Prehypertensive Group Research Articles

Factors associated with the severity of hypertension among Malaysian adults.

High blood pressure is a worldwide problem and major global health burden. Whether alone or combined with other metabolic diseases, high blood pressure increases the risk of cardiovascular disease. This study is a secondary data analysis from the National Health and Morbidity Survey 2015, a population-based study that was conducted nationwide in Malaysia using a multi-stage stratified cluster sampling design. A total of 15,738 adults ≥18-years-old were recruited into the study, which reports the prevalence of hypertension stages among adults in Malaysia using the JNC7 criteria and determinants of its severity. The overall prevalence of raised blood pressure was 66.8%, with 45.8% having prehypertension, 15.1% having Stage 1 hypertension, and 5.9% having Stage 2 hypertension. In the multivariate analysis, a higher likelihood of having prehypertension was observed among respondents with advancing age, males (OR = 2.74, 95% CI: 2.41–3.12), Malay ethnicity (OR = 1.21, 95% CI: 1.02–1.44), lower socioeconomic status, and excessive weight. The factors associated with clinical hypertension (Stages 1 and 2) were older age, rural residency (Stage 1 OR = 1.22, Stage 2 OR = 1.28), Malay ethnicity (Stage 2 OR = 1.64), diabetes (Stage 2 OR = 1.47), hypercholesterolemia (Stage 1 OR = 1.34, Stage 2 OR = 1.82), being overweight (Stage 1 OR = 2.86, Stage 2 OR = 3.44), obesity (Stage 1 OR = 9.01, Stage 2 OR = 13.72), and lower socioeconomic status. Almost 70% of Malaysian adults are at a risk of elevated blood pressure. The highest prevalence was in the prehypertension group, which clearly predicts a future incurable burden of the disease. Public health awareness, campaigns through mass and social media, and intervention in the work place should be a priority to control this epidemic.

High sensitivity C-reactive protein in pre-hypertensive young adults

Abstract High sensitivity C-reactive protein (hs-CRP) levels have been recommended by the Center for Disease Control and Prevention (CDC) and the American Heart Association (AHA) to be part of the global risk prediction assessment for cardiovascular diseases (CVD) in asymptomatic individuals. Hypertension is one of the major risk factors of CVD. It is usually preceded by a pre-hypertensive state in which, without intervention may lead to hypertension at an accelerated rate. Since studies have reported variation in the hs-CRP levels amongst different ethnic groups, it is therefore crucial to study the hs-CRP values in our population for it to be more a more reliable parameter when used as an early predictor of CVD. This study was conducted to compare the hs-CRP levels between the normotensive and pre-hypertensive categories of blood pressure (BP) among young adults in Kuantan, Pahang, Malaysia. Methods: A total of 167 young adults were recruited in this comparative cross sectional study, 96 (57.5%) in the normotensive (NT) and 71 (42.5%) pre-hypertensive (PHT) groups. Blood samples were assayed for hs-CRP levels. There was significant difference in the levels of the hs-CRP (p= 0.031) between the NT and PHT groups. The geometric mean of hs-CRP at 95% CI for NT was 0.87mg/L (0.79 to 0.96) and PHT, 1.42 mg/L (0.95 to 2.12), respectively. In our study, the hs-CRP levels in the PHT subjects were significantly higher compared to the NT group.

A correlative study of serum uric acid and serum malondialdehyde level in early essential hypertension

Background: Hypertension (HT) posing a major public health challenge to the universe in socioeconomic and epidemiological transition. Hyperuricemia in HT is coupled with augmented cardiovascular morbidity and mortality. It also predates the development of HT and suggests that it is not simply a consequence of HT per se. Increased urate level along with greater production of oxygen-free radical and augmented oxidative stress may contribute to progression of HT. Aims and Objectives: This study aims to assess the correlation between serum uric acid (SUA), serum malondialdehyde S. MDA) level, and blood pressure in early essential HT. Materials and Methods: In this cross-sectional study, after applying inclusion and exclusion criteria, 200 subjects were divided into three groups: 50 subjects as control group, 75 in prehypertensive group, and 75 in hypertensive group. SUA and S. MDA level were estimated in all subjects. Data were analyzed by appropriate statistical methods. Results: A significant and positive correlation was observed between SUA and S. MDA level in HT group. Both parameters were correlated positively and significantly with systolic blood pressure (SBP), but not with diastolic blood pressure (DBP) in hypertensive individuals. Conclusion: An elevated SUA level is predictive for the evolution of both HT and coronary artery disease. Hyperuricemia plays a role in the formation of free radicals and oxidative stress through increased lipid oxidation. Furthermore, positive correlation with SBP further established its potential role in the etiopathogenesis of essential HT.

New Insights into the Pathogenesis of Intradialytic Hypertension

Background: Intradialytic hypertension is identified as an independent predictor of adverse clinical outcome in hemodialysis patients. Little is known about its pathophysiological mechanism. Objective: The aim of this study is to provide new insights into the mechanisms underlying this arterial pressure dysregulation. Methods: 62 subjects on chronic hemodialysis were included in this study. Blood pressure was monitored before, during and following each dialysis session for a 3-month period. Pre- and post-dialysis blood samples were drawn from all the subjects to perform immunoassays, monocyte extractions and western blot analyses. Results: Blood pressure values separated the subjects with in two groups: normal blood pressure (n=53) and intradialytic hypertension (n=9) groups. Renin, angiotensin converting enzyme I and aldosterone plasma concentrations significantly diverged between the groups. Vascular endothelial nitric oxide assessment revealed significantly lower plasma L-citrulline and angiotensin-converting enzyme II in post-dialysis intradialytic hypertensive patients, along with high endothelin I and asymmetric dimethylarginine concentrations. Plasma collectrin levels were significantly higher in pre and post-dialysis intradialytic hypertensive group compared to a normal blood pressure group. Post-dialysis interleukin 6 was significantly higher in intradialytic hypertensive group compared to normal blood pressure group. Finally, pre-dialysis intradialytic hypertension was associated with significantly higher circulating vascular endothelial growth factor C with monocytic up-regulation of vascular endothelial growth factor C/tonicity-responsive enhancer binding protein expression. Conclusion: Impairment of vascular endothelial nitric oxide key regulatory elements, as well as monocytic vascular endothelial growth factor C seems to be more prevalent in intradialytic hypertension. These clues could pinpoint novel therapeutic interventions in intradialytic hypertension management.

Factors influencing blood pressure classification for adults: Gender differences.

Hypertension is a common condition contributing to many diseases. Factors influencing blood pressure (BP) classification for adults have changed over time. This study aimed to identify factors influencing BP classification according to gender. Data from the Sixth Korean National Health and Nutrition Examination Survey (2014) were used in this descriptive, cross-sectional study. Participants were 1555 adults (589 men, 966 women). Measures included demographic, health-related, and lifestyle factors. Compared with the male normal BP group, in the male prehypertension group, body mass index, problem drinking, and reduced sleep duration were higher; and in the male hypertension group, age, poor subjective health status, body mass index, diabetes, problem drinking, smoking, and sodium intake were higher. Compared with the female normal BP group, age, and body mass index were higher in the female prehypertension group; and age, poor subjective health status, body mass index, menopause, and diabetes were higher in the female hypertension group. Hypertension and prehypertension prevention interventions for adults should be distinguished according to gender.

Prevalence of Non-responders for Blood Pressure and Cardiometabolic Risk Factors Among Prehypertensive Women After Long-Term High-Intensity Interval Training.

Background: Exercise is known to improve cardiometabolic outcomes; however, results are typically reported as mean values, and there is wide interindividual variability in terms of response that has not been explored in populations at risk for hypertension. Our aim was to investigate both the effects on and the prevalence of non-responders (NRs) for decreasing blood pressure (BP) and other risk factors among prehypertensive women after long-term high-intensity interval training (HIIT). A secondary aim was to report potential variables that can predict decreases in BP after HIIT.Methods: Sedentary overweight/obese women (age 35.9 ± 5.4 year; body mass index [BMI] 30.9 ± 6.2 kg/m2) were assigned to a prehypertensive (PreHTN; N = 44) or normotensive (NT; N = 40) group according to their ambulatory BP at baseline. Subjects underwent a thrice-weekly 16-week HIIT program (7–10 × 1 min exercise with 2 min of rest). Training-induced changes in body composition and cardiovascular, metabolic, strength, and endurance performance markers were measured, and the prevalence of NRs was reported as a percentage. All outcomes were analyzed by multivariable regression.Results: Statistically significant (P < 0.05) decreases in systolic BP (SBP) were detected in the PreHTN group (Δ −8 mmHg) compared with baseline, whereas the NT group (Δ + 3 mmHg) showed a non-significant increase in SBP. Diastolic BP (DBP) was significantly decreased in the PreHTN group (Δ −5.8 mmHg) and non-significantly decreased (Δ −2 mmHg) in the NT group. Also, there were significant differences (P < 0.0001) in the prevalence of NRs based on SBP between the PreHTN and NT groups (11.4 vs. 68.8%), but similar prevalence of NRs based on DBP. SBP alone was a powerful predictive factor for a beneficial SBP reduction, explaining 51.2% of the results, which was similar to other more complex models tested.Conclusion: The prevalence of NRs based on SBP and DBP was different between prehypertensive and normotensive subjects after 16 weeks of HIIT. Other comorbidities such as body composition and metabolic outcomes showed almost similar modifications between prehypertensive and normotensive subjects, being the most basic predictive factor for BP reduction baseline SBP, which we refer to as ‘BP health status’ (51.2%). This improvement in BP was accompanied by other known improvements of HIIT on body composition, metabolic and endurance performance in both study cohorts.Trial Registration: ClinicalTrials.gov ID: NCT03000140 (Register 20 December, 2016).

A comparative study of hypertension and obesity with reference to risk factors in school children aged 6-12 years in urban and rural area

Background: Childhood obesity and hypertension are on the rise and limited data are available regarding the profile of childhood obesity and hypertension from India. We studied the prevalence of childhood obesity and hypertension in a representative sample of school children to find out the relationship between obesity and hypertension in study population.Methods: This prospective, cross-sectional, observational study was conducted in Department of Pediatrics, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India and data were collected from urban and rural primary schools of Yavatmal from 1489 children between ages 6-12years, selected randomly. Anthropometric measurements were taken to calculate BMI and blood pressure was taken. Data was analyzed using CDC guidelines and statistically using contingency coefficient. Overweight and obesity were defined by body mass index for gender and age. Gender, age and height were considered for determining hypertension. The hypertensive children were followed up at 3 monthly intervals, 3 times, to look for persistent hypertension.Results: Amongst the 1489 children, prevalence of hypertension was 4.49% and that of pre-hypertension was 1.47% and that of overweight was 1.74% and obese was 0.87%. In girls and boys both, increasing BMI was associated significantly (p&lt;0.0001) with average SBP and average DBP in both pre-hypertension and hypertension groups in rural and urban areas. A higher prevalence of pre-hypertension and hypertension seen in the present study group compared to similar studies in the state. Children with higher BMI were associated with pre-hypertension or hypertension.Conclusions: Prevalence of sustained hypertension overweight and obesity is on rise in children in this part of world. Possible related factors for this current trend may be the increasing sedentary life style, altered eating habits, and increased fat content of diet. The result suggests the need for more public awareness and prevention programs for childhood obesity and hypertension.

A1446 Association between salt intake and uric acid, and its interaction on the risk of prehypertension among Chinese young adults

Objectives: High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and daily salt intake, as well as its interaction on the risk of prehypertension. Methods: A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Salt intake was estimated from early-morning urine specimens using an equation validated for this study population. Results: Increasing quartiles of salt intake were associated with high urinary UA/creatinine levels in prehypertensive participants. Estimated salt intake positively correlated with urinary UA/creatinine excretions in the prehypertensive group. In addition, the prehypertensive group had higher levels of salt intake and serum UA than the normotensive group. The multivariate-adjusted odds ratios (95% confidence interval) for prehypertension compared with normotension were 1.68 (1.27–2.22) for salt intake and 1.71 (1.21–2.42) for serum UA. Increasing salt intake and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest salt intake and serum UA quartiles entailed 3.48 times greater risk of prehypertension. Conclusion: Salt intake is associated with urinary UA excretion in prehypertensive participants. High levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

Do Changes in Hemodynamic Parameters Depend Upon Length of Sleep Deprivation? Comparison Between Subjects With Normal Blood Pressure, Prehypertension, and Hypertension.

The main objective of the study was to analyze the impact of sleep deprivation upon hemodynamic and autonomic parameters in subjects with normal blood pressure (BP) compared to prehypertension and hypertension at 24, 28, and 32 h of total sleep deprivation (TSD). Thirty volunteers, healthy men with current medical tests indicating the absence of disease took part in the study. After physical examination (basic neurological, clinical examination, echocardiography and doppler ultrasound of the renal arteries, evaluation of the autonomic nervous system) subjects were divided into three groups: I – normotensive, II – pre-hypertensive, III – hypertensive (age: 31.2 ± 2.1 vs. 33.5 ± 2.7 vs. 36.8 ± 2.7 years, p > 0.05; BMI: 25.2 ± 0.8 vs. 29.0 ± 1.5 vs. 26.4 ± 1.0 kg/m2, p > 0.05). Hemodynamic and autonomic parameters were automatically measured at rest and in a tilted position with a Task Force Monitor. The Task Force Monitor consists of electrocardiography, impedance cardiography, oscillometric, and continuous BP measurement. Mixed models with random effects was applied in order to analyze the parameters’ dependence on the time and the group of patients. One-way ANOVA or Kruskal–Wallis test were used to detect differences between normotensive, pre-hypertensive and hypertensive groups in each time point. In the pre-hypertensive group 28-h TSD resulted in increased vagal outflow [changes in high frequency heart rate (HR) variability, p = 0.0189], as evidenced by decreased HR (p = 0.0293). Moreover after 24-h TSD and 28-h TSD we observed changes in BP parameters. In hypertensive group, the most important changes in hemodynamic parameters: systolic blood pressure (sBP, p = 0.0031), diastolic blood pressure (dBP, p = 0.0136), cardiac output (CO, p = 0.0439) and changes in HR (p = 0.0063) after tilt test were observed after 32-h TSD. In conclusion, our results show that changes in hemodynamic parameters during sleep deprivation depend on the baseline BP and duration of TSD. What is important, both groups reported a decrease of sBP and dBP during the TSD (pre-hypertensive group after 24, 28-h TSD; hypertensive group after 32-h TSD. In our opinion, this is the first study which considers three homogenous groups in terms of gender: only men, during different points of acute TSD: 24, 28, and 32 h of TSD in laboratory condition.

Association of blood pressure components with mortality and cardiovascular events in prehypertensive individuals: a nationwide population-based cohort study

Background: The effects of each blood pressure index [systolic and diastolic blood pressure (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP)] on the occurrence of mortality and cardiovascular (CV) events have not yet been investigated in prehypertensive populations.Methods: A total of 30,258 prehypertensive Korean participants underwent periodic health examination between 2003 and 2004 were enrolled, and the associations of BP components with mortality and CV events were investigated. Moreover, based on the DBP [80 ≤ DBP <90 mmHg (N = 21,323) and DBP <80 mmHg (N = 8,935)], the effects of BP components were also evaluated.Results: Multivariate Cox analyses in prehypertensive group revealed that the hazard ratios (HRs) were 1.121 and 1.130 per 10 mmHg increase in SBP and PP for mortality, respectively. Additionally, 10 mmHg increase of SBP (HR:1.090) was still significantly, but increase of PP (HR:1.060) was marginally associated with higher incidence of CV events. However, there were no significant associations with increase in DBP or MAP on adverse clinical outcomes in prehypertensive group. In the prehypertensive subjects with DBP <80 mmHg, CV events more frequently occurred by 38.8% and 28.5% per 10 mmHg increase in SBP and PP, respectively.Conclusions: Prehypertensive subjects might need to be cautioned when they have high SBP or PP with low DBP even in healthy populations.Key messagePrehypertensive subjects should be cautioned when they have high-systolic blood pressure or pulse pressure with low-diastolic blood pressure, even without previous hypertension, diabetes mellitus or chronic kidney disease.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study.

OBJECTIVESThe aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.METHODSIn this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.RESULTSThe 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.CONCLUSIONSOur results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Pre-pregnancy blood pressure and body mass index trajectories and incident hypertensive disorders of pregnancy.

There are few studies examining patterns in body mass index (BMI) and blood pressure (BP) and subsequent hypertensive disorders of pregnancy (HDPs). We examined the association of BMI (n = 1342) or BP (n = 2266) trajectories in the 5 years preceding birth with HDPs using adjusted logistic regression. Compared to normal-weight BMI and low-normal BP groups, membership to the overweight BMI group (OR: 2.95, 95%CI: 1.57-5.53, p = 0.001) and higher-normal (OR: 2.74, 95%CI:1.49-5.04, p = 0.001) and prehypertensive (OR:7.27, 95%CI: 3.29-16.06, p < 0.001) BP groups were associated with higher odds of HDPs. Our data suggest maintaining normal-weight and low-normal BP in the years preceding pregnancy may help avoid HDPs.

ASSOCIATION BETWEEN SALT INTAKE AND URIC ACID, AND ITS INTERACTION ON THE INCIDENCE OF PREHYPERTENSION AMONG CHINESE YOUNG ADULTS

Objective: High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and daily salt intake, as well as its interaction on the risk of prehypertension. Design and method: A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Salt intake was estimated from early-morning urine specimens using an equation validated for this study population. Results: Increasing quartiles of salt intake were associated with high urinary UA/creatinine levels in prehypertensive participants (from quartile 1 to quartile 4: 0.12, 0.17, 0.24, and 0.33, P for trend < 0.001)). Estimated salt intake positively correlated with urinary UA/creatinine excretions in the prehypertensive group (r = 0.496; P < 0.001). In addition, the prehypertensive group had higher levels of salt intake and serum UA than the normotensive group [salt intake: 13.22 ± 3.52 vs. 12.35 ± 3.42 g/day, P < 0.001; serum UA: 290.0 (233.6–340.6) vs. 255.6 (211.6–305.0) μmol/L, P < 0.001]. The multivariate-adjusted odds ratios (95% confidence interval) for prehypertension compared with normotension were 1.68 (1.27–2.22) for salt intake and 1.71 (1.21–2.42) for serum UA. Increasing salt intake and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest salt intake and serum UA quartiles entailed 3.48 times greater risk of prehypertension.Conclusions: Salt intake is associated with urinary UA excretion in prehypertensive participants. High levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

INFLUENCE OF ANTIHYPERTENSIVE TREATMENT ON MMP-9 LEVELS IN CONTROLLED HYPERTENSIVE INDIVIDUALS

Objective: Ambulatory blood pressure monitoring (ABPM), in addition to peripheral blood pressure (BP) measurements, provides data on central hemodynamic, such as pulse wave velocity (PWV), augmentation index (AI 75%) and central pressure, which are associated with arterial stiffness. The development of arterial stiffness is related to an extracellular matrix enzyme called metalloproteinase-9 (MMP-9). The aim of the current study is to evaluate the correlation between the variables obtained by ABPM and levels of MMP-9 at different BP levels. Design and method: On-hundred and one individuals were enrolled: 21 normotensive (NT), 36 prehypertensive (PH), and 44 controlled hypertensive (CHT). Peripheral and central BP parameters were evaluated by ABPM using Mobil-O-Graph® 24-hour monitor and MMP-9 levels were determined in all participants. The levels of MMP-9 were assessed using the Human Matrix metalloproteinase-9 Quantikine ELISA kit (R & D Systems, Inc., Minneapolis, MN, USA) with a calculation of medians being presented as nanograms per milliliter (ng/mL). Subsequently, MMP-9 values were transformed into logarithms to reflect normal distribution for statistical analysis. Results: Age of the participants ranged from 30–71 years. MMP-9 concentration was significantly higher in the PH (log 4.74 ± 0.5) compared to CHT group (log 4.41 ± 0.5; p = 0.02). Mean PWV was greater in CHT than PH (8.1 ± 1.2 m/s vs. 6.9 ± 1 m/s; p-value = 0.0003, respectively), but no differences were found in AI 75% between CHT and PH groups. On the other hand, PH individuals had higher mean PWV than NT individuals (8.1 ± 1.2 m/s vs. 6.9 ± 1 m/s; p-value = 0.0003, respectively). MMP-9 levels correlated with cardiac output and peripheral vascular resistance in the three periods evaluated by ABPM (24 h, wakefulness and sleep). Conclusions: Prehypertensive individuals present greater arterial stiffness and MMP-9 levels than normotensive subjects, fact that demonstrate already structural alterations in this group. In its turn, higher levels of MMP-9 are observed in prehypertensive compared to controlled hypertensive subjects, suggesting that antihypertensive therapy may reduce MMP-9 plasma levels.

Biochemical markers of hypertension, prehypertension

ObjectiveThere are insufficient researches aimed at evaluating biochemical markers of mechanisms of formation of AH and lesion of target organs in hypertension and prehypertension. The aim of that research was to study the level of endothelial dysfunction markers and damage to the cardiovascular system in hypertension and prehypertension. Patients and methodsA cross-sectional study was performed among 938 people aged 18 to 65 years. All respondents were surveyed, blood pressure measured, for glucose, cholesterol, interleukin-6, sFAS, LIGHT, hFABP, NT-ProBNP and an Endocan concentrations were tested. Depending on the level of blood pressure participants were splitted into groups with normotension, prehypertension and hypertension. ResultsComparing the markers of inflammation, apoptosis and target organ damage in the prehypertensive group, the level of the LIGHT protein was Me=265.2pg/ml (Q25–Q75: 197.7–444.3), in the control group — Me=251.1pg/ml (Q25–Q75: 176.6–376.6), the Endocan level was Me=660.6pg/ml (Q25–Q75: 419.6–867.4) and in the control group Me=587.5pg/ml (Q25–Q75: 401.9–838.1). In the AH group, the level of the LIGHT Me=273.1pg/ml (Q25–Q75: 195.1–455.2), Endocan Me=668.2pg/ml (Q25–Q75: 434.8–977.3), heart-type fatty-acid-binding protein Me=2233.1pg/ml (Q25–Q75: 1518.4–3391.1) exceeded the control group. ConclusionThus, the development of prehypertension and hypertension is characterized by an increase in the activity of biochemical markers of endothelial dysfunction and damage to target organs, more expressed in the presence of hypertension.

Association between urinary sodium excretion and uric acid, and its interaction on the risk of prehypertension among Chinese young adults

High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and urinary sodium excretion, as well as its interaction on the risk of prehypertension. A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Increasing quartiles of sodium excretion were associated with high urinary UA/creatinine levels in prehypertensive participants. Estimated sodium excretion positively correlated with urinary UA/creatinine excretions in the prehypertensive group. In addition, the multivariate-adjusted odds ratios for prehypertension compared with normotension were 1.68 (1.27–2.22) for sodium excretion and 1.71 (1.21–2.42) for serum UA. Increasing sodium excretion and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest sodium excretion and serum UA quartiles entailed 3.48 times greater risk of prehypertension. Sodium excretion is associated with urinary UA excretion in prehypertensive participants. The present study shows that high levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

Association of Habitually Low Intake of Dietary Calcium with Blood Pressure and Hypertension in a Population with Predominantly Plant-Based Diets.

This study aimed to assess the association of habitually low dietary calcium intake with blood pressure or hypertensive risk using data from the China Health and Nutrition Survey (CHNS) in 2009. We included 6298 participants (2890 men and 3408 women) aged 18 years or older in this analysis. Food intakes were measured by 3-day 24-h individual recalls combined with a weighing and measuring of household food inventory. The participants were divided into normotensive, pre-hypertensive and hypertensive groups according to their mean blood pressure of three repeated measurements. Six intake levels were decided by percentiles of gender-specific dietary calcium intakes (P0–10, P10–30, P30–50, P50–70, P70–90, and P90–100). Average dietary calcium intakes were 405 mg/day for men and 370 mg/day for women, 80% and 84% of which were derived from plant-based food in men and women, respectively. Multiple linear regression analyses showed that dietary calcium intakes were not related with blood pressure in both genders (all P > 0.05). Logistic regression analyses showed a lower risk of pre-hypertension with higher dietary calcium intakes in women (all Pfor trend < 0.001), but not in men; no association between dietary calcium intake and hypertensive risk was found in both genders (all Pfor trend > 0.05). This study suggests that there are no conclusive associations of habitually low dietary calcium intake with blood pressure or hypertensive risk in Chinese individuals consuming predominantly plant-based diets.

Impaired Arterial Baroreflex Sensitivity in Prehypertension

Prehypertension is associated with increased risk of hypertension and cardiovascular disease (CVD). The physiological mechanisms underlying this risk are unknown, and the appropriate therapeutic approach to this preclinical but high‐risk population remain unclear. Previous studies have shown increased resting sympathetic nerve activity, as well as augmented blood pressure (BP) responses during mental stress in prehypertension, suggesting autonomic dysregulation at rest and during stress. We hypothesized that compared to normotensive controls (BP ≤ 120/80 mm Hg), prehypertensives (BP 120/80–139/89 mm Hg) have impaired arterial baroreflex sensitivity (BRS), the major feedback system regulating autonomic tone in response to BP changes, as well as increased neurocardiovascular reactivity to mental stress. Twenty‐two participants were studied; 12 otherwise healthy prehypertensives (age 35±6 years) were compared to 10 normotensive controls (age 32±6 years,) matched for age, gender, race, and body mass index. We recorded muscle sympathetic nerve activity (MSNA) using microneurography, beat‐to‐beat arterial BP, and heart rate (HR) via continuous EKG during five minutes of supine rest and three minutes of mental stress induced via mental arithmetic. We measured resting arterial baroreflex sensitivity (BRS) using the modified oxford technique in which IV boluses of nitroprusside and phenylephrine were infused to manipulate arterial BP. The slope of the linear relationship between diastolic BP and MSNA burst incidence was assessed for sympathetic BRS, and between change in systolic BP and R‐R interval for cardiovagal BRS. As expected, baseline systolic BP (130±7 vs. 117±8 mmHg) and diastolic BP (87±7 vs. 74±8 mmHg) were significantly higher in prehypertensives (p&lt;0.001), but HR (70±10 vs. 66±13 beats/min, p&gt;0.05) was comparable between the groups. Resting MSNA (25±12 vs. 18±10 bursts/min) tended to be higher in prehypertensives (p=0.08). Sympathetic BRS was comparable between the groups at rest, but cardiovagal BRS (13±10 vs. 22±10 ms/mmHg) was significantly lower in prehypertensives (p=0.03). During mental arithmetic, minute‐by‐minute increases in BP, HR and MSNA did not differ between the groups. There was a significant positive correlation between the diastolic BP response during mental stress and resting cardiovagal BRS (r=0.703, p=0.016), and with sympathetic BRS (r=0.795, p=0.010) within the prehypertensive group. However, there was no significant relationship between BP responses during mental stress with cardiovagal (r=0.126, p=0.766) or sympathetic BRS (r=0.287, p=0.581) in normotensive controls. These findings suggest that an early impairment of arterial BRS may be present in prehypertension and may modulate BP responses to stress, contributing to increased hypertension and CVD risk.Support or Funding InformationSupported by NIH HL‐098744, NIH DK‐00756, VA Merit I01CX001065, AHA 15CSA24340001This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Anthropometric Indices Predict the Development of Hypertension in Normotensive and Pre-Hypertensive Middle-Aged Women in Tianjin, China: A Prospective Cohort Study.

BackgroundThe aims of this study were to investigate the relationship between optimal anthropometric indices and their cut-off values and the incidence of hypertension in a cohort of middle-aged women in China.Material/MethodsA cohort of 812 women, aged between 40–70 years were recruited between May 2011 and June 2013. An ideal baseline blood pressure was defined as <120/80 mmHg; pre-hypertension was 120–139/80–89 mmHg; hypertension was ≥140/≥90 mmHg. Anthropometric measurements included waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR). The cohort was divided into an ideal blood pressure group (Group 1) and a pre-hypertensive group (Group 2). Two-year follow-up blood pressure measurements were performed. Receiver-operating characteristic (ROC) curve analysis determined the optimal anthropometric indices and cut-off values for developing hypertension.ResultsAt two-year follow-up, hypertension developed in 9.0% (n=31) in Group 1 and 32.3% (n=121) in Group 2. Logistic regression analysis showed that in both groups, women in the highest quartile for WC, BMI, WHR, and WHtR had a significantly increased risk of developing hypertension compared with the lowest quartile (P<0.05). ROC curve area under the curve (AUC) for these anthropometric indices were greater in Group 1, and for WC in Groups 1 and 2, with the optimal cut-off values greater in Group 1.ConclusionsIn a cohort of middle-aged women in China, anthropometric indices of obesity were predictive of the development of hypertension during a two-year follow-up period.

Association of prehypertension and hyperhomocysteinemia with subclinical atherosclerosis in asymptomatic Chinese: a cross-sectional study

ObjectivesComorbid hypertension and hyperhomocysteinemia is an important risk factor for carotid atherosclerotic plaque formation. We put forward the hypothesis that the subjects with comorbid prehypertension and hyperhomocysteinemia also had an...