Risk Of Prevalent Hypertension Research Articles

P124 Chronotype and OSA combine to modify risk of hypertension

Abstract Introduction There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population. Methods Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension. Results After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004). Discussion Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.

The impact of delayed heart rate recovery on prevalent hypertension

ABSTRACT Objectives: Delayed heart rate recovery (HRR) is considered an indicator of autonomic nervous dysfunction, which is a primary pathological mechanism of hypertension. The present study aimed to explore the independent association between delayed HRR and prevalent hypertension. Methods: In this cross-sectional study, 314 inpatients were recruited between January 2018 and December 2019. HRR was defined as the peak heart rate during exercise minus the 2nd-minute heart rate after exercise in the treadmill exercise test. Results: The mean HRR in the hypertension group was lower than that in the non-hypertension group (41 bpm vs. 46 bpm; P < 0.001). After full adjustment, each standard deviation increase in HRR was associated with a 35% decrease in the risk of prevalent hypertension (OR: 0.65, 95% CI: 0.48–0.87; P = 0.004). When the HRR was divided into quartiles, the risk in the top quartile was 26% of that in the bottom quartile (OR: 0.26, 95% CI: 0.12–0.56; P = 0.001). Furthermore, smooth curve fitting showed that the risk of prevalent hypertension decreased linearly with the increase in HRR. Conclusion: Delayed HRR was independently associated with prevalent hypertension. The association was linear and robust over the entire range of HRR. The present study suggested that delayed HRR could be used to optimize hypertension risk stratification.

Abstract P269: Combined Associations of Objective Sleep Efficiency and Overweight With the Prevalence of Hypertension in Japanese Adults

Introduction: Poor sleep efficiency is a risk for prevalent hypertension, and also overweight is one of the major risk factors for hypertension. Generally, overweight participants have poor sleep efficiency, and thus, overweight may modify the association between poor sleep efficiency and hypertension. However, there are no previous reports to examine the impact of overweight on the association between poor sleep efficiency and hypertension. Hypothesis: Poor sleep efficiency is associated with increased with prevalent hypertension, particularly in individuals with non-overweight. Methods: We conducted a cross-sectional study of 779 participants aged 20 years or older who lived in Miyagi prefecture, Japan. All the participants were recruited from June 2017 to March 2018. Sleep efficiency was measured by HSL-101 sleep sensor, and then we classified all the participants into four groups according to their sleep efficiency (good; ≥90%/poor; &lt;90%) and the presence or absence of overweight which was defined as BMI of 23 kg/m 2 or higher based on the Western Pacific Region of WHO criteria for Japanese. Hypertension was defined as morning home blood pressure ≥135/85 mmHg or receiving treatment for hypertension. Multivariable logistic regression models were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to assess the combined associations of poor sleep efficiency and overweight with prevalent hypertension. Models were adjusted for sex, age, alcohol drinking status, smoking status, average daily steps, urinary sodium/potassium ratio, and sleep duration. Results: Of the 779 participants (68.3% women, mean age 61.0 years), 252 (32.3%) had poor sleep efficiency, 331 (42.5%) had overweight, and 303 (38.9%) had hypertension. The prevalence of poor sleep efficiency was higher in men (41.7% in men vs. 28.0% in women), and the individuals with poor sleep efficiency had a higher proportion of overweight (52.8 % in participants with poor sleep efficiency vs. 37.6 % in those with good sleep efficiency) and shorter sleep duration. In a multivariable analysis, compared with individuals with good sleep efficiency and non-overweight for hypertension, the adjusted ORs (95% CIs) of those with poor sleep efficiency and non-overweight, good sleep efficiency and overweight, and poor sleep efficiency and overweight for hypertension were 1.79 (1.08 to 2.98), 2.99 (1.99 to 4.49), and 4.15 (2.56 to 6.71), respectively. Conclusions: Poor sleep efficiency was associated with increased prevalence of hypertension even in individuals with non-overweight, and additionally the risk of poor sleep efficiency for prevalent hypertension in individuals with overweight was relatively higher than that in individuals with non-overweight.

Cumulative association of obstructive sleep apnea severity and short sleep duration with the risk for hypertension.

Obstructive sleep apnea (OSA) and short sleep duration are individually associated with an increased risk for hypertension (HTN). The aim of this multicenter cross-sectional study was to test the hypothesis of a cumulative association of OSA severity and short sleep duration with the risk for prevalent HTN. Among 1,499 patients undergoing polysomnography for suspected OSA, 410 (27.3%) previously diagnosed as hypertensive and taking antihypertensive medication were considered as having HTN. Patients with total sleep time (TST) <6 h were considered to be short sleepers. Logistic regression procedures were performed to determine the independent association of HTN with OSA and sleep duration. Considering normal sleepers (TST ≥6 h) without OSA as the reference group, the odds ratio (OR) (95% confidence intervals) for having HTN was 2.51 (1.35–4.68) in normal sleepers with OSA and 4.37 (2.18–8.78) in short sleepers with OSA after adjustment for age, gender, obesity, diabetes, depression, current smoking, use of thyroid hormones, daytime sleepiness, poor sleep complaint, time in bed, sleep architecture and fragmentation, and study site. The risk for HTN appeared to present a cumulative association with OSA severity and short sleep duration (p<0.0001 for linear trend). The higher risk for HTN was observed in short sleepers with severe OSA (AHI ≥30) (OR, 4.29 [2.03–9.07]). In patients investigated for suspected OSA, sleep-disordered breathing severity and short sleep duration have a cumulative association with the risk for prevalent HTN. Further studies are required to determine whether interventions to optimize sleep may contribute to lower BP in patients with OSA.

Combined effect of hyperuricemia and overweight/obesity on the prevalence of hypertension among US adults: result from the National Health and Nutrition Examination Survey.

Hypertension is a large and growing public health problem worldwide. Hyperuricemia and overweight/obesity are two of the most important risk factors for hypertension. However, their combined effect on the risk of hypertension is not known. Participants aged 20 years and older from the National Health and Nutrition Examination Survey from 1999-2012 were used to evaluate the separate and combined effects of hyperuricemia and overweight/obesity on the risk of prevalent hypertension among different race, gender and age groups. Participants (31,473) were used to estimate separate and combined effects on the prevalence of hypertension. The overall prevalence of hypertension among adults with a combination of hyperuricemia and overweight/obesity (50.2%, 95% confidence interval (CI) 48.3-52.1%) was significantly higher than separate hyperuricemia (41.7%, 95% CI 37.2-46.2%) and overweight/obesity (30.6%, 95% CI 29.5-31.8%). The magnitude of odds ratio (OR) from the combination of hyperuricemia and overweight/obesity (OR=4.53, 95% CI 4.05-5.07) was significantly higher than both hyperuricemia (OR=2.62, 95% CI 2.07-3.32) and overweight/obesity (OR=2.08, 95% CI 1.89-2.30). Combined effect of hyperuricemia and overweight/obesity on the risk of hypertension is much stronger than any separate one. These data can provide important information for identification of target populations for future intervention and patient management.

Association of hypertension with coexistence of abnormal metabolism and inflammation and endothelial dysfunction

To explore association of hypertension with coexistence of inflammation and endothelial dysfunction and abnormal metabolism, a community-based study was conducted among Mongolian people in China. Demographic characteristics and lifestyle risk factors were investigated, blood pressure, body weight and waist circumference were measured, fasting blood samples were obtained to measure blood lipids, fasting plasma glucose and the biomarkers of inflammation and endothelial dysfunction, C-reactive protein (CRP), soluble intercellular cell adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin) and angiotensin II. Rates of abnormal metabolism, elevated CRP, elevated sICAM-1, elevated sE-selectin and elevated angiotensin II as well as coexistence of abnormal metabolism with the elevated biomarkers were all higher in hypertensives than these in normotensives (all p < 0.01). Compared with subjects with normal metabolism and without any elevated biomarker, multivariate adjusted odds ratio (95% confidence interval) of hypertension associated with abnormal metabolism, elevated CRP, elevated sICAM-1, elevated sE-selectin, elevated angiotensin II, coexistences of abnormal metabolism with elevated CRP, elevated sICAM-1,elevated sE-selectin and elevated angiotensin II were 2.209 (1.594–3.062), 2.820 (1.992–3.992), 2.370 (1.665–3.374), 1.893 (1.331–2.691), 2.545 (1.793–3.612), 2.990 (2.102–4.252), 2.551 (1.775–3.667), 2.223 (1.544–3.220), 3.135 (2.185–4.519), respectively. In conclusion, this study indicated that inflammation and endothelial dysfunction was associated with hypertension and abnormal metabolism, and individuals with co-existence of abnormal metabolism with inflammation and endothelial dysfunction had higher risk of prevalent hypertension among Mongolian population. This study suggests that further study on treatment for hypertension patients with coexistence of abnormal metabolism with inflammation and endothelial dysfunction should be conducted in the near future.

Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis

A number of studies have reported that sleep duration might have an important role in the development of hypertension. However, the results have been inconsistent. In this study, a meta-analysis was performed to clarify the association between sleep duration and hypertension risk. PubMed, Embase and ISI web of science databases updated on 28 October 2011 were searched for eligible publications. Pooled odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CI) was calculated using a random- or fixed-effect model. Six prospective (N=9959) and seventeen cross-sectional (N=105432) studies were identified for the data analysis on sleep duration. The results indicated that short sleep duration was associated with an increased risk of prevalent hypertension (OR=1.20, 95% CI: 1.09-1.32, P<0.001), especially among subjects younger than 65 years and females. In addition, short sleep duration was also associated with an increased risk of incident hypertension among subjects younger than 65 years (RR=1.33, 95% CI: 1.11-1.61, P=0.002). Overall, there was a significant association between long sleep duration and the risk of prevalent hypertension (OR=1.11, 95% CI: 1.05-1.17, P<0.001). Further subgroup analysis also suggested a significant association between long sleep duration and the risk of prevalent hypertension among subjects younger than 65 years (OR=1.12, 95% CI: 1.06-1.19, P<0.001). The present meta-analysis indicated that short sleep duration was associated with an increased risk of hypertension in the overall polulation and incident hypertension among subjects younger than 65 years. In addition, long sleep duration might be associated with a risk of prevalent hypertension, especially among subjects younger than 65 years.

Fibrillin-1 genotype and risk of prevalent hypertension: A study in two independent populations

Objective. Mutations in the fibrillin-1 gene are the cause of Marfan syndrome. We wanted to investigate the relationship between a mutation in this gene and risk of prevalent hypertension. Methods. In a cross-sectional study, the effect of a G–A substitution in intron 27 in the fibrillin-1 gene (rs11856553) on risk of prevalent hypertension was studied in two large population-based studies: the Health 2006 study, consisting of 3193 women and men, age 18–69 years, and the MONICA10 study, consisting of 2408 women and men, age 41–72 years. In 1646 MONICA10 participants, blood pressure (BP) was also measured by 24-h ambulatory recordings. Results. Among the 3193 Health 2006 participants 23 had the G–A variant, and among the 2408 MONICA10 participants 18 had the G–A variant. In Health 2006, the odds ratio estimate (95% confidence intervals) for the G–A variant for risk of hypertension, defined as systolic (S) BP ≥ 140 mmHg or diastolic (D) BP ≥ 90 mmHg or on antihypertensive medicine, was 2.67 (1.14–6.18), p = 0.022. The corresponding figure for moderate to severe hypertension, defined as SBP ≥ 160 mmHg or DBP ≥ 100 mmHg, was 9.68 (4.24–22.12), p < 0.0001. In MONICA10, the odds ratio estimate (95% confidence intervals) for the G–A variant for risk of moderate to severe ambulatory hypertension, defined as 24-h mean SBP ≥ 150 mmHg or 24-h mean DBP ≥ 90 mmHg, was 5.73 (1.96–16.7), p = 0.0014. Conclusion. The G–A substitution in the fibrillin-1 gene (rs11856553) is a rare genetic variant that is associated with an increased risk of prevalent hypertension, particularly of moderate to severe prevalent hypertension.

Nutrient Intake, Lifestyle Factors and Prevalent Hypertension in Korean Adults: Results from 2007-2008 Korean National Health and Nutrition Examination Survey

Hypertension is a well-known risk factor for cardiovascular disease. Previous studies have shown that changes in diet and lifestyle factors can prevent the development of hypertension, but the combined effects of these modifiable factors on hypertension are not well established. The objective of this study is to investigate associations of diet and lifestyle factors, evaluated both individually and in combination, with prevalent hypertension among Korean adults. We analyzed data obtained from the 2007-2008 Korean National Health and Nutritional Examination Survey, a nationwide cross-sectional study using a stratified, multistage probability sampling design. The associations of 12 nutrient intakes and lifestyle factors with risk of hypertension were explored using restricted cubic spline regression and logistic regression models among 6,351 adults. Total energy and several nutrients and minerals, including, calcium, vitamin A, vitamin C, and sodium, showed non-linear relationships with the risk of prevalent hypertension. In multivariate logistic regression models, dietary score, obesity and alcohol intake were independently associated with the risk of prevalent hypertension, but smoking and physical activity were not. Overall, participants whose dietary habits and lifestyle factors were all in the low-risk group had 68% lower prevalence of hypertension (OR: 0.32, 95 CI: 0.14-0.74) compared to those who were at least one in the high-risk group of any dietary or lifestyle factors. The result suggests that combined optimal lifestyle habits are strongly associated with lower prevalence of hypertension among Korean adults. (Korean J Community Nutr 17(3) : 329~340, 2012)