Prehypertensive Participants Research Articles

Exercise Training for Blood Pressure: A Systematic Review and Meta‐analysis

BackgroundWe conducted meta‐analyses examining the effects of endurance, dynamic resistance, combined endurance and resistance training, and isometric resistance training on resting blood pressure (BP) in adults. The aims were to quantify and compare BP changes for each training modality and identify patient subgroups exhibiting the largest BP changes.Methods and ResultsRandomized controlled trials lasting ≥4 weeks investigating the effects of exercise on BP in healthy adults (age ≥18 years) and published in a peer‐reviewed journal up to February 2012 were included. Random effects models were used for analyses, with data reported as weighted means and 95% confidence interval. We included 93 trials, involving 105 endurance, 29 dynamic resistance, 14 combined, and 5 isometric resistance groups, totaling 5223 participants (3401 exercise and 1822 control). Systolic BP (SBP) was reduced after endurance (−3.5 mm Hg [confidence limits −4.6 to −2.3]), dynamic resistance (−1.8 mm Hg [−3.7 to −0.011]), and isometric resistance (−10.9 mm Hg [−14.5 to −7.4]) but not after combined training. Reductions in diastolic BP (DBP) were observed after endurance (−2.5 mm Hg [−3.2 to −1.7]), dynamic resistance (−3.2 mm Hg [−4.5 to −2.0]), isometric resistance (−6.2 mm Hg [−10.3 to −2.0]), and combined (−2.2 mm Hg [−3.9 to −0.48]) training. BP reductions after endurance training were greater (P<0.0001) in 26 study groups of hypertensive subjects (−8.3 [−10.7 to −6.0]/−5.2 [−6.8 to −3.4] mm Hg) than in 50 groups of prehypertensive subjects (−2.1 [−3.3 to −0.83]/−1.7 [−2.7 to −0.68]) and 29 groups of subjects with normal BP levels (−0.75 [−2.2 to +0.69]/−1.1 [−2.2 to −0.068]). BP reductions after dynamic resistance training were largest for prehypertensive participants (−4.0 [−7.4 to −0.5]/−3.8 [−5.7 to −1.9] mm Hg) compared with patients with hypertension or normal BP.ConclusionEndurance, dynamic resistance, and isometric resistance training lower SBP and DBP, whereas combined training lowers only DBP. Data from a small number of isometric resistance training studies suggest this form of training has the potential for the largest reductions in SBP.

527 EFFECT OF INDIVIDUALIZED EDUCATIONAL PROGRAMS ON LIFESTYLE AND BLOOD PRESSURE IN CHINESE ADULTS WITH PREHYPERTENSION

Objective: To investigate the effect of individualized educational programs on lifestyle and blood pressure among Chinese adults with prehypertension. Background: Prehypertension is a health problem that is becoming increasingly concerned in China, and lifestyle modification by health education is recommended as the primary treatment. The effective intervention of PHT is still at the beginning stage in China and no mature strategy is available. Methods: We screened 39 prehypertensive participants from physical examination center and enquired about their lifestyle (smoking, alcohol consumption, diet, physical exercise, and psychological situation) and weight after informed consent. Health education materials were distributed and after the vulnerabilities of their living habits were identified, 12-week nichetargeting custom-made individualized health education was given for modification by person-to-person home visits and telephone interviews. The data about the participants’ lifestyle, blood pressure and weight were also collected 12 weeks later. Results: After 12-week individualized educational programs, participants improved their lifestyle including smoking, salt-intake, high-fat diet and physical activity (p < 0.05). Only 38 pairs of blood pressure values were available and the reduction in systolic blood pressure and weight had a statistical significance 12 weeks later (p < 0.05) (Table 1).Conclusions: 12 weeks of individualized educational programs, combined with person-to-person contact with health professionals, reduced the systolic blood pressure and weight in Chinese adults with prehypertension by improving their lifestyle.

509 L-CITRULLINE SUPPLEMENTATION REDUCED PERIPHERAL BLOOD PRESSURE IN CHINESE ADULTS WITH PREHYPERTENSION

Background: Prehypertension is a growing problem worldwide, and in Caucasian samples certain fruits or their supplements have demonstrated success in improving blood pressure. The aim of this study was to investigate the effect and mechanism of L-citrulline in regulating blood pressure among Chinese adults with prehypertension. Methods: From 369 patients attending a free physical examination, 40 prehypertensive participants were identified and randomly allocated to: an intervention group who received one-to-one health education plus 3 g L-citrulline; and a control group gave a placebo, both twice a day. 24-hour ambulatory blood pressure was collected at baseline and eight weeks later and concentration of nitric oxide synthase at eight weeks later. Results: L-citrulline reduced the maximum, minimum and office systolic blood pressure; the maximum diastolic blood pressure (p < 0.05); and maximum mean arterial pressure (p < 0.01). No significant effects were noted for the remaining blood pressure values notably the minimum diastolic blood pressure. Concentration of nitric oxide synthase was significantly up-regulated in the intervention group (p < 0.05) (Table 1).Conclusions: The results showed that L-citrulline automatically regulated blood pressure via improved nitric oxide production in Chinese adults with prehypertension.

Effects of anthocyanins on cardiovascular risk factors and inflammation in pre-hypertensive men: a double-blind randomized placebo-controlled crossover study

High intake of fruits and vegetables is associated with reduced cardiovascular risk. A number of fruits and vegetables are rich in anthocyanins, which constitute a subgroup of the flavonoids. Anthocyanins have demonstrated anti-inflammatory and anti-oxidative properties, and anthocyanin-rich interventions have indicated beneficial effects on blood pressure and other cardiovascular risk factors. We assessed whether a purified anthocyanin supplement improves cardiovascular metabolic risk factors and markers of inflammation and oxidative stress in prehypertensive participants, and whether plasma polyphenols are increased 1-3 h following intake. In all, 31 men between 35-51 years with screening blood pressure >140/90 mm Hg without anti-hypertensive or lipid-lowering medication, were randomized in a double-blinded crossover study to placebo versus 640 mg anthocyanins daily. Treatment durations were 4 weeks with a 4-week washout. High-density lipoprotein (HDL)-cholesterol and blood glucose were significantly higher after anthocyanin versus placebo treatment (P=0.043 and P=0.024, respectively). No effects were observed on inflammation or oxidative stress in vivo, except for von Willebrand factor, which was higher in the anthocyanin period (P=0.007). Several plasma polyphenols increased significantly 1-3 h following anthocyanin intake. The present study strengthens the evidence that anthocyanins may increase HDL-cholesterol levels, and this is demonstrated for the first time in prehypertensive and non-dyslipidemic men. However, no other beneficial effects in the short term were found on pathophysiological markers of cardiovascular disease.

Relationship between inflammation and microalbuminuria in prehypertension

Inflammation is a pathogenic factor for target-organ damage (TOD) in hypertension. This study examined the relationship between inflammatory parameters and urinary albumin excretion (UAE) in prehypertension. A total of 65 prehypertensive subjects (blood pressure (BP) 120-139/80-89 mm Hg) and 26 healthy volunteers with BP <120/80 mm Hg were included. High-sensitivity C-reactive protein (hs-CRP), and serum and urinary tumor necrosis factor-α (TNF-α) were measured as inflammatory markers. Prehypertensive individuals had higher levels of inflammatory parameters and UAE than healthy subjects. Analyses carried out in prehypertensive participants showed that BP was similar between individuals with normoalbuminuria or microalbuminuria (MAB) (UAE between 30 and 299 mg per day). However, serum hs-CRP and urinary TNF-α excretion were higher in prehypertensives with MAB. Multiple regression analysis showed that systolic blood pressure (r=0.29, P<0.01), hs-CRP (r=0.20, P<0.001), and urinary TNF-α (r=0.69, P<0.001) were independently correlated with UAE (adjusted R(2)=0.73, P<0.001). Finally, logistic regression analysis performed in the prehypertensive group with the absence or presence of MAB as the dependent variable demonstrated that hs-CRP (3.92 (1.45-10.58), P=0.007) and urinary TNF-α (1.69 (1.20-2.37), P=0.002) were independent risk factors for the presence of MAB. Inflammatory parameters are significantly and independently associated with UAE in prehypertensive subjects, suggesting that inflammation may be a pathogenic factor for the early vascular or TOD in these individuals.

Relationship between central blood pressures and carotid intima-media thickness in prehypertensive participants

ObjectiveTo investigate the relationship between central blood pressures and carotid intima-media thickness in prehypertensive participants.MethodsAccording to the blood pressure level, 346 individuals were divided into two groups. Namely, normotensive controls...

Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in community of Chengdu

Objective: In this paper we estimate the prevalence of prehypertension in community of Chengdu and evaluate the relationship between prehypertension and other risk factors for CVD and multiple metabolic disorders. Methods: The study used data from participants of three communities in Chengdu. A sample of 3524 persons, aged 18 years and over, completed an interviewer administered questionnaire and blood pressure measurements, physical examination and blood samples were obtained and analyzed for all individuals. Results: (1) The prevalence of prehypertension in Chengdu was 34.07% and increased with age up to 30–39 (39.93%) and then declined in the older age groups. Prehypertension was more common in males than females (41.16% vs 23.89%, P<0.05). (2) Prevalence of some cardiovascular risk factors in prehypertensives was significantly higher than that in normotensives (P<0.05). (3) Odds of hyperglycemia, increased fasting blood glucose, hyperuricemia and obesity, overweight, and increased waist circumference were significantly higher among prehypertensive participants when compared to normotensive participants. Conclusions: Prehypertension occurs in 34.07% of Chengdu and is associated with increased prevalence of other CVD risk factors. Health-care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat modifiable risk factors in these persons.

The relationship between 24 h ambulatory blood pressure monitoring rhythm and carotid-radial pulse wave velocity, intima media thickness in prehypertensive subjects

ObjectiveTo analyse the relationship between 24 h ABPM rhythm and crPWV, IMT in prehypertensive subjects.MethodsAccording to the blood pressure level, 286 cases were divided into two groups, namely, normotensive controls...

Differences in Healthy Lifestyles Between Prehypertensive and Normotensive Children and Adolescents in Northern China

This study aimed to evaluate the prevalence and differences of healthy lifestyles among children and adolescents differing in blood pressure status. A cross-sectional study analyzed 5,270 children and adolescents ages 5-18 years. Anthropometric measurements and information on six healthy lifestyles (normal body mass index [BMI], appropriate physical activity, sufficient sleep, appropriate breakfast, no smoking, and no alcohol use) were collected by well-trained personnel. The prevalence of healthy lifestyles was relatively low. Only 22.4% of the study participants had all six healthy lifestyle characteristics. The participants with prehypertension were less likely to have a normal BMI (odds ratio [OR] 0.362; 95% confidence interval [CI] 0.292-0.449) or to be nonsmokers (OR 0.793; 95% CI 0.64-0.982) than those with normal blood pressure. Overall, the prehypertensive participants had a lower likelihood of having four to six (especially all 6) of the healthy lifestyles (OR 0.688; 95% CI 0.561-0.844) than their normotensive counterparts. In addition, some socioeconomic factors, such as family income, had an impact on healthy life habits. Among children and adolescents, poor prehypertensive status was associated with a low likelihood of healthy lifestyles. Evaluation of multiple healthy lifestyles as a whole should receive more attention for better prevention and control of high blood pressure.

Blood Pressure Increases During a Simulated Night Shift in Persons at Risk for Hypertension

Shift work with sleep disruption is a systemic stressor that may possibly be associated with blood pressure dysregulation and hypertension. We hypothesize that rotation to a simulated night shift with sleep deprivation will produce blood pressure elevations in persons at risk for development of hypertension. We examined the effects of a simulated night shift on resting blood pressure in 51 diurnal young adults without current hypertension. Resting blood pressure was monitored throughout a 24-h period of total sleep deprivation with sustained cognitive work. Twelve participants (23.5%) reported one or more parents with a diagnosis of hypertension. Ten participants were classified as prehypertensive by JNC-7 criteria. Only two prehypertensive subjects reported parental hypertension. Results indicate that, as the night shift progressed, participants with a positive family history of hypertension showed significantly higher resting diastolic blood pressure than those with a negative family history of hypertension (p = 0.007). Prehypertensive participants showed elevated blood pressure throughout the study. These data suggest that rotation to a simulated night shift with sleep deprivation may contribute to blood pressure dysregulation in persons with a positive family history of hypertension.

Acute Exercise Is Associated With Greater Nighttime Blood Pressure Dipping In Women Classified As Non-dippers

Acute exercise has been shown to improve the non-dipping (ND) blood pressure pattern in hypertensive individuals. Prehypertensive individuals have increased risk for developing hypertension and for having a ND pattern. PURPOSE: To assess whether acute exercise affects the non-dipping blood pressure of prehypertensive individuals. METHODS: We assessed 24-hour blood pressure patterns in low to moderately active normotensive (n=8) and prehypertensive (n=22) women. Ten of the prehypertensive had a ND pattern for mean arterial pressure (MAP). Participants wore an ambulatory blood pressure monitor on two days separated by one week. In the first session, participants wore the monitor on a non-exercise weekday, and walked on a treadmill for 30 minutes at a moderate intensity before the second 24-hour measurement. Participants kept activity diaries and sleep records for each measurement. Repeated measures ANOVA was used to assess group differences across conditions. RESULTS: The condition effect was not significant (p=.30) and the group by condition interaction approached significance (p=.08). The group effect was significant (p=.009). This difference was characterized by greater dipping in the normotensive and dipper prehypertensive participants compared to ND prehypertensive participants. Although the interaction effect was not significant, ND prehypertensive participants were the only group to experience greater MAP dipping after acute exercise. CONCLUSION: Our results indicate that the ND pattern for MAP can be improved with moderate intensity acute exercise in ND women at increased risk for developing hypertension. Supported by: College of William & Mary Summer Research Grant; Borgenicht Program for Aging Studies and Exercise Science

Cardiovascular and Metabolic Predictors of Progression of Prehypertension Into Hypertension

Prehypertension (defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) frequently evolves to hypertension (HTN) and increases cardiovascular risk. It is unclear whether metabolic and/or cardiac characteristics favor development of HTN in prehypertensive subjects. We evaluated baseline anthropometric, laboratory, and echocardiographic characteristics of 625 untreated prehypertensive participants in the Strong Heart Study, without prevalent cardiovascular disease (63% women; 22% with diabetes mellitus; mean age: 59+/-7 years) to identify predictors of the 4-year incidence of HTN. Diabetes mellitus was assessed by American Diabetic Association criteria, and a diabetes-specific definition of HTN was used. Four-year incidence of HTN was 38%. Incident HTN was independently predicted by baseline systolic blood pressure (odds ratio [OR]: 1.60 per 10 mm Hg; 95% CI: 1.30 to 2.00; P<0.0001), waist circumference (OR: 1.10 per 10 cm; 95% CI: 1.01 to 1.30; P=0.04), and diabetes mellitus (OR: 2.73; 95% CI=1.77 to 4.21; P<0.0001), with no significant effect for age, sex, hemoglobin A1c, homeostatic model assessment index, C-reactive protein, fibrinogen, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides, plasma creatinine, or urine albumin:creatinine ratio. Higher left ventricular mass index (OR: 1.15 per 5 g/m(2.7); 95% CI: 1.01 to 1.25; P=0.03) or stroke volume index (OR: 1.25 per 5 mL/m(2.04); 95% CI: 1.10 to 1.50; P=0.03) was also identified, together with baseline systolic blood pressure and the presence of diabetes mellitus, as an independent predictor of incident HTN, without an additional predictive contribution from other anthropometric, metabolic, or echocardiographic parameters (all P>0.10). Thus, progression to HTN in 38% of Strong Heart Study prehypertensive participants could be predicted by higher left ventricular mass and stroke volume in addition to baseline systolic blood pressure and prevalent diabetes mellitus.

Prehypertension, Obesity, and Risk of Kidney Disease: 20-Year Follow-up of the HUNT I Study in Norway

The combined effect of blood pressure (BP) and body weight on risk of kidney disease has not been previously studied. To improve risk stratification in prehypertensive individuals (ie, BP, 120 to 139/80 to 89 mm Hg), we examined the interaction between BP and body weight on the risk of end-stage renal disease or chronic kidney disease (CKD)-related death. Retrospective cohort study. 74,986 adults participating in the first Health Study in Nord-Trøndelag (88% participation rate) were linked to the Norwegian Renal Registry and Cause of Death Registry. BP and body weight were measured by using standard procedures, and other relevant covariates were obtained from an extensive questionnaire. Hazard ratios for treated end-stage renal disease and CKD-related death were calculated. Mean systolic BP and body mass index (BMI) were 136.8 +/- 23.3 (SD) mm Hg and 25.2 +/- 3.9 kg/m(2), whereas 12.9% had treated hypertension at baseline, respectively. During a median follow-up of 21 years (1,345,882 person-years), 507 men (1.4%) and 319 women (0.8%) initiated renal replacement therapy (n = 157) or died of CKD (n = 669). Multiadjusted risk of these kidney outcomes increased continuously with no lower threshold for BP. The risk associated with body weight started to increase from a BMI of 25.0 kg/m(2). In participants with BP less than 120/80 mm Hg, risk did not increase with increasing BMI. In prehypertensive participants, multivariate adjusted hazard ratios in the BMI categories 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and 35.0 kg/m(2) or greater were 1.21 (95% confidence interval [CI], 0.67 to 2.17), 1.10 (95% CI, 59 to 2.00), 2.66 (95% CI, 1.28 to 5.53), and 5.94 (95% CI, 1.94 to 18.20) compared with BP less than 120/80 mm Hg and BMI of 18.5 to 24.9 kg/m(2), respectively (P = 0.02 for trend). Corresponding risks in hypertensive participants were 2.13 (95% CI, 1.23 to 3.70), 2.40 (95% CI, 1.40 to 4.15), 3.32 (95% CI, 1.89 to 5.81), and 5.53 (95% CI, 3.01 to 10.20), respectively (P < 0.001 for trend). Baseline creatinine measurements were not available; hence, a secondary analysis was performed that excluded all individuals who experienced outcomes in the 5 years after the study start. Participants with prehypertension are not at increased risk of serious kidney outcomes if BMI is less than 30.0 kg/m(2). However, the risk of kidney disease increases substantially if prehypertension is present in obese participants.

Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: analysis from a cross-sectional survey.

BackgroundRecent studies have documented an increased risk of cardiovascular disease (CVD) in persons with systolic blood pressures of 120–139 mmHg and/or diastolic blood pressures of 80–89 mmHg, classified as prehypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. In this paper we estimate the prevalence of prehypertension in Jamaica and evaluate the relationship between prehypertension and other risk factors for CVD.MethodsThe study used data from participants in the Jamaica Lifestyle Survey conducted from 2000–2001. A sample of 2012 persons, 15–74 years old, completed an interviewer administered questionnaire and had anthropometric and blood pressure measurements performed by trained observers using standardized procedures. Fasting glucose and total cholesterol were measured using a capillary blood sample. Analysis yielded crude, and sex-specific prevalence estimates for prehypertension and other CVD risk factors. Odds ratios for associations of prehypertension with CVD risk factors were obtained using logistic regression.ResultsThe prevalence of prehypertension among Jamaicans was 30% (95% confidence interval [CI] 27%–33%). Prehypertension was more common in males, 35% (CI 31%–39%), than females, 25% (CI 22%–28%). Almost 46% of participants were overweight; 19.7% were obese; 14.6% had hypercholesterolemia; 7.2% had diabetes mellitus and 17.8% smoked cigarettes. With the exception of cigarette smoking and low physical activity, all the CVD risk factors had significantly higher prevalence in the prehypertensive and hypertensive groups (p for trend < 0.001) compared to the normotensive group. Odds of obesity, overweight, high cholesterol and increased waist circumference were significantly higher among younger prehypertensive participants (15–44 years-old) when compared to normotensive young participants, but not among those 45–74 years-old. Among men, being prehypertensive increased the odds of having >/=3 CVD risk factors versus no risk factors almost three-fold (odds ratio [OR] 2.8 [CI 1.1–7.2]) while among women the odds of >/=3 CVD risk factors was increased two-fold (OR 2.0 [CI 1.3–3.8])ConclusionPrehypertension occurs in 30% of Jamaicans and is associated with increased prevalence of other CVD risk factors. Health-care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat modifiable risk factors in these persons.

Abdominal obesity and inflammation predicts hypertension among prehypertensive men and women: the ATTICA Study

The aim of this work was to assess the 5-year incidence of hypertension and its predictors among prehypertensive adults. Under the context of the ATTICA Study, data from 1188 individuals, free of cardiovascular disease, but with defined high blood pressure levels (prehypertension) at baseline examination (during 2001-2002) were retrieved. In 2006, the 5-year follow-up of the study was performed, and 798 of the prehypertensive participants were allocated. In this work, incidence and determinants of developing hypertension were evaluated. The 5-year ageadjusted incidence of hypertension was 18.7% in men and 24.6% in women (P = 0.05); while almost one half of prehypertensive individuals at the age of 55-65 years developed hypertension, and approximately 6 out of 10 people over 65 years of age developed the disease. Multiple logistic regression analysis revealed that increased age (odds ratio [OR] per 1 year = 1.09, 95% confidence interval [CI] 1.07-1.12), male sex (OR = 0.40, 95% CI 0.21-0.68), high education status (OR per 1 year of school = 0.94, 95% CI 0.88-0.98), waist circumference (OR per 1 cm = 1.04, 95% CI 1.02-1.06) and C-reactive protein (OR per 1 mg/l = 1.12, 95% CI 1.05-1.20), were positively associated with the development of hypertension. Moreover, greater adherence to Mediterranean diet seems to protect only prehypertensive, with abdominal obesity patients prone to develop hypertension (OR = 0.94, 95% CI 0.90-0.98). Annual incidence of hypertension was roughly 4% in men and women. Older people, with low education, abdominal obesity, lower adherence to the Mediterranean diet, and increased inflammation, constitute a model of prehypertensive individuals that are prone to develop hypertension.

Abstract 3668: Predictors of Four-Year Incident Arterial Hypertension From Initial Prehypertension: The Strong Heart Study.

Background: Pre-hypertension (defined by JNC-VII) frequently evolves to arterial hypertension (HTN) and is recently shown to increase cardiovascular risk, especially in diabetics. It is unclear which metabolic and cardiac characteristics predict development of HTN in pre-hypertensive subjects. Methods: 627 pre-hypertensive participants in the Strong Heart Study, free of anti-hypertensive treatment and without prevalent cardiovascular disease or significant valve disease, were studied (64% women; 41% diabetic; 58±7 yrs). All participants underwent complete echocardiographic, anthropometric and laboratory testing. We evaluated 4-year incidence of HTN using anthropometric and metabolic profile as first predictors, and echocardiographic indices thereafter. Results: Four-year incidence of HTN was 41%. Preliminary analysis identified diabetes (DM by ADA criteria) as a significant predictor of incident HTN (53% among participants with DM vs 33% in non DM; OR= 2.02, 95% CI=1.42–2.88; p&lt;0.001). Accordingly, additional analysis was performed separately in participants with or without baseline DM. After adjusting for age, gender, and heart rate, strongest predictor of HTN in DM was baseline systolic blood pressure (OR= 1.07/mmHg, 95% CI=1.03–1.12; p=0.001) with weaker effect of echocardiographic relative wall thickness (p=0.03). In non-DM, independent predictors of HTN were systolic blood pressure (HR= 1.08/mmHg, 95% CI=1.04–1.12; p&lt;0.001), non-HDL cholesterol (HR= 1.01/mg*dL-1, 95% CI=1.00–1.01; p=0.01) and high LV mass index (OR=1.04 g/m2.7, 95% CI=1.01–1.07; p= 0.007). Higher Doppler stroke volume and total peripheral resistance also entered alternative models without LV mass (each p&lt;0.05). Conclusion: In a population of pre-hypertension adults we demonstrate high incidence of HTN (41%). Independent predictors of HTN at 4-year follow-up are presence of diabetes and higher baseline systolic blood pressure. In non-DM, LV mass index is an indipendent predictor of incident HTN in addition to baseline systolic blood pressure and non-HDL cholesterol.

Cardiac and Systemic Hemodynamic Characteristics of Hypertension and Prehypertension in Adolescents and Young Adults

The epidemic of overweight is increasing the prevalence of both prehypertension and early-onset hypertension, but few population-based data exist on their impact on cardiac structure and function in adolescents and young adults. We analyzed clinical characteristics, hemodynamic parameters, and left ventricular structure and function in 1940 participants, 14 to 39 years of age, in the Strong Heart Study. Hypertension occurred in 294 participants (15%), who were more often men (70% versus 30%), older (age, 31+/-7 versus 25+/-8 years), and more commonly diabetic (23% versus 4.5%; all P<0.001) than their normotensive counterparts. Prehypertension occurred in 675 (35%) of participants with similar trends in gender, age, and diabetes status. After adjustment for covariates, both hypertensive and prehypertensive participants had higher left ventricular wall thickness (0.83 and 0.78 versus 0.72 cm), left ventricular mass (182 and 161 versus 137 g), and relative wall thickness (0.30 and 0.29 versus 0.28 cm) and 3- and 2-fold-higher prevalences of left ventricular hypertrophy than their normotensive counterparts (all P<0.001). Hypertension and prehypertension also were associated with higher mean pulse pressure/stroke volume index (1.24 and 1.15 versus 1.02 mm Hg/mL x m2) and total peripheral resistance index (3027 and 2805 versus 2566 dynes x s x cm(-5) x m2; all P<0.001). In a population with high prevalences of obesity and diabetes, hypertension and prehypertension are associated with increases in both cardiac output and peripheral resistance index. Despite the young age of participants with hypertension and prehypertension, they had prognostically adverse preclinical cardiovascular disease, including left ventricular hypertrophy and evidence of increased arterial stiffness.

A Longitudinal Study of Hypertension Risk Factors and Their Relation to Cardiovascular Disease

This study estimated hypertension incidence and explored hypertension risk factors and their association with cardiovascular disease. Data collected from 4549 American Indian participants in the 3 exams of the Strong Heart Study were used. Hypertension was defined as systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, or current use of antihypertensive medication. Generalized linear models were used to identify the risk factors for hypertension and the correlates of blood pressures. Cox proportional models with time-dependent covariates and the mixed models were used to explore the association of hypertension with cardiovascular disease. There was no sex difference in hypertension. After adjustment for other risk factors, the risks of developing hypertension among subgroups in each characterized group were as follows: prehypertensive versus normotensive, 3.21 times; macroalbuminuria and microalbuminuria versus normal, 3.47 and 1.72; diabetic versus nondiabetic, 1.56; overweight and obese versus normal weight, 1.30 and 1.51; and current alcohol drinking versus not, 1.22. Moreover, systolic blood pressure was significantly and positively associated with age, obesity, and albuminuria and negatively with smoking. After adjusting all other risk factors, those pretreated, untreated, controlled, and uncontrolled hypertensive participants had &1.74, 1.81, 2.19, and 2.77 times higher risks of developing cardiovascular disease compared with normotensive participants, respectively. In 45- to 74-year-old American Indians, the risk of developing hypertension was rising. Prehypertensive participants had 3.2/1.74 times higher risk of developing hypertension/cardiovascular disease than normotensive participants. Age, diabetes, and macro/microalbuminuria were independently significant risk factors of both hypertension and cardiovascular disease.