Predictor Of Incident Hypertension Research Articles

Transforming Hypertension Diagnosis and Management in The Era of Artificial Intelligence: A 2023 National Heart, Lung, and Blood Institute (NHLBI) Workshop Report.

Hypertension is among the most important risk factors for cardiovascular disease, chronic kidney disease, and dementia. The artificial intelligence (AI) field is advancing quickly, and there has been little discussion on how AI could be leveraged for improving the diagnosis and management of hypertension. AI technologies, including machine learning tools, could alter the way we diagnose and manage hypertension, with potential impacts for improving individual and population health. The development of successful AI tools in public health and health care systems requires diverse types of expertise with collaborative relationships between clinicians, engineers, and data scientists. Unbiased data sources, management, and analyses remain a foundational challenge. From a diagnostic standpoint, machine learning tools may improve the measurement of blood pressure and be useful in the prediction of incident hypertension. To advance the management of hypertension, machine learning tools may be useful to find personalized treatments for patients using analytics to predict response to antihypertension medications and the risk for hypertension-related complications. However, there are real-world implementation challenges to using AI tools in hypertension. Herein, we summarize key findings from a diverse group of stakeholders who participated in a workshop held by the National Heart, Lung, and Blood Institute in March 2023. Workshop participants presented information on communication gaps between clinical medicine, data science, and engineering in health care; novel approaches to estimating BP, hypertension risk, and BP control; and real-world implementation challenges and issues.

Sex Difference in the Associations among Obesity-Related Indices with Incident Hypertension in a Large Taiwanese Population Follow-Up Study.

Hypertension is a major risk factor for stroke, atherosclerosis, and other cardiovascular diseases, and obesity is a major risk factor for hypertension. The aim of this longitudinal study was to investigate sex differences in the correlations among obesity-related indices and incident hypertension in a large Taiwanese cohort. We included 21,466 enrollees in the Taiwan Biobank and followed them for 4 years. Of the 21,466 patients enrolled in this study, 6899 (mean age, 49.6 ± 10.9 years) were male and 14,567 (mean age, 49.7 ± 10.0 years) were female. Data on visceral adiposity index (VAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), lipid accumulation product (LAP), conicity index (CI), body roundness index (BRI), body mass index (BMI), body adiposity index (BAI), and abdominal volume index (AVI) were collected and analyzed. The results showed that all of the studied obesity-related indices were significantly associated with incident hypertension. Among them, WHtR was the strongest predictor of hypertension in both sexes. In addition, interactions between VAI, LAP, CI, BMI, and AVI with sex on incident hypertension were also statistically significant. CI and AVI were more strongly associated with hypertension in the men than in the women, while VAI, LAP, and BMI were more strongly associated with hypertension in the women. In conclusion, the studied obesity-related indices were found to be predictors of incident hypertension, and there were differences in the associations between the male and female participants. Our findings may imply that reducing body weight may be associated with a lower risk of developing hypertension.

Abstract P036: Pooled Cohort Equation As A Predictor Of Incident Hypertension Among Hispanics/latinos: The Hispanic Community Health Study/study Of Latinos (HCHS/SOL)

Introduction: Hypertension risk assessment is the first step towards primary prevention of hypertension. The pooled cohort equation (PCE) provides an atherosclerotic cardiovascular disease (ASCVD) risk score. We sought to examine whether incident hypertension varied across categories of ASCVD risk as defined by the PCE Methods: Data from the HCHS/SOL baseline and visit 2 exam were used. Hypertension (baseline and incident) was defined as SBP >140 mm Hg and DBP >90 mm Hg. We included participants 40-74 years of age free of hypertension and ASCVD at baseline (n=3,692). Participants were classified into one of four ASCVD risk categories based on the PCE: low (<5%), borderline (5-7.5%), intermediate (7.5-to 10%) and high (>10%). Survey logistic regression models were used to determine the risk of hypertension overall, by age group and Hispanic/Latino background (Dominican, Central American, Cuban, Mexican, Puerto-Rican, South American) accounting for HCHS/SOL complex survey design. Results:: Overall, at baseline, the mean age was 51.2 ±0.23 years, 56% female, SBP: 119.7±0.26 and DBP: 72.6±0.20, ASCVD risk scores: low (65%); borderline (14.7%), intermediate (7.5%), and high (13.5%); 29.8% developed hypertension over 5.9 (range 4.1 – 9.6) years of follow-up. Intermediate (OR=2.2, CI: 1.5-3.2) and high (OR=2.5, CI: 1.9-3.5) baseline ASCVD risk categories were associated with increased odds of incident hypertension at follow-up compared to the low risk category. Age group and Hispanic/Latino background modified the relationship between increased baseline ASCVD score and incident hypertension, with strongest associations among those aged 50-59 years old (OR=2.3, CI: 1.7, 3.2) and Hispanics/Latinos of Dominican descent (OR=4.1, CI: 2.0, 8.4). Conclusions: Higher ASCVD risk was associated with an increased incidence of hypertension that varied by age and Hispanic/Latino background. The PCE ASCVD risk score can help guide public health measures to prevent hypertension.

Prevalent migraine as a predictor of incident hypertension.

BackgroundMigraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013.MethodsThe present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets.ResultsA significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20–1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables.ConclusionExtra attention should be paid to prevention and control of hypertension in working-age migraine patients.

Handgrip strength as a predictor of incident hypertension in the middle-aged and older population: The TCLSIH cohort study

ObjectivesThe independent role of muscular strength in the prevention of chronic disease is increasingly being recognized. However, no cohort study has assessed the relationship between handgrip strength and the incidence of hypertension among the middle-aged and older population. The aim of this prospective cohort study was to investigate whether handgrip strength is related to incident hypertension among people aged 40 years and over. Study designThis prospective cohort study (n = 8,480) was performed between 2013 and 2019 as part of the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study, Tianjin, China. Main outcome measuresParticipants without baseline hypertension were followed up for ~6 years (median 4.0 years). Hypertension was defined according to the JNC7 criteria. Handgrip strength was measured using a hydraulic handheld dynamometer. Adjusted Cox proportional hazards regression models were used to assess the relationships between weight-adjusted handgrip strength and the risk of incident hypertension. ResultsThe incidence rate of hypertension per 1000 person-years was 70. The fully adjusted hazards ratios (95% confidence interval) of the incidence of hypertension for increasing quartiles of weight-adjusted handgrip strength were: 1.00(reference), 0.84 (0.75–0.95), 0.78 (0.69–0.88), and 0.66 (0.58–0.75) (P for trend<0.0001). Moreover, the adjusted hazards ratio (95% confidence interval) of incident hypertension for per unit increase in weight-adjusted handgrip strength was 0.17 (0.10–0.27) (P<0.0001). Similar results were observed in males and females. ConclusionsThe present cohort study is the first to find that high weight-adjusted handgrip strength, but not absolute handgrip strength, is significantly and independently related to low risk of incident hypertension among the middle-aged and older population.

Urine albumin-to-creatinine ratio within the normal range and risk of hypertension in the general population: A meta-analysis.

Inconsistent findings on the association between urine albumin‐to‐creatinine ratio (UACR) and risk of hypertension have been reported. This meta‐analysis sought to evaluate the association between the elevated level of UACR within the normal range and incident hypertension in the general population. We comprehensively searched PubMed and Embase databases until July 31, 2020. All longitudinal observational studies that assessed the association of elevated baseline level of UACR within the normal range with incident hypertension in the general population were included. The predictive value was estimated by pooling risk ratio (RR) with 95% confidence intervals (CI) for the highest versus the lowest category of UACR level. Nine articles (10 studies) involving 27 771 individuals were identified and analyzed. When compared with the lowest category of UACR, individuals with the highest UACR had a 1.75‐fold (RR 1.75; 95% CI 1.47–2.09; p < .001) higher risk of hypertension in a random effect model. Gender‐specific analysis indicated that the impact of UACR on the development of hypertension seemed to be stronger in women (RR 2.47; 95% CI 1.10–5.55; p = .029) than in men (RR 1.88; 95% CI 1.35–2.61; p < .001). An increased UACR within the normal range is independently associated with a higher risk of hypertension in the general population. Baseline UACR can be served as a predictor of incident hypertension in the general population.

PLASMA N-GLYCOME AS INCIDENCE HYPERTENSION PREDICTOR

Objective: N-glycosylation, one of the most complex co- and post-translational modifications, is a highly regulated process influenced by many diseases. There is evidence that N-glycosylation could be a marker of hypertension. The aim of this study was to determine if plasma N-glycome is predictor of incident hypertension (HTN). Design and method: We selected 271 unrelated cases with incident hypertension and 271 controls matched for age, BMI and follow-up time from the TwinsUK cohort (mean follow-up time was 8.5 years). Longitudinal plasma N-glycome (39 directly measured traits) was measured by ultra-performance liquid chromatography (HILIC-UPLC). Logistic regression with elastic net penalty (a = 1 and l = 10e-2) and 10-fold cross validation was implemented on this subset fitting two models: null, with baseline age, BMI and follow-up time, and glyco, with null + baseline plasma N-glycans as predictors. Models were evaluated by comparing their area under the curves using bootstrap test. Most important glycans contributing to prediction of incident HTN in elastic net were further assessed by Cox survival analysis to estimate their effect on the risk of incident HTN. Cox models were fitted using the whole dataset, with baseline BMI and age as covariates and Family ID as random effect. Results: Glyco model (AUC = 0.628, 95%CI = 0.582–0.675) was significantly better in prediction of incident HTN in contrast to null model (AUC = 0.524, 95%CI = 0.475–0.570; p &lt; 0.001) explaining an extra 10%. The glyco model identified 6 plasma glycans mostly contributing to the prediction. These include four high branched structures with two to four sialic acids (GP25, GP27, GP31, GP32) originating from a-1-acid glycoprotein, one structure with two branches and one sialic acid (GP15), and one glycan peak (GP2) without sialic acid, related to high mannose structure or structure ending with a bisecting N-acetylglucosamine residue. Cox survival analysis showed that only GP32 significantly increased risk (log(HR) = 0.253, 95%CI = 0.075–0.432; p = 0.006) of incident hypertension. Conclusions: Baseline plasma N-glycome is associated with incident hypertension in our cohort of adult female subjects. N-glycome of a-1-acid glycoprotein appears to contribute the most to hypertension risk and merits further validation studies in independent cohorts.

Neighborhood Walkability as a Predictor of Incident Hypertension in a National Cohort Study.

The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score <70) walkable. The primary outcome was incident hypertension defined at the second visit (collected between 2013 and 2017). We derived risk ratios (RR) using modified Poisson regression adjusting for age, race, sex, geographic region, income, alcohol use, smoking, exercise, BMI, dyslipidemia, diabetes, and baseline blood pressure (BP). We further stratified by race, age, and geographic region. Among 6,894 participants, 6.8% lived in more walkable areas and 38% (N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P < 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.

Uric acid and salt intake as predictors of incident hypertension in a primary care setting

BackgroundHypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. ObjectivesTo estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. MethodsRetrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120mm Hg and diastolic BP ≤ 80mm Hg) and high-normal BP group (systolic BP 121-139mm Hg and/or diastolic BP 81-89mm Hg). ResultsIn multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. ConclusionIn a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension.

Prediction of incident hypertension and arterial stiffness using the non-insulin-based metabolic score for insulin resistance (METS-IR) index.

Hypertension is associated with insulin resistance (IR), metabolic syndrome (MS), and arterial stiffness. Non-insulin-based IR indexes were developed as tools for metabolic screening. Here, we aimed to evaluate the novel non-insulin-based Metabolic Score for IR (METS-IR) index for the prediction of incident hypertension and arterial stiffness evaluated using pulse wave velocity (PWV) analysis, compared with other non-insulin-based IR indexes. We evaluated two populations, a cross-sectional evaluation of high-risk individuals (n=305) with a wide range of metabolic comorbidities and dyslipidemia in whom PWV measurement was performed and a 3-year prospective cohort of normotensive individuals (N=6850). We observed a positive correlation between METS-IR and PWV in the cross-sectional cohort, which was higher compared with other non-insulin-based fasting IR indexes; furthermore, PWV values >75th percentile were associated with the upper tercile of METS-IR values. In the prospective cohort, we observed an increased risk for incident hypertension for the upper METS-IR tercile (METS-IR≥46.42; HR: 1.81, 95% CI: 1.41-2.34), adjusted for known cardiovascular risk factors, and observed that METS-IR had greater increases in the predictive capacity for hypertension along with SBP and the Framingham Hypertension Risk Prediction Model compared with other non-insulin-based IR indexes. Therefore, METS-IR is a novel non-insulin-based IR index which correlates with arterial stiffness and is a predictor of incident hypertension, complementary to previously validated risk prediction models.

Predictors of incident hypertension in healthy non-diabetic postmenopausal women with normal renal function

Introduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal function.Patients and methods: This retrospective cohort study evaluated 141 recently postmenopausal women at baseline and annually thereafter (follow-up time: 1 to 8 years). Blood samples were obtained, and ultrasound evaluations were performed at baseline. A detailed medical history, anthropometric parameters, blood pressure and cardiovascular risk factors were recorded for every woman at each visit. Incident hypertension was defined as the first occurrence of office systolic or diastolic blood pressure, measured at 2 different visits within 2 months or history of initiation of antihypertensive medication.Results: Incident hypertension was diagnosed in 30 out of 141 women (21.3%). The median time to incident hypertension was 3.5 years. Adiposity, elevated cholesterol and triglyceride levels, insulin resistance and parity were positively associated with incident hypertension. In multivariate analysis, however, obesity and insulin resistance were the only statistically significant variables associated with more than 3-fold and 2-fold respectively increased risk of incident hypertension (HOMA-IR, O.R = 1.988, p-value =.043; obesity, O.R = 3.746, p-value =.019).Conclusion: A significant proportion of women entering the menopause present incident hypertension and this is mostly associated with obesity and insulin resistance.

Predictors of incident hypertension in healthy, non-diabetic postmenopausal women with normal renal function

Introduction: We aimed to investigate the incidence of hypertension and to identify potential risk factors in healthy, non-diabetic recently postmenopausal Greek women with normal renal function.Pa...

Is Waist-to-Height Ratio Superior to Body Mass Index and Waist Circumference in Predicting the Incidence of Hypertension?

Background: It is still controversial which anthropometric indicator could be the best predictor of the incident hypertension. Objectives: To examine the relative power of body mass index (BMI), waist circumference (WC), skinfold thickness, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting the incidence of hypertension in Chinese adults. Method: Data were obtained from the China Health and Nutrition Survey. Overweight was defined as BMI ≥23 kg/m² and general obesity as BMI ≥27.5 kg/m². Abdominal obesity was defined by WC values ≥90 cm for males and ≥80 cm for females. Skinfold thickness, WHR, and WHTR were divided into low and high groups according to receiver operating characteristics. Cox regressions and nomograms were employed to compare the relative power of 5 indicators in predicting incident hypertension. Results: When all indicators were analyzed simultaneously, the best predictor of incident hypertension was general obesity (p < 0.001, adjusted hazard ratio [HR] 1.9, 95% CI 1.6–2.2). The results stratified by sex showed that BMI and WC were the more powerful predictors of hypertension in males (adjusted HR 1.8 and 1.3, 95% CI 1.4–2.3 and 1.1–1.5, respectively) as well as in females (adjusted HR 2.0 and 1.4, 95% CI 1.6–2.4 and 1.2–1.6, respectively). Conclusions: BMI and WC may predict incident hypertension better than skinfold thickness, WHR, and WHTR in the Chinese population.

Sex specific impact of different obesity phenotypes on the risk of incident hypertension: Tehran lipid and glucose study

BackgroundTo investigate the association between different obesity phenotypes and the risk of incident hypertension among both genders.MethodsThe study population included 3659 Iranians (men = 1540), aged ≥20 years free of hypertension at baseline. Participants were classified into six categories of body mass index (BMI)-metabolic health status, in which unhealthy metabolic status was defined based on the presence of > 1 component of metabolic syndrome (MetS) using the joint interim statement (JIS) criteria or the presence of insulin resistance (IR). The association between different obesity phenotypes and incident hypertension was assessed using multivariate Cox’s proportional hazard models adjusted for age, current smoking, low physical activity, diabetes mellitus, family history of premature cardiovascular disease, estimated glomerular filtration rate, phase of recruitment, BMI and systolic blood pressure, considering metabolically healthy normal weight group as the reference.ResultsAfter a median follow-up of 11.6 years 1122 participants (men = 493) experienced hypertension. Using JIS criteria, a significant higher risk of hypertension was observed among metabolically healthy obese and well as metabolically unhealthy groups among men in the age adjusted model; however, a significant higher risk in the fully adjusted model was seen among women in the metabolically healthy obese [hazard ratio (HR) 95% confidence interval (CI) 1.96(1.16–3.32)] as well as metabolically unhealthy normal weight [1.98(1.37–2.86)], overweight [2.08(1.49–2.90)] and obese [2.06(1.27–3.30)] groups. Using insulin sensitive normal weight group as the reference, among men, being overweight or obese with and without IR was significant predictors of incident hypertension in the age adjusted model; however, among women, insulin resistant overweight [1.46(1.06–2.02)] and obese groups, [1.63(1.01–2.62)] showed significant risk in the fully adjusted model.ConclusionWe concluded that first, there was significant difference between genders in the associations between obesity phenotypes and incident hypertension. Second, in general, metabolic status defined by MetS components as compared to IR could do better in identifying high risk women for hypertension. Third, women populations who are metabolically healthy obese using MetS definition or those with either > 1 component of metabolic syndrome or overweight/obese ones with IR should be prioritized for implementing urgent preventive strategies against hypertension focusing on lifestyle changes.

Life style habits, biochemical factors and their interaction in the prediction of incident hypertension during 21-year follow-up

Background: Hypertension is a global health threat and major cardiovascular risk. Various risk-prediction models for incident hypertension have been developed but not many of them have studied the risk-predictive value of life style factors in combination with cardiovascular biomarkers during long-term period of over 10 years.Methods: We examined differences in several classical variables for 299 subjects in OPERA (Oulu Project Elucidating Risk of Atherosclerosis) cohort in subjects with no or new hypertension during a follow-up period of 21 years. Effect of both various life style habits and biomarkers were investigated.Results: Baseline blood pressure, being overweight and smoking actively were independent predictors of new hypertension in majority of multivariate models during long-term follow-up of 21 years in subjects without previous hypertension. Increased high-sensitive C-reactive protein (hsCRP) level (> 3 mg/L) was the strongest predictor of incident hypertension in univariate model. Subjects with two or all three of main risk factors (being overweight, smoking actively and having high hsCRP) had 4-fold risk for incident hypertension.Conclusions: Smoking, overweight and increased hsCRP level had risk-predictive value in incident hypertension prediction during long-term follow-up of 21 years. Assessment and measurement of these parameters could be used in help of detecting high risk subjects and primary prevention of hypertension very early on. In addition, the study shows that blood pressure at the middle-age should be followed and treated intensively to prevent hypertension in the older age.KEY MESSAGES:Baseline blood pressure, being overweight and smoking actively are independent predictors of new hypertension during a long-term follow-up of 21 years.Having two or all three risk factors (smoking actively, body mass index over 25 kg/m2, high-sensitive C-reactive protein (hsCRP) level over 3 mg/L) indicates a 4-fold risk for incident hypertension within 21-year follow-up.

Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa.

BackgroundOne of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort.MethodsWe conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004–2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.ResultsAmong 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3–5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3.ConclusionOver 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.

Waist-to-height ratio index for predicting incidences of hypertension: the ARIRANG study

BackgroundSeveral anthropometric indices such as body mass index (BMI) and waist circumference (WC) have been examined as indicators of cardiovascular diseases, in both adults and children. However, the waist-to-height ratio (WHtR) is considered a better predictor for the detection of cardiovascular risk factors, than BMI. We investigated the association between the WHtR and incident hypertension.MethodsA total of 1718 participants, aged 39–72 years, were recruited in this longitudinal study. Participants were divided into 2 groups according to the development of hypertension during 2005–2008 (baseline) and 2008–2011 (follow-up). Logistic regression models were used to evaluate the WHtR as a significant predictor of hypertension.ResultsDuring the 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were diagnosed, with an incidence rate of approximately 4% per year. The WHtR was significantly higher in the participants who had developed hypertension than in those who had not (0.54 ± 0.05 vs. 0.51 ± 0.05, p < 0.001). After adjusting for age, sex, smoking status, alcohol intake, regular exercise status, total cholesterol, and systolic blood pressure, at the baseline, the logistic regression analysis indicated that the participants with the highest quartile of the WHtR (WHtR≥0.54) were 4.51 times more likely to have hypertension than those with the lowest quartile (odds ratio 4.51; 95% confidence interval 2.41–8.43; p < .0001). The area under the curve for the WHtR, in identifying hypertension risk, was significantly greater than that for the BMI (p = 0.0233).ConclusionA positive association between WHtR and the incidence of hypertension was observed in Korean adults. The findings of the present community-based prospective study suggest that the WHtR may be a better predictor of incident hypertension.

Abstract 095: Comparison of Various Anthropometric Indices for the Identification of a Predictor of Incident Hypertension

We compared the predictive capability of weight, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), body mass index (BMI), body roundness index (BRI), and a body shape index (ABSI) to identify incident hypertension, and to determine whether any of these indices may be used as a better single predictor of incident hypertension. A total of 1,718 populations aged 39-72 years were collected in a longitudinal study. Logistic regression models were used to evaluate various anthropometric indices as significant predictors of hypertension. During 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were reported. The BRI and ABSI were significantly higher in the participants who had developed hypertension than in those who had not (4.15±1.01 vs. 3.57±1.03, 0.80±0.04 vs. 0.78±0.05; respectively, p &lt;0.001). After adjusting for confounding variables, logistic regression analysis indicated that participants within the highest quartile of WC and WHtR were 4.79 and 4.51 times more likely to have hypertension than those within the lowest quartile (OR 4.79, 95% CI 2.49-9.20 vs. OR 4.51, 95% CI 2.41-8.43, respectively, p&lt;0.0001); in contrast, no such correlation was found for BMI, WHR, BRI, and ABSI. WC (AUC: 0.672) showed a more powerful predictive ability for hypertension (p&lt;0.0001) than BMI (AUC: 0.623), and an equal predictive power for hypertension as WHtR (AUC: 0.662) and BRI (AUC: 0.662) in the general population. We concluded that WC and/or WHtR but not BMI, showed superior prediction capability compared to WHR, BRI and ABSI, for determining the incidence of hypertension in a community-based prospective study.

Prediction of Incident Hypertension Within the Next Year: Prospective Study Using Statewide Electronic Health Records and Machine Learning.

BackgroundAs a high-prevalence health condition, hypertension is clinically costly, difficult to manage, and often leads to severe and life-threatening diseases such as cardiovascular disease (CVD) and stroke.ObjectiveThe aim of this study was to develop and validate prospectively a risk prediction model of incident essential hypertension within the following year.MethodsData from individual patient electronic health records (EHRs) were extracted from the Maine Health Information Exchange network. Retrospective (N=823,627, calendar year 2013) and prospective (N=680,810, calendar year 2014) cohorts were formed. A machine learning algorithm, XGBoost, was adopted in the process of feature selection and model building. It generated an ensemble of classification trees and assigned a final predictive risk score to each individual.ResultsThe 1-year incident hypertension risk model attained areas under the curve (AUCs) of 0.917 and 0.870 in the retrospective and prospective cohorts, respectively. Risk scores were calculated and stratified into five risk categories, with 4526 out of 381,544 patients (1.19%) in the lowest risk category (score 0-0.05) and 21,050 out of 41,329 patients (50.93%) in the highest risk category (score 0.4-1) receiving a diagnosis of incident hypertension in the following 1 year. Type 2 diabetes, lipid disorders, CVDs, mental illness, clinical utilization indicators, and socioeconomic determinants were recognized as driving or associated features of incident essential hypertension. The very high risk population mainly comprised elderly (age>50 years) individuals with multiple chronic conditions, especially those receiving medications for mental disorders. Disparities were also found in social determinants, including some community-level factors associated with higher risk and others that were protective against hypertension.ConclusionsWith statewide EHR datasets, our study prospectively validated an accurate 1-year risk prediction model for incident essential hypertension. Our real-time predictive analytic model has been deployed in the state of Maine, providing implications in interventions for hypertension and related diseases and hopefully enhancing hypertension care.

Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study

BackgroundHypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population.MethodsWe studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension.ResultsAfter 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that higher triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension.ConclusionThe triglyceride and glucose index can predict the incident hypertension among the Chinese population.