Body mass index and risk of incident hypertension over the life course: the Johns Hopkins Precursors Study

How much excess weight loss can reduce the risk of hypertension?

Background

A 25% relative reduction in the prevalence of hypertension is a global target. This meta-analysis estimated the effect of excess weight loss on hypertension.

Methods

We searched PubMed, Web of Science and Scopus until January 2016. We included prospective cohort studies addressing the association between overweight/obesity and hypertension. We expressed the strength of association using risk ratio and the excess risk using attributable risk fraction with 95% CI based on the random-effects model.

Results

We found 7617 references and included 10 studies with 173 828 participants. Compared with normal weight, the risk ratio of hypertension was 1.52 (1.37, 1.67; 9 studies, I2 = 82.4%) for overweight and 2.17 (1.84, 2.50; 9 studies, I2 = 88.9%) for obesity. The excess risk of hypertension attributable to overweight was 32% (24%, 40%; 8 studies, I2 = 85.5%) and that attributable to obesity was 47% (40%, 54%; 8 studies, I2 = 88.2%). That means, excess weight loss may reduce the risk of hypertension by between 24% and 40% in people who are overweight and by between 40% and 54% in people who are obese.

Conclusions

Excess weight loss is a vital strategy for controlling hypertension and is sufficient for achieving the global target, particularly if it is accompanied with other preventive measures.

The effect of body mass index and physical activity on hypertension among Chinese middle-aged and older population

Few studies have been conducted to explore the independent and combined associations of body mass index (BMI) and physical activity with risk of hypertension in Chinese population. A cross-sectional study of 5291 individuals (aged ≥ 40 years) selected using multi-stage sampling method was conducted from October 2013 to December 2015. In the present analysis, 55.64% of the participants were women, and the mean age of participants was 55.37 ± 10.56. Compared with individuals in normal group, the risks of hypertension were nearly double in overweight subjects (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.53–2.05) and more than three times higher in obese subjects (3.23, 2.62–4.13). Multi-adjusted odds for hypertension associated with low, moderate, and high physical activity were 1.44 (1.17–1.86), 1.40 (1.09–1.79) and 1.000, respectively. In comparison with normal weight subjects who reported high levels of physical activity, subjects who reported both low levels of physical activity and obesity showed the highest risk of hypertension (5.89, 3.90–8.88). In conclusion, both elevated BMI and reduced physical activity appear to play an important role in the risk of hypertension among Chinese middle-aged and older population. The risk of hypertension associated with overweight and obesity can be reduced considerably by increased physical activity levels.

Hypertension in Obesity and the Impact of Weight Loss

PURPOSE OF REVIEW

Several interrelated mechanisms promote the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease.

RECENT FINDINGS

The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Bariatric surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.

Age at First Childbirth and Hypertension in Postmenopausal Women

Whether age at first childbirth has an effect on hypertension incidence is unclear. The objectives of this study were to examine the relationship between age at first childbirth and hypertension and to examine whether degree of obesity, measured as body mass index, mediates age at first childbirth-related hypertension in postmenopausal women. This study analyzed 4779 postmenopausal women data from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Logistic regression analyses were used to investigate relationship between age at first childbirth and hypertension. Mediation analysis was performed to examine the contribution of body mass index to age at first childbirth-related hypertension. Mean of participants’ age at first childbirth and current age were 23.8 and 63.4 years, respectively. The prevalence of hypertension was 51.1%. Age at first childbirth was significantly associated with the prevalence of hypertension (odds ratio, 0.963; 95% confidence interval, 0.930–0.998; P =0.036). Women with age at first childbirth ≤19 years had significantly higher risk of hypertension (odds ratio, 1.61; 95% confidence interval, 1.17–2.23; P =0.004) compared with those >19 years. Multivariable-adjusted prevalence of hypertension was significantly lower in women who delivered the first infant at 20 to 24 (45.5%), 25 to 29 (46.1%), and ≥30 (39.9%) years compared with those at ≤19 years (58.4%). Body mass index completely mediated age at first childbirth–hypertension relationship (indirect effect: odds ratio, 0.992; 95% confidence interval, 0.987–0.998; P =0.008). Age at first childbirth was significantly associated with hypertension in postmenopausal women. Body mass index mediated the effects of age at first childbirth on hypertension.

Adult Pre-pregnancy Weight Change and Risk of Developing Hypertensive Disorders in Pregnancy

BACKGROUND

While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders in pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change and HDP. We examined the impact of adult pre-pregnancy weight change on the development of HDP.

METHODS

We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalised estimating equations were used to assess the effect of baseline BMI (mean age 20 years) and pre-pregnancy weight change on the incidence of HDP.

RESULTS

Over 9 years of follow up, 301 incident HDP cases (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 (95% CI 1.3, 2.2) and 2.15 (95% CI 1.4, 3.3) times more likely to develop HDP than normal weight women, respectively. Compared with stable weight women, women with small (>1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR 1.67 95% CI 1.3, 2.2; RR 2.31, 95% CI 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24 years were 46% (95% CI 0.4, 0.8) less likely to develop HDP.

CONCLUSIONS

Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP.

Pre-pregnancy weight change and incidence of gestational diabetes mellitus: A finding from a prospective cohort study

AIMS

In a population-based cohort study we examined the associations between early adult pre-pregnancy weight change and the risk of gestational diabetes mellitus (GDM).

METHODS

The study included 3111 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. These women have been surveyed regularly since 1996. Women without diabetes and GDM were followed-up between 2003 and 2012. Generalized estimating equations were used to assess the effect of baseline (1996, mean age 20years) and pre-pregnancy body mass index (BMI) and the pre-pregnancy weight changes on the incidence of GDM. The full models were adjusted for sociodemographic and lifestyle factors.

RESULTS

From 2003 to 2012, 229GDM cases (4.4%) were reported in 5242 pregnancies. Relative to normal BMI women, obese women at baseline (RR: 1.8, 95% CI: 1.1, 2.8) and prior to pregnancy (RR: 2.7, 95% CI: 2.0, 3.6) were at greater risk of GDM. Weight gains prior to each study pregnancy were strongly associated with increased GDM risk with an adjusted RR ranging from 2.0 to 2.9. Within under/normal range of BMI, women with a moderate/high (>2.5%/year) weight gain had 2.7 (95% CI: 1.3, 5.5) times the risk of GDM compared with women with stable weight.

CONCLUSIONS

Early adult weight gain, even within normal BMI range, is an important risk factor for the development of GDM. Weight gain prevention from early adulthood to prior to pregnancy appears to be the main strategy to prevent the incidence of GDM.

Research Opportunities and Challenges in the Era of Healthy Living Medicine: Unlocking the Potential

Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).

Body mass trajectories, diabetes mellitus, and mortality in a large cohort of Austrian adults

There are only few studies on latent trajectories of body mass index (BMI) and their association with diabetes incidence and mortality in adults.We used data of the Vorarlberg Health Monitoring & Prevention Program and included individuals (N=24,875) with BMI measurements over a 12-year period. Trajectory classes were identified using growth mixture modeling for predefined age groups (<50, 50-65, >65 years of age) and men, women separately. Poisson models were applied to estimate incidence and prevalence of diabetes for each trajectory class. Relative all-cause mortality and diabetes-related mortality was estimated using Cox proportional hazard regression.We identified 4 trajectory classes for the age groups <50 years and 50 to 65 years, and 3 for age groups >65 years. For all age groups, a stable BMI trajectory class was the largest, with about 90% of men and 70% to 80% of women. For the low stable BMI classes, the corresponding fasting glucose levels were the lowest. The highest diabetes prevalences were observed for decreasing trajectories. During subsequent follow-up of mean 8.1 (SD 2.0) years, 2741 individuals died. For men <50 years, highest mortality was observed for steady weight gainers. For all other age-sex groups, mortality was the highest for decreasing trajectories.We found considerably heterogeneity in BMI trajectories by sex and age. Stable weight, however, was the largest class over all age and sex groups, and was associated with the lowest diabetes incidence and mortality suggesting that maintaining weight at a moderate level is an important public health goal.

Body Composition Outcomes of a Qigong Intervention Among Community-Dwelling Aging Adults

Aging causes various changes in body composition, which are critical implications for health and physical functioning in aging adults. The aim of this study was to explore the body composition outcomes of a qigong intervention among community-dwelling aging adults. This was a quasi-experimental study in which 90 participants were recruited. Forty-eight participants (experimental group) attended a 30-min qigong program 3 times per week for 12 weeks, whereas 42 participants (control group) continued performing their usual daily activities. The experimental group achieved a greater reduction in the fat mass percentage at the posttest, and exhibited increased fat-free mass, lean body mass percentage, and lean body mass to fat mass ratio compared with the controls. No difference between the two groups in body mass index, fat mass, and lean body mass was observed. These results indicated that the qigong intervention showed beneficial outcomes of body composition among community-dwelling aging adults.

BMI history and risk of incident fatty liver: a population-based large-scale cohort study

BACKGROUND AND AIMS

Most physicians might consider that fatty liver would develop along with increasing body weight; however, an association between BMI history and incident fatty liver has not been clarified as yet.

METHODS

We carried out a population-based cohort study that included 4427 healthy Japanese individuals who received yearly health-checkup programs over a decade. Fatty liver was diagnosed using ultrasonography.

RESULTS

During the observational period, 38.7% (case/N=1002/2588) of men and 17.3% (319/1847) of women were diagnosed with fatty liver. Among these, only 18.9% (189 of 1002 participants) of men and 18.5% (59 of 319) of women developed fatty liver when they reached the lifetime maximum BMI. Adjusted odds ratio of the difference between lifetime maximum BMI and BMI at age 20 years (ΔBMImax-20 years) for incident fatty liver was 1.33 [95% confidence interval (CI) 1.28-1.39, P<0.001] in men or 1.40 (95% CI 1.33-1.49, P<0.001) in women. According to receiver operator characteristic (ROC) analysis, the optimal cut-off points of ΔBMImax-20 years for incident fatty liver were 4.82 kg/m [area under ROC curve 0.70 (95% CI 0.68-0.72), P<0.001] in men and 4.11 kg/m [area under ROC curve 0.76 (95% CI 0.73-0.79), P<0.001] in women.

CONCLUSION

The ΔBMImax-20 years was associated with an increased risk of incident fatty liver. In addition, more patients developed fatty liver not at the maximum point of BMI history, but after that. Therefore, it is useful to check ΔBMImax-20 years and to continue observing the individuals for detection of fatty liver.

Anthropometric measures change and incidence of high blood pressure levels among adults: a population-based prospective study in Southern Brazil

OBJECTIVE

The objective was to evaluate the effects of BMI and waist circumference change on the cumulative incidence of high blood pressure levels (HBP) among adults.

METHODS

Prospective longitudinal study in Southern Brazil, with a sample evaluated in 2009 (n = 1720) and 2012 (n = 1213). The incidence of HBP was estimated using measured values of systolic and diastolic arterial pressure (≥140/90 mmHg).

RESULTS

The prevalence of overweight (BMI ≥ 25 kg/m) was 47.3% in 2009 and 55.0% in 2012. The incidence of HBP was 32.0%. Being overweight or having an elevated waist circumference (top quartile) in the two waves increased the incidence of HBP [odds ratio 3.41 (95% confidence interval (CI) 2.10; 5.53) and 5.42 (95% CI 2.65; 11.08), respectively] compared with those always eutrophic. Being overweight in either wave also increased the risk of HBP, whereas reducing waist circumference was a protective factor. When the annual BMI and waist circumference change were evaluated (conditional to the baseline measurements, age, and sex) the adjusted predicted incidence of HBP was 46.5% (95% CI 36.9; 56.1) among individuals with an annual BMI change more than +1.0 kg/m, and 45.1% (95% CI 36.7; 53.4) among those with an annual waist circumference change more than +3.0 cm. Among those who reduced their BMI and waist circumference, the incidence of HBP were 25.9 and 23.8%, respectively.

CONCLUSION

Being overweight (in any wave), maintaining an elevated waist circumference, or having an annual rise of these measurements above the expected values, all increased the incidence of HBP. Reducing the waist circumference showed greater benefits for the prevention of HBP than BMI changes.

Continued increases in hypertension over three decades in Fiji, and the influence of obesity

Objectives:

To analyse trends during 1980–2011 in hypertension prevalence and SBP/DBP by sex in Fiji Melanesian (i-Taukei) and Indian adults aged 25–64 years; and to assess effects of BMI.

Methods:

Unit record data from five population-based surveys were included (n = 14 191). Surveys were adjusted to the nearest previous census to improve national representativeness. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg and/or on medication for hypertension. Regression (Poisson and linear) was used to assess period trends.

Results:

Over 1980–2011 hypertension prevalence (%) and mean blood pressure (BP) (SBP/DBP mmHg) increased significantly (P < 0.001) in both sexes and ethnicities. Increases in hypertension were: from 16.2 to 41.3% in i-Taukei men (mean BP from 122/73 to 135/81); from 20.5 to 37.8% in Indian men (mean BP from 122/74 to 133/81); from 25.9 to 36.9% in i-Taukei women (mean BP from 126/76 to 132/81); and from 17.6 to 33.1% in Indian women (mean BP 117/71 to 130/81). The age-adjusted trend in hypertension and mean BP (over 32 years) declined after adjusting for BMI, with effects of obesity greater in women than men, and in Indians than i-Taukei. BMI explained 45% of the age-adjusted increase in DBP over the period in Indians (both sexes), and 16% (men) and 38% (women) in i-Taukei.

Conclusion:

Significant increases have occurred in hypertension prevalence and SBP/DBP in both sexes and ethnicities of Fiji during 1980–2011 with no indication of decline, contributing to significant premature mortality from cardiovascular disease.

Patterns of Systemic Hypertension among Adults with Perinatally Acquired HIV

Patients with perinatally acquired HIV may be at risk for the development of age-related non-AIDS diseases. The primary aim of this study was to describe patterns of systemic hypertension among a cohort of adults (≥18 years) with perinatally acquired HIV. A retrospective cohort study was conducted among adults (≥18 years) with perinatally acquired HIV infection. Primary outcomes included documentation of systemic hypertension as well as several additional non-AIDS-associated illnesses. Systemic hypertension incidence rates and rate ratios (RRs) were calculated among groups aged ≥18 and <18 years at the time of hypertension diagnosis. The overall prevalence of hypertension in the cohort (N = 109) was 26.6%, and the incidence rate of hypertension was significantly higher among those aged ≥18 years compared to those who are aged <18 years at the time of diagnosis (RR: 10.0, CI: 7.29-13.71). By multivariable analysis, only coexisting renal disease was associated with an increased risk of hypertension diagnosis.

Validity of body adiposity index in predicting body fat in Brazilians adults

OBJECTIVES

The aim of this study was to compare various methods of assessing body compositions with body adiposity index (BAI) and to identify the validity of BAI as a predictor of body fat in Brazilian adults.

METHODS

This study included 706 individuals (average age 37.3 years, SD = 12.1). Anthropometric data included percent body fat obtained by skinfold thicknesses, bioelectrical impedance analysis and DXA. Body mass index (BMI), waist/hip ratio, and BAI were calculated. The correlation between variables was assessed by Pearson's correlation coefficient, and the Bland-Altman and Kaplan Meier graphic approaches were used to verify the agreement between BAI and DXA.

RESULTS

There was a strong correlation between BAI and BMI (r = 0.84 in men and r = 0.86 in women, P < .001), waist circumference (r = 0.77 in men and r = 0.75 in women, P < .001) percent fat by skinfold thicknesses (r = 0.71 in men and r = 0.71 in women, P < .001) and by DXA (r = 0.72 in men and r = 0.78 in women, P < .001). The Bland-Altman approach showed an overestimation of BAI in males and an underestimation in women using DXA as the reference method. The agreement between BAI and DXA through the Kaplan-Meier analysis was 41%.

CONCLUSIONS

It was found that BAI does not replace other measurements of body fat, but compared with more complex methods can be an alternative for estimating the body fat in the absence of these methods.

Joint effects of age and body mass index on the incidence of hypertension subtypes in the China Health and Nutrition Survey: A cohort study over 22years

OBJECTIVES

We seek to investigate the joint effects of age and body mass index (BMI) on the incident hypertension subtypes among Chinese adults during 1989-2011.

METHODS

We investigated the Incidence rates (IRs, per 100person-years) of hypertension subtypes, adjusted relative risks (RRs) and population attributable risk percent (PAR%) of BMI for hypertension, and clarified the age-specific effect of BMI on incident hypertension utilizing a dynamic cohort study from the China Health and Nutrition Survey (CHNS) 1989-2011.

RESULTS

Normotensive participants (n=53,028) at baseline were included, with mean age was 41.7 (95% CI, 41.6-41.7)years old. During a total of 118,694person years (average was 6.38years) of follow-up, a total of 5208 incident cases of hypertension were documented. The IRs of hypertension were 4.4 (95% CI, 4.3-4.5), which increased gradually by age and BMI (Ptrend<0.001). Compared with those with BMI<22kg/m(2), the RR of hypertension was 3.13 (95% CI, 2.84-3.45) in the group with BMI≥28kg/m(2). The PAR% (BMI>22 vs. BMI<22) for hypertension in Chinese population was 32% (95% CI, 29-34%). Similar trends were observed in all age and BMI groups for both isolated systolic hypertension and systolic-diastolic hypertension, which were mainly affected by age. In contrast, the peak IR of isolated diastolic hypertension was observed in participants aged 30-49years with higher BMIs.

CONCLUSIONS

The PAR% (IR of BP≥140/90 or treatment for BMI>22 vs. IR for BMI<22) of elevated body weight for hypertension was 32% in Chinese population.

Maximum BMI and microvascular complications in a cohort of Japanese patients with type 2 diabetes: the Japan Diabetes Complications Study

AIMS

The aim of this study was to examine the associations between possible indices of obesity based on information on weight history and the incidence of microvascular complications.

METHODS

A cohort of individuals with type 2 diabetes from 59 institutes in Japan was followed for 8years. Patients were classified into three categories according to weight at entrance and past maximum weight: normal (BMI at baseline <25kg/m(2) and maximum BMI <25kg/m(2)), past obesity (BMI at baseline <25kg/m(2) and maximum BMI ≥25kg/m(2)), and current obesity (BMI at baseline ≥25kg/m(2)) groups. The outcomes were diabetic retinopathy and overt nephropathy.

RESULTS

BMI at maximum and baseline of the 1809 patients was 26.5±3.5 and 23.1±3.0kg/m(2) (p<0.01), respectively (23.0±1.6 and 20.6±1.9kg/m(2) for normal, 27.4±2.0 and 22.8±1.4kg/m(2) for past obesity, and 30.1±2.9 and 27.0±1.8kg/m(2) for current obesity). The hazard ratios of past and current obesity compared to normal were 1.92 (95% CI, 1.08-3.41; p=0.03) and 2.21 (1.16-4.22; p=0.02), respectively, for overt nephropathy and 1.38 (1.05-1.83; p=0.02) and 1.64 (1.18-2.28; p<0.01), respectively, for diabetic retinopathy after adjustment for confounders.

CONCLUSIONS

Past obesity as well as current obesity were associated with increased risks of microvascular complications. Further identification of high-risk populations may be possible by classifying normal weight patients by past obesity.

Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies

The effect of low-carbohydrate diet (LCD) on body composition, especially fat mass, in obese individuals remains to be elucidated. We performed a meta-analysis to provide quantitative summary estimates of the mean change of body weight (kg) and fat mass (kg) in LCD comparing to those in control diet. Literature searches were performed using EMBASE, MEDLINE and Cochrane Library until Dec 2014. Fourteen randomized controlled studies were included in this meta-analysis. Eight studies including very LCD (50 g carbohydrate or 10% calorie from carbohydrate) and seven studies including mild LCD (about 40% calorie from carbohydrate). Meta-analysis carried out on data of 1416 obese individuals, showed that LCD was associated with decrease in body weight (-0.70 kg [95% CI -1.07/-0.33]) or fat mass (-0.77 kg [-1.55/-0.32]). Subgroup meta-analysis of studies in over 12 months suggested that LCD was not associated with decrease in body weight (-0.44 kg [-0.94/0.07]), but LCD was associated with decrease in fat mass (-0.57 kg [-1.05/-0.09]). In addition, very LCD was associated with decrease in fat mass (-0.97 kg [-1.50/-0.44]), but mild LCD was not associated with decrease in fat mass (-0.43 kg [-1.15/0.33]). LCD, especially very LCD, might be effective for decrease in fat mass in obese individuals. © 2016 World Obesity.

Self-Care Behaviors and Related Factors in Hypertensive Patients

BACKGROUND

An assessment of an individual's hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension.

OBJECTIVES

The objective of this study was to investigate the self-care behaviors of hypertensive patients.

PATIENTS AND METHODS

This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects.

RESULTS

The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435).

CONCLUSIONS

Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

The Role of Body Fat and Fat Distribution in Hypertension Risk in Urban Black South African Women

Developing countries are disproportionately affected by hypertension, with Black women being at greater risk, possibly due to differences in body fat distribution. The objectives of this study were: (1) To examine how different measures of body composition are associated with blood pressure (BP) and incident hypertension; (2) to determine the association between baseline or change in body composition, and hypertension; and (3) to determine which body composition measure best predicts hypertension in Black South African women. The sample comprised 478 non-hypertensive women, aged 29–53 years. Body fat and BP were assessed at baseline and 8.3 years later. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) (n = 273) and anthropometry. Hypertension was diagnosed based on a systolic/diastolic BP ≥140/90 mmHg, or medication use at follow-up. All body composition measures increased (p<0.0001) between baseline and follow-up. SBP and DBP increased by ≥20%, resulting in a 57.1% cumulative incidence of hypertension. Both DXA- and anthropometric-derived measures of body composition were significantly associated with BP, explaining 3–5% of the variance. Baseline BP was the most important predictor of hypertension (adjusted OR: 98–123%). Measures of central adiposity were associated with greater odds (50–65%) of hypertension than total adiposity (44–45%). Only change in anthropometric-derived central fat mass predicted hypertension (adjusted OR: 32–40%). This study highlights that body composition is not a major determinant of hypertension in the sample of black African women. DXA measures of body composition do not add to hypertension prediction beyond anthropometry, which is especially relevant for African populations globally, taking into account the severely resource limited setting found in these communities.

Religious Social Support and Hypertension Among Older North American Seventh-Day Adventists

Seventh-day Adventists have been noted for their unique lifestyle, religious practices and longevity. However, we know little about how religion is directly related to health in this group. Specifically, we know nothing about how religious social support is related to hypertension. Using data from the Biopsychosocial Religion and Health Study, we carried out a cross-sectional study of 9581 and a prospective study of 5720 North American Seventh-day Adventists examining new 534 cases of hypertension occurring up to 4 years later. We used binary logistic regression analyses to examine study hypotheses. Of the religious social support variables, in both the cross-sectional and prospective study only anticipated support significantly predicted hypertension, but the relationship was mediated by BMI. There were no significant race or gender differences. The favorable relationships between anticipated support and hypertension appear to be mediated by BMI and are an indication of how this dimension of religion combined with lifestyle promotes good health, specifically, reduced risk of hypertension.

Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey

OBJECTIVES

We investigated the prevalence, awareness, treatment, and control of hypertension and associated risk factors in the Bangladeshi adult population.

METHODS

The data for this study were extracted from the nationally-representative 2011 Bangladesh Demographic and Health Survey. Socio-demographic profiles, height, weight, blood pressure measurements, and management were recorded from 7876 adults aged 35 years or older. Multilevel logistic regression models were used to identify the risk factors for hypertension awareness, treatment, and control.

RESULTS

Overall, age-standardized prevalence of prehypertension and hypertension were 27.1 and 24.4%, respectively. Among patients with hypertension, 50.1% were aware of their condition, 41.2% were in treatment, but only 31.4% had controlled hypertension. There was a wide disparity in hypertension management between the poor and the wealthy households. Rich households were more likely to be aware of their hypertension [odds ratio (OR) 1.92, 95% confidence interval (CI) 0.97-3.79, P = 0.06], receiving treatment (OR 3.34, 95% CI 1.55-7.18, P < 0.001) and controlling their condition (OR 2.88, 95% CI 1.28-6.46, P = 0.01), as compared to the poor residents. Participants who had lower education were less likely to be aware of, in treatment for, and in control of their condition.

CONCLUSION

One in four adults had hypertension in Bangladesh, and awareness and treatment of hypertension are quite low. Improvements in detection and treatment strategies are needed to prevent the growing disease burden associated with hypertension.

Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18-65-Year-Old Chinese Adults

Background

Overweight and obesity increase the risk of elevated blood pressure; most of the studies that serve as a background for the debates on the optimal obesity index cut-off values used cross-sectional samples. The aim of this study was to determine the cut-off values of anthropometric markers for detecting hypertension in Chinese adults with data from prospective cohort.

Methods

This study determines the best cut-off values for the obesity indices that represent elevated incidence of hypertension in 18–65-year-old Chinese adults using data from the China Health and Nutrition Survey (CHNS) 2006–2011 prospective cohort. Individual body mass index (BMI), waist circumference (WC), waist:hip ratio (WHR) and waist:stature ratio (WSR) were assessed. ROC curves for these obesity indices were plotted to estimate and compare the usefulness of these obesity indices and the corresponding values for the maximum of the Youden indices were considered the optimal cut-off values.

Results

Five-year cumulative incidences of hypertension were 21.5% (95% CI: 19.4–23.6) in men and 16.5% (95% CI: 14.7–18.2) in women, and there was a significant trend of increased incidence of hypertension with an increase in BMI, WC, WHR or WSR (P for trend < 0.001) in both men and women. The Youden index indicated that the optimal BMI, WC, WHR, WSR cut-off values were 23.53 kg/m², 83.7 cm, 0.90, and 0.51 among men. The optimal BMI, WC, WHR, WSR cut-off values were 24.25 kg/m², 79.9 cm, 0.85 and 0.52 among women.

Conclusions

Our study supported the hypothesis that the cut-off values for BMI and WC that were recently developed by the Working Group on Obesity in China (WGOC), the cut-off values for WHR that were developed by the World Health Organization (WHO), and a global WSR cut-off value of 0.50 may be the appropriate upper limits for Chinese adults.

Five-year weight changes associate with blood pressure alterations independent of changes in serum insulin

OBJECTIVE

In overweight-related hypertension, the effect of weight changes on blood pressure (BP) is believed to be mediated by insulin. To test this hypothesis, we studied 5-year changes in weight, BP, and insulin in a general population of Danish adults (n = 3443; mean age 45.7 ± 7.6 years).

METHODS

We assessed the glucose-insulin metabolism by a standard oral glucose tolerance test. We divided the antihypertensive and antidiabetic medication-free participants into three groups: weight loss (n = 515), weight stable (n = 1778), and weight gain (n = 1150).

RESULTS

Losing on average 6.5 kg body weight, the weight loss group experienced a 28.2% reduction [(95% confidence interval [CI] -31 to -25); P < 0.001] in fasting insulin and a 23.9% reduction [(95% CI -28 to -19); P < 0.001] in 2-h insulin. Gaining on average 6.4 kg, the weight gain group experienced a 12.5% increase [(95% CI 9 to 16); P < 0.001] in fasting insulin and 32.8% increase [(95% CI 28 to 38); P < 0.001] in 2-h insulin. Using linear regression adjusting for differences in sex, age, family history of hypertension, baseline BMI, SBP and DBP, lifestyle risk factors, and their 5-year changes, weight loss was associated with a decrease in SBP of -1.8 mmHg (95% CI -2.8 to -0.7), whereas weight gain with an increase in SBP of 1.9 mmHg (95% CI 1.2 to 2.6), both with P less than 0.001. Adding fasting insulin, 2-h insulin, Δfasting insulin, and Δ2-h insulin only marginally attenuated the association, and furthermore, none of the insulin variables was significantly associated with SBP or DBP (P ≥ 0.08). The results for changes in DBP were similar to SBP.

CONCLUSION

Five-year weight changes associate with BP alterations independent of the insulin changes.

Cardiovascular and renal effects of weight reduction in obesity and the metabolic syndrome

Obesity is a critical public health issue worldwide. Patients with obesity have markedly increased morbidity and mortality compared to the general population. The increased health risks of obesity in part are due to its close association with each of the other components of the metabolic syndrome, including hypertension, dyslipidemia, and insulin resistance. Accordingly, obese individuals are at particularly increased risk of cardiovascular disease and chronic kidney disease. Modest weight loss results in improvements in serum cholesterol levels, blood pressure, and glycemic profiles. Lifestyle interventions for weight loss have long been the mainstay of treatment in obesity. However, the existing literature demonstrates limited weight loss sustainability and inconsistent cardiovascular and renal benefits using these modalities. In addition to improvements in intermediate risk factors, surgical interventions provide a more lasting impact on long-term cardiovascular and renal outcomes, though carry higher short-term risks due to perioperative complications.

Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension

IMPORTANCE

High body mass index (BMI) and low physical fitness are risk factors for hypertension, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors may help inform more effective interventions in susceptible subgroups.

OBJECTIVE

To determine the interactive effects of BMI and physical fitness on the risk of hypertension in a large national cohort.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included all 1,547,189 military conscripts in Sweden from January 1, 1969, through December 31, 1997 (97%-98% of all 18-year-old men nationwide each year), who were followed up through December 31, 2012 (maximum age, 62 years). Data analysis was conducted August 1 through August 15, 2015.

EXPOSURES

Standardized aerobic capacity, muscular strength, and BMI measurements obtained at a military conscription examination.

MAIN OUTCOMES AND MEASURES

Hypertension identified from outpatient and inpatient diagnoses.

RESULTS

A total of 93,035 men (6.0%) were diagnosed with hypertension in 39.7 million person-years of follow-up. High BMI and low aerobic capacity (but not muscular strength) were associated with increased risk of hypertension, independent of family history and socioeconomic factors (BMI, overweight or obese vs normal: incidence rate ratio, 2.51; 95% CI, 2.46-2.55; P < .001; aerobic capacity, lowest vs highest tertile: incidence rate ratio, 1.50; 95% CI, 1.47-1.54; P < .001). Aerobic capacity was inversely associated with hypertension across its full distribution (incidence rate ratio per 100 W, 0.70; 95% CI, 0.69-0.71; P < .001). A combination of high BMI (overweight or obese vs normal) and low aerobic capacity (lowest vs highest tertile) was associated with the highest risk of hypertension (incidence rate ratio, 3.53; 95% CI, 3.41-3.66; P < .001) and had a negative additive and multiplicative interaction (P < .001). Although high BMI was a significant risk factor for hypertension, low aerobic capacity also was a significant risk factor among those with normal BMI.

CONCLUSIONS AND RELEVANCE

In this large national cohort study, high BMI and low aerobic capacity in late adolescence were associated with higher risk of hypertension in adulthood. If confirmed, our findings suggest that interventions to prevent hypertension should begin early in life and include not only weight control but aerobic fitness, even among persons with normal BMI.

Hypertension among adults in Bangladesh: evidence from a national cross-sectional survey

Background

Hypertension is an increasing problem in Southeast Asia, particularly in Bangladesh. Although some epidemiological studies on hypertension have been conducted in Bangladesh, the factors associated with hypertension in this nation remain unclear. We aimed to determine the factors associated with hypertension among the adults in Bangladesh.

Methods

We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). A total of 7,839 (3,964 women and 3,875 men) adults aged 35 years and older who participated in the survey was included. Hypertension was defined by a systolic blood pressure ≥ 140 mmHg and/or, diastolic blood pressure ≥ 90 mmHg and/or, receipt of an anti-hypertensive medication at time of the survey. The degree of association between the risk factors and the outcome was assessed by the odd ratio (OR) obtained from the bivariate and multivariable logistic regression models.

Results

The overall prevalence of hypertension was 26.4 %, and the prevalence was higher in women (32.4 %) than men (20.3 %). Study participants with the age group of 60–69 years had higher odds of having hypertension (AOR: 3.77, 95 % CI: 3.01–4.72) than the age group 35–39 years. Moreover, individuals who had higher educational attainment (AOR: 1.63, 95 % C.I: 1.25–2.14) and higher wealth status (AOR = 1.91, 95 % CI: 1.54–2.38) had higher odds of having hypertension than the individuals with no education and lower social status, respectively. The analysis also showed that high BMI (AOR: 2.19, 95 % C.I: 1.87–2.57) and having diabetes (AOR: 1.54, 95 % C.I: 1.31–1.83) were associated with the increasing risk of hypertension.

Conclusions

Our study shows that the risk of hypertension was significantly associated with older age, sex, education, place of residence, working status, wealth index, BMI, and diabetes. Moreover, hypertension is largely untreated, especially in rural settings. The health system needs to develop appropriate strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations.

Obesity: physiologic changes and implications for preoperative management

The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to have a firm understanding of their altered multi-organ physiology in order to safely prepare the obese patient for an operation. A careful preoperative evaluation may also serve to identify risk factors for postoperative adverse events. Subsequently, preoperative measures may be implemented to mitigate these complications. In this manuscript we address the major considerations for the preoperative evaluation of the severely obese patient.

Association between body mass index and onset of hypertension in men and women with and without diabetes: a cross-sectional study using national health data from the State of Kuwait in the Arabian Peninsula

OBJECTIVE

Obesity contributes directly to the risk of diabetes and hypertension. Effective management of diabetes is essential to prevent or delay the onset of comorbid hypertension. In this study, we delineate the association body mass index (BMI) has with risk and age at onset of hypertension and explore how this association is modulated by sex and the pre-existing condition of diabetes.

DESIGN

Cross-sectional study using retrospective data.

SETTING

Kuwait Health Network that integrates primary health and hospital laboratory data into a single system.

PARTICIPANTS

We considered 3904 native Kuwaiti comorbid individuals who had the onset of type 2 diabetes prior to that of hypertension, and 1403 native Kuwaiti hypertensive individuals with no incidence of diabetes. These participants have been regularly monitored for BMI, glycated haemoglobin and blood pressure measurements. Mean variance in BMI per individual over the period from registration is seen to be low.

MAIN OUTCOME MEASURES

Association between age at onset of hypertension and BMI (as measured at hypertension diagnosis); HRs for developing hypertension.

RESULTS

Risk of hypertension increases with obesity levels, and is higher in patients with diabetes than in patients without diabetes but of similar obesity levels. Age at onset of hypertension is inversely related to BMI; this relationship is seen to be stronger in men compared to women (slope estimate in men, -0.62 years per unit increase in BMI; in women -0.18) and in individuals (particularly women) with diabetes compared to those without (slope estimate in women, -0.39 vs -0.18, p<0.001; in men -0.66 vs -0.62; p=0.66).

CONCLUSIONS

The observation that the presence of diabetes doubles the slope of inverse relationship between hypertension onset age and BMI in women (while the slope is high in men irrespective of diabetes status) leads to a possible proposition that pre-existing diabetes narrows down sex-specific differences in the impact of obesity on blood pressure.

Obesity, albuminuria, and gamma-glutamyl transferase predict incidence of hypertension in indigenous Australians in rural and remote communities in northern Australia

OBJECTIVE

To describe the incidence of hypertension in a cohort of Australian Aboriginal and Torres Strait Islanders.

METHOD

A follow-up study conducted among 1831 indigenous population aged 15 years and over without hypertension at baseline from 19 communities in North Queensland during 1997-2008. Main measurements included baseline and follow-up weight, waist circumference, blood pressure, fasting glucose, lipids (triglycerides and cholesterol), gamma-glutamyl transferase, urinary albumin creatinine ratio, self-reported tobacco smoking, alcohol intake and physical activity.

RESULTS

Hundred cases of hypertension developed over 2633.4 person-years giving a crude incidence of hypertension of 22.6 (16.2-31.4) per 1000 person-years in females and 60.0 (47.1-76.6) per 1000 person-years for males. Age standardized overall incidence was 51.9 per 1000 person-years. Aboriginal participants were twice as likely as Torres Strait Islanders to develop hypertension, which increased with age. Obesity (BMI >30) strongly predicted incident hypertension independently of age or sex (adjusted hazard ratio 2.9, 95% confidence interval 1.9-4.8). Albuminuria and elevated gamma-glutamyl transferase increased the risk of hypertension (adjusted hazard ratio 1.4-1.7) in this population.

CONCLUSION

Incidence of hypertension in indigenous Australian adults is nearly double than that of the general Australian population. High background prevalence of obesity, diabetes and albuminuria contributes to this excess. As well as early detection and management of high blood pressure, albuminuria and diabetes in primary care settings, attention should be equally focused on community-level prevention and management of obesity.

Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials

BACKGROUND

The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI).

METHODS

We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m(2), 25 to <30 kg/m(2), and ≥30 kg/m(2)) or a continuous variable.

FINDINGS

Analyses were based on 135,715 individuals from 22 trials who had 14,353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m(2) higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics.

INTERPRETATION

We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

FUNDING

None.

Body Mass Index Is Associated with Hypertension in Japanese Young Elderly Individuals: Findings of the New Integrated Suburban Seniority Investigation

OBJECTIVE

This study aimed to investigate the association between BMI at 65 years of age and the development of hypertension during the subsequent five years.

METHODS

A total of 1,003 participants (65 years of age) who had no history of myocardial infarction and/or hypertension at baseline health check-ups (1996-2005) and participated in a secondary health check-up when the subjects reached 70 years of age were analyzed.

RESULTS

Using fully adjusted models, men with a BMI of <18.5 [odds ratio (OR), 4.08; 95% confidence interval (CI), 1.32-1.83], BMI of 23.0-24.9 (OR, 2.00; 95% CI, 1.18-3.40) and BMI of ≥25.0 (OR, 1.98; 95% CI, 1.10-3.56) were found to be at higher risk of developing hypertension than did those with a BMI of 18.5-22.9.

CONCLUSION

Leanness or being overweight/obese at age 65 increases the risk of subsequent hypertension.

Development of a risk prediction model for incident hypertension in a working-age Japanese male population

The aim of this study was to develop a risk prediction model for incident hypertension in a Japanese male population. Study participants included 15,025 nonhypertensive Japanese male workers (mean age, 38.8±8.9 years) who underwent an annual medical checkup at a company. The participants were followed-up for a median of 4.0 years to determine new-onset hypertension, defined as a systolic blood pressure (BP) ⩾140 mm Hg, a diastolic BP ⩾90 mm Hg, or the initiation of antihypertensive medication. Participants were divided into the following two cohorts for subsequent analyses: the derivation cohort (n=12,020, 80% of the study population) and the validation cohort (n=3005, the remaining 20% of the study population). In the derivation cohort, a multivariate Cox proportional hazards model demonstrated that age, body mass index, systolic and diastolic BP, current smoking status, excessive alcohol intake and parental history of hypertension were independent predictors of incident hypertension. Using these variables, a risk prediction model was constructed to estimate the 4-year risk of incident hypertension. In the validation cohort, the risk prediction model demonstrated high discrimination ability and acceptable calibration, with a C-statistic of 0.861 (95% confidence interval 0.844, 0.877) and a modified Hosmer-Lemeshow χ2 statistic of 15.2 (P=0.085). A risk score sheet was constructed to enable the simple calculation of the approximate 4-year probability of incident hypertension. In conclusion, a practical risk prediction model for incident hypertension was successfully developed in a working-age Japanese male population.

The association of maternal adult weight trajectory with preeclampsia and gestational diabetes mellitus

BACKGROUND

Preeclampsia (PE) and gestational diabetes mellitus (GDM) adversely affect pregnancy outcomes and the subsequent health of both mother and infant. It is known that elevated pre-pregnancy body mass index (BMI) is associated with increased risk of these obstetrical complications. However, little is known about the role of adult weight patterns prior to pregnancy.

METHODS

Self-reported weight at ages prior to the current pregnancy was recorded in a prospective cohort study of 3567 pregnant women, allowing assessment of longitudinal pre-pregnancy weight trajectories and their association with subsequent PE and GDM in the study pregnancy.

RESULTS

Women who would subsequently experience PE or GDM in the study pregnancy experienced on average almost double the rate of adult weight gain than other women [PE: additional 0.30 kg/year, 95% confidence interval (CI) 0.09, 0.51 and GDM: additional 0.34 kg/year, 95% CI 0.21, 0.48]. Women with mean adult annual weight gain above the 90th percentile (1.4 kg/year) had elevated risk of subsequent PE and GDM independent of their BMI at age 18 and of their obesity status at the time of the study pregnancy. Finite mixture trajectory modelling identified four monotonely ordered, increasing mean weight trajectories. Relative to the second lowest (most common) weight trajectory, women in the highest trajectory were at greater risk of PE [odds ratio (OR) 5.0, 95% CI 2.9, 8.8] and GDM (OR 2.8, 95% CI 1.7, 4.5).

CONCLUSIONS

These results indicate that higher adult weight gain trajectories prior to pregnancy may play a role in predisposing women to PE or GDM.

Insomnia and its association with hypertension in a community-based population in China: a cross-sectional study

OBJECTIVE

To investigate the prevalence of hypertension and its association with insomnia in a community-based population in China.

METHODS

A cross-sectional study which recruited 10 054 participants aged ≥18 years was conducted in Beijing. The association between self-reported insomnia and hypertension was determined by multiple logistic regression models. Age, gender, education, obesity, body mass index, physical activity, current smoking, current drinking, work stress, diabetes and dyslipidaemia were adjusted for as confounders. Prevalence ratios (PRs) with corresponding 95% CIs were reported as effect measurements.

RESULTS

The number of subjects with no insomnia, occasional insomnia and frequent insomnia was 7632 (75.9%), 1545 (15.4%) and 877 (8.7%), respectively. The prevalence of hypertension in those with no insomnia, occasional insomnia and frequent insomnia was 37.3%, 43.0% and 48.0%. Compared with subjects with no insomnia, the multivariate adjusted PRs and 95% CIs for those with occasional insomnia and frequent insomnia were 1.01 (0.91 to 1.12) and 0.92 (0.83 to 1.03) for men and 1.08 (1.00 to 1.16) and 1.12 (1.02 to 1.22) for women.

CONCLUSIONS

Self-reported insomnia is associated with a higher risk of hypertension in women.

The pathophysiology of hypertension in patients with obesity

The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting.

Development of new fatty liver, or resolution of existing fatty liver, over five years of follow-up, and risk of incident hypertension

BACKGROUND & AIMS

Approximately 50% of hypertensive patients have non-alcoholic fatty liver disease (NAFLD), but whether change in fatty liver status over time modifies risk of developing hypertension is uncertain. Our aim was to determine whether a change in fatty liver status (either development of new fatty liver, or resolution of existing fatty liver) over five years modified risk of incident hypertension at five year follow-up.

METHODS

11,448 patients without hypertension were examined at baseline and at five year follow-up, using a retrospective cohort study design. Fatty liver status (absent or present) was assessed at baseline and follow-up using standard ultrasound criteria. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for incident hypertension at follow-up were estimated controlling for potential confounders, compared to the reference group (patients who did not have fatty liver at either baseline or follow-up).

RESULTS

911 patients developed incident hypertension. Incident fatty liver developed during follow-up in 1418 patients and fatty liver at baseline resolved during follow-up in 684 patients. Developing incident fatty liver was associated with incident hypertension, even after adjustment for multiple confounders (aOR=1.60 (95% CI 1.30, 1.96; p<0.001). Further adjustment for change in body mass index between baseline and follow-up only slightly attenuated this association (aOR=1.36 (95% CI 1.10, 1.67; p=0.004). With resolution of fatty liver at follow-up, risk of incident hypertension was not different from the reference group (aOR=1.21 (95% CI 0.90, 1.63; p=0.21).

CONCLUSIONS

Development of incident fatty liver is associated with increased risk of hypertension.

Longitudinal trajectories of BMI and cardiovascular disease risk: the national longitudinal study of adolescent health

OBJECTIVE

In adulthood, excess BMI is associated with cardiovascular disease (CVD); it is unknown whether risk differs by BMI trajectories from adolescence to adulthood.

DESIGN AND METHODS

The National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal adolescent cohort (mean age: 16.9 years) followed into adulthood (mean age: 28.8 years) [n = 13,984 individuals (41,982 observations)] was examined. Separate logistic regression models for diabetes, hypertension, and inflammation were used to examine odds of risk factors at given adult BMI according to varying BMI trajectories from adolescence to adulthood.

RESULTS

CVD risk factor prevalence at follow-up ranged from 5.5% (diabetes) to 26.4% (hypertension) and 31.3% (inflammation); risk differed across BMI trajectories. For example, relative to men aged 27 years (BMI = 23 kg/m(2) maintained over full study period), odds for diabetes were comparatively higher for men of the same age and BMI ≈ 30 kg/m(2) with ≈8 BMI unit gain between 15 and 20 years (OR = 2.35; 95% CI, 1.51, 3.66) or in those who maintained BMI ≈ 30 kg/m(2) across the study period (OR = 2.33; 1.92, 2.83) relative to the same ≈8 BMI unit gain, but between 20 and 27 years (OR = 1.44; 1.10, 1.87).

CONCLUSIONS

Specific periods and patterns of weight gain in the transition from adolescence to adulthood might be critical for CVD preventive efforts.

Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study

Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] <25 kg/m(2)] and obese (n = 54; BMI ≥25 kg/m(2)). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e'), peak systolic LV circumferential strain rate, and E/e'/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e'/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s'), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e'/S-LAs in the obese patients, whereas only s' contributes to the E/e'/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms.

A mobile health intervention for weight management among young adults: a pilot randomised controlled trial

BACKGROUND

Today's generation of young adults are gaining weight faster than their parents; however, there remains insufficient evidence to inform interventions to prevent this weight gain. Mobile phones are a popular means of communication that may provide a convenient, inexpensive means to deliver health intervention programmes. This pilot study aimed to measure the effect of a 12-week mobile health (mHealth) intervention on body weight, body mass index and specific lifestyle behaviours addressed by the programme.

METHODS

University students and staff aged 18-35 years (n = 51) were randomised (ratio 1 : 1, intervention : control). Both groups received a printed diet booklet with instructions prepared by a dietitian. The intervention group also received Short Message Service (SMS) text messages (four per week), e-mails (four per week), and had access to smartphone applications and Internet forums.

RESULTS

Pre- to post-intervention, participants in the intervention group decreased their body weight [mean (SD)] [-1.6 (2.6) kg], increased their light intensity activity [34 (35) min day(-1)] and reported an increased vegetable (1.0 median serving day(-1)) and decreased sugar-sweetened beverage intake [-355 (836) mL week(-1)]. Despite this, post-intervention changes in outcomes were not significantly different from controls.

CONCLUSIONS

The piloted mHealth programme provided some short-term positive changes in weight, nutrition and physical activity using a low cost, convenient delivery method for this population. However, changes were no different from those observed among controls. This might partly be explained by intervention participants' low engagement with the programme, which is likely to require further modification to provide more regular, personalised, monitored support.

Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students

OBJECTIVE

This study evaluates the impact of a number of demographic, biological, behavioural and lifestyle health risk factors on the incidence of hypertension in Thailand over a 4-year period.

DESIGN

A 4-year prospective study of health risk factors and their effects on the incidence of hypertension in a national Thai Cohort Study from 2005 to 2009.

SETTING

As Thailand is transitioning from a developing to a middle-income developed country, chronic diseases (particularly cardiovascular disease) have emerged as major health issues. Hypertension is a major risk factor for heart attack and stroke and cross-sectional studies have indicated that the prevalence is increasing.

STUDY PARTICIPANTS

A total of 57 558 Sukhothai Thammathirat Open University students who participated in both the 2005 and 2009 questionnaire surveys and who were normotensive in 2005 were included in the analysis.

MEASURES

Adjusted relative risks associating each risk factor and incidence of hypertension by sex, after controlling for confounders such as age, socioeconomic status, body mass index (BMI) and underlying diseases.

RESULTS

The overall 4-year incidence of hypertension was 3.5%, with the rate in men being remarkably higher than that in women (5.2% vs 2.1%). In both sexes, hypertension was associated with age, higher BMI and comorbidities but not with income and education. In men, hypertension was associated with physical inactivity, smoking, alcohol and fast food intake. In women, hypertension was related to having a partner.

CONCLUSIONS

In both men and women, hypertension was strongly associated with age, obesity and comorbidities while it had no association with socioeconomic factors. The cohort patterns of socioeconomy and hypertension reflect that the health risk transition in Thais is likely to be at the middle stage. Diet and lifestyle factors associate with incidence of hypertension in Thais and may be amenable targets for hypertension control programmes.

'TXT2BFiT' a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial

BACKGROUND

Despite international efforts to arrest increasing rates of overweight and obesity, many population strategies have neglected young adults as a target group. Young adults are at high risk for unhealthy weight gain which tends to persist throughout adulthood with associated chronic disease health risks.

METHODS/DESIGN

TXT2BFiT is a nine month two-arm parallel-group randomized controlled trial aimed at improving weight management and weight-related dietary and physical activity behaviors among young adults. Participants are recruited via general practice (primary medical care) clinics in Sydney, New South Wales, Australia. All participants receive a mailed resource outlining national physical activity and dietary guidelines and access to the study website. Additional resources accessible to the intervention arm via the study website include Smartphone mobile applications, printable handouts, an interactive healthy weight tracker chart, and a community blog. The study consists of two phases: (1) Intensive phase (weeks 1 to 12): the control arm receives four short message service (SMS) text messages; the intervention arm receives eight SMS messages/week tailored to their baseline stage-of-change, one Email/week, and personalized coaching calls during weeks 0, 2, 5, 8, and 11; and (2) Maintenance phase (weeks 14 to 36): the intervention arm receives one SMS message/month, one Email/month and booster coaching calls during months 5 and 8. A sample of N = 354 (177 per arm) is required to detect differences in primary outcomes: body weight (kg) and body mass index (kg/m2), and secondary outcomes: physical activity, sitting time, intake of specific foods, beverages and nutrients, stage-of-change, self-efficacy and participant well-being, at three and nine months. Program reach, costs, implementation and participant engagement will also be assessed.

DISCUSSION

This mobile phone based program addresses an important gap in obesity prevention efforts to date. The method of intervention delivery is via platforms that are highly accessible and appropriate for this population group. If effective, further translational research will be required to assess how this program might operate in the broader community.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000924853.