Risk Factors For Hypertension In Adults Research Articles

Longitudinal study of the relationship between sleep duration and hypertension in Chinese adult residents (CHNS 2004–2011)

ObjectiveTo determine the associations between sleep duration and hypertension in Chinese adults. MethodsThis longitudinal study analyzed 9851 adults who had participated in at least two rounds of the CHNS (China Health and Nutrition Survey) during 2004–2011. Sleep duration was classified into ≤7, 8, and ≥9 h. Age, sex, residence location, education level, smoking, drinking alcohol, drinking tea, drinking coffee, activity level, and body mass index were adjusted as confounders in a generalized linear mixed model. ResultsThe unadjusted analysis showed that compared with a normal sleep duration (8 h), the odds ratios (ORs) for those with short (≤7 h) and long (≥9 h) sleep durations were 1.24 and 1.17, respectively (95% confidence intervals [CIs] = 1.14–1.36 and 1.06–1.29). After adjusting for confounding factors, the effect of a short sleep duration on hypertension was still statistically significant, with an OR of 1.13 (95% CI = 1.04–1.24), while a long sleep duration no longer had a statistically significant effect. ConclusionsA short sleep duration is an independent risk factor for adult hypertension, whereas a long sleep duration is not in Chinese adults. The prevalence of hypertension should be prevented and controlled by improving the sleep status of adults.

Prenatal lead exposure modifies the effect of shorter gestation on increased blood pressure in children

BackgroundHigh blood pressure (BP) in childhood is frequently renal in origin and a risk factor for adult hypertension and cardiovascular disease. Shorter gestations are a known risk factor for increased BP in adults and children, due in part to a nephron deficit in children born preterm. As nephrogenesis is incomplete until 36 weeks gestation, prenatal lead exposure occurring during a susceptible period of renal development may contribute to programming for later life renal disease. The relationship between shorter gestation and children's BP has not yet been explored to identify i) critical windows using nonlinear piecewise models or ii) combined with other early life risk factors such as prenatal lead exposure. Objectives(1) To evaluate the nonlinear relationship between lower gestational age and childhood BP measured at 4–6 years of age, and (2) to investigate modification by prenatal lead exposure. MethodsIn a prospective longitudinal birth cohort, we assessed 565 children between 4 and 6 years of age (mean: 4.8 years) in the PROGRESS cohort in Mexico City, Mexico. Gestational age at delivery was calculated using maternal report of last menstrual period (LMP) and confirmed with Capurro physical examination at birth. We measured pregnant women's blood lead levels (BLLs) in the second trimester via inductively coupled plasma-mass spectrometry and children's BP using an automated device. We performed both linear and nonlinear piecewise regression analyses to examine associations of gestational age with children's BP adjusting for children's age, sex, height, prenatal exposure to smoke, and maternal socioeconomic status. We stratified to assess modification by prenatal lead exposure, and used a data-adaptive approach to identify a lead cutpoint. ResultsMaternal second trimester BLLs ranged from 0.7 to 17.8 μg/dL with 112 (20%) women above the CDC guideline level of 5 μg/dL. In adjusted linear regression models, a one week reduction in gestational age was associated with a 0.5 mm Hg (95%CI: 0.2, 0.8) increase in SBP and a 0.4 mm Hg (95%CI 0.1, 0.6) increase in DBP. Our nonlinear models suggested evidence for different magnitude estimates on either side of an estimated join-point at 35.9 weeks' gestation, but did not reach statistical significance. However, when stratified by prenatal lead exposure, we identified a cutpoint lead level of concern of 2.5 μg/dL that suggested an interaction between gestational age and blood lead. Specifically, for BLLs ≥ 2.5 μg/dL, SBP was 1.6 (95%CI: 0.3, 2.9) mm Hg higher per each week reduction in gestational age among children born before 37.0 weeks; and among children born after 37.0 weeks, this relationship was attenuated yet remained significant [β: 0.9, 95%CI (0.2, 1.6)]. At BLLs below 2.5 μg/dL, there was no appreciable association between lower gestational age and SBP. ConclusionsOur findings suggest that shorter gestation combined with higher prenatal lead exposure contributes to a higher risk of increased SBP at 4–6 years of age, particularly among infants born <37 weeks gestation. Our results underscore the importance of preventing prenatal lead exposure - even levels as low as 2.5 μg/dL - especially among pregnant women at risk for preterm birth. Given that high BP in childhood is a risk factor for adult hypertension and cardiovascular disease later in life, these results may have implications that extend across the life span.

Pulse rate reactivity in childhood as a risk factor for adult hypertension: the 1970 British cohort study.

Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in childhood and risk of hypertension in adulthood. A total of 6507 participants (51.6% women) underwent clinical examination at 10 years of age that involved measurement of blood pressure, BMI, and pulse rate pre and postexamination. Hypertension was ascertained by self-reported doctor diagnosis 32 years later at age 42. On average, there was a reduction in pulse rate after the medical examination (-1.2 ± 8.2 bpm), although nearly a third of the sample recorded an increase in pulse rate of at least 3 bpm. A total of 488 (7.5%) study members developed hypertension at follow-up. After adjustment for a range of covariates, including resting blood pressure and BMI in childhood, a heightened pulse rate response to the examination (≥3 bpm) was associated with greater risk of hypertension in adulthood (odds ratio = 1.30, 95% confidence interval, 1.02, 1.67). The association persisted whether we modelled pulse rate as an absolute measure (postexamination) or a change score. These observational data suggest that elevated childhood cardiovascular reactivity could increase risk for hypertension in adulthood.

Childhood adiposity trajectories are associated with late adolescent blood pressure: birth to twenty cohort.

BackgroundElevated blood pressure in childhood is a risk factor for adult hypertension which is a global health problem. Excess adiposity in childhood creates a predisposition to develop adult hypertension. Our aim was to explore distinct sex-specific adiposity trajectories from childhood to late adolescence and examined their association with blood pressure.MethodsLatent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to derive sex-specific and distinct body mass index (BMI: kg/m2) trajectories. We studied 1824 black children (boys = 877, girls = 947) from the Birth to Twenty (Bt20) cohort from Soweto, South Africa, and obtained BMI measures at ages 5 through 18 years. Participants with at least two age-point BMI measures, were included in the analysis. Analysis of variance (ANOVA), chi-square test, multivariate linear and standard logistic regressions were used to test study characteristics and different associations.ResultsWe identified three (3) and four (4) distinct BMI trajectories in boys and girls, respectively. The overall prevalence of elevated blood pressure (BP) was 34.9 % (39.4 % in boys and 30.38 % in girls). Boys and girls in the early onset obesity or overweight BMI trajectories were more likely to have higher BP values in late adolescence. Compared to those in the normal weight BMI trajectory, girls in early onset obesity trajectories had an increased risk of elevated BP with odds ratio (OR) of 2.18 (95 % confidence interval 1.31 to 4.20) and 1.95 (1.01 to 3.77). We also observed the weak association for boys in early onset overweight trajectory, (p-value = 0.18 and odds ratio of 2.39 (0.67 to 8.57))ConclusionsDistinct weight trajectories are observed in black South African children from as early as 5 years. Early onset adiposity trajectories are associated with elevated BP in both boys and girls. It is important to consider individual patterns of early-life BMI development, so that intervention strategies can be targeted to at-risk individuals.

Clinical Implications

HomeHypertensionVol. 67, No. 2Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Feb 2016https://doi.org/10.1161/HYPERTENSIONAHA.115.06955Hypertension. 2016;67:237Early Growth and Midchildhood Blood Pressure (p 301)Download figureDownload PowerPointIn recent years, the prevalence of hypertension and prehypertension, conditions previously confined to adult populations, increased among children and adolescents. Considering that high blood pressure (BP) in early life is a strong risk factor for adult hypertension, identifying modifiable determinants of elevated BP as early as possible in the life course could translate into new preventive strategies. In a study of 957 participants of Project Viva, a US prebirth cohort, we investigated the associations of adiposity gain (change in body mass index z score) and linear growth (change in length or height z score) during 4 early-life age intervals (birth to 6 months, 6 months to 1 year, 1–2 years, and 2–3 years) with BP in midchildhood (age range, 6–10 years). We found that each additional z score gain in body mass index during birth to 6 months and 2 to 3 years corresponded with 0.81 (95% confidence interval, 0.15–1.46) and 1.61 (95% confidence interval, 0.33–2.89) mm Hg higher systolic BP, respectively. Length/height gain was unrelated to midchildhood BP, nor did any association of early growth with BP differ by birth size. Our findings suggest that faster adiposity gain during the first 6 postnatal months and in the preschool years leads to higher BP in midchildhood, regardless of size at birth. Strategies to reduce accrual of adiposity during early life may reduce midchildhood BP, with the potential to reduce risk of hypertension and cardiovascular disease in adulthood.Renal Denervation Versus Pharmacotherapy (p 397)Catheter-based renal denervation (RDN) has been considered as a new hope for patients with resistant hypertension and spread worldwide after the first studies were published in 2011. However, the first randomized controlled studies appeared only at the beginning of 2014 and cast some doubts on the real antihypertensive effect of RDN.In this issue of Hypertension, Rosa et al present 12-month results of the Prague-15 study, which compared RDN to intensified pharmacological treatment. Per-protocol analysis showed that spironolactone addition might be more effective in blood pressure reduction than RDN with 1 year of treatment in truly resistant hypertension. Spironolactone should be considered as a part of the combination drug strategy in all resistant hypertensive patients. On the other hand, this study revealed a relatively high incidence of spironolactone side effects, especially related to antiandrogen actions.These results do not support RDN using the current techniques as a general approach to treat resistant hypertension. More effective multielectrode systems and new generation catheters remain to be established, as do potential benefits in specific patient groups. Currently, RDN should be used only in specialized hypertension centers as a part of properly designed studies.Download figureDownload PowerPointCardiovascular Effects of Living Kidney Donation (p 368)Download figureDownload PowerPointThis 1-year prospective study of kidney donors and carefully selected fit-for- donation control subjects demonstrated that the expected decline in glomerular filtration rate after donation is associated with a range of adverse cardiovascular effects including increased left ventricular mass, reduced long axis function, reduced aortic distensibility, a rise in high-sensitivity C-reactive protein, and an increased prevalence of detectable high sensitivity troponin and microalbuminuria. These findings provide a pathophysiological basis for the recent observation that kidney donors may be at increased late risk of cardiovascular events when compared with appropriate highly selected healthy controls (although their absolute risk remains lower than the general population). They also provide some evidence that a reduced glomerular filtration rate may be an independent risk factor for cardiovascular disease in the community, and that this effect may be mediated by effects on large arteries, the left ventricle, and systemic inflammation. Early-stage chronic kidney disease affects >10% of US and UK populations, so that although these effects may confer a small increase in risk to an individual, the effects on public health could be large. It has been known for some time that patients with early-stage chronic kidney disease are at greater risk of cardiovascular disease than of progression to serious renal disease. This study provides mechanistic insights into this heightened risk and suggests that efforts to reduce cardiovascular events should be centered on reducing left ventricular disease and large artery stiffness rather and not just on preventing and treating atheroma. Previous Back to top Next FiguresReferencesRelatedDetails February 2016Vol 67, Issue 2 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.115.06955 Originally publishedFebruary 1, 2016 PDF download Advertisement

Blunted Autonomic Responses and Low-Grade Inflammation in Mongolian Adults Born at Low Birth Weight.

Low birth weight (LBW) has been considered as a risk factor for adult hypertension that is associated with deterioration of autonomic functions and low-grade inflammation. To explore the above effects of LBW, we measured blood pressure (BP) and heart rate variability during postural change from a supine position to a sitting position in 21 healthy Mongolian adults aged 23-34 years: 4 with LBW (birth weight < 2,500 g), 13 with normal birth weight (NBW, 2,500 g ≤ birth weight < 4,000 g), and 4 with high birth weight (HBW, ≥ 4,000 g). Mongolian population is known to have higher prevalence of hypertension. The ratio of low frequency (LF, 0.04-0.15 Hz) to high frequency components (HF, 0.15-0.40 Hz) was used as an index of sympathetic nerve activity, and HF was used as an index of parasympathetic nerve activity. In contrast to the NBW group, the LBW and HBW groups showed no significant increase in heart rate, systolic BP and LF/HF following postural change. We also measured blood cell counts and other blood parameters related to inflammation. After adjusting for age, BMI, sex and family history of hypertension, LBW was retained as an independent predictor only for higher counts of leukocytes (β = -0.51, p < 0.05), basophils (β = -0.62, p < 0.01), eosinophils (β = -0.83, p < 0.001), and platelets (β = -0.61, p < 0.05). We propose that LBW leads to blunted autonomic responses and low-grade inflammation in seemingly healthy Mongolian adults.

Very Low Birth Weight is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis

Low birth weight (LBW), resulting from intrauterine growth retardation (IUGR) or prematurity, is a risk factor for adult hypertension and chronic kidney disease. LBW is associated with reduced nephron endowment and increased glomerular volume; however, the development of secondary focal segmental glomerulosclerosis (FSGS) has not been reported previously. The authors describe six patients with clinical and pathologic findings suggesting a secondary form of FSGS, in whom a history of prematurity and very LBW was obtained. No other known causes of secondary FSGS were identified. The cohort consisted of two women and four men with a mean age of 32 yr. Patients were born at 22 to 30 wk gestation with mean birth weight of 1054 g (range 450 to 1420 g). Mean 24-h urine protein was 3.3 g/d (range 1.3 to 6.0 g/d), mean creatinine clearance 89 cc/min (range 71 to 132 cc/min), mean creatinine 1.2 mg/dl (range 0.9 to 1.5 mg/dl), and mean serum albumin 4.1 g/dl (range 3.4 to 4.8 g/dl). No patient had full nephrotic syndrome. Renal biopsy revealed FSGS involving a minority (mean 8.8%) of glomeruli, with a predominance of perihilar lesions of sclerosis (five of six patients), glomerulomegaly (all six patients), and only mild foot process effacement (mean 32%), all features typical of postadaptive FSGS. Our findings support that very LBW and prematurity promote the development of secondary FSGS. Because birth history is often not obtained by adult nephrologists, this risk factor is likely to be underrecognized.

Blood pressure during the first five years of life: relation to ethnic group (black or white) and to parental hypertension.

Blood pressure was measured in 392 healthy, full-term, appropriate-weight infants and was measured again at 6, 15, 24, 36, 48, and 60 months of age. Systolic pressure rose from birth to six months of age, remained at a plateau until 15 months of age, and from 24 to 60 months rose an average of 1 mmHg per year. Diastolic pressure rose from birth to 24 months but showed little change from 24 to 60 months. The correlation of systolic with diastolic pressure decreased seriatim from birth to 60 months. Blood pressure did not vary as a function of ethnic group, sex, or socioeconomic status during the first five years of life. The association of body size with blood pressure was no more than modest during this period, but seemed to be closer for females than for males. A closer child-parent association was found for heart rate than for blood pressure. The child's heart rate was inversely associated with the parent's blood pressure although the child's blood pressure was not associated with the parent's pressure. During the first five years of life, a low heart rate may be a more significant risk factor for adult hypertension than elevated blood pressure.