Risk Factors For Chronic Hypertension Research Articles

Analysis of risk factors of preeclampsia in pregnant women with chronic hypertension and its impact on pregnancy outcomes

ObjectiveTo investigate the risk factors and maternal and fetal outcomes of preeclampsia after pregnancy in patients with primary chronic hypertension.MethodsA total of 500 singleton pregnant women with a history of hypertension who were admitted for delivery at our Hospital from March 2015 to May 2022 were retrospectively collected by random sampling and divided into the non-occurrence group (n = 200) and the occurrence group (n = 300) according to whether they were complicated by preeclampsia. Afterward, the general data and the pregnancy-related data of patients were collected for comparison.ResultsThe univariate analysis showed significant differences between the non-occurrence group and the occurrence group in terms of the proportion of preeclampsia history (4.00% VS 24.67%, χ2 = 37.383, P < 0.001), duration of hypertension > 3 years (18.00% VS 31.67%, χ2 = 11.592, P < 0.001), systemic therapy (20.50% VS 10.00%, χ2 = 10.859, P < 0.001), gestational age at admission [37.72 (34.10, 38.71) VS 35.01 (31.91, 37.42) weeks, Z = -9.825, P < 0.001]. Meanwhile, the multivariate analysis showed that a history of preeclampsia (OR = 6.796, 95% CI: 3.575 ∼ 10.134, χ2 = 8.234, P < 0.001), duration of hypertension > 3 years (OR = 3.456, 95% CI: 2.157 ∼ 5.161, χ2 = 9.348, P < 0.001), and a lack of systemic antihypertensive treatment (OR = 8.983, 95% CI: 7.735 ∼ 9.933, χ2 = 9.123, P < 0.001) were risk factors for chronic hypertension complicated by preeclampsia during pregnancy.ConclusionA history of preeclampsia, a longer duration of hypertension, and a lack of systematic antihypertensive treatment are risk factors for chronic hypertension complicated by preeclampsia during pregnancy. The occurrence of preeclampsia in pregnant women with chronic hypertension increases the incidence of maternal HELLP syndrome and fetal distress.

Deep autoencoders and multivariate analysis for enhanced hypertension detection during the COVID-19 era

&lt;abstract&gt; &lt;p&gt;The incidence of hypertension has increased dramatically in both elderly and young populations. The incidence of hypertension also increased with the outbreak of the COVID-19 pandemic. To enhance hypertension detection accuracy, we proposed a multivariate outlier removal method based on the deep autoencoder (DAE) technique. The method was applied to the Korean National Health and Nutrition Examination Survey (KNHANES) database. Several studies have identified various risk factors for chronic hypertension. Chronic diseases are often multifactorial rather than isolated and have been associated with COVID-19. Therefore, it is necessary to study disease detection by considering complex factors. This study was divided into two main parts. The first module, data preprocessing, integrated external features for COVID-19 patients merged by region, age, and gender for the KHNANE-2020 and Kaggle datasets. We then performed multicollinearity (MC)-based feature selection for the KNHANES and integrated datasets. Notably, our MC analysis revealed that the "COVID-19 statement" feature, with a variance inflation factor (VIF) of 1.023 and a p-value &amp;lt; 0.01, is significant in predicting hypertension, underscoring the interrelation between COVID-19 and hypertension risk. The next module used a predictive analysis step to detect and predict hypertension based on an ordinal encoder (OE) transformation and multivariate outlier removal using a DAE from the KNHANES data. We compared each classification model's accuracy, F1 score, and area under the curve (AUC). The experimental results showed that the proposed XGBoost model achieved the best results, with an accuracy rate of 87.78% (86.49%–88.1%, 95% CI), an F1 score of 89.95%, and an AUC of 92.28% for the COVID-19 cases, and an accuracy rate of 87.72% (85.86%–89.69%, 95% CI), an F1 score of 89.94%, and an AUC of 92.23% for the non-COVID-19 cases with the DAE_OE model. We improved the prediction performance of the classifiers used in all experiments by developing a high-quality training dataset implementing the DAE and OE in our method. Moreover, we experimentally demonstrated how the steps of the proposed method improved performance. Our approach has potential applications beyond hypertension detection, including other diseases such as stroke and cardiovascular disease.&lt;/p&gt; &lt;/abstract&gt;

Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda

Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension. This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda. This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension. A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; P=.03), controlling for age, gravidity, and eclampsia. Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.

Abstract 10916: Management of Chronic Hypertension Prior to Pregnancy Among Women Veterans

Introduction: Maternal chronic hypertension (MCH), defined as chronic hypertension affecting pregnancy, has increased rapidly in prevalence among civilians. Although women Veterans have more risk factors for chronic hypertension than civilian women, little is known about MCH in this group. Methods: This descriptive, observational study used data from the Surgical Treatment Outcomes for Patients with Psychiatric Disorders (STOPP) project, which includes 11 million Veterans with and without mental illness using the Veterans Health Administration. Women Veterans aged 18-60 years at time of pregnancy identification were included if they had chronic hypertension before pregnancy in fiscal years 2010-2019. We identified chronic hypertension and first pregnancy based on diagnosis codes and defined uncontrolled blood pressure as ≥140/90 mm Hg on at least one measurement in the year prior to pregnancy. For antihypertensive medications (AHMs) that are recommended or not recommended for use in pregnancy, multivariable logistic regression was used to assess the association of comorbidities with (a) non-recommended AHM received 0-6 months before pregnancy, (b) non-recommended AHM received during pregnancy (c) recommended AHM received 0-6 months before pregnancy, and (d) recommended AHM received during pregnancy. Results: In total, 9.9% (4,302/43,251) of women Veterans who became pregnant had MCH, with mean age 37.0 years (SD=8.2). Among those with MCH who met inclusion criteria, 62% (N=1,839) had uncontrolled blood pressure in the year prior to pregnancy. Furthermore, 20% (N=611) received a non-recommended AHM 0-6 months before pregnancy, 19% (N=564) received a non-recommended AHM during pregnancy, 26% (N=784) received a recommended AHM 0-6 months before pregnancy, and 33% (N=995) received a recommended AHM during pregnancy. Chronic kidney disease (OR 3.0, 95% CI: 1.6-5.6) and diabetes (OR 2.5, 95% CI:1.9-3.2) were most strongly associated with use of a non-recommended AHM during pregnancy. Conclusion: Interventions are needed among women Veterans to decrease the prevalence of MCH, increase blood pressure control prior to pregnancy, and ensure antihypertensives not recommended for use in pregnancy are transitioned to safe alternatives.

Chronic hypertension, perinatal mortality and the impact of preterm delivery: a population-based study.

To estimate the association between chronic hypertension and perinatal mortality and to evaluate the extent to which risks are impacted by preterm delivery. Cross-sectional analysis. United States, 2015-18. Singleton births (20-44 weeks of gestation). Chronic hypertension, defined as elevated blood pressure diagnosed before pregnancy or recognised before 20 weeks of gestation. We derived the risk of perinatal mortality in relation to chronic hypertension from Poisson models, adjusted for confounders. The impacts of misclassification and unmeasured confounding were assessed. Causal mediation analysis was performed to quantify the impact of preterm delivery on the association. Of the 15 090 678 singleton births, perinatal mortality rates were 22.5 and 8.2 per 1000 births in chronic hypertensive and normotensive pregnancies, respectively (adjusted risk ratio 2.05, 95% CI 2.00-2.10). Corrections for exposure misclassification and unmeasured confounding biases substantially increased the risk estimate. Although causal mediation analysis revealed that most of the association of chronic hypertension on perinatal mortality was mediated through preterm delivery, the perinatal mortality rates were highest at early term, term and late term gestations, suggesting that a planned early term delivery at 37-386/7 weeks may optimally balance risk in these pregnancies. Additionally, 87% (95% CI 84-90%) of perinatal deaths could be eliminated if preterm deliveries, as a result of chronic hypertension, were preventable. Chronic hypertension is associated with increased risk for perinatal mortality. Planned early term delivery and targeting modifiable risk factors for chronic hypertension may reduce perinatal mortality rates. Maternal chronic hypertension is associated with increased risk for perinatal mortality, largely driven by preterm birth.

PD31-05 HYPERTENSION FOLLOWING RENAL TRAUMA IN A PEDIATRIC POPULATION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-05 HYPERTENSION FOLLOWING RENAL TRAUMA IN A PEDIATRIC POPULATION Catalina K. Hwang, Vishnu Iyer, Judith C. Hagedorn, and Alexander J. Skokan Catalina K. HwangCatalina K. Hwang More articles by this author , Vishnu IyerVishnu Iyer More articles by this author , Judith C. HagedornJudith C. Hagedorn More articles by this author , and Alexander J. SkokanAlexander J. Skokan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hypertension (HTN) has a reported incidence of around 4% after pediatric renal trauma. Risk factors for long-term HTN include medial parenchymal lacerations, high AAST injury grade, and HTN in the acute postinjury period. Little is known about BP trends over time to guide decision-making on the duration of monitoring. We hypothesized that most postinjury HTN spontaneously resolves, with an incidence of sustained HTN similar to the general population. METHODS: We retrospectively reviewed records of all pediatric renal trauma patients (<18 years) who presented to our Level 1 trauma center from 2010-2019 for demographic, injury characteristics and follow-up data. Only routine follow-up visits were included. BPs were graded based on age-, sex- and height-normalized data to identify normotension, elevated BP (EBP), and HTN per age-appropriate guidelines. HTN is a subset of EBP. At least 3 follow-up BP readings was required for inclusion criteria. RESULTS: From a total of 179 patients, 97 met inclusion criteria. No patients were discharged on antihypertensives. Median follow-up duration was 32 (IQR 6-65) months. On follow-up, 67% were always normotensive and 33% had EBP. 23% had HTN. Of those with EBP, 41% had onset at injury with persistence, 31% had late onset after initial normotension, and 28% had initial EBP that later spontaneously resolved. The time to late onset or resolution of EBP/HTN was variable, occurring at respective means of 50 (SD 41) and 18.6 (SD 37.5) months. The incidence of postinjury EBP was significantly higher in males (p=0.003). No other variables had a statistically significant relationship with long-term EBP (Table 2). Four patients (11.4%) with EBP had this finding addressed at an outpatient visit. Two patients were started on antihypertensives by an outpatient provider in follow-up. CONCLUSIONS: Postinjury HTN is more common than previously reported, and is not routinely recognized or addressed when present in follow-up. Up to 1/3 of those with early HTN will have spontaneous resolution, but HTN can also develop in a delayed manner in some patients. Patient/parent counseling is important to raise awareness and encourage routine monitoring after discharge. Further work is necessary to determine risk factors for chronic HTN, and indications for long-term follow-up and medical intervention. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e540-e540 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catalina K. Hwang More articles by this author Vishnu Iyer More articles by this author Judith C. Hagedorn More articles by this author Alexander J. Skokan More articles by this author Expand All Advertisement Loading ...

Association between secondhand smoke exposure and hypertension: nearly as large as smoking.

: Active smoking is a widely accepted risk factor for cardiovascular disease and is recognized as a major public health problem. Passive smoking, also known as secondhand smoke exposure (SHSE), is thought to have similar cardiovascular consequences and the risk has been postulated to be equivalent to that of active smoking. A major component of this risk involves the connection with chronic hypertension. There are several population-based observational studies investigating the relationship between SHSE and chronic hypertension, all of which demonstrate a positive association. Given that SHSE appears to be a risk factor for chronic hypertension, SHSE should also be a risk factor for hypertensive end-organ disease. Many studies have sought to investigate this relationship, but this has yet to be fully elucidated. In this review, we focus on the current evidence regarding the association between SHSE and hypertension as well as exploration of the links between SHSE and hypertensive end-organ damage.

HYPERTENSIVE DISORDERS IN PREGNANCY: FREQUENCY AND ASSOCIATED FACTORS IN A COHORT OF BRAZILIAN WOMEN

Objective. To evaluate the frequency of and risk factors associated with hypertensive disorders in general antenatal care in five distinct areas of Brazil.Methods. We performed a cohort study of 4892 women enrolled in midpregnancy from 1991 to 1995. Patients were queried at enrollment about hypertension prior to pregnancy. Medical diagnoses of hypertensive disorders in pregnancy were abstracted from patient records. Hypertensive disorders in pregnancy were classified according to recommendations of the American College of Obstetrics and Gynecology (ACOG).Results. Of 4892 women studied, 367 (7.5%) presented hypertensive disorders, 113 (2.3%) being preeclampsia/eclampsia and 198 (4.0%) chronic hypertension. Frequencies of superimposed preeclampsia/eclampsia and transitory hypertension were 0.5% and 0.7%, respectively. Greater brachial arm circumference was strongly associated both with preeclampsia/eclampsia and with chronic hypertension (threefold difference across extreme quartiles, p ≤0.001). In adjusted analyses, being older, black, and obese were important and statistically significant risk factors for chronic hypertension. Similarly, nulliparity was a statistically significant risk factor for preeclampsia/eclampsia, and tendencies toward increased risk were seen for older, black, and obese women in adjusted analyses. Preeclampsia/eclampsia and chronic hypertension were notably less frequent in Manaus, although regional differences were statistically significant only for chronic hypertension.Conclusions. Hypertensive disorders commonly complicate pregnancy in Brazilian women. Risk factors for these disorders appear similar to those reported in other countries. Use of an inappropriately sized cuff to measure blood pressure may result in many false-positive diagnoses in more obese women. The considerably lower frequency of hypertensive disorders found in Manaus, in the Amazon region, warrants further study.