-3 LC PUFAs with systolic and diastolic BP with linear mixed effects models or linear regression, and pooled the estimates with a random effects model. We also investigated age-specific and sex-specific associations.ResultsA total of 2188 participants from 7 cohorts were included. Overall, no associations between breast milk n-3 LC PUFAs and BP were observed. In the pooled analysis, each 0.1 wt% increment in breast milk docosahexaenoic acid (DHA) was associated with a 1.19 (95% CI − 3.31, 0.94) mmHg lower systolic BP. Associations were similar for boys and girls and at different ages.ConclusionIn this individual participant meta-analysis, we found no evidence for an association between breast milk n-3 LC PUFAs and BP.

1421-P: The Impact of Blood Pressure on Risk of Death Is Influenced by Prior Cardiovascular Disease in Patients with Type 2 Diabetes and a Recent Coronary Event

The relationship between blood pressure and mortality in T2DM is controversial, with concern for increased risk associated with lower blood pressure. We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline systolic blood pressure (SBP) and mortality in 5852 patients with T2DM who, as required for entry to the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial, had a recent acute coronary syndrome (ACS). Risk of death was assessed in a Cox model that adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, natriuretic peptide (BNP) and urine albumin/creatinine at baseline. Overall there was no significant association between SBP and risk of death (P=0.20), but in 2325 patients with additional CVD (index ACS + at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure) there was a significant association between lower SBP and higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13; 95% CI 1.05 to 1.23) whereas in 3527 patients with only the index ACS no association was observed (hazard ratio per 10 mmHg lower SBP 0.95; 95% CI 0.86 to 1.04, P for interaction &amp;lt;0.001). In ELIXA participants, an association between lower SBP and higher risk of death was seen only in patients with additional CVD. Disclosure M.O. Wijkman: None. B. Claggett: None. R. Diaz: None. H.C. Gerstein: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi. Consultant; Self; Kowa Pharmaceuticals America, Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Sanofi. L. Kober: Speaker’s Bureau; Self; AstraZeneca, Novartis AG. Other Relationship; Self; AstraZeneca. E. Lewis: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen, Novartis Pharmaceuticals Corporation, Theracos, Inc. A.P. Maggioni: None. E. Wolsk: None. D. Aguilar: None. R. Bentley-Lewis: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Janssen Pharmaceuticals, Inc. J.J. McMurray: Other Relationship; Self; AbbVie Inc., Alnylam Pharmaceuticals, Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Bristol-Myers Squibb, Cardurion, GlaxoSmithKline plc., Novartis Pharmaceuticals Corporation, Theracos, Inc. J.L. Probstfield: None. M.C. Riddle: Consultant; Self; ADOCIA, Dance Biopharm Holdings, Inc., GlaxoSmithKline plc., Sanofi US, Theracos, Inc. Research Support; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk Inc. J. Tardif: Research Support; Self; Esperion Therapeutics, Inc., Ionis Pharmaceuticals, Inc., REGENXBIO Inc., Sanofi, Servier. Other Relationship; Self; Amarin Corporation, AstraZeneca, DalCor Pharmaceuticals. S. Solomon: Consultant; Self; AstraZeneca, Theracos, Inc. Research Support; Self; AstraZeneca, Theracos, Inc. M.A. Pfeffer: Consultant; Self; AstraZeneca, CinCor, Correvio, Corvidia, DalCor Pharmaceuticals, GlaxoSmithKline plc., Innovative Science, Jazz Pharmaceuticals, MyoKardia, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., PharmaScience, Sanofi US, Servier, Takeda Development Center Americas, Inc. Research Support; Self; Novartis Pharmaceuticals Corporation. Funding Sanofi (NCT01147250)

Repurposing antihypertensive drugs for the prevention of Alzheimer's disease: a Mendelian randomization study.

BackgroundEvidence concerning the potential repurposing of antihypertensives for Alzheimer’s disease prevention is inconclusive. We used Mendelian randomization, which can be more robust to confounding by indication and patient characteristics, to investigate the effects of lowering systolic blood pressure, via the protein targets of different antihypertensive drug classes, on Alzheimer’s disease.MethodsWe used summary statistics from genome-wide association studies of systolic blood pressure and Alzheimer’s disease in a two-sample Mendelian randomization analysis. We identified single-nucleotide polymorphisms (SNPs) that mimic the action of antihypertensive protein targets and estimated the effect of lowering systolic blood pressure on Alzheimer’s disease in three ways: (i) combining the protein targets of antihypertensive drug classes, (ii) combining all protein targets and (iii) without consideration of the protein targets.ResultsThere was limited evidence that lowering systolic blood pressure, via the protein targets of antihypertensive drug classes, affected Alzheimer’s disease risk. For example, the protein targets of calcium channel blockers had an odds ratio (OR) per 10 mmHg lower systolic blood pressure of 1.53 [95% confidence interval (CI): 0.94 to 2.49; p = 0.09; SNPs = 17]. We also found limited evidence for an effect when combining all protein targets (OR per 10 mmHg lower systolic blood pressure: 1.14; 95% CI: 0.83 to 1.56; p = 0.41; SNPs = 59) and without consideration of the protein targets (OR per 10 mmHg lower systolic blood pressure: 1.04; 95% CI: 0.95 to 1.13; p = 0.45; SNPs = 153).ConclusionsMendelian randomization suggests that lowering systolic blood pressure via the protein targets of antihypertensive drugs is unlikely to affect the risk of developing Alzheimer’s disease. Consequently, if specific antihypertensive drug classes do affect the risk of Alzheimer’s disease, they may not do so via systolic blood pressure.

Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples.

While the association between 24-h urinary sodium and potassium excretion with blood pressure is well established, the relationships of these ions to spot urine measurements are unclear. Our purpose is to assess the association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. Spot urine and blood pressure were collected annually during a 5-year period from 4360 Japanese workers with ages ranging from 19 to 55 years. Estimates of 24-h sodium and potassium excretion were based on Tanaka's formula. Overall, a single standard deviation increase in the estimated sodium excretion (36.5 mmol/day) was associated with a 1.3 mmHg higher systolic blood pressure and a 0.8 mmHg higher diastolic blood pressure (P < 0.001). A single standard deviation increase in estimated potassium excretion (8.9 mmol/day) was associated with a 1.1 mmHg lower systolic blood pressure and a 0.7 mmHg lower diastolic blood pressure (P < 0.001). As a combined measure of the excretion of both electrolytes, the estimated 24-h sodium-to-potassium ratio was positively associated with both blood pressures (P < 0.001). Associations of blood pressure with sodium and the sodium-to-potassium ratio increased with age and were stronger in men compared to women. Associations with potassium and the sodium-to-potassium ratio were stronger in individuals who were overweight. The findings provide evidence for an association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. As convenient measures of dietary intake for each electrolyte, repeated spot urine samples may be useful for assessing hypertension risk, especially in men, older individuals, and overweight individuals.

Abstract P224: Urinary Excretion of Sodium, Potassium, Calcium and Magnesium and Blood Pressure Among a Population of ≥ 20-Year-Olds: Evidence From Southwest Coastal Bangladesh

We analyzed data from a stepped wedge randomized trial to evaluate how urinary Na, K, Ca and Mg excretion are associated with the change in blood pressure (BP) among the adult population. We followed up a cohort of 1,191 participants (&gt;20 years old) from 540 households in 16 communities of southwest coastal Bangladesh for five visits during December 2016 - April 2017 when they were exposed to high salinity drinking water. In all visits, we measured participants’ BP (N=5,746) and 24-hour urinary Na, K, Ca and Mg. We used multilevel linear regression models to determine the association among change in urinary excretion of Na, K, Ca and Mg with differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP). Models included participant-, household-, and community-level random intercepts and were adjusted for age, sex, BMI, physical activity, smoking status, and household wealth. We restricted analysis among participants who had complete 24-hour urine collection based on measured versus expected urinary creatinine ratio of &gt;=0.7 (N=5,103). The median urinary 24 hours Na excretion was 164 mmol, K was 34 mmol, Ca was 126 mg, and Mg was 83 mg in visit 1. The mean population SBP was 115.6 mmHg in visit 1 and 110.2 in visit 5, and the mean DBP was 68.9 mmHg in visit 1 and 65.9 in visit 5. Compared to visit 1, we found 85% higher urinary Ca in visit 3 and 57% higher urinary Mg in visit 5. We found 100 mmol per 24 hours increase in urinary Na was associated with 1.74 (95% CI: 0.85, 2.62) mmHg higher SBP and 0.51 (95% CI: -0.06, 1.08) mmHg higher DBP, and 50 mmol per 24 hours increase in urinary K was associated with 2.39 (95% CI: 0.84, 3.94) mmHg lower SBP and 0.79 (95% CI: -1.76, 0.17) mmHg lower DBP. We found 100 mg per 24 hours increase in urinary Ca was associated with 0.29 (95% CI: 0.02, 0.60) mmHg lower SBP and 0.32 (0.07, 0.57) mmHg lower DBP, and 100 mg per 24 hours increase in urinary Mg was associated with 1.09 (95% CI: 0.55, 1.64) mmHg lower SBP and 0.41 (0.07, 0.76) mmHg lower DBP. We found SBP lowering effect of urinary Mg increased if urinary Ca was lower (p = 0.048). We found urinary K, Ca, and Mg are associated with lower BP in coastal Bangladesh. Our results suggest a high intake of these beneficial minerals alongside Na reduction may successfully lower mean BP of the population.

Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention

Introduction: Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3.Methods: Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed.Results: Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%–10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2–3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit.Conclusions: An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.

Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross-sectional study in Uganda.

The authors sought to describe the association between human immunodeficiency virus (HIV) and blood pressure (BP) levels, and determined the extent to which this relationship is mediated by body weight in a cross-sectional study of HIV-infected and HIV-uninfected controls matched by age, sex, and neighborhood. Mixed-effects models were fit to determine the association between HIV and BP and amount of effect of HIV on BP mediated through body mass index. Data were analyzed from 577 HIV-infected and 538 matched HIV-uninfected participants. HIV infection was associated with 3.3mmHg lower systolic BP (1.2-5.3mmHg), 1.5mmHg lower diastolic BP (0.2-2.9mmHg), 0.3m/s lower pulse wave velocity (0.1-0.4mmHg), and 30% lower odds of hypertension (10%-50%). Body mass index mediated 25% of the association between HIV and systolic BP. HIV infection was inversely associated with systolic BP, diastolic BP, and pulse wave velocity. Comprehensive community-based programs to routinely screen for cardiovascular risk factors irrespective of HIV status should be operationalized in HIV-endemic countries.

Abstract P026: Relationship Between Antihypertensive Adherence and Emergency Department Blood Pressure

Background: Blood pressure is often uncontrolled in the Emergency Department (ED), but the contribution of medication non-adherence to this is not known. Methods: Three hundred ED patients with hypertension were enrolled from June 2012 to April 2013 to evaluate the association of antihypertensive adherence (measured by serum assay and by survey) with systolic blood pressure (SBP) in the ED. Presence of anti-hypertensive medications in the blood was detected using a previously validated mass spectrometric assay. Adherence was defined as the ratio of detected to prescribed antihypertensive medications (1=completely adherent, 0=completely non-adherent, &lt;1=partially non-adherent). Patients also completed the Adherence to Refills and Medications Scale (ARMS, where a score of 12 defines adherence and &gt;12 indicates some degree of non-adherence). Spearman’s rho was used to evaluate correlation of the assay and ARMS. A single BP was measured by research staff using an oscillometric cuff with the patient in a seated position. Multiple linear regression was used to assess the relationship between adherence and SBP, adjusting for age, sex, race, insurance, literacy/numeracy, education, and comorbid conditions. Missing numeracy for 18 subjects was imputed. Results: Three participants failed to meet inclusion criteria. Remaining 297 patients were 59.1±11.2 (SD) years old, 53.9% female, 62.3% White, 37.7% diabetic, and 24.6% had chronic kidney disease. Patients were prescribed a median of 2 medications (interquartile range 1 to 3, maximum 5). Mean SBP was 136.7±24.2 mmHg. By the assay, 214 (72.1%) patients were adherent, 59 (19.9%) partially non-adherent, and 24 (8.0%) completely non-adherent. By ARMS, 65 (21.9%) were adherent, 232 (78.1%) were non-adherent (rho=-0.23, p&lt;0.001). Adherence by assay was associated with 11.6mmHg lower SBP (95% CI -17.7 to -5.4 mmHg, p&lt;0.001) compared to partial or complete non-adherence. Adherence (by ARMS) was associated with 5.9 mmHg lower SBP, but this was not statistically significant (95% CI -12.6 to 0.8 mmHg, p=0.08). Conclusions: In this preliminary study, antihypertensive adherence measured by a mass spectrometry assay was associated with lower SBP among patients in the ED. The assay may be a useful tool for future research.

Seasonal and Diurnal Variations in Cardiometabolic Traits in the GOLDN Study

Seasonal and diurnal variations in cardiometabolic traits are driven by changes in photoperiod and outdoor temperature and also the circadian clock. Because participant recruitment in the multi‐sited family‐based Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) cohort was evenly distributed over a 3‐year period and ranged between 7:00 AM and 11:00 AM, we had the opportunity to examine whether photoperiod and outdoor temperature on the day of participants' assessment and time of assessment associate with cardiometabolic traits. We used multiple linear regression models adjusted for age, sex, BMI and study site (n =821). Outdoor temperature showed associations with blood pressure (BP) independent of photoperiod. Each additional 1oC increase was associated with 0.19 mmHg lower systolic BP [β ± SE = ‐0.19 ± 0.05 mmHg; P =0.0002] and 0.10 mmHg lower diastolic BP [β ± SE = ‐0.10 ± 0.03 mmHg; P =0.001]. The association between outdoor temperature and BP was modified by age and hypertension status, but not geographical location. No seasonal differences were observed in self‐reported dietary intake, and anthropometric, lipid and glycemic traits. Furthermore, assessment time showed associations with fasting lipids [total cholesterol (P =3.3E‐06), LDL‐C (P =0.004), and TG (P =0.004)] and postprandial response to a high‐fat meal (P =1.1E‐07). The observed associations lend support to the oscillation of important cardiometabolic traits, and suggest that cross‐sectional analyses of population‐based cohorts may need to factor in seasonality and assessment time when investigating cardiometabolic traits, particularly BP.

Prospective relevance of fruit and vegetable consumption and salt intake during adolescence for blood pressure in young adulthood

Fruit and vegetable (FV) consumption and salt intake are known dietary influences on blood pressure (BP) in adults, but data on their long-term relevance during growth for later BP are rare. We aimed to examine the independent and concomitant influences of adolescent FV and salt intakes on BP in young adulthood. In total, 206 participants (108 males) provided a plausible BP measurement in young adulthood (18-25years) as well as three repeated 3-day weighed dietary records, 24-h urine samples and BP measurements during adolescence (11-16years). FV intake was assessed based on dietary records and its urinary biomarkers such as potassium, oxalate and hippuric acid. Urinary sodium chloride (NaCl) was used to estimate salt intake. Prospective associations of adolescent FV and salt intake with adult BP were examined in sex-stratified linear regression models. In multivariable models, a 100g higher FV intake during adolescence was prospectively related to 0.9mmHg lower systolic BP in young adult females (P=0.02), but not in males (P=0.8). Biomarkers supported the findings for FV regarding systolic BP. Concurrently, a 1g higher salt intake was related to 1.7mmHg higher systolic BP in young men only (P=0.01). For diastolic BP, results were inconsistent. Our findings suggest that in adolescent healthy girls, a higher FV intake may be more relevant for BP than a reduced salt intake and the opposite appears to apply for boys. The physiological implications of the observed sex-specific diet-BP relationships need deeper examination.

Patterns of sedentary time and cardiometabolic risk among Canadian adults

ObjectiveThe aim of this study is to examine the associations of total sedentary time and patterns of sedentary time with cardiometabolic biomarkers in a large representative sample of Canadian adults. MethodsThe study is based on 4935 adults aged 20–79years, from the 2007/09 and 2009/11 Canadian Health Measures Survey. Total sedentary time, patterns of sedentary time (≥20minute prolonged sedentary bouts, number of sedentary breaks), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived. Waist circumference, systolic and diastolic blood pressure, high-density lipoprotein (HDL) cholesterol, and C-reactive protein were measured. Triglycerides, low-density lipoprotein (LDL) cholesterol, insulin, and glucose were also measured in a fasting sub-sample (n=2551). ResultsTotal sedentary time and time in ≥20minute prolonged sedentary bouts were associated with higher insulin and lower diastolic blood pressure levels (P<0.05). On average, each additional 10 breaks/day was associated with 0.83 (95%CI: 1.35, 0.31) cm lower waist circumference, 0.32 (0.62, 0.02) mmHg lower systolic blood pressure, 0.01 (0.00, 0.02) mmol/l higher HDL-cholesterol, 3.72 (1.34, 6.13) % lower triglycerides, 0.57 (0.23, 0.92) % lower glucose, and 4.19 (1.80, 6.63) % lower insulin. ConclusionThese findings in a large representative sample of Canadian adults indicate that breaking up sedentary time may be particularly important for cardiometabolic health.

Light-Intensity Physical Activity and Cardiometabolic Biomarkers in US Adolescents

BackgroundThe minimal physical activity intensity that would confer health benefits among adolescents is unknown. The purpose of this study was to examine the associations of accelerometer-derived light-intensity (split into low and high) physical activity, and moderate- to vigorous-intensity physical activity with cardiometabolic biomarkers in a large population-based sample.MethodsThe study is based on 1,731 adolescents, aged 12–19 years from the 2003/04 and 2005/06 National Health and Nutrition Examination Survey. Low light-intensity activity (100–799 counts/min), high light-intensity activity (800 counts/min to <4 METs) and moderate- to vigorous-intensity activity (≥4 METs, Freedson age-specific equation) were accelerometer-derived. Cardiometabolic biomarkers, including waist circumference, systolic blood pressure, diastolic blood pressure, HDL-cholesterol, and C-reactive protein were measured. Triglycerides, LDL- cholesterol, insulin, glucose, and homeostatic model assessments of β-cell function (HOMA-%B) and insulin sensitivity (HOMA-%S) were also measured in a fasting sub-sample (n = 807).ResultsAdjusted for confounders, each additional hour/day of low light-intensity activity was associated with 0.59 (95% CI: 1.18–0.01) mmHG lower diastolic blood pressure. Each additional hour/day of high light-intensity activity was associated with 1.67 (2.94–0.39) mmHG lower diastolic blood pressure and 0.04 (0.001–0.07) mmol/L higher HDL-cholesterol. Each additional hour/day of moderate- to vigorous-intensity activity was associated with 3.54 (5.73–1.35) mmHG lower systolic blood pressure, 5.49 (1.11–9.77)% lower waist circumference, 25.87 (6.08–49.34)% lower insulin, and 16.18 (4.92–28.53)% higher HOMA-%S.ConclusionsTime spent in low light-intensity physical activity and high light-intensity physical activity had some favorable associations with biomarkers. Consistent with current physical activity recommendations for adolescents, moderate- to vigorous-intensity activity had favorable associations with many cardiometabolic biomarkers. While increasing MVPA should still be a public health priority, further studies are needed to identify dose-response relationships for light-intensity activity thresholds to inform future recommendations and interventions for adolescents.

1430 – Dementia and lower blood pressure in seven low and middle income countries: the 10/66 cross-sectional surveys

Introduction A relative decline in systolic blood pressure has been found to occur prior to and around the clinical onset of dementia but the reasons for this remain unclear. Aims and objectives In a large series of surveys carried out using identical methodology in populations with relatively low mean blood pressures we investigated the consistency of the association between dementia, dementia severity and resting blood pressure. Methods The analysed sample comprised 15,022 participants from eleven cross-sectional surveys carried out in seven low and middle income countries (Cuba, Dominican Republic, Peru, Venezuela, Mexico, China and India). Associations between dementia status (ascertained through a detailed assessment with extensive cross-cultural validation) and resting blood pressure were described for each sample and then compared in meta-analyses. Results In age- and sex-adjusted linear regression analyses, there was a high level of between-site heterogeneity in these associations (I-squared 60.2% for dementia and SBP). The only site with significant and consistent associations was Cuba (n=2944), the sample with highest mean systolic blood pressure, where dementia was associated with 7.9mmHg lower systolic blood pressure (95% CI 4.7-11.1) and 2.6mmHg lower diastolic blood pressure (95% CI 0.9-4.2). In general, associations between dementia and lower blood pressure were weak or absent in these surveys. Conclusions The association between dementia and low blood pressure, generally observed in Western settings was not observed in these populations with lower hypertension prevalence. These findings do not support a hypothesis that lower blood pressure in dementia is purely secondary to underlying neurodegeneration.