Hypertension Medication Use Research Articles

Abstract P373: Higher Plaque Volume but Not Density of Coronary Artery Calcium is Associated With Left Ventricular Mass

Coronary artery calcium (CAC) predicts future cardiovascular disease (CVD) events, including heart failure (HF), improves risk stratification beyond traditional CVD risk factors, and is associated with a higher left ventricular mass (LVM), a HF risk factor. Recent findings from the MESA have shown that for a given CAC volume, higher CAC density was inversely associated with incident CVD. It remains uncertain whether CAC volume and density associate differently with LVM. In a multi-ethnic cohort of community dwelling individuals free from clinical CVD at recruitment, we determined the independent cross-sectional associations of baseline CAC volume and density, measured by non-contrast cardiac CT, with LVM, measured by MRI. In 2432 participants with prevalent CAC (density can only be assessed in those with CAC > 0), the mean age was 66 ± 10 years, 59% were men, 50% were European-, 22% were African-, 20% were Hispanic-, and 13% were Chinese-Americans. Median (25-75 th ) CAC volume was 78 (23-259) mm 3 , mean CAC density was 2.7 ± 0.7, and mean LVM was 151 ± 41 grams. CAC density and natural log ( ln ) CAC volume were correlated (correlation coefficient=0.60, P-value < 0.01). Multivariable linear regression models investigated associations of ln (CAC volume) and CAC density with LVM. Model 1 adjusted for demographics (age, sex, and ethnicity) and body surface area. Model 2 included Model 1 plus CVD risk factors (smoking status, fasting glucose, total and HDL cholesterol, systolic blood pressure, and use of medications for hypertension, diabetes, and abnormal lipids). In fully adjusted models one log unit increase in CAC volume as associated with 1.7 gram increase in LVM (Beta = 1.7, 95% CI: 0.7 to 2.6, P < 0.01). In contrast, a unit increase in CAC density was associated with 1.9 gram decrease in LVM (Beta = -1.9, 95% CI: -3.9 to 0.1, P = 0.07). Higher CAC volume, but not CAC density, was cross-sectionally associated with higher LVM; a risk factor for HF. Higher calcium density of coronary artery plaques may not be a hazard for ischemic heart disease mediated increase in LVM. Future studies should determine independent associations of CAC volume and density with incident HF.

Abstract P077: Validation of the Pooled Cohort Equations for CVD Risk Assessment in African Americans: The Jackson Heart Study

Background: Cardiovascular disease (CVD) risk assessment tools such as the Framingham Risk Score are useful to identify population high risk subgroups for targeted intervention. However, no CVD risk score specific for African Americans (AAs) were available until the Pooled Cohort Equations (PCE) was introduced in 2013 for calculating sex- and race-specific10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD). This study evaluated the performance of PCE in the Jackson Heart Study (JHS), a prospective cohort study of CVD in AAs. Methods: The analytic sample included 2,191 JHS participants who were 40-79 years old without a history of CVD or CVD procedures at baseline (2000-2004) and who were not a shared participant in the Atherosclerosis Risk in Communities (ARIC) Study. ASCVD events (CHD and stroke) were ascertained by active surveillance with medical records abstraction. Because all participants were followed at least 8 years through 2012, validation of the PCE was based on 8-year observed and predicted risks of ASCVD. The PCE was evaluated for discrimination and calibration properties using c-index and Hosmer-Lemeshow (HL) x 2 statistic, respectively. Overall and subgroup analysis among participants (no diabetes, LDL between 70 and 189 mg/dL and not taking statins) for whom CVD risk assessment may be applied to guide treatment for high blood cholesterol were performed. Stratified analyses evaluating the performance of PCE by baseline characteristics, including sex, age (<50/≥50 years), income (affluent*/not affluent), education (<high school/≥high school), BMI (<30/≥30), diabetes status (yes/no), self-reported use of hypertension medications (yes/no), self-reported use of statins (yes/no) and current smoking status (yes/no) were also performed. Results: There were a total of 63 incident ASCVD events (29 CHD; 34 stroke). The PCE predicted total number of event was 130, with a c-index=0.78 (95% CI 0.54-0.96) and a HL x 2 =38.2 (p<0.001). The PCE showed a similar discrimination but better calibration property in the subset of participants for whom CVD risk assessment may be applied to guide treatment for high blood cholesterol (n=1,576, c-index=0.78, 95% CI 0.43-1; HL x 2 =21.9, p=0.005). In stratified analyses, PCE had better calibration in participants who were younger (n=831, HL x 2 =10.5, p=0.23), not affluent (n=1,120, HL x 2 =12.6, p=0.12), less educated (n=186, HL x 2 =6.6, p=0.58), those with lower BMI (n=833, HL x 2 =8.5, p=0.39), those with diabetes (n=287, HL x 2 =11.1, p=0.20), and statin users (n=159, HL x 2 =10.8, p=0.21). Conclusions: Overall, the PCE showed good discrimination but did not calibrate well and overestimated the risk of ASCVD. In the subset of participants for whom CVD risk assessment may be applied to guide treatment for high blood cholesterol, the PCE showed improved calibration but still overestimated risk. *Defined as 3 times above poverty level.

Abstract MP023: Changes in Systolic Blood Pressure Differs by Immigration History in a Cohort of Older Mexican Americans

Background: Studies on immigrant health suggest that foreign-born individuals have better health outcomes than their native-born counterparts due to health selection. However, effects of immigration history on changes in cardiovascular conditions and risk factors are less well understood. Objective and Hypothesis: We examined the association between immigration history and change in systolic blood pressure (SBP). We hypothesized that Mexican Americans born outside the US and immigrated after age 30 (FB30+), would have lower SBP at baseline and have slower increase in SBP compared to people who were born in the US (US-B) or immigrated from Mexico before age 30 (FB<30). Methods: Participants come from the Sacramento Area Latino Study on Aging (n=1789), a longitudinal cohort of community-dwelling older Mexican Americans (mean age=70.6 years); 51% were born in Mexico. Immigration history was categorized as US-B, FB<30, and FB30+. SBP measures were available at baseline and at five follow-ups over ten years. A mixed effects linear model was used to examine the association between immigration history and SBP. Other covariates included gender, education, current hypertension medication use, and baseline measures of age, BMI, and diabetes. Follow up time was defined as time since enrollment. Quadratic time was included to account for non-linear change in SBP. Two interaction terms (immigration history x linear time and immigration history x quadratic time) were included to assess differences in SBP change by nativity. Results: The study included 1598 participants after exclusions. The figure shows the predicted average SBP by immigration history over the study period, derived from the mixed linear model. Compared to US-B, the FB<30 and FB30+ experienced an average of 7.3 (95% CI 2.0-12.7) and 7.9 (95% CI 2.2-13.5) mmHg increase in SBP over the study period, respectively. Conclusions: In contrast to current literature, immigrants appeared to be at greater risk for adverse cardiovascular risk factors.

Abstract P054: Translation of Diabetes Interventions Into Community Settings: 12-month Results of the Lifestyle Intervention for the Treatment of Diabetes Trial

Objective: Professionally delivered intensive lifestyle weight loss interventions (LWLs) have been shown to improve weight status and CVD risk factors among adults with diabetes in rigorously conducted trials. We report the 12-month results of a trial in which a LWL was delivered by community health workers (CHWs), among predominantly minority and/or lower socioeconomic status participants. Research Design and Methods: We recruited overweight or obese adults with diabetes and without CVD primarily via review of electronic medical records and physician referrals. The study featured two 12-month interventions: (1) LWL delivered by trained CHWs in community settings which involved weekly group sessions and 3 individual sessions with an interventionist, or (2) diabetes self-management education (DSM) comprised of 12 monthly group sessions delivered at a primary care clinic. The main outcome was change in United Kingdom Prospective Diabetes Study (UKPDS) estimated 5-year CVD risk at 12 months; secondary outcomes included weight loss, UKPDS risk score components (hemoglobin A1c, blood pressure, lipids) and use of medications affecting these components. Results: We screened 1102 and randomized 260 adults (age range 23-83, mean 55.9, 67% female, 48% black, 52% < college degree, mean A1c 7.6%, 37.3% A1c<7%, mean BMI 37.7 kg/m 2 ). Baseline demographic and CVD risk factors were equally distributed between the 2 groups of 130 participants each. At 12 months, 92.3% of LWL and 98% of DSM participants were retained. There was not a significant difference in 5-year UKPDS estimated CVD risk by arm (increased from 5.1% to 5.9% in LWL, and 5.5% to 6.1% in DSM, group comparison p=0.61). There was no evidence of effect modification by the pre-specified parameters of gender, race/ethnicity or baseline BMI. Follow-up A1c, SBP, and total cholesterol did not significantly differ by arm. Weight loss was greater in LWL compared to DSM participants (mean of 3.2% vs 1.1% of total body weight, p=0.02). At least 5% weight loss was achieved by 30.8% of LWL and 18.1% of DSM participants (p=0.02). Among LWL participants, 11.7% discontinued their diabetes medication compared to only 1.6% of DSM participants (p=0.005); 87.5% of those who discontinued medication had achieved an A1c<7% at follow-up, compared to 36.8% who continued using diabetes medication. Hypertension and lipid lowering medication use did not differ by arm. Conclusions: In a diverse sample of adults with diabetes, a CHW-delivered LWL intervention produced greater weight loss compared to a monthly DSM education, but did not appreciably alter 5-year UKPDS-estimated CVD risk, A1c, or CVD risk factors. The average weight loss achieved (3.2%) may not have been sufficient to produce meaningful changes in metabolic functioning and CVD risk factors, however, some participants in both interventions achieved improved glycemic control without use of medications.

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN).

BackgroundAntihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women.Methods and ResultsParticipants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42–52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow‐up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95% CI, 2.24–3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95% CI, 1.93–2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95% CI, 1.55–2.45) compared with whites. Use of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β‐blocker usage did not decrease over time.ConclusionsAmong this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.

Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.

Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity.

Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome. Blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI = 41.1 kg/m2 ) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores. Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR = 1.46, 95% CI = 1.00-2.13, P = 0.052). Higher WBI predicted greater odds of having high triglycerides (OR = 1.88, 95% CI = 1.14-3.09, P = 0.043). Analyzed categorically, high (vs. low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps < 0.05). Individuals with obesity who self-stigmatize may have heightened cardiometabolic risk. Biological and behavioral pathways linking WBI and metabolic syndrome require further exploration.

Albuminuria is an independent risk factor of T4 elevation in chronic kidney disease

This study was to explore the association between thyroid dysfunction and albuminuria. 581 cases with chronic kidney disease (CKD) were included in this study. The clinical characteristics consisted of sex, age, serum creatinine, urinary albumin-to-creatinine ratio (ACR), thyroid function were recorded. Estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI four-level race equation. Prevalence of different thyroid diseases was calculated by chi-square test. Levels of thyroid hormone were compared among different albuminuria groups by Kruskal-Wallis test. Spearman’s correlation was used to assess the association between albuminuria and thyroid hormone. Our study showed that total T4 and free T4 were significantly different among ACR < 30 mg/g, 30–300 mg/g and >300 mg/g (P < 0.001 and =0.007, respectively). Positive correlation between T4 (total T4 and free T4) and albuminuria was evaluated by correlation analysis (P = 0.001 and <0.001, respectively). Albuminuria was an independent influence factor of T4 after adjustment for age, sex, serum creatinine, albumin, hs-CRP, smoking status, systolic blood pressure, diabetes mellitus, medication use for diabetes mellitus, eGFR, LDL-cholesterol, triglycerides, hypertension, and medication use for hypercholesterinemia. In conclusion, T4 was positively correlated with albuminuria, and it was completely not consistent with our anticipation. Further study is needed to elucidate the causation association between albuminuria and T4.

Hypertension medication use among past 30-day marijuana users in a community sample from northeast Florida

Hypertension medication use among past 30-day marijuana users in a community sample from northeast Florida

Pre-eclampsia and risk of subsequent hypertension: in an American Indian population

ABSTRACTBackground and Objectives: Pre-eclampsia (PE) shares a number of proposed pathophysiologic mechanisms related to those implicated in cardiovascular disease (CVD), such as endothelial dysfunction, inflammation, insulin resistance, and impaired renal regulation. PE has also been associated with subsequent hypertension, CVD, and related mortality in later life. Methods: At follow-up, the four most recent blood pressures, body mass index (BMI), and use of hypertensive medications were recorded from clinic visits of 130 PE cases and 289 normal pregnancies. Student’s t test, Chi-square testing, multivariate linear, and logistic regression were used in analysis. Results: Follow-up measurements occurred a mean of 13.11 years post PE pregnancy. Multivariate linear regression showed a significant and independent association between current systolic blood pressure and previous history of PE (β = 4.47, p = 0.04), while adjusting for age, BMI, and blood pressure from 1 year prior to and up to the 20th week of gestation. A similarly adjusted multivariate logistic regression model found an odds ratio of 3.43, 95% CI 1.83–6.43, p = 0.001 for subsequent hypertension. Logistic regression analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with subsequent hypertension. Discussion and Conclusions: PE appears to confer risk of subsequent hypertension on this cohort of American Indian women within as little as 8 years. This risk is independent of additional risk factors such as increased age, BMI, and blood pressure prior to 20 weeks of gestation. There is evidence of increased risk among those with more severe PE.

Lipid Changes Around the Final Menstrual Period Predict Carotid Subclinical Disease in Postmenopausal Women.

Atherogenic changes in lipids occur among women around the time of the natural menopause, that is, within 1 year of the final menstrual period (FMP). We investigated whether lipid changes around the FMP are related to carotid intima-media thickness, interadventitial diameter, and plaque in postmenopausal women. A total of 863 natural postmenopausal women with no history of heart attack or stroke underwent carotid ultrasound scans at follow-up year 12 or 13 of the Study of Women's Health Across the Nation. Estimates of their annual change in lipids were segmented into the year before and after the FMP, before the year before FMP, and 1 year after FMP. Multivariate analyses were adjusted for sociodemographic characteristics, time from FMP to scan, baseline body mass index and systolic blood pressure, and use of medications for hypertension and diabetes mellitus at the scan. Smaller increases in high-density lipoprotein cholesterol and apolipoprotein A1 within 1 year of the FMP were related to greater interadventitial diameter, β (SE)=-0.036 (0.015), P=0.02, and β (SE)=-0.035 (0.013), P=0.006, respectively. Greater increases in low-density lipoprotein cholesterol within 1 year of FMP were related to greater likelihood of plaque scores ≥2, odds ratio, 1.071; 95% confidence interval, 1.018-1.127; P=0.009. Magnitude of associations was reduced but remained significant with further adjustment for premenopausal lipid levels. The difference in probability of elevated plaque scores was 50% between those in the highest and lowest low-density lipoprotein cholesterol change tertiles. Changes in lipids as women approach the FMP provide useful clinical information for understanding postmenopausal carotid indices.

Cardiovascular Risk Factors of Adults Age 20-49 Years in the United States, 1971-2012: A Series of Cross-Sectional Studies.

BackgroundThe health of younger adults in the U.S. has important public health and economic-related implications. However, previous literature is insufficient to fully understand how the health of this group has changed over time. This study examined generational differences in cardiovascular risk factors of younger adults over the past 40 years.MethodsData were from 6 nationally representative cross-sectional National Health and Nutrition Examination Surveys (1971–2012; N = 44,670). Participants were adults age 20–49 years who self-reported sociodemographic characteristics and health conditions, and had examination/laboratory measures for hypertension, hyperlipidemia, diabetes, obesity, and chronic kidney disease. Prevalences of sociodemographic characteristics and health status were determined by study period. Logistic regression was used to determine the odds [odds ratio (OR), 95% confidence interval] of health conditions by study period: models adjusted only for age, sex, and race, and fully adjusted models additionally adjusted for socioeconomic characteristics, smoking, BMI, diabetes, and/or hypertension (depending on the outcome) were assessed.ResultsParticipants in 2009–2012 were significantly more likely to be obese and have diabetes compared to those in 1971–1975 (OR = 4.98, 3.57–6.97; OR = 3.49, 1.59–7.65, respectively, fully adjusted). Participants in 2009–2012 vs. 1988–1994 were significantly more likely to have had hypertension but uncontrolled hypertension was significantly less likely (OR = 0.67, 0.52–0.86, fully adjusted). There was no difference over time for high cholesterol, but uncontrolled high cholesterol was significantly less likely in 2009–2012 vs. 1988–1994 (OR = 0.80, 0.68–0.94, fully adjusted). The use of hypertensive and cholesterol medications increased while chronic kidney and cardiovascular diseases were relatively stable.ConclusionsCardiovascular risk factors of younger U.S. adults have worsened over the past 40 years, but treatment for hypertension and high cholesterol has improved. The sub-optimal and worsening health in younger adults may have a substantial impact on health care utilization and costs, and should be considered when developing health care practices.

Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults

ObjectiveThe aim of this study was to examine the relationship between sodium and potassium intakes and blood pressure (BP) in a clinical sample. MethodsSecondary analysis of baseline data from 328 participants (mean age: 43.6 ± 8 y, mean body mass index [BMI]: 32.4 ± 4.2 kg/m2, mean systolic BP [SBP]/diastolic BP [DBP]: 124.9 ± 14.5/73.3 ± 9.9 mm Hg) of the 12-mo HealthTrack randomized controlled weight loss trial was conducted. Resting BP and 24-h urine sodium and potassium were measured. Dietary intake was evaluated with 4-d food records and self-reported diet histories. ResultsUrinary sodium was positively correlated (Spearman's rho) with SBP (r = 0.176; P = 0.001) and DBP (r = 0.150; P = 0.003). The ratio of sodium to potassium was positively correlated with SBP (r = 0.1; P = 0.035). Urinary sodium (F [4,323] = 20.381; P < 0.0005; adjusted R2 = 0.231) and sodium-to-potassium ratio (F[4,323] = 25.008; P < 0.0005; adjusted R2 = 0.227) significantly predicted SBP after controlling for age, sex, BMI, and hypertension medication use. Dietary sodium and potassium significantly predicted urinary sodium (B = 0.33, t = 4.032, P < 0.01) and potassium (B = 0.67, t = 8.537, P < 0.01) excretion, respectively, after adjustment for energy and BMI. Median dietary sodium intake was 3197 mg/d and median dietary potassium intake was 2886 mg/d. Cereal-based products and dishes were the major contributors (22%) to total sodium intake. ConclusionsIn the present study, a high dietary sodium intake and high sodium-to-potassium ratio predicted high SBP. This suggests a need to focus dietary advice on reduction of sources of sodium and increasing sources of potassium in weight loss interventions to improve BP control.

Serum fibroblast growth factor-23 and incident hypertension: the Atherosclerosis Risk in Communities (ARIC) Study.

Elevated serum fibroblast growth factor-23 (FGF23), an endogenous hormone, is associated with disturbed mineral homeostasis, cardiovascular disease, and chronic kidney disease. It is unclear whether FGF23 impacts the development of incident hypertension. We examined the association between elevated FGF23 and incident hypertension in a community-based cohort. We investigated the association of serum FGF23, measured at baseline (1990-1992), with incident hypertension at two follow-up visits (1993-1995 and 1996-1998) in 7948 middle-aged men and women without hypertension at baseline participating in the Atherosclerosis Risk in Communities Study. Incident hypertension was determined by measured blood pressure (DBP ≥ 90 mmHg or SBP ≥ 140 mmHg) and/or self-reported hypertension medication use at follow-up exams. Complementary log-log models that accounted for interval censoring were used to model the association between FGF23 and incident hypertension. During a median follow-up of 5.9 years, 27% (2152/7948) participants developed hypertension. A nonlinear association between serum FGF23 and incident hypertension was observed; only persons in the highest decile of serum FGF23 had an increased risk of incident hypertension. After adjustment for demographics, behaviors, and adiposity, the hazard ratio for incident hypertension was 1.24 (95% confidence interval: 1.11, 1.39) for the highest decile of FGF23 compared with the lowest quintile. The association was further attenuated in the final model after adjusting for renal function (hazard ratio: 1.21, 95% confidence interval: 1.08, 1.35). High levels (≥60.6 pg/ml) of FGF23 are associated with a modestly increased risk of incident hypertension in the general population, independent of kidney function.

Abstract P089: Pre-eclampsia and Risk of Subsequent Hypertension: In an American Indian Population

Background and Objectives: Preeclampsia (PE) is a pregnancy-specific disorder that affects 2-8% of all pregnancies and as many as 60,000 annual maternal mortalities globally. A number of proposed pathophysiologic mechanisms relate to similar factors implicated in cardiovascular disease, such as endothelial dysfunction, inflammation, insulin resistance and impaired renal regulation. Pre-eclampsia has been associated with subsequent hypertension, cardiovascular disease and related mortality in later life. Methods: The 3 most recent blood pressures, body mass index (BMI) and use of hypertensive medications were recorded from electronic medical records of routine clinic visits for 130 cases and 289 controls previously identified and carefully characterized for a study of the etiology and complications of PE. Comparison between case and control groups was made using the student t test for continuous variables and chi-square testing for discrete variables. Linear regression analysis was used to evaluate the effects of risk factors on subsequent systolic and diastolic blood pressure (SBP and DBP respectively). Results: Follow-up measurements occurred a mean of 13.11 years (range 3.6 to 36.7 years) post PE pregnancy. Cases were of similar age (35.9 vs 36.1 years, p=0.82); but with significantly higher BMI (34.1 vs 31.6, p&lt;0.002), systolic (127.2 vs 121.3 mm Hg, p&lt;0.001 and diastolic (76.2 vs 72.6 mm Hg, p&lt;0.001) blood pressure, and more likely to be using hypertensive medications (35/130, 27% vs 25/289, 9%, p&lt;0.001). Linear regression showed significant and independent association between BMI (SBP β=0.47, DBP β=0.29), age (SBP β=0.19, DBP β=0.14), previous history of PE (SBP β=4.47, DBP β=2.71) and current systolic and diastolic blood pressure (all p values &lt;0.002). Analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with both SBP (β=6.54, p&lt;0.006) and DBP (β=4.96, p&lt;0.001). Discussion and Conclusions: PE appears to confer risk of subsequent hypertension on American Indian women after a period of at least 13 years. This risk is independent of additional risk factors such as increased BMI and age. The risk is apparent soon after the affected pregnancy and there are undoubtedly cases where the hypertension of PE fails to resolve post partum.

Abstract MP35: Relation of Left Ventricular Structure to Incident Heart Failure in African Americans: The Jackson Cohort of the Atherosclerosis Risk in Communities Study

Introduction: Studies in non-Hispanic whites suggest that early adaptive changes in cardiac structure due to hypertension may influence the development of heart failure (HF). The predictive value of left ventricular (LV) structure to incident acute decompensated HF (ADHF) has not been well-studied in African Americans (AA) despite the higher incidence of HF in this group. Hypothesis: We hypothesized that incidence of ADHF in AA varies according to cardiac structures and LV geometry type. Methods: The study sample included 1,737 participants who attended the third examination cycle of the Jackson cohort of ARIC between 1993 and1995 and underwent echocardiography, anthropometry and phlebotomy for glucose and lipids. Left atrial size, aortic root diameter (AOD), LV wall thicknesses and chamber dimensions, LV mass, LV mass index, LV hypertrophy (LVH) and LV geometric patterns [normal geometry, concentric hypertrophy, eccentric hypertrophy (EH), concentric remodeling] were determined by echocardiography. Cutoff for LVH was defined as above the 80th percentile of LV mass index. HF data was available up to December 31, 2011. In the primary analyses we adjusted for age, sex, smoking, diabetes, body mass index, systolic blood pressure, and use of hypertension medications in the multivariable model. Results: Over a follow-up period of approximately 18 years, 188 participants developed ADHF. Incident ADHF was significantly related to AOD [HR 1.42 (1.03, 1.97)], LV internal diameter in diastole (cm) [HR 1.60 (1.24, 2.05)], LV mass [HR 1.003 (1.002, 1.005)], LVM index [HR 1.01 (1.004, 1.02) and LVH [HR 1.62 (1.16, 2.27)]. In terms of LV geometry, EH was significantly related to incident ADHF in the multivariable model [HR 2.94 (1.70-5.10)]. Conclusion: In our large community-based sample of AAs, we observed that AOD, LV internal diameter in diastole, LV mass, LV mass index, LVH and EH geometry were significantly related to long-term incidence of ADHF independent of standard risk factors. These findings suggest echocardiography may be helpful in risk stratifying members of this high risk population for ADHF.

Abstract P237: Cardiovascular Disease Risk Factor Associations with Volume and Density Components of Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction: Coronary artery calcium (CAC) strongly predicts incident cardiovascular disease (CVD) beyond traditional risk factors. CAC volume and density can be determined separately. CAC volume is positively associated with CVD risk, whereas CAC density is inversely associated with CVD risk. Hypothesis: We assessed the hypothesis that traditional CVD risk factors would associate differently with CAC volume than with CAC density. Methods: Baseline measurements from 6814 community-dwelling participants free of known CVD were collected for the Multiethnic Study of Atherosclerosis between 2000 and 2002. The 3398 CAC-positive participants were included in these analyses. Multivariable linear regression models were used to evaluate independent risk factors for CAC volume and CAC density separately. Results and Conclusions: Standardized beta coefficients for risk factors significantly associated with increased CAC volume in the multivariable linear regression model included age (β=0.34), male gender (β=0.48), diabetes (β=0.38), current smoking (β=0.27), hypertension medication use (β=0.18), family history of MI (β=0.21), body mass index (β=0.17), total cholesterol (β=0.06), and reduced walking pace (β=0.12). Compared to the non-Hispanic white (NHW) reference group, Chinese (β=-0.62), African-American (β=-0.48), and Hispanic (β=-0.47) race/ethnicities had decreased CAC volume. Risk factors positively associated with increased CAC density in the multivariable linear regression model included HDL (β=0.03), and Chinese (β=0.39), African-American (β=0.16), and Hispanic (β=0.18) race/ethnicities in comparison with NHW. Diabetes (β=-0.10) and body mass index (β=-0.08) were both inversely associated with CAC density. In conclusion, CVD risk factors predicted both increased CAC volume and decreased CAC density, suggesting they could increase atherosclerotic risk both by increasing CAC volume and decreasing CAC density. Ethnic groups other than NHW had lower risk CAC plaques, with lower volume and greater density.

Psychotropic and stimulant medication (PSM) use among testicular cancer survivors (TCS): A multi-institutional clinical study of 680 patients given cisplatin-based chemotherapy (CHEM) (NCI 1R01 CA157823-02).

242 Background: Testicular cancer (TC) is the most common cancer in men aged 15-40, with survival rates after diagnosis &gt; 95%. Testicular cancer survivors (TCS) are known to be at increased risk for certain acute and chronic medical conditions, but few studies have examined barometers of their psychological health. The objective is to characterize the prevalence of PSM use and associations with demographics, health behaviors, and treatment-associated toxicities among TCS. Methods: TCS aged &lt; 50 years at first-line CHEM completed a questionnaire regarding co-morbidities and prescription drug use, including PSMs. For co-morbidities, peripheral neuropathy (PN) responses of ‘a little’, “quite a bit”, or “very much” were scored ‘yes.’ Fisher’s exact test was used to examine the significance of various associations. Results: Among the first 680 consecutively enrolled TCS, median age at TC diagnosis was 31y (range, 15-49y) and median time since CHEM completion was 52mo (range 12-360mo). 85 TCS (12.5%) reported PSM use, including antidepressants (N = 65 [76.5%]), anxiolytics (N = 23 [27%]), and stimulants (N = 21 [25%]) with 20 TCS on ≥ 2 PSMs (23%). Compared to non-users, more PSM users were unemployed (11.8% vs. 4.4%%; P &lt; .01), self-rated their health as fair/poor (12.2% vs 4%; P &lt; .01), and had gained &gt; 20lb since CHEM (39.8% vs 23.4%;P &lt; .01). PSM users were more likely to have tinnitus (49.4% vs. 36.4%; P &lt; 0.04), both tinnitus and PN (43.5% vs. 27.2%; P &lt; 0.01), cardiovascular disease (26.2% vs. 15.6%; P &lt; .02), and greater use of prescription medications for pain control (20% vs. 4.7%; P &lt; 0.01), hypertension (16.5% vs. 7.1%; P &lt; 0.01), diabetes (8.3% vs. 2.9%; P &lt; 0.02), and testosterone replacement (10.6% vs. 5.0%; P = 0.048). Conclusions: Future studies should aim for identification of high-risk patients in need of intensified preventive and therapeutic interventions.

Hypertension, Diuretic Use, and Risk of Hearing Loss

BackgroundHearing loss is highly prevalent among adults in the United States. Hypertension also is common and often treated with diuretics. Hypertension may increase the risk of hearing loss by decreasing vascular supply to the stria vascularis. Use of thiazides has been anecdotally associated with hearing loss. In small studies, furosemide use has been associated with hearing loss that is usually reversible, but can be permanent. We investigated the relation among hypertension, diuretic use, and hearing loss in a prospective cohort of 54,721 women in the Nurses' Health Study I, 1994 to 2012. MethodsEligible participants included 54,721 female nurses aged 48 to 73 years in 1994 who provided information on thiazide diuretic and furosemide use in 1994, answered the question on hearing loss over their lifetime in 2012, and did not report hearing loss with date of onset before date of onset of hypertension diagnosis or medication use. The outcome was self-reported hearing loss. Cox proportional hazards regression was used to adjust for potential confounders. ResultsDuring 774,096 person-years of follow-up, 19,296 cases of hearing loss were reported (incidence rate, 25 cases per 1000 person-years). At baseline in 1994, the mean age was 57.9 years and mean body mass index was 26.3 kg/m2. Some 30.8% of participants had a history of hypertension. History of hypertension was independently associated with a modestly higher risk of hearing loss (multivariable adjusted relative risk, 1.04 [1.01-1.07]). Among women with a history of hypertension, neither thiazide diuretic (multivariable adjusted relative risk, 1.07 [0.99-1.16]) nor furosemide use (multivariable adjusted relative risk, 0.91 [0.75-1.09]) was significantly associated with risk of hearing loss when compared with women not taking antihypertensive medications. There was no significant effect modification by age. ConclusionsHistory of hypertension was associated with a small increased risk of hearing loss. Thiazide diuretic use and furosemide use were not associated with risk of hearing loss among women with a history of hypertension.

Abstract 10209: The Severity of the Metabolic Syndrome Increases over Time within Individuals, Independent of Baseline Metabolic Syndrome Status and Medication Use: The Atherosclerosis Risk in Communities Study

Background: Clinical significance of traditional ATP-III metabolic syndrome (MetS) is a subject of debate, possibly due to its inability to track disease progression over time. We have developed a continuous MetS severity z-score such that the relative contributions of each of the MetS components to the overall severity score vary by sex- and race/ethnicity, and thus the score changes over time with MetS components. We aim to examine how MetS severity changes over time within individuals. Methods: Changes in MetS severity score were assessed over a 12-year period (Visits 1-4) among 9,291 participants of the Atherosclerosis Risk in Communities study, after excluding those with baseline MetS, CVD or diabetes. Age-adjusted rate of change in the MetS severity score and MetS prevalence as assessed using ATP-III MetS criteria were compared among sex- and racial/ethnic subgroups. Further, effects of age (&lt;50, 50-60, and &gt;60 years) and use of medications for hypertension, diabetes and dyslipidemia on MetS severity progression were examined. Results: MetS severity z-scores increased among 76% of participants between visits 1 and 4, with an overall increase in z-score from 0.08 (±0.77) at baseline to 0.48 (±0.96) at visit 4. The greatest progression was observed among African-American women. Baseline MetS severity z-scores predicted the time until ATP-III MetS diagnosis, with 90.2% of individuals with score of ≥1.0 (n=1,097) progressing to ATP-III MetS by visit 4. Score progression was higher among those younger (&lt;50 years) at baseline but was independent of baseline MetS status or the use of medications to treat blood pressure, lipids and diabetes. Conclusion: The severity of metabolic derangements as measured using this sex- and race/ethnicity specific MetS z-score increases over time within individuals and predicts diagnosis of ATP-III MetS. These data may have implications for tracking MetS related risk over time within individuals.