Systolic Blood Pressure In Women Research Articles

The prone position in healthy pregnant women and in women with preeclampsia \u2013 a pilot study

BackgroundThe prone position is rarely used in medical settings in pregnancy. There is no published information about the prone position in women with preeclampsia. This study examined the feasibility and acceptability of the prone position in pregnant women, and the short-term effect of the prone position on blood pressure (BP) in term healthy pregnant women and in women with preeclampsia.MethodsAfter ethics approval, written consent and trial registration (ACTRN:12615000160538 registered 18/02/2015, date of first participant enrolled 03/03/2015), 50 healthy term pregnant women and 15 women with preeclampsia had BP, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), fetal heart rate (FHR) and comfort levels measured in two positions: left lateral, and prone. Measurements were after five minutes rest in each position.ResultsMean ± SD age, gestation and body mass index for healthy pregnant women was 33 ± 4.1 years, 38 ± 1.0 weeks and 27 ± 3.2 kg.m− 2 and for women with preeclampsia was 32 ± 4.7 years, 36 ± 3.4 weeks, 31 ± 5.6 kg.m− 2 respectively. No clinically significant changes occurred in healthy pregnant women in the prone position. Systolic BP was reduced in the prone position in women with preeclampsia (P = 0.019, mean difference − 6.6 mmHg, 95% confidence interval − 11.9 to − 1.3 mmHg). 33% of women with preeclampsia experienced a 10 mmHg or greater reduction in systolic BP in the prone position. 42% of healthy pregnant women and 47% of women with preeclampsia preferred the prone position to lateral.ConclusionsThis is the first study to examine the prone position in women with preeclampsia. For short periods of time the prone position is feasible and comfortable in pregnant women including those at term. The prone position may reduce systolic BP in women with preeclampsia without obvious adverse effects. Larger studies with women lying for longer periods in the prone position are required. Pregnancy should not be a contraindication to the prone position for short periods of time.Trial registrationACTRN:12615000160538

Mineral Intake Ratios Are a Weak but Significant Factor in Blood Pressure Variability in US Adults

BackgroundHypertension contributes substantially to chronic disease and mortality. Mineral intakes can modify blood pressure. ObjectiveIndividual minerals and their intake ratios in US adults and their association with blood pressure were examined. MethodsRegression models were used to examine the associations of sodium, potassium, and calcium intakes and their ratios from food and supplements with blood pressure in 8777 US adults without impaired renal function from the 2011–2014 NHANES. We evaluated men (n = 4395) and women (n = 4382) separately. Models for predicting blood pressure were developed using age, blood pressure medication, race, body mass index (BMI), and smoking as explanatory variables. ResultsFew adults met the recommended intake ratios for sodium:potassium (1.2% and 1.5%), sodium:calcium (12.8% and 17.67%), and sodium:magnesium (13.7% and 7.3%) for men and women, respectively. Approximately half of adults (55.2% of men and 54.8% of women) met calcium:magnesium intake ratio recommendations. In our regression models, the factors that explained the largest amount of variability in blood pressure were age, blood pressure medication, race/ethnicity, BMI, and smoking status. Together, these factors explained 31% and 15% of the variability in systolic blood pressure in women and men, respectively. The sodium:potassium (men and women), sodium:magnesium (women), and sodium:calcium (men) intake ratios were positively associated with systolic blood pressure, whereas calcium intake was inversely associated with systolic blood pressure in men only. When mineral intake ratios were added individually to our regression models, they improved the percentage of variability in blood pressure explained by the model by 0.13–0.21%. ConclusionsStrategies to lower blood pressure are needed. Lower sodium:potassium intake ratios provide a small benefit for protection against hypertension in US adults.

Predictive performance of obesity indexes for the risk of high blood pressure in an adult population

Comparisons of predictive performance of various anthropometric measures in high blood pressure have not been investigated. This study aimed at evaluating and comparing the predictive power of Body Mass Index (BMI), Body Adiposity index (BAI) and A Body Shape Index (ABSI) for predicting hypertension in adults.The data of 277 subjects (109 men and 168 women) as a part of the major Lifestyle Promotion Project (LPP) conducted in the districts of Tabriz-East Azerbaijan-Iran were collected for this study. The weight, height, waist and hip circumferences were measured and BMI, BAI and ABSI were calculated. Blood pressure was measured twice, after 5 minutes of rest. The ANOVA and Receiver Operating Characteristic (ROC) were used for statistical analysis.In all subjects, BMI (area under the curve (AUC): 0.65) predicted systolic blood pressure equally (P<0.05). None of them had a significant prediction for diastolic blood pressure. By gender, considering P-value (P<0.05), BMI predicted systolic in men (AUC: 0.71) and women (AUC: 0.61) and diastolic blood pressure only in men (AUC: 0.79). In addition systolic blood pressure in women was predicted by both BAI (AUC: 0.66) and ABSI (AUC: 0.67). Furthermore, BAI (AUC: 0.82) predicted diastolic blood pressure in men.Although it was claimed that ABSI and BAI as the indexes of high waist circumference and body fat percent respectively, express the excess risk, based on our results, they are not better alternative than BMI in the clinical evaluation for screening for high blood pressure.

Leptin Levels and Insulin Dependence in Latent Autoimmune Diabetes in Adults.

Latent autoimmune diabetes in adults (LADA) is an autoimmune type of diabetes accounting for up to 10% of all cases of diabetes initially diagnosed as type 2 diabetes mellitus. It has been demonstrated that LADA patients with a lower body mass index (BMI) undergo a faster depletion of beta cell function and require insulin therapy earlier. In this study, we assayed a panel of adipokines (leptin, adiponectin, omentin, resistin, visfatin) and proinflammatory cytokines (interleukin 2, interleukin 6, tumor necrosis factor-α) in 71 LADA patients and tested the association with a number of clinical and immunological features. Among men, leptin was positively and significantly correlated with BMI and fat mass (r = 0.487 and r = 0.664, respectively), resistin was positively and significantly correlated with total and low-density lipoprotein cholesterol (r = 0.644 and r = 0.746, P < 0.0001) and with interleukin 2 (r = 0.688, P < 0.01). Omentin showed an inverse correlation with systolic blood pressure in women (r = -0.359, P < 0.001) and a positive correlation with interleukin 2 in both genders (r = 0.395, P < 0.01). The Cox regression analysis showed that leptin levels were inversely and significantly related with the risk of early insulin dependence. Higher leptin secretion may exert a direct effect on beta cell function leading to more insulin sensitivity.

Prevalence and extent of coronary artery calcification in an asymptomatic cardiovascular Mexican population: Genetics of Atherosclerotic Disease study

The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. The sample included 1,423 individuals (49.5% men), aged 53.7±8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC>0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC>0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).

Abstract P165: Effects of Lactation on Postpartum Blood Pressure among Women with Gestational Hypertension and Preeclampsia

Introduction: Lactation is associated with improved maternal blood pressure (BP) in later life and in the postpartum period among normotensive women. However, little is known about whether lactation is also cardio-protective in women with pregnancy-related hypertensive disorders. This study aimed to characterize the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy compared to those who developed preeclampsia or gestational hypertension. Hypothesis: Lactation will be associated with lower postpartum BP, particularly in women with hypertensive disorders of pregnancy. Methods: Data were obtained from a cohort of normotensive women who participated in the Prenatal Exposures &amp; Preeclampsia Prevention study (n=651; 65% African American; 83% overweight or obese prior to pregnancy). Women were enrolled during pregnancy and attended a postpartum visit where data on lactation and BP were collected following a standardized protocol. Analysis of variance (ANOVA) was used to assess the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy, developed gestational hypertension (2 or more BP measurements &gt;140/90), or developed preeclampsia (gestational hypertension plus proteinuria). Further analyses adjusted for age, race, smoking, prepregnancy weight, and time since delivery. Results: A total of 439 women attended the postpartum study visit (mean time since birth 8.5 months); 50 (11%) developed gestational hypertension, and 38 (9%) preeclampsia. Lactation was reported by 246 (56%) with 84 (19%) reporting lactation for ≥ 6 months. Women who lactated were older, wealthier, and more likely to plan to lactate compared to those who did not lactate. There was no association between lactation duration and postpartum systolic BP for women who remained normotensive during pregnancy (never lactated: 111.0 mmHg vs. lactated ≥ 6 months: 112.9 mmHg, p=0.83) nor among women who developed preeclampsia (never lactated: 121.3 mmHg vs. lactated ≥ 6 months: 128.3 mmHg, p=0.35). However, greater lactation duration was associated with lower systolic BP among women who developed gestational hypertension (never lactated: 127.8 mmHg vs. lactated ≥ 6 months: 109.4 mmHg, p=0.04). This relationship remained significant after adjusting for covariates. Similarly, lactation was associated with lower postpartum diastolic BP only for women with a history of gestational hypertension. Conclusions: Lactation appears to lower postpartum BP among women who develop gestational hypertension, but do not develop preeclampsia. Future work should investigate the mechanisms driving the relationship between lactation and postpartum BP in gestational hypertension.

The traditional Japanese dietary pattern and longitudinal changes in cardiovascular disease risk factors in apparently healthy Japanese adults.

Few epidemiological studies have assessed the relationship between the traditional Japanese dietary pattern and longitudinal changes in cardiovascular disease risk factors among Japanese people. We designed a 3-year longitudinal study of 980 subjects living in Japan to evaluate how the Japanese dietary pattern is related to longitudinal changes in well-recognized risk factors for cardiovascular disease among apparently healthy Japanese adults. Dietary consumption was assessed via a validated food frequency questionnaire. Principal component analysis was used to derive three major dietary patterns-"Japanese," "sweets-fruits-cooked wheaten food," and "Izakaya (Japanese Pub)" from 39 food groups. After adjustment for potential confounders, the mean (95% confidence interval) for the change per year in diastolic blood pressure for men, systolic blood pressure, and diastolic blood pressure for women related to the "Japanese" dietary pattern factor score tertiles were 0.89 (0.10, 1.68), 2.25 (0.19, 4.31), and 0.75 (-1.00, 2.50) for the lowest tertile, 0.77 (-0.02, 1.56), 1.01 (-1.13, 3.15), and 0.44 (-1.38, 2.26) for the middle tertile and - 0.04 (-0.81, 0.72), -0.48 (-2.52, 1.56), and -0.77 (-2.51, 0.96) for the highest tertile (trend P value = 0.03, <0.01, and 0.04, respectively). A significant detrimental relationship was found between the "Izakaya (Japanese Pub)" pattern factor score tertiles and the longitudinal change in serum triglyceride concentration only in men (trend P value = 0.02). Greater adherence to a traditional Japanese diet was independently related to a decreased change every year in diastolic blood pressure in men and women and in systolic blood pressure in women over a 3-year follow-up period. The findings suggest that the "Japanese" dietary pattern appeared to be related to a fall in blood pressure, which might have a beneficial effect on cardiovascular disease. A randomized trial is required to clarify the underlying mechanism.

Batasan indeks massa tubuh dan lingkar perut diabetesi di Indonesia untuk prediksi abnormalitas kadar HDL-kolesterol dan tekanan darah

Background: According to National Basic Health Survey (Riskesdas) 2007 and 2013 in Indonesia, diabetes prevalence had been increasing from 1,1% to 1,5%. Diabetic tends to have obesity related to abnormal blood lipid level and high blood pressure which lead to some complications such as cardiovascular diseases and hypertension. Therefore early prevention of complications is needed.Objective: This study was to identify body mass index (BMI) and waist circumference (WC) cut-off point in Indonesian diabetic as the predictor of lipid profile and high blood pressure abnormality.Method: The Crossectional study using secondary data, Riskesdas 2007. Subjects in this study were 615 diabetics who admitted been diagnosed as diabetes by physicians and/or had oral glucose test result ≥ 200 mg%. Data that had been analyzed were lipid profile (total cholesterol, LDL-chol, HDL-chol) and systolic-diastolic blood pressure, BMI (kg/cm2), WC (cm), lifestyle, and subject’s characteristic. Receiver Operating Characteristic (ROC) is used to identify BMI and WC cut-off point for predicting lipid profile and blood pressure abnormality.Results: On the average, subjects have high blood pressure and dyslipidemia. Both IMT and LP are able to predict high blood pressure and low HDL-chol significantly (AUC ≥ 59; all p&gt;0,05). BMI=23 kg/cm2 can predict low HDl-chol (Se=63,3%; Sp=54,0%; p=0,04), high systolic (Se=68,3%; Sp=60,6%; p=0,000) and diastolic (Se=68,3%; Sp=60,6%; p=0,000) blood pressure in men, whereas in women can predict only low HDL-chol (Se=72,3%; Sp=47,8%; p=0,000). LP=80 cm can screen high systolic (Se=73,8%; Sp=63,6%; p=0,000) and diastolic (Se=72,4%; Sp=55,3%; p=0,000) blood pressure in men and high systolic blood pressure in women (Se=71,5%; Sp=52,6%; p=0,000). However, to predict low HDL-chol in women, cut-off point of LP is 78 cm (Se=74,2%; Sp=41,5%; p=0,003).Conclusion: Although BMI and LP can be used to predict high blood pressure and low HDL-chol, however, both measures have the different function when they are applied to both gender. To predict low HDL-chol in men and women, BMI=23 kg/cm2 can be used, and LP=80 cm can be applied to screen high systolic blood pressure in both genders. Nevertheless, more research is needed to show the consistency of these results, such as using better study design and considering for confounding variables (ethnic, diabetes duration, lifestyle, hypertension, and diabetes medicine).

Sex‐specific acute heart failure phenotypes and outcomes from PROTECT

Differences in manifestation, treatment, and outcomes of acute heart failure between men and women have not been well studied. The objective of this analysis was to characterize differences in clinical presentation, and in-hospital and post-discharge outcomes between sexes in acute heart failure patients. Clinical profiles, treatment characteristics, and outcomes were compared between sexes in 2033 patients hospitalized for acute heart failure and impaired renal function. Women comprised 33% of the study population and were older, had higher body mass index, LVEF, and systolic blood pressure, and a greater prevalence of diabetes. At baseline, women showed signs and symptoms of congestion comparable with men, but more often had rales, orthopnoea, and worse renal function. Women were less intensively diuresed, as indicated by lower oral and intravenous diuretic doses used, fewer dose increases, and less total weight loss during hospitalization. Furthermore, hospitalization was slightly but significantly prolonged in women (11.04 ± 7.8 vs. 10.65 ± 8.86 days; P = 0.024). Age-adjusted 180-day mortality was lower in women (15.8% vs. 18.5%, hazard ratio 0.74; 95% confidence interval 0.59-0.93, P = 0.010), but multivariable risk-adjusted mortality was similar in both sexes, mainly attributable to lower blood urea nitrogen, higher LVEF, and higher systolic blood pressure in women compared with men. Women with acute heart failure present with a clinical profile different from that of men, with more hypertension, diabetes, and depression, and a preserved LVEF. During hospitalization, they were less intensively diuresed. Nevertheless, risk-adjusted 180-day outcome was similar between sexes.

Sex and Age Differences in the Relation of Depressive Symptoms With Blood Pressure

Longitudinal associations between depressive symptoms and blood pressure have been inconsistent. Most studies have examined incident hypertension as an outcome, and few have examined effect modification. This study examined moderating influences of sex and age on coincident trajectories of depressive symptoms and blood pressure among 2,087 participants from the Baltimore Longitudinal Study of Aging (aged 19-97 years; 53% men; 74% white). Participants underwent clinical blood pressure measurement and completed the Center for Epidemiological Studies-Depression (CES-D) scale on up to 14 occasions (mean = 3.8; SD = 2.6) over up to 29 years (mean = 7.8; SD = 6.4). CES-D was log-transformed (CES-D(log)) for analyses. Mixed-effects regression revealed that prospective relations of CES-D(log) to diastolic blood pressure differed by age in women (b = 0.095; P = 0.001) but not men; greater CES-D(log) attenuated the expected age-related decline in diastolic blood pressure. Across all testing sessions, greater CES-D(log) was associated significantly with higher average systolic blood pressure for women (b = 2.238; P = 0.006) but not men. Age-stratified analyses showed that greater CES-D(log) was associated significantly with higher average systolic (b = 3.348; P = 0.02) and diastolic (b = 1.730; P < 0.03) blood pressure for older adults (≥58.8 years at first visit). In the younger age cohort, sex moderated the relation of CES-D(log) to systolic blood pressure (b = -3.563; P = 0.007); greater CES-D(log) in women, but lesser CES-D(log) in men, was associated with higher systolic blood pressure. Results demonstrate sex and age differences in the relation between depressive symptoms and blood pressure. Findings suggest the potential importance of preventing, detecting, and lowering depressive symptoms to prevent hypertension among women and older adults.

Changes in physical activity and modelled cardiovascular risk following diagnosis of diabetes: 1‐year results from the ADDITION‐Cambridge trial cohort

AimsTo describe change in physical activity over 1 year and associations with change in cardiovascular disease risk factors in a population with screen-detected Type 2 diabetes.MethodsEight hundred and sixty-seven individuals with screen-detected diabetes underwent measurement of self-reported physical activity, cardiovascular disease risk factors and modelled cardiovascular disease risk at baseline and 1 year (n = 736) in the ADDITION-Cambridge trial. Multiple linear regression was used to quantify the association between change in different physical activity domains and cardiovascular disease risk factors at 1 year.ResultsThere was no change in self-reported physical activity over 12 months. Even relatively large changes in physical activity were associated with relatively small changes in cardiovascular disease risk factors after allowing for changes in self-reported medication and diet. For every 30 metabolic equivalent-h increase in recreational activity (equivalent to 10 h/brisk walking/week), there was an average reduction of 0.1% in HbA1c in men (95% CI −0.15 to −0.01, P = 0.021) and an average reduction of 2 mmHg in systolic blood pressure in women (95% CI −4.0 to −0.05, P = 0.045).ConclusionsFew associations were observed between change in different physical activity domains and cardiovascular disease risk factors in this trial cohort. Cardiovascular disease risk reduction appeared to be driven largely by factors other than changes in self-reported physical activity in the first year following diagnosis.

Cortisol, obesity, and the metabolic syndrome: A cross‐sectional study of obese subjects and review of the literature

Circulating cortisol and psychosocial stress may contribute to the pathogenesis of obesity and metabolic syndrome. To evaluate these relationships, we performed a cross-sectional study of 369 overweight and obese subjects and 60 healthy volunteers and reviewed the previous literature.Overweight and obese subjects had at least two other features of Cushing’s syndrome. They underwent measurements representing cortisol dynamics (24h urine cortisol excretion (UFC), bedtime salivary cortisol, 1 mg dexamethasone suppression test) and metabolic parameters (BMI, blood pressure (BP); fasting serum triglycerides, HDL, insulin, and glucose). Subjects also completed the Perceived Stress Scale (PSS). UFC, salivary cortisol and weight from 60 healthy volunteers were analyzed.No subject had Cushing’s syndrome. UFC and dexamethasone responses were not associated with BMI or weight. However, salivary cortisol showed a trend to increase as BMI increased (P< 0.0001), and correlated with waist circumference (WC) in men (rs=0.28, P=0.02) and systolic BP in women (rs=0.24, P =0.0008). Post-dexamethasone cortisol levels were weak to moderately correlated with fasting insulin (rs=− 0.31, P=0.01) and HOMA-IR (rs=−0.31, P=0.01) in men and systolic (rs=0.18, P= 0.02) and diastolic BP (rs=0.20, P=0.009) in women. PSS results were higher in obese subjects than controls, but were not associated with cortisol or metabolic parameters. As expected, WC correlated with fasting insulin, HOMA-IR and systolic BP (adjusted for BMI and gender; P < 0.01). Literature showed inconsistent relationships between cortisol and metabolic parameters.Taken together, these data do not support a strong relationship between systemic cortisol or stress and obesity or metabolic syndrome.

Abstract 156: Gender Differences Related to Increased Vascular Age in Hypertensive Patients

Background: Vascular age (VA) has been increasingly considered in the evaluation of hypertensive patients but the gender differences have not established yet. Objective: To characterize gender differences in clinical and vascular parameters in treated hypertensive patients with increased vascular age. Methods: A cross-sectional study was carried out to evaluate hypertensive patients on stable drug therapy, both genders, aged 30-74 years. Blood pressure (BP) was measured and ultrasonography was performed to evaluate brachial flow-mediated dilation (FMD). Carotid-femoral pulse wave velocity (cfPWV) was obtained by Complior SP and normalized by mean BP (cfPWV-N). The 10-year risk for general cardiovascular disease from Framingham Heart Study was used to calculate VA. The median of VA was 76 years, and the study population was divided into four groups: women with lower vascular age (LVA, &lt; 76 years, n=50) or higher vascular age (HVA, ≥ 76 years, n=82), men with LVA (n=26) or HVA (n=27). Results: Mean age was similar between men and women with HVA (62±5 vs 60±6 years) and with LVA (49±8 vs 51±8 years). LVA men presented greater systolic BP (143±15 vs 132±16 mmHg, p&lt;0.01) compared to LVA women, but no difference between gender was observed in HVA groups (154±15 vs 152±17 mmHg) and diastolic BP was similar in LVA (88±10 vs 88±13 mmHg) and in HVA (89±10 vs 92±14 mmHg) groups. Men with HVA presented greater cardiovascular risk (31±2 vs 18±6 %, p&lt;0.001), cfPWV (12±2 vs 10±2 m/s, p&lt;0.05), cfPWV-N (11±2 vs 9±2 m/s, p&lt;0.05) compared to HVA women. FMD was significantly reduced in HVA women compared to LVA group (11±7 vs 6±5 %, p&lt;0.01), but no significant difference was noted in men due to reduced values even in LVA group (8±5 vs 6±5 %). There was a stronger correlation of vascular age to systolic BP in women (r=0.56, p&lt;0.001) than in men (r=0,30, p&lt;0.05) although the correlation to cfPWV was stronger in men (r=0.45 and r=0.30, p&lt;0.01 for both). On the other hand, VA was inversely correlated to brachial FMD only in women (r=-0.28, p&lt;0.05). Conclusion: In this population of treated hypertensive patients, men seem to develop endothelial dysfunction earlier than women, and vascular stiffness is more exacerbated in men with higher vascular age, showing more advanced vascular disease in this gender.

OP76 Households and Health: How Small Clusters Can Influence Results

BackgroundThere have been studies suggesting that various measures of health, health behaviours or health seeking cluster within households. Previous research on the impact of omitting small clusters from analyses have...

Participation, socioeconomic status and group or individual counselling intervention in individuals at high risk for type 2 diabetes: One-year follow-up study of the FIN-D2D-project

AimsTo describe socioeconomic characteristics of participants and their effect on uptake and completion of the implementation project (FIN-D2D) for the National Type 2 Diabetes Prevention Programme. Furthermore, to assess the effectiveness of individual vs. group intervention during one-year follow-up. MethodsAt baseline, 2820 men and 5764 women aged <65 years participated in the non-randomized implementation project in primary health care setting; one-year follow-up was available for 1067 men and 2122 women. Socioeconomic status included education and occupation. Interventions were individual and/or group-based. The changes in cardiovascular risk factors and glucose tolerance were used as measures of the effectiveness of intervention. Results68.4% of the men and 69.8% of the women participated in some of the intervention modalities offered. Low education and not working were related to active participation in the intervention in men. 88.2% of men and 76.1% of women selected the individual instead of group intervention. The effectiveness of individual vs. group interventions did not differ, except for minor changes in systolic blood pressure in women and glucose tolerance in men. ConclusionsSocioeconomic status modulated participation in interventions. Both types of intervention worked equally well, but participation in group intervention was low.

Abstract P279: Trends in Treatment and Control of Vascular Risk Factors in U.S. Stroke Survivors: Results from the National Health and Nutrition Examination Surveys (NHANES), 1999-2008

Introduction: Treatment and control of vascular risk factors reduce the likelihood of recurrent stroke in stroke survivors. Current nationally-representative data are sparse regarding prevention treatment and control rates. Methods: We evaluated rates of blood pressure, cholesterol, and dysglycemia treatment and control (to goal levels) in a weighted sample of 936 adult stroke survivors using data from five consecutive two-year NHANES cycles, 1999 to 2008. We used weighted linear regression to estimate time trends. Results: The Figure shows sex-specific trends in mean systolic and diastolic blood pressure, total and HDL cholesterol, glucose, and hemoglobin A1c from 1999 to 2008. All measures remained unchanged over the study period, except for a decrease in mean (SE) systolic blood pressure in women from 142 (3.4) to 131 (1.9) mmHg, and total cholesterol in men from 5.4 (0.2) to 4.6 (0.2) mmol/L (p &lt; 0.05 for both). Blood pressure treatment rates did not change in either sex, but control rates increased in women from 23% (11 of 38) in 1999–2000 to 59% (50 of 93) in 2007–2008 (p = 0.03). Cholesterol treatment rates increased in women from 28% (19 of 73) to 34% (51 of 127) (p = 0.01) without increases in control to goal levels. In contrast, cholesterol control rates increased in men from 62% (17 of 23) to 78% (40 of 50) (p = 0.01). Dysglycemia treatment rates decreased in women from 20% (18 of 73) to 10% (15 of 127) (p = 0.02) but not in men, and control rates did not significantly change in either sex. Anti-platelet medication use also increased from 24% (36 of 157) to 34% (84 of 241) (p = 0.05). Conclusions: Despite improvements in blood pressure and cholesterol control rates in women and men, respectively, stroke secondary prevention through treatment and control of vascular risk factors remains substantially sub-optimal. Urgent action is needed to identify and close these gaps to reduce stroke morbidity and mortality in this high-risk group.

Abstract P051: Inflammation is Significantly Associated With High Blood Pressure in Females Only

INTRODUCTION The causes of high blood pressure are complex and based on an interaction between multiple biological factors and behaviours. Insulin resistance and inflammation are commonly acknowledged mechanisms in the development of CVD, while insulin resistance and relative body weight correspondingly predict the development of high blood pressure. HYPOTHESIS We aimed to compare insulin resistance, relative body weight, and inflammation in the association with SBP. METHODS In 2001-2005 a random sample of residents aged 30-74 years in the municipalities of Vara and Skövde, South-western Sweden, were invited to a survey of cardiovascular risk factors. In all 1811 participants in Vara (participation rate 81%) and 1005 participants in Skövde (70%) were enrolled. Subjects with a known history of hypertension were excluded for the current study. Specially trained nurses saw all subjects in the morning after a 10 hours over night fast, and venous blood samples were taken. A physical examination included body height and body weight (light cloths and no shoes), blood pressure was measured twice in a supine position after a 5 minutes rest (arm in heart level). The mean of the 2 measurements was used for statistical analyses. Hs-CRP and plasma insulin were analysed, and BMI and HOMA-index were calculated using standard algorithms. The log form of HOMA-ir was used in statistical analyses. Associations were explored in males and females separately using multivariate linear regression. RESULTS In all 2538 subjects, 1266 men (50%) and 1272 women (50%) without known hypertension were included. BMI and HOMA-ir were both significantly associated with SBP in both males and females, while hs-CRP was associated with SBP in women only. These factors were accordingly entered into a multivariate linear regression model also including age. In men HOMA-ir [regression coefficient, (95% confidence interval), and p-value] [5.4 (2.5-8.4), p&lt;0.001], was significantly associated with SBP, while BMI [0.2 (-0.3-0.5), p=0.087], and CRP was not [0.02 (-0.1-0.1), p=0.138]. In women all three mechanisms came out significantly; HOMA-ir [5.4 (2.2-8.6), p&lt;0.001], BMI [0.4 (0.2-0.5), p&lt;0.001], and CRP [0.2 (0.02-0.4), p=0.031]. There were statistically significant interaction terms between gender and CRP (p=0.037), and gender and HOMA-ir (P=0.045), respectively, while no corresponding interaction was found for BMI. CONCLUSIONS Our study confirms a strong impact of insulin resistance and relative body weight on blood pressure levels in both men and women. However, a significant association between hs-CRP and systolic blood pressure in women was not seen in men. Gender differences in insulin resistance and inflammation were statistically confirmed by interaction terms. These findings have implications for future research and for development of clinical practice.

Assessment of lifestyle effect on oxidative stress biomarkers in free‐living elderly in rural Japan

Oxidative stress is believed to play a crucial role in aging and age-related diseases, and is widely thought to increase morbidity and mortality in the elderly. Assessment of biomarkers of oxidative stress, such as 8-isoprostane and 8-hydroxy-2-deoxyguanosine, are considered to be useful in predicting disease risks at the population level. The aim of the present study was to assess the health status of the elderly by comparing their lifestyles and levels of oxidative stress biomarkers. We carried out a cross-sectional study where urine samples from a total of 100 elderly men and women were assayed for 8-isoprostane, 8-hydroxy-2-deoxyguanosine, selenium, cadmium and creatinine. They were asked to answer a questionnaire that included questions about their lifestyle. Most of the participants were prehypertensive, non-alcohol users and on a rich plant-based diet. There were no differences in any biomarkers of oxidative stress between men and women. 8-Isoprostane was found to correlate positively with systolic blood pressure in women, but not in men. There was a slight increase of 8-isoprostane in participants with a poor intake of vegetables, and a decrease of 8-hydroxy-2-deoxyguanosine in participants who consumed fish. Multiple regression analysis showed that oxidative stress biomarkers were positively associated with cadmium, and negatively associated with selenium and fish intake in all participants, 89% of which were non-smokers. Results from the present study show that fish intake has the potential of decreasing oxidative stress among elderly persons.

The relation between health literacy, hypertension knowledge, and blood pressure among middle-aged Japanese adults

With the growth in the popularity of the Internet, individuals' skills in finding and applying information about health issues [health literacy (HL)] are affecting their health behaviors. This study aimed to examine functional HL (FHL), critical HL (CHL), and hypertension knowledge (HK) among middle-aged Japanese adults. In addition, to measure health outcomes, we examined the relationship between HL, HK, and blood pressure (BP) level. The study included middle-aged participants who received an annual health check-up at an urban clinic in Japan. FHL, CHL, and HK were assessed using structured questionnaires. In addition, BP was obtained from the electronic medical record. Participants included 139 women and 181 men with a mean age of 54.4 years (standard deviation = 0.69). Individuals with lower reading comprehension scores in FHL were more likely to have a history of hypertension (P = 0.003) and diabetes mellitus (P = 0.02). Individuals with lower CHL had significantly higher rates of current smoking (P = 0.03) and men with lower CHL had a significantly higher waist circumference (P = 0.03). There was a significant relationship between sex and HK (P = 0.03). Systolic BP in women with higher HL and HK was significantly lower than in men with higher FHL (P < 0.001), CHL (P = 0.01), and HK (P = 0.001). Lower HL and HK were associated with a poor health status and BP level in middle-aged participants. Further research is needed to examine the role of health management in improving outcomes and to address disparities between individuals with higher and lower HL.

Relationship between plasma adipokines, inflammation, insulin resistance and subclinical atherosclerosis in newly diagnosed type 2 diabetes

Background: The aim of this study was to investigate the occurrence of subclinical atherosclerosis, evaluated by carotid artery intima-media thickness (CIMT) in subjects with newly diagnosed type 2 diabetes. Methods: A total of 167 subjects, 50 newly diagnosed type 2 diabetic subjects and 117 non-diabetic subjects were included in the study. Obese and overweight newly diagnosed type 2 diabetic patients were matched for age and BMI with obese and overweight non-diabetic subjects. Only postmenopausal women were selected. The following biomarkers were analyzed: fasting glucose, HbA1c, fasting insulin, fasting proinsulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, adiponectin, leptin, hs-CRP, urine albumin/creatinine ratio. 75 g oral glucose tolerance test was performed in all subjects. Ultrasound imaging was used to evaluate IMT of the common carotid artery. Results: CIMT was greater in newly diagnosed type 2 patients compared to non-diabetic subjects. When analyzed by BMI, the difference regarding CIMT between diabetic and non-diabetic subjects was significant only in overweight subjects, in both sexes. In univariate analysis in men with newly diagnosed type 2 diabetes, CIMT was positively correlated with age, SBP, triglycerides, leptin and negatively correlated with HDL-cholesterol and in women CIMT was positively correlated with SBP and leptin. Independent determinants of CIMT in patients with newly diagnosed type 2 diabetes were in men age (β = 0.556, p = 0.0028) and log leptin (β = 0.393, p = 0.049) and in women systolic blood pressure (β = 0.48, p = 0.026). Conclusions: Subclinical atherosclerosis is present in newly diagnosed type 2 diabetic subjects. Body fat accumulation in men and hypertension in postmenopausal women have a primary role in increase carotid intima-media thickness.